Riding with L5 / S1 pain issues

[Seramount]

for the last 10 days been having significant leg pain/numbness. continued to ride the whole time (usually 25-30 mi each time), and interestingly enough, I'm pain-free while riding.

about an hour after getting off the bike, pain returns. tried ice, ibuprofen, yoga...not much relief.

finally went to a chiro, got a diagnosis and an adjustment. post-treatment, pain levels dropped from 6 to 4.

I mentioned riding to him and his cautionary advice was, if I HAD to ride, to only do about 20 min max and at very low effort.

since that's the only time I get relief, my plan is to continue to do 90 min or so.

anyone else had this issue? did riding help or hurt the situation...?

[Ozz]

riding helps for me as leaning forward opened the facets where I had problems (sciatica) ...however....I eventually had the fusion.

Detailed here:

http://forums.thepaceline.net/showthread.php?t=84775

[HenryA]

I've had some pretty bad problems with my back, but riding always makes it better. IMO, until you get this completely diagnosed via some kind of imaging, and having that read by a neurosurgeon or back specialist you're just guessing what and where the problem is. Once you figure that out, its probably time for PT and chiropractic care.

You will probably be given some exercises to generally balance and increase your core strength. The theory being that when all the bones are held in proper alignment by strong balanced muscles you may improve considerably. PT and scrupulously following the prescribed exercises worked well for me. My PT suggested this book as a general guide: "Ultimate Back Fitness and Performance" from --- http://backfitpro.com/

See a doctor first to get a proper diagnosis.

[makoti]

First off: how do you know it's L5/S1 issues? Did you have an MRI? What did it say?
I have had wicked back pain. Riding seemed to help stretch me out & make it feel better, but I did find a lot of relief with two things: Deep muscle massage & Acupuncture. The acupuncture helped reduce the pain for months but it always came back, so I would call this a temporary fix. The massage, however, did wonders. It took several visits, a few touchups, and now I've been problem free for years. Find a certified massage person (this is "my guy" & his credentials. I'd look for something similar. He's gotten me through back, hip, IT band, knee, and shoulder issues. This being healthy is gonna kill me. https://www.amtamassage.org/famt/WayneSickels).
And you didn't ask, but I've never thought much of Chiro's. I went to a few, never impressed. And the more I learned, the less I liked. I wouldn't get an x-ray in a chiro office (never been in one with an RT to take them & the films I've seen out of those offices are basically unusable), and they wouldn't be doing any adjustments to me without taking one before they started. How do they know if there isn't something broken or that snapping me around isn't going to make it worse? I know people who swear by theirs, and if their happy, that's great. Not for me.
PT, on the other hand, may be a good idea.
Good luck no matter how you go after it.

[awdwon]

Pretty much what others have said. I've had similar issues with pain that come and go over the years. For me it's been yoga and accupuncture as well as the odd trip to the chiro (my guy actually does the accupuncture as well). Finding a good chiropractor can be pretty tough but they do exist. If you can find an acupuncturist or chiropractor that specializes in sports medicine you might be better off.

[rnhood]

Numbness is a condition that needs to be addressed by a real doctor, not some glorified physical therapist (aka chiropractor). It could be any of a number of things but, seeing an orthopedic doctor is the only sure way to getting to the root cause.

[awdwon]

An orthopaedic doctor is probably your best bet to get to the root cause but there are plenty of treatments that I'd try before opting for injections or surgery. Just as there are plenty of bad chiropractors (or glorified physiotherapists as you call them) there are plenty of terrible orthopaedic doctors. I had a botched diagnosis on my broken wrist from an ortho Dr. which resulted in having to have it re-broken 8 weeks later and plated. My glorified physiotherapist got my wrist and my back working in short order with chiro and accupuncture and there are plenty of professional athletes that he works with on an ongoing basis that I'm sure are thankful for his services.

[Seramount]

as far as the diagnosis, my research on my symptoms and the chiro's opinion both indicated L5 / S1.

had a second chiro adjustment this afternoon.

was going to stay off the bike, but finally opted to just do an easy 20-miler.

two hours post-ride, I'm pain-free. am icing the lower back and applying some medicinal applications of 100-proof whiskey.

absolutely the best I've felt in almost two weeks.

the term 'real doctor' is curious. there are all kinds of approaches to health...some dufus who finished last his in his med school class is supposed to be considered a higher authority...? uhhh, nah.

there are other solutions besides drugs and scalpels...

[chwupper]

When I had my disk problems, my doctor said I could do whatever I wanted, as long as I could handle the pain. The pain was debilitating, so I didn't do much. When you get down to it, your nerves will tell you what you need to know.

[Uncle Jam's Army]

I've dealt with L5/S1 issues for a LONG time. I find I can generally ride through it as it's the only thing that gives my back relief from whatever compression issues I'm dealing with. I can usually ride normally, but, depending on nerve impingement, I can experience a drop off in leg strength. Just last week I had a recurrence of back pain I dealt with in early May. My chiropractor told me my pelvis was twisted severely. Needed two adjustments on consecutive days. Getting better, but still not great.

My doctors are completely useless when it comes to these issues. In 2012, I had an MRI done and I have degenerative disc disease in L1 through L5, ranging from moderate to severe. It's only going to get worse, and the only thing I can do is stay on top of my stretching and core exercises, eat well to keep excess weight off, and train. All the docs I've seen say PT with pain management, if it gets worse, cortisone shots. That's no way to live for me so I'll keep to my routine and just deal as best I can when these issues pop up.

P.S., I know this sounds banal, but think about balance in your posture. Don't shift your weight to one foot when standing or one side when sitting (like in your car), both your sit bones on your saddle when you ride. Always think centered. Kind of hard to do if, like me, you have a leg length discrepancy.

[bcroslin]

I nearly had back surgery due to a fracture of my L5 vertebrae. I endured 4 rounds of facet injections in my spine and was borderline addicted to pain killers. The orthopedic surgeon who diagnosed me after 2 MRI's, a CAT scan and several x-rays wanted to fuse my L4, L5 and S1. I came within just a few weeks of having surgery. I've got arthritis in my spine and the doctor told me I have spinal stenosis like a 60 yr old. Thanks skateboarding!

In my experience, the only thing that will help is rest and being horizontal for a long period of time. Massages, stretching and chiropractors will only make things worse. Riding warms up the muscles and that provides some relief but you're likely not helping things. You need to take it easy and lay in bed - the firmer the mattress the better. Over time the muscles relax and things go back to normal. Or they don't. Everything I've read over the years essentialy says back pain goes away on its own with rest and there's no real rhyme or reason or magic bullet.

Any reason why you haven't been to a doctor?

[makoti]

there are other solutions besides drugs and scalpels...

And a good Dr will explore them with you.

[makoti]

I nearly had back surgery due to a fracture of my L5 vertebrae. I endured 4 rounds of facet injections in my spine and was borderline addicted to pain killers. The orthopedic surgeon who diagnosed me after 2 MRI's, a CAT scan and several x-rays wanted to fuse my L4, L5 and S1. I came within just a few weeks of having surgery. I've got arthritis in my spine and the doctor told me I have spinal stenosis like a 60 yr old. Thanks skateboarding!

In my experience, the only thing that will help is rest and being horizontal for a long period of time. Massages, stretching and chiropractors will only make things worse. Riding warms up the muscles and that provides some relief but you're likely not helping things. You need to take it easy and lay in bed - the firmer the mattress the better. Over time the muscles relax and things go back to normal. Or they don't. Everything I've read over the years essentialy says back pain goes away on its own with rest and there's no real rhyme or reason or magic bullet.

Any reason why you haven't been to a doctor?

This is a good example of why having tests run makes sense. You KNEW you had a fracture & arthritis, neither of which are helped by any of the things I would have suggested. Keeping active can possibly help with the arthritis, but not that fracture. That last bit is so true. I've seen people with bulging discs walking around without a care in the world, and people with rod-straight backs who couldn't walk. Still, it's so important to get solid information on what IS going on so you know what to try.
FWIW, I've never met anyone who was better off after back surgery. I'm sure some have been & it's likely I never see the happy ones, but still. Good luck to you. Back pain is no fun at all.

[bcroslin]

I've never met anyone who was better off after back surgery.

Truer words have never been written. I've met so many people who are on their 2nd and 3rd back surgeries. I opted to drastically change my lifestyle by losing weight, excersizing and staying off my feet for nearly a month. I also had to stop taking pain killers so I could get a baseline on my pain. It's been about 10 years since I've had chronic pain but I still have occasional referencing pain in my hip. The only thing that helps is rest and being horizontal.

[Uncle Jam's Army]

I nearly had back surgery due to a fracture of my L5 vertebrae. I endured 4 rounds of facet injections in my spine and was borderline addicted to pain killers. The orthopedic surgeon who diagnosed me after 2 MRI's, a CAT scan and several x-rays wanted to fuse my L4, L5 and S1. I came within just a few weeks of having surgery. I've got arthritis in my spine and the doctor told me I have spinal stenosis like a 60 yr old. Thanks skateboarding!

In my experience, the only thing that will help is rest and being horizontal for a long period of time. Massages, stretching and chiropractors will only make things worse. Riding warms up the muscles and that provides some relief but you're likely not helping things. You need to take it easy and lay in bed - the firmer the mattress the better. Over time the muscles relax and things go back to normal. Or they don't. Everything I've read over the years essentialy says back pain goes away on its own with rest and there's no real rhyme or reason or magic bullet.

Any reason why you haven't been to a doctor?

About the only thing I agree with here is the need for a firm mattress. Stretching and core exercises have, without a doubt, helped alleviate my symptoms. To say that they make things worse, I don't know. It goes against everything my PT's and chiropractor have told me. You obviously are of a different view, which is ok.

[bcroslin]

About the only thing I agree with here is the need for a firm mattress. Stretching and core exercises have, without a doubt, helped alleviate my symptoms. To say that they make things worse, I don't know. It goes against everything my PT's and chiropractor have told me. You obviously are of a different view, which is ok.

I should clarify what I wrote. Stretching and excersizing should be avoided if you're having acute prolonged pain. Once the pain is gone go nuts.

[Uncle Jam's Army]

I should clarify what I wrote. Stretching and excersizing should be avoided if you're having acute prolonged pain. Once the pain is gone go nuts.

I agree with that.

[TomP]

Many of us have back problems. There is a time and place for all disciplines. I am optometrist but have extensive medical background in neuro working at Craig Rehabilitation Hospital here in Colorado. I also have access to some of the worlds finest health care people of many disciplines.

IMHO, just because you had an MRI, or CT before, doesn't mean things haven't changed. I would suggest building a new team. Re-evaluate from scratch. If you are lucky enough to only have facet arthritis causing your pain, then a radio frequency ablation will give long term relief. You still need good diet, especially anti-inflammatory based, core strength, and flexibility.

While I am more medically based, Chiropractic is actually proven beneficial for mid and lower back. I think high velocity adjustments can be dangerous for the cervical area.

[makoti]

You obviously are of a different view, which is ok.

More than a different view, he likely had different issues. Not all back problems are spine related. It's not always L5/S1 (although WebMD would have you think that). Not all fractures occur due to trauma. Simple exams can go a long way in giving you a better idea of what is going on.

[Seramount]

In my experience, the only thing that will help is rest and being horizontal for a long period of time. Massages, stretching and chiropractors will only make things worse.

Any reason why you haven't been to a doctor?

my experience is the polar opposite of yours...being horizontal has been absolutely the worst thing to endure with this problem. there was NO position that was comfortable. none, zero, zilch...the combo of persistent pain and sleep deprivation was horrible.

that is, up until the first chiro adjustment...I was able to get 3 hrs of rest that night. after the second adjustment, I slept almost 6 hrs. imo, that's not a coincidence.

the admonition to avoid massage, stretching and chiro is going to be completely ignored. I'm finding benefit from each.

as for not seeing a doctor...I called my PCP on monday. got voice mail...left a detailed message saying I was in significant pain and was requesting a referral to a clinic specializing in spine disorders that the PCP had previously sent me to for a herniated L4/L5 several years ago.

called again on tues, got voicemail again. they finally called me late on FRIDAY and said I'd need to come in for an office visit the following week to get the referral. unimpressed with their lack of urgency to get me relief, I curtly declined their offer to make an appt.

in contrast, the chiro got me in the same day I called and the adjustment provided almost instantaneous relief from the intense discomfort that had plagued me for days.

my instincts say being inactive is not an appropriate course of action. I walked a mile this morning and then did a light swim session for an hour...pain level is currently down to 1, sometimes a 2.

plan on doing a leisurely ride after work.

[Ozz]

...

plan on doing a leisurely ride after work.

If you can manage the pain thru rest, stretching, PT, etc then go for it. Don't give up on getting some scans / x-rays and a diagnosis on what the underlying condition is that is causing the problems.

Mine was undetected for years....had a flare up of sciatica around 1999, and an epidural cortisone injection cleared it up...no problems whatsoever until 2010 when it flared up again. More scans showed condition had worsened of over the years. Tried to make it right with more PT, stretching and more epidural cortisone. Didn't work after about 9 mos so went with the surgery.

Pain free for 4 yrs now...no restrictions, but I pay attention to my movements, core strengthening, and stretching.

YMMV

[blueride]

I opted for lumber spine surgery after fracturing L5 so badly that non surgical options offered little promise.
I tried Kyphoplasty before opting for surgery, but it didn't help, nor did anything else. It took me a full year to recover from the surgery, but now I'm fine and back riding my bike. Good luck .

[texbike]

Wow! I just read this! I'm sorry that you're having the issues, but maybe I can finally keep up with you! :)

So, what has changed in your routine that could have caused the sudden onset of the pain? Have you changed anything on your bike that would impact your position? Have you changed your regular day shoes by chance or started wearing socks that are a different thickness?

The reason I ask is that I had an issue several years back that could be directly tied to a pair of shoes. While we were moving I was wearing an older pair of tennis shoes that were reserved for yard work, muddy trails, etc. During the moving process, I pulled off a piece of the heel on one of the shoes that was loose. Later that day and into the night my back was killing me. To the point that I couldn't sleep and could barely move the next morning. This continued for another day or so until the move was completed. I blamed it on the physical effort of moving everything. After a couple of days (after I stopped wearing the shoes) the pain went away and all was back to normal. A week or two later, I put the same shoes on to do some stuff around the yard and to run errands. By the end of that day, the exact same pain was back in full force. I could barely sleep that night. I began to ask myself what could have been causing it and remembered pulling that piece of the heel off of the shoe. Hmmmm. Apparently it was enough to throw my geometry off enough to cause back issues. I threw the shoes away the next day and haven't had the issue since.

Sorry for the long story, but my basic point in it is perhaps it would be a good idea to think back when the pain first appeared and see if you can associate any changes in your life at that time that could be the cause of the pain. Just a thought...

Good luck!

Mike

[bigbill]

I'm fighting back issues right now. My PCP has me doing a series of Prednisone, I'm on day three, to see if inflammation can be reduced. I had back spasms that eventually settled into sciatica in my left leg. I've got Skelaxin which IMO, is a better muscle relaxer than Flexeril which makes me forget my name. I'm going to take it easy until I'm done with the Prednisone but the strength is back in my left leg and I've just got general soreness but nothing that I need pain medicine for.

I wanted 6K miles this year and had a great start which put me about 1K ahead of last years miles but I'm eating in to that lead daily.

[buddybikes]

Back problems for years, spondylosis of L4/L5. Friend had is more severly than mine and had neuro surgeon at New England Baptist do fusion - he is now back to building things (like hardcore stuff) I went to same surgeon, he sent me to their spine center that focuses on non surgical work, plus having nerve block this wed to see if ablation makes sense.

If you go to someone who cuts, go to neurosurgeon and one like mine - who said, surgery isn't reversable, yes we may end up that route but at last resort.

[CheshireCat]

Many of us have back problems. There is a time and place for all disciplines. I am optometrist but have extensive medical background in neuro working at Craig Rehabilitation Hospital here in Colorado. I also have access to some of the worlds finest health care people of many disciplines.

IMHO, just because you had an MRI, or CT before, doesn't mean things haven't changed. I would suggest building a new team. Re-evaluate from scratch. If you are lucky enough to only have facet arthritis causing your pain, then a radio frequency ablation will give long term relief. You still need good diet, especially anti-inflammatory based, core strength, and flexibility.

While I am more medically based, Chiropractic is actually proven beneficial for mid and lower back. I think high velocity adjustments can be dangerous for the cervical area.

I had to comment...
you don't happen to be a pm&r D.O. do you?

that sounded like something straight from the rehab docs. I am trying not to comment on this thread because there are SO many things to consider before doling out blanket advice, but I couldn't agree with your statement more.

well put, and solid advice.

[RobJ]

I have an annular tear of my L5/S1, which was diagnosed through an MRI by a Neurosurgeon. I originally had a herniated disc (in college) that put an end to my competitive running. I don't believe they were the same discs, but too long ago to remember. I use a massage therapist and chiro too. But to echo the comments of the others any treatment without a scan makes no sense and can be dangerous. A heart surgeon doesn't just go in and dig around without reason and a load of tests up front. I fully trust those without an MD in their title and have used acupuncture and other means in the past, but again not without knowing what is going on physiologically. The numbness you are experiencing could most likely be the disc pressing on the spinal cord or other nerves. My herniated disc felt like a hip problem, so the end point of pain usually doesn't signal where the real problem originates.

The herniated disc took care of itself and started running long after college, marathons etc. A lot of stiffness and dull pain when not running or cycling but the massages and chiro help, much as you reference.

The neurosurgeon advised against surgery since the replacement disc would be man-made material requiring a swap out in about 30 years (I would be in my 70's). He recommended no running and take up cycling and other core exercises like rock climbing and yoga. I notice I get more flare ups (severe pain, can't straighten up etc) when I am not training regularly and put on a few pounds or weirdly enough when I am not running. I spent the last 6 months focusing my training only on cycling and the back is causing more problems. When I added back the running, things improved. I am quite inflexible by nature from my years of distance running, so the massage really helps and I need to really develop my core.

Stick with what works. Try out some yoga routines/poses, look for a chiro who is also ART (Active Release Techniques) certified. Also have you had your bike position checked recently by a certified fitter? But again get a good picture of what is going on.

[RobJ]

Oh and check out this video. Recommended by my coach and seems to be helping with the back pain.

https://www.youtube.com/watch?v=4BOTvaRaDjI

[TomP]

I had to comment...
you don't happen to be a pm&r D.O. do you?

that sounded like something straight from the rehab docs. I am trying not to comment on this thread because there are SO many things to consider before doling out blanket advice, but I couldn't agree with your statement more.

well put, and solid advice.

Thanks. That's one of the nicest compliments I've had. I specialize in neuro-optometry. I work as part of a multi-discipline team at Craig Rehabilitation Hospital and in private practice. I work closely with physiatrists, D.O.'s, etc. The goal being to look at everything to achieve the best functional outcome.

[mikoglaces]

Truer words have never been written. I've met so many people who are on their 2nd and 3rd back surgeries. I opted to drastically change my lifestyle by losing weight, excersizing and staying off my feet for nearly a month. I also had to stop taking pain killers so I could get a baseline on my pain. It's been about 10 years since I've had chronic pain but I still have occasional referencing pain in my hip. The only thing that helps is rest and being horizontal.

Well, I had L5/S1 herniated disc, which then ruptured (as I was dismounting from my bike), and I had surgery, and I am much better. It's been maybe 8-9 years, and while I experience occasional soreness I am way better off than before. I haven't seen my back doctor in years. When I ruptured the disc, surgery became the only option. I do agree that other treatments should be attempted first, including epidurals possibly. That had worked for me some years earlier but not the second go- round.