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Vinnie Moscaritolo
03-02-2006, 07:32 AM
Brothers,

I have been on my back for a few weeks now, attempting to recover from an L5-S1 disc bulge with all the sciatica hamstring and calf pain fun that comes with it.

the whole thing started quite innocently last Nov after a day long drive in a car that didn't have very good lumbar support, (I am sure that the disc had a long history of damage but this is when I noticed it) I started to feel some tightness in the upper hamstring, thought maybe it was soreness from previous deadlifts...

I manage to aggravate the condition some more till mid Jan when I really started to have symptoms of a torn hamstring ligament.

and the floor fell through beginning of Feb, when I had to check into an ER..

after an MRI, I discovered that the L5-S1 was bulging and pressing on the nerve root..

I have been in Physical Therapy since beginning of Feb, first re-torquing a twisted pelvis back into place, then using the McKenzie exercises (back extension) to attempt to push the bulge back into place ..

I guess at 45 years old, I am probably a candidate for microsurgery, but I would rather treat this conservatively..

I am curious if anyone here has been through this and how they handled it.. The last time I bashed up a disc I was in my 20s and recovered pretty quick.


BTW, when doing the MRI I convinced the tech that I was worried the magnetic fields would damage my alien implant..
he spent more than a few minutes attempting to reassure me that it would be ok.. :D

Cold War Scout
03-02-2006, 07:52 AM
V:

While I have no advice to offer, I did want to express my sorrow for the physical situation. I'm sure I speak for everybody here when I wish you a complete, if not speedy, recovery.

CWS

Jack Rumbaugh
03-02-2006, 09:20 AM
I have a double herniation at L4-5. I am doing fine after chiropractic and moderate PT. I am a huge advocate of chiro.

Jack

Marc "Crafty Dog" Denny
03-02-2006, 09:30 AM
Speaking only as an opinionated layman, from what you say (e.g. the part about the car ride) I strongly suspect that your psoas, ilio and quad
(i.e. all your hip flexor) muscles to be tight. I also suspect an imbalance between internal and external rotation of your femurs.

Most people have not even heard of the psoas (inside of spine to femur) or ilio (crest of hip to femur).

When these are tight, the lower back is compressed. IMHO to some degree a large majority of the population suffers from tight hip flexors due to the evolutionarily speaking unnatural amount of sitting that we do.

In addition to tight flexors, most people also have an imbalance between external and internal rotation of the femurs with external dominating. Test: Without thinking about it, stand. Look down at your feet. They should be parallel and hip width. To the extent that either one, or both, points out you have external rotation. Ext. rot. causes pressure at the sacrum.

I strongly suggest you confer with someone who can teach you how to stretch the hip flexors muscles and re-establish balance of internal/external rotation. At first you may need to pay for some body work, and maybe a chiro, but ulimately YOU will need to do the work.

Are you worth it?

Vinnie Moscaritolo
03-02-2006, 10:16 AM
my psoas.. no kidding my sore ass...

actually you are not just lifting your leg Mr Dog, you nailed it right on the head..

there is an imbalance between quads and hamstrings, and the psoas were tight. I only realized this later, as I also had an arch on the same side foot that was falling.. One of the things that occurred when transitioning from 30 years of hard karate training to power lifting.. I have started to correct all of this, but for now I gotta heal the disc..


and of course shining a chair with my ass does help much..

Marc "Crafty Dog" Denny
03-02-2006, 10:46 AM
Tail wags for the kind words.

Forgive me for being relentless here, but to heal the disc you will need to allow it to heal-- a process which MUST include getting to the issues that cause it to be compressed. IMHO these can not come "later" or "after", they must be part and parcel of what you do FIRST.

Vinnie Moscaritolo
03-02-2006, 10:52 AM
yes you are correct again, bone breath... I am doing lots of floor work, 4 / 5 times a day, to correct those issues.. and the healing part too.. I am trying badly to avoid the micro surgery.

SUAREZ CORPORATE
03-02-2006, 10:55 AM
I agree with all said before. Physical therapy is quite important, to strengthen and balance various muscle groups (including the abdominal muscles, which are often overlooked with back pain). The microsurgical back techniques are quite good, and I know several people who are essentially back to normal, with minimal back pain, after having the procedure done. Ask your family doctor, and your physical therapist, for recommendations of surgeons in your area who have had good success.

michael
03-02-2006, 01:47 PM
Vinnie, I had the same problem occur about 10 years ago, and still deal with it. Mine flared up after a 4 hour drive, after which I went straight into a workout. I was fine until the next morning. I tried to get out of bed, hit the floor, and struggled for about two hours just to get dressed. Went to a sports medicene doc and did the narcotic/muscle relaxers for about a week until the pain was bearable. Did the MRI, vax-d, chiropractic, stretching, PT, etc., everything short of surgery.

I'm not pain free, but it gets better every year. I refused to do surgery unless it became unbearable. I've pretty much rebuilt my back with exercise, including deadlifts, which many docs will tell you not to do. They are strongly recommended on the CrossFit site, and they helped me. Other things that help are a lot of walking--as much as you can stand,superman's, stretching, heat/ice, sleeping with a pillow under your knees while on your back, or between your knees if sleeping on your side. Don't sleep on your stomach. Get an inversion table, it's worth it's weight in gold. I bought mine off the Home Shopping Network and it is made by Hang-ups, and was about 300.00. Worth every penny.

It will be a long, gradual process and will probably never be perfect, but it is possible to make it much better without surgery. Marc offers excellent advice also. It will get better with time and diligent effort.

armed_flyfisher
03-02-2006, 06:12 PM
I had a bulging L5-S1 disc ten years ago. Surgery was necessary when I started suffering neurological deficit (foot drop). The surgery went perfectly and I had a good recovery. Since then I've had one flair-up that I got through with PT and prednizone (sp?). Before and after that flair-up, I've been very active (rock climbing, cycling, hiking, etc.).

I would merely say that if surgery becomes the best option, the outcome may well be very positive.

Very best of luck to you!

5shot
03-02-2006, 07:23 PM
My back has gone out on me 3 times ???

I am now in about day 11 of the most recent episode.

Today is better than yesterday.

Think better or worse?

Better is better.

Get well quick

Dont Tread on Me
03-02-2006, 07:37 PM
Vinnie,

I had my ambulance ride on Dec 5 when my L5-S1 disc bulged and I hit the deck. It happened during a weight training session where I relaxed my core (abs). I'm with you with all those shooting pains in your butt etc.

YMMV but here is my experience.

First two weeks were hell for me as various back and leg muscles went into spasm. I got into physical therapy during week 2. The massage really helped loosen the muscles. I then went through back extension exercises to push the bulge back combined with ice to kill any inflammation. This was combined with core strengthening exercises (dead bug, etc).

I got back to running and weight training in mid January but it took me through most of Feb to get back to five miles a day at my old pace and lifting almost as much weight as before. I've had to change a few weight training exercises to avoid pressure on my disc.

I follow good body mechanics (lifting, bending etc) that the physical therapist gave me and I now do a core work every day religiously

I'm pain free if I avoid bad positions and I'm really enjoying having a strong core - it helps with everything, including shooting.

One thing I've lost is karate right now. I tried some sparring but found the impact worried the disc. I'm trying to loose some weight and strengthen more core more before I go back.

Please PM if you want more info.

PS - sneezing and consterpation are to be avoided at all costs where you are right now!

Bruce Piffel
03-02-2006, 07:59 PM
I have had my share of bad back problems over the years but most were cured by #1 medicine,Chiro,and finally exercises. If I keep the weight down the problems seem to go away.

What ever you do don't sneeze.......:eek: This is the most pain I had ever felt in my life.

I did that once while up on the roof one cold winter day(don't Ask) and thought I might be there for the night.

Getting yourself caught in you zipper is a close second.:D

Al Lipscomb
03-03-2006, 05:50 AM
My problems started with a blown left knee and then weight gain from the inactivity. Long periods of sitting bring out the worst of it. I have not done the MRI yet but may need to before long. Trying to get the weight off is the hard part when your knees are gone. Some good information in this thread I am going to have to go over it all to see if there is anything I can add to help me out.

Vinnie Moscaritolo
03-03-2006, 12:38 PM
thanks guys, for all the 411. I tried the iliopsoas stretch this morning at Physical Therapy, and I was pretty loose, so maybe this was more a combo of bad sitting posture, bad shoes (no arch support) and the weight I was deadlifting (breaking 500) ..
all of it adds up..

I'll keep the iliopsoas stretch though, I liked it a lot, as well as all
the core strengthening stuff.

Vinnie Moscaritolo
03-04-2006, 04:56 AM
FYI: I just got a prescription of prednisilone and will see if this drops the inflammation enough to avoid surgery. I have been told from enough MDs that this works.. i should know something in a few days.

Vinnie Moscaritolo
03-05-2006, 11:16 AM
OK here's an update. prednisilone works great! I regained a ton of mobility and about 80% of the pain is gone, It still hurts and is stiff but in 48 hours a lot changed... I should have done this at the beginning, to bad I couldn't find a MD worth his BWM in the past..

SO that's my advice to start with, you gotta control the inflammation, then you can address the muscle issues.


btw here is a good internet ref about herniated discs
http://www.aafp.org/afp/990201ap/575.html it has a great diagram about disc loading.

http://www.aafp.org/afp/990201ap/575_f3.jpg

Vinnie Moscaritolo
03-05-2006, 07:28 PM
Prednisone (and similiar steroids) have very nasty side effects and are quite toxic.

actually I don't believe they do in in the term and dosage I am using, 5mg x 4 day, for a 4 day course + 2 day taper is unlikely to have any effect other than the drastic drop in inflammation for a 210 male. While pantothenic acid might show promise as a good alternative for long term use, I still believe the steroid is the proper solution for short term cases.

I lived for 10 years with a woman who had to do substantially larger doses for her lupus management, and I saw first hand what the large does do.

I would like to see a double blind study that demonstrates pantothenic acid's effects.

I will forward this to my friend for her information, she probably already has empirical evidence one way or the other.

SUAREZ CORPORATE
03-05-2006, 08:21 PM
However... Yikes! :eek: Prednisone (and similiar steroids) have very nasty side effects and are quite toxic.

High dose steroids have very few negative effects when taken for less than 2 weeks. We give them routinely for many different problems (asthma, various rashes, etc.) for 5-7 days, with excellent results.


The doctors make money prescribing highly toxic prednisone for you, Where did you come up with this? I will assume you have made some honest misunderstanding here, because you are incredibly wrong. No doctor makes a penny from writing a prescription. If he happens to actually sell medications in his office, he could make a profit off that sale, but I don't know any medical doctor who does that (I know most veterinarians do this).

If a physician writes a prescription for prednisone, rather than your preferred GNC combo, it is because he feels it is better for you. If you choose to believe the doctor is uninformed, so be it, but don't assign financial incentive where it doesn't belong.

Vinnie Moscaritolo
03-06-2006, 12:58 PM
yes long term dosage it is toxic, again I we are talking about long term dosage.

lets also agree on that.

SUAREZ CORPORATE
03-06-2006, 08:43 PM
I don't know how GNC came into this discussion. You brought it, I didn't. What does GNC have to do with this discussion, please? Do you work for GNC?

Every MD I know gets kickbacks and "gifts" from the drug companies to write prescriptions for their drugs, particularly the new and highest profit drugs. That is why drug companies churn old standards, modifying them slightly so they can patent the newly modified version and charge higher prices for the new patented drug. Sure, doctors get kickbacks, either directly or indirectly. That is what drug company sales people do. I've asked my doctors. My set of $1,100 (each) MRIs kicked back a $500 fee (per MRI) to the doctor who prescribed them. That sort of kickback is standard throughout the medical industry. I've asked the drug company sales reps (all in the anti-histamine business, so my sample is somewhat limited). They all funnel $ to the doctors that buy their products, either directly or indirectly (as trips, seminars, "educational experiences", etc.).

"Follow the money" works as well in the medical business as it does elsewhere.Well, I guess your doctor friends have quite a different experience than myself and all my doctor friends. Not a single person I know gets more than the occasional free lunch or dinner out of a drug rep. Any "$500 kickbacks" to a doctor for ordering an MRI is actually illegal. The pharma industry came under stringent guidelines for the trips, gifts, etc. a few years ago, because it was getting ridiculous.

Look, I don't want to argue with you about this. Suffice it to say I am a doctor. Have been for 20 years. I run a group of several doctors. We prescribe what we feel is best for the patient. Are we influenced by the advertising? Sure. So is everyone. That is why advertising is done. We are actually influenced more by the patients requesting certain highly-advertised drugs, when we are trying to convince them that a cheaper generic or over-the-counter version is just as good.

If you wish to believe that doctors are evil or whatever, that is fine. Thankfully, most people don't believe that.

I tend not to comment on medical issues on boards like this, because I have no desire to engage in arguments like this.

Vinnie Moscaritolo
03-07-2006, 01:56 PM
prednisone is toxic at any dose for any duration


last I checked, falling out of helicopters, crashing, jumping into war zones, getting shot at, stabbed, and clubbed are all things that are toxic at any dose for any duration, as is life itself..I am amazed I made it past 30, nevermind 45.

I wasted three week of agonizing pain screwing around with nauturapaths and alternative meds and treatments, short of having a witch doctor dance around me .. The steroid knocked back 80% of the pain in three days, to where I at least can begin healing.. It's a tradeoff you need to weigh and decide on. for me it works.


I really want to end this part of the thread and get back to more how we can use physical therapy, stretching and strengthening to avoid these problems, there was some good stuff on this early on this thread.

seth bailey
03-07-2006, 08:24 PM
I had a spinal fusion done in July, and though not perfect I am ten times better now. I didn't see it mentioned before, but there is a website: www.spineuniverse.com (http://www.spineuniverse.com) ( I hope I spelled that right). I learned a great deal there. Maybe you can to. Good luck.

Vinnie Moscaritolo
03-18-2006, 07:40 PM
http://www.chiroweb.com/archives/17/16/06.html

Can Herniated Discs Reduce in Size or Resorb?

by David BenEliyahu,DC,DACBSP,DAAPM
In the past, it was believed that once a patient acquired a herniated disc, it was permanent. However, recent research with MRI and CT outcome studies has documented that this is fallacy. Herniated discs in the cervical and lumbar spine have been shown to not only reduce in size after a period of conservative care, but in many cases regress and disappear upon reimaging.
Numerous medical studies and some chiropractic studies have been performed and published. In recent studies by Mochida et al., both cervical (CDH) and lumbar (LDH) disc herniations were studied in pre- and post-MR imaging conditions. In CDH cases, they demonstrated that in 40% of the time, there was a reduction in size or regression. In LDH cases, they demonstrated about a 60% reduction or regression in the size of the herniation. They also found that the larger the extrusion or sequestration, the better the rate of regression. They concluded that disc regression or resorption depended upon size, location and the phase of the injury. Discs tended to reduce in size early on after onset, and more so in the lateral or sequestered type of herniation than smaller or subligamentous herniations. It is interesting to note that most patients in Mochida's study did well clinically with conservative care regardless of the MRI outcome.
In a different study, Mochida found that there is a large percentage of macrophages in excised herniated disc material, as well as evidence of neovascularization. As such, the reduction in size is most likely due to phagocytic or macrophagic digestion, since the body attacks the disc fragment as a foreign protein, much like any other antigen. Immunohistochemistry studies are being conducted at this time to elucidate the pathophysiology of disc herniation and regression.
In a similar study of LDH outcome by Bozzao et al., 63% of the patients treated nonsurgically with epidurals, medication, etc., demonstrated disc resorption upon repeat imaging. In a prospective study of patients with LDH, Ellenberg et al. documented that patients with CT evidence of herniated discs and EMG evidence of radiculopathy had a 78% rate of disc reduction. Matsubara found in a similar study that medical care involving medication, physiotherapy, traction and epidural steroid injections resulted in disc regression in 60% of the cases. In another prospective study, Bush et al. showed disc regression in 12 of the 13 cases studied. The period of care averaged six months, with a range of 2-12 months for good clinical and anatomical MRI outcome.
In one of the few chiropractic care MRI studies, I published a prospective case series of 27 patients with either CDH or LDH. I obtained pre- and post-chiropractic care MRIs and found that in 63% of the cases, there was either a reduction in size, or the disc herniation resorbed completely. I also found that 80% of the cases had good clinical outcomes, and 78% of the patients returned to their preinjury occupations. Chiropractic care was shown to be amenable to the clinical management of the disc herniation not only on a clinical level, but on an anatomical level as well. In a study by Cassidy et al. on the effects of side posture manipulation on CT-documented herniated discs, the authors found that 13 of 14 patients had good clinical results. Of those, about half had a decrease in the size of the herniation on repeat CT followups.

Case Report
In a recent case that I treated, a 48-year-old female patient presented with acute low back and associated leg/extremity pain into the foot. She had evidence of radiculopathy with diminished sensation at the L4/5 dermatomes, and positive root tension signs with a positive straight leg raise at 35 degrees on the left and 45 degrees on the right. DTRs were within normal limits, and there was no significant motor weakness. An MRI of the lumbar spine revealed a large focal disc herniation centrally and to the left.
The patient began treatment on a three times per week schedule and was treated with lumbar flexion/distraction, interferential current and microcurrent delivered by pads and probes. Microcurrent therapy was combined with regular interferential therapy and helped reduce pain and increase circulation to enhance the healing process. Microcurrent was then delivered to the LS spine and lower extremity by probes, stimulating the acupuncture points of the bladder meridian as well as stimulation along the affected dermatome.
The microcurrent therapy helped afford the patient pain management and reduced the healing period. The patient improved significantly with the above mode of care, and repeat MRI imaging showed a reduction in the size of the herniation.

Vinnie Moscaritolo
04-05-2006, 12:18 PM
Well brothers.

the pain got so bad in the last few weeks that I submitted to going under the knife. My only regret was that I didn't do it any earlier.

The Dr was a real top notch pro. (if you need recomendation in the central CA area, PM me) He removed the bulging disc material with minimal mashing. I was on my feet and walking around the hosiptal and terrroizing the staff about an hour after coming to from surgery. Stayed overnight to try and get a bit of sleep and walked out the door the next morning.

Right now I am just taking Motrin for pain relief.
It does feel like someone stabbed me in the back with a 6 inch blade.. (they smile at your face...) but for the most part the leg pain is gone.

I credit this revovery to the Dr's great work, and to the fact that I did lots and lots of core strengthing before the op.

I should be back to doing stupid stuff in a few short weeks and back to weight bearing workouts in a about three months.

thanks for all the prayers and wishes. I appreciated them.

Al Lipscomb
04-05-2006, 12:48 PM
Glad to hear you are better. We have been missing you.

P.S. Great news, Macs can now run Windows

(running for cover).

Al Lipscomb
04-05-2006, 02:26 PM
Well, I guess your doctor friends have quite a different experience than myself and all my doctor friends. Not a single person I know gets more than the occasional free lunch or dinner out of a drug rep.
Well down here the cardiologists (I hope I spelled that right) sure seem to do well. I was over at ones house the other day and almost fell over when I saw the wireless mouse given as "advertising" by a drug rep. It had their logo on it so I guess it was legit. I am lucky to get a mouse pad!

They also get to go to the clasess for CPE credits or something like that. It would be hard for me to study on the cruise ship but they seemed to be able to make it work.

Maybe these things are dependent on factors like location and area of practice?

I am also cautious about "alternative" drugs. They find lots of problems with the formulations that get approval after scientific testing. I do not think it unresonable that ingesting large quantities of any chemical is not without risk.

michael
04-05-2006, 02:47 PM
Vinnie,

It's great to here that your surgery went well, and that you are getting relief. I may have to take the plunge someday, but I'm too chicken right now.

denko
04-05-2006, 07:58 PM
Vinnie, I am glad it worked for you.

Vinnie Moscaritolo
05-18-2006, 09:37 AM
just an update, it's been about an month and a half since I got back surgery for the bulged disc and I feel great. I have been bac to the gym and back to my normal lifting. Obviously I have had to avoid anything that does back compression like squats and deadlifts, but it is summer and I can do other kinds of leg work like uphill hiking.

so the bottom line is the surgery worked. My advice to those who consider it is, it helps if you do the therapy, stay in shape and get a very good mechanic to work on you..

skirmishline
06-04-2006, 02:27 PM
I had a discectomy in September of 2002. It was the right move for me. Nothing else was working and it had gotten to the point that the only pain free position I could find was laying down, usually with my feet elevated. The most comfortable position I could find looked like a horizontal sitting position; laying on the floor, knees bent, lower legs in a chair. Five minutes in that position beat two percocet!

When I came out of surgery the surgeon told me that some of my herniated disc had actually broken off. There were bits of it laying against my sciatic! No size reduction or re-absorbtion possible in this case.

I can do anything that I used to do but I can't do it as long and hard. I still cut firewood; I just take a lot of breaks, get a smaller load, and call it a day sooner.

I think surgery should be the final option but never rule it out.

Al Lipscomb
06-04-2006, 06:33 PM
Glad to here everything worked out well for you. There are times where there is just not enough left for the body to build back up on.