OT: Back injury

[TomP]

Hi All,

I have had some nagging back pain since May. I tried a variety of things, including medication, and sometimes they would help for awhile, but then it would come back. Sometimes it would really hurt, but mostly it would just be uncomfortable and annoying.

Finally I had an MRI. This was after seeing a Physiatrist (physical medicine and rehab doctor) and my internist. Both thought I had a muscle strain / sprain. Well, the MRI showed arthritic changes, stenosis of several nerve foramina (moderate to severe), some scoliosis, and a couple of buldging discs, one more than the others. All of these problems were in the L2-5 area. The physiatrist believes many of these changes have taken 10 to 20 years to accummulate.

So, I figure the stenosis, arthritic changes and scoliosis are from many years of power lifting and beating myself up. I forgot to ask him, but will about the buldging dics. It just seems to me that that the bulding discs are probably more recent and what are more likely causing the discomfort.

I've been using NSAIDS, heat, core strengthening and stretching. These all help - especially the heat. I am going to get an epi-dural steroid injection. I am also going to go for physical therapy with an orthopedic PT who specializes in the back.

I am just curious as to other's experience with similar problems. I just read a post on another site and one person said it was mostly just time that helped them. Fortunately riding feels good on my back.

Any thoughts are most appreciated and I will also post on what transpires (both good and bad) to hopefully help others.

Thanks,
Tom

[gasman]

Tom-


Studies of treatment for backpain show that :

1. Surgery is only really indicated for either an acute disc rupture causing pain/ numbness or weakness in the area innervated by the nerve root or for clear neurologic deficits- ie. loss of bowel or bladder control. Studies have shown that if you take a large group of people with back pain and randomize them into a 2 groups and they recieve either surgery or conservative treatment after one year 1/2 of the patients in each group will be better.In other words after one year you may be just the same whether or not you have surgery. Eugene has one of the highest rates of back surgery in the country and probably still has just as many people with back pain.

2. Epidural steroids have really only been shown to work for acute disc rupture with pain of less than 6 weeks duration. That being said there are some people who get great benefit from the block. There is little downside for some potential benefit.

I would say you should continue with exercises, heat and other conservative measures that seem to help. Keep riding and keep moving.

Good luck.

[pale scotsman]

Tom, first off sorry to hear about the nagging pain. I'm kind of in the same boat. The good thing is 50% of back pain clears up over time. I've used these to good effect, http://www.amazon.com/gp/product/B0009BY0HE?tag2=bellaonlinewe-20 . Also the cobra (http://www.yogalearningcenter.com/images/asanas/cobra.jpg) pose really seems to alleviate the bulging of the disks.

[Ginger]

Ah, welcome to my world.

Gasman, as always, gives an excellent reference


My hamstring pain this summer that I posted up about (you may have missed it...)? It was actually bulging discs at L2/L3 and L5/S1. Most likely initiated by my mortocycle accident in 2000 (Evidently my L5 was fractured...but not enough to need a brace...I still don't get that..). By the time I had my MRI this fall I had a serious leg strength imbalance and some bladder control issues, but those cleared up with physical therapy.

This is what has worked so far for me, your mileage may vary:
1. Before you continue on the bike, have your doc or physical therapist check your position on the bike. I have a good neutral back position when I'm on the tops and the drops, but I have to work on my strength to get onto the hoods. You may have to take some time off the bike. Or you may have to revise your position until you can ride with your back in a good neutral position.

2. Self traction. Have your PT or doc show you the many ways to do self traction. My basic understanding is that self traction will help blood get to the discs and if they're going to heal, they need that. I do it about 5 times per day. (I do seated work...but you can do it standing too..) (My other basic understanding is that *if* they're going to heal, they can take up to 500 days...I'm NOT staying off the bike for 500 days.)

3 Core strength. When I was first tested in PT I was a 4 out of 5...better than the 2.5 average strength rating. However, there's always room for improvement. The physio ball is your friend.

4. Avoid lumbar twisting exercises. For obliques do "sunshines" with weight. Have your pt or doc critique your form on your exercises and pick out ones you can do or current exercises you can modify.

5. Improve your upper body strength...mostly the stuff between your shoulder blades, part of my issue is triceps strength. Pushups off the ball with a plus paying particular attention to not allowing the lumbar region to flex. At all.

6. Planks are your friend. Even with my core strength it took me 8 weeks of PT to be able to do them correctly.

7. Pilates. I'm only just starting...but my PT encouraged the work as very appropriate to the bulging lumbar discs.

Let me know what your doc says...it's always good to hear divergent opinions.

[Elefantino]

Tom:

I've had a number of epi blocks, as well as radio frequency lesioning. Epi blocks didn't work for me. The RFL would usually last several months, until the weather warmed up. (I always had them in the winter, when the pain was most annoying.)

This winter, I have forgone both because they're more hassle, to me, than they're worth. I just eat vitamin IB when I need to and ride lots. Riding, one of my back surgeons told me, opens the facets and makes things nice.

Back pain is the worst. I've had multiple surgeries; I sympathize. Wish I had more info on bulging discs, but I've only ruptured them, which required surgery.

Best to you and your back. Keep riding!

[Ginger]

Oh...yeah...I've been using fishoil for the pain...seems to work just fine.

[FierteTi52]

I've been deal with back problems for 20 years and it's no fun.
A few things that help me.
1. Stretch twice a day. A doctor will give you the proper stretchs. Tight
hamstrings are the worst.
2. Core strength, I do aquatic Pilates. etc
3. Don't be seditary, keep active.
4. I hang from a chin up bar ocassionaly to relax the discs.
5. A Chiropractor helps most people, but not all.
6. Vitiman "I" as needed.
7. Hot tub.
8. RIDE YOUR BIKE. A properly fitted bike really helps to keep the
vertabrates moving freely.
9. Ride wide tires at a reasonble pressure
Good Luck
Jeff

[Tonger]

Tom,

It sounds like you just have what are referred to as degenerative changes in the spine (essentially like arthritis) which is likely worsened by your scoliosis. Scoliosis is basically a curvature of the spine which results in uneven loading of the vertebral bodies and often results in disc height loss/bulging in addition to foraminal narrowing. The neural foramina are the openings through which the nerve roots exit the spinal canal and, if narrowed by degenerative changes, can cause nerve root compression and pain. Additionally, disc bulging into the spinal canal or neural foramina can cause nerve root compression as well. Easing of the inflammation/swelling by NSAIDS and even an epidural steroid injection can result in temporary pain relief. An epidural steroid injection typically consists of a long acting steroid mixed with local anesthetic that is placed in the vicinity of the irritated nerve roots. This can cause easing of the symptoms for up to several months. Typically low back pain associated with spinal cord or nerve root compression is worsened with loading of the spine. If you think about this it makes sense - since loading of the spine compresses the already bulging discs making the spinal canal and neural foramina smaller.

This is what I know about degenerative spine and the treatment.

1. There is no "magic bullet". These changes have taken years to accumulate and the symptoms won't go away overnight. However conservative measures such as stretching (spine and hamstrings) and yoga can dramatically decrease the pain symptoms. Similarly, increasing your core strength without loading your spine (no more squats!) can also reduce the functional loading of your spine.

2. From what I understand, distraction of the spine (aka traction) can provide temporary relief of symptoms but offers no lasting benefits. So, while self traction can definitely make you feel better temporarily, I wouldn't spend the money for an inversion table.

3. Surgery often doesn't work and can definitely leave you worse off than when you started. I personally wouldn't even consider it unless I had leg weakness or smelled involuntarily of urine.

4. I would ask my MD for a perscription for some physical therapy sessions so that you can learn how to do the back stretching exercises correctly.

Don't get discouraged because a lot of back pain will resolve over time. I blew a disc in my back almost 3 years ago and have only recently become completely pain free. That probably has a lot to do with my present level of conditioning but you don't have to let yourself go as much as I did...

Good luck!

Tonger

[andy mac]

i have been suffering leg/hip/back issues for a number of years. tight back and hamstrings, pelvis out of place, etc. also have a bit of an L-5/S-1 bulge.

an interesting recent breakthrough i am mad at myself for not working out earlier was the way i sleep. have always slept on my front often with a knee up and out to the side.

this is apparently bad news for someone with a tight lower back and hamstrings and possibly the reason my pelvis was always outta whack. now trying to sleep on my side or on my back - not easy, even after jack daniels.

may be something to consider? hope it all works out ok.

:beer:


andy.

[TomP]

Wow - thanks for the great advice! It all makes perfect sense to me and matches with what I have found so far by trial and error that helps. Ibuprofen, heat, self-traction, core strength, NO twisting (boy was that unfriendly), NO loading the back, stretching, more overall strengthening.

I am really encouraged by what everyone has said and the time involved. I don't mind how long it takes, it's just good to have a reference.

I'm going to try some of the other tips offered and am looking forward to the PT. I'm pretty lucky there. I work in Rehab and have good friends in the field and at several of the top hospitals (including Craig Rehabilitation Hospital). I asked them for who they would recommend as being the best orthopedic PT specialing in back. I also have access to, and will see a PT who did her doctoral thesis on stenosis and developed protocols for the therapy.

Thanks again,
Tom

[Skrawny]

I agree with all the above.

80% of back pain goes away in 4-8 weeks.
Allopathic medicine gives NSAIDS and 80% get better in 4-8 weeks.
Chiropractic medicine does alignments and 80% get better in 4-8 weeks.
I'm sure herbalists have something special that they can give that will make 80% of back pain get better in 4-8 weeks....

ALL will say regular core strengthening, and modifications of your lifestyle (careful lifting that box like that!) are necessary to prevent re-injury. Some are more prone to re-injury; although whether it is because of failure to change some of the chronic "irritants," or whether it is because of a "weak back" is never very clear.

The 20% of back pain that is chronic is a huge problem in health care as not much has been shown to consistantly help other than -you guessed it- core strenthening, lifestyle modification, and NSAIDs.

Good luck, TomP. I hope you find solutions that help.
-s

[CalfeeFly]

I would recommend you be very careful with the injections.

I had them and I developed an adrenal insufficiency which is something you do not want. Essentially your adrenals are fooled by the steroids to think they don't have to work as hard. Then you have to replace the cortisol and it is guesswork. When they start to work again (hopefully) and you don't know it you are taking too much and so forth. Having gone through it I do not think it is worth the risk. It is not a fun problem to have with your body.

In researching my illness and trying to figure out what happened to me I found a medical study. They did injections on 10 athletic people and 9 developed an insufficiency. Why they study did not know. My guess is the activity level could have changed how the steroids are absorbed or something like that.

I'd never do it again and risk it. Being that sick was not fun at all. At one point I was sleeping 18 hours a day. Then they found the problem and eventually the medicine was making me sick since my adrenals had started to function. If you take the medicine too long or too much you can suppress the adrenals for the long haul.

I have a lot wrong with my back including fractures but I would not use this method to control pain again. It is just not worth it.

[Skrawny]

In researching my illness and trying to figure out what happened to me I found a medical study. They did injections on 10 athletic people and 9 developed an insufficiency. Why they study did not know. My guess is the activity level could have changed how the steroids are absorbed or something like that.

Interesting...
Not to hijack this thread, but that study suggests that athletes' hormonal states are very sensitive to hydrocortisone shots. Floyd Landis was getting hydrocortisone shots during the Tour for his hip and this testosterone to epitestosterone ratio was messed up; specifically his testosterone was normal but his epitestosterone was very low (reportedly).
Interesting...

-s