OT (?) - Cycling and Sciatica...

[OtayBW]

...or a sciatica-like problem. I'm looking for any advice you may have with regard to a back problem.

This is the typical thing you get when you bend over to pick up a paper clip or something, and you're down for 2-3 days....except that was 11 weeks ago. There is non-trivial pain and highly restricted mobility, now with numbness/weakness in my leg. My Dr/MRI last week indicated "discs bulging in a bunch of places between L3-4 and pressing on the nerve roots". He sends me to guy for a steroid/lidocaine epidural (!) and a follow up consult with a surgeon....

The ONE thing that has provided relief has been cycling. I am pain free on the bike, and after a few hours, I'm feeling pretty good for a while. Surprising...

So, I'm wondering if anyone has any experience or words of wisdom with this. I'm thinking of trying out chiropractic, physical therapy, or acupunture before this gets carried away. How do you find/evaluate the good ones to go to?

I would appreciate any thoughts.

[lemondsteel]

I have the typical pain on my right side. The bike does make it feel better but it's not a cure. I have an inversion bed and it helps alot to loosen things up. My best relief/cure has been to lay flat on the floor roll a tennis ball up in a towel and lay on it right at the right side point. you can feel the tenderness by pressing an know right where to place it. I have also found that I have to be totally relaxed, especially the stomach muscles. May take 2 or 3 times but you'll feel it pop (at least mine does) and go back into place. I also take 800mg of ibuprofen for 4-5 days. Great for the inflamation. Mine is always on the right side and never the left. In addition to the inversion bed I have a roller massage heating bed that lays flat on the floor. This is not your cheap Walmart variety. Cost 2500 bucs 15 years ago. I have had back surgeries on L1 and L2 in the past but that never bothers me like the sciatica on the right side.
The tenderness stays for 7-10 days after it pops into place.
I can't rmember what the joints called on each side of your hip but you can feel the joint on each side of the lumbars and below your hip bones. Yours might not be the same problem but the only time my sciatica gets inflamed is when these little finger joints get out of wack. My 2 cents.

[MattTuck]

Where in MA are you? I know an accupuncturist who has offices in Concord, and Belmont. He worked on me for a non-spine or bike related problem, but I liked him.

He also used to ride and do some racing, so you can talk shop with him during the treatment.


PM if you want me to put you in touch with him.

I'd also try massage.

I'm more suspicious of chiropractors, but that is just me.

[Ozz]

I've been through this...had the epidural cortisone injections twice....not for about the past 5 years though (knock wood).

The reason for the cortisone injection is to get the inflammation under control. Essential the nerve gets irritated and swells, that causes more irritation as it passes thru some narrow openings heading for your legs.

As long as I stretch well after riding, work on core strength and pay attention to posture and when I lift things, I usually stay pain free. I and some times start to feel twinges come on and Alleve usually gets it under control quickly.

The cycling position helps stretch out my spine and relieves pressure on the sciatic nerves.

I used to get it in just my left leg, but recently I have started having paine in my right hip / butt....frankly I am hoping it is just some more sciatica, but my fear is hip arthitis or degeneration.....getting old sucks. :crap:

[eddief]

i was down for 5 weeks. inflamed sacral joint. this was 15 or so years ago. at that time, my western med doc, suggested bed rest, then we did epidural, then i was still no better.

then i found a PT who would do house calls. she said "i would have had you stretching first and then walking some in the first 3 days."

granted, by the time she got to me, i had been bed resting for over a month, but she said bed rest for many is not the best solution. i am not a doc, nor to i play one on tv, but i have had the best luck with PT's each time something like this has happened = sacral joint, neck pain, shoulder pain.

[mickeyc7]

I have had a chronic lower back problem very similar to yours for many years.
I have tried several epidural injections with little success.
A couple years ago I have a procedure called a facet rhizotomy where a local anethetic is injected and then a heated probe is inserted to burn nerve endings which send the "pain" signal to the brain. Granted, this does nothing to alleviate the underlying condition but the pain I felt is substantially lessened.

[MattTuck]

I have had a chronic lower back problem very similar to yours for many years.
I have tried several epidural injections with little success.
A couple years ago I have a procedure called a facet rhizotomy where a local anethetic is injected and then a heated probe is inserted to burn nerve endings which send the "pain" signal to the brain. Granted, this does nothing to alleviate the underlying condition but the pain I felt is substantially lessened.


that sounds so gnarly!! gotta love the surgeon that came up with the idea.

"Hey, we've been trying to treat the underlying condition; why don't we just try to treat the symptom!"

[OtayBW]

Facet rhizotomy, huh? OK - I am stepping away from the keyboard....

Wow. There is some really good information here.

Lemondsteel: Your methods sound pretty good. Kill the inflammation and work it back into place. The only thing that comes to mind is that in my case, the pain area moves. It shoots left, then right - it's all over the place. It's hard to pinpoint. I do have one of those inversion tables, but so far, not much help with that.

MattTuck: PM on the way. I'd like to hear about your acupuncture guy. I'm ~6 mi SE of Worcester, but I make it down thataway often. I'm also not a big fan of the Chiropractors either, partly because it didn't work for me on an unrelated problem years ago, and also because I find the whole thing a little creepy - but that's just me.

Ozz: Epidural is presumably what's next on the menu according to my doc, but I won't do that until all other possibilities are exhausted.

Eddief: Yes, in my case as well, inactivity doesn't help. Surprising what they do and do not recommend. I'm amazed at the limited recommendations that I get from my Dr. It's all about the epidural with a consult from the surgeon.

Mickeyc7: Oh yeah, facet rhizotomy..... Anybody know a good chiropractor?....

Thanks for the information y'all. If nothing else, I've sort of realized that I have probably been a little lax myself in assuming that this would all work itself out - it always has. But I clearly need to become much more proactive about all this. We'll see where it goes.

[capybaras]

Find a good yoga class. And aside from that, constantly "hug in your low belly." Makes a huge difference in letting you do things that used to throw out your back like picking things up, brushing your teeth, scrubbing the floor, and eventually coughing and sneezing don't do any damage.

[eddief]

There is certainly a real place for the specialized expertise of a physician. And consider the amount of hands-on anything they do compared to a PT. When was the last time a physician touched anything other than your sphincter or your jewels...and for more than 10 seconds at a time?

Sports medicine PT.

[rugbysecondrow]

I have gone through lower back issues (two herniated discs) and no offense to people here, but don't take any of this prescribed advise. Speak with your DR and your PT specialist. I would NOT start stretching, core or any exercise program prescribed by anybody here period. It is way to debilitating, too painful, demoralizing to leave up to amateur info from a cycling forum. Nobody here has seen your MRI, knows your facts or anything else, so just know that the free advice you get is worth what you pay for it.

What I will say is that you should follow the exercises prescribed by your DR or PT, do the work. Avoid surgury at all costs, but listen to your DR. Ask questions, seek addition opinions if necesary and be patient. I don't beleive in chiropractors, go see a real Dr or a real PT specialist. A great PT will really make your life better. It will get better, but a back injury is for life and it will require constant effort and care.

[93legendti]

I have gone through lower back issues (two herniated discs) and no offense to people here, but don't take any of this prescribed advise. Speak with your DR and your PT specialist. I would NOT start stretching, core or any exercise program prescribed by anybody here period. It is way to debilitating, too painful, demoralizing to leave up to amateur info from a cycling forum. Nobody here has seen your MRI, knows your facts or anything else, so just know that the free advice you get is worth what you pay for it.

What I will say is that you should follow the exercises prescribed by your DR or PT, do the work. Avoid surgury at all costs, but listen to your DR. Ask questions, seek addition opinions if necesary and be patient. I don't beleive in chiropractors, go see a real Dr or a real PT specialist. A great PT will really make your life better. It will get better, but a back injury is for life and it will require constant effort and care.
This is good advice.

My wife has bad sciatica and herniated a disc. She has gotten good relief from the PT her MD sent her to.

[MarcusPless]

I would agree with any advice that suggests paying attention to the local MD/PT folks that have actually seen you and/or your case. I experienced a herniated L5/S1 disk a number of years (maybe 17) ago. It was bad. My sciatic nerve was quite compressed. To the point where I would wake up in the middle of the night and feel as if I had just rolled into the campfire, and my left foot was literally on fire. Not pleasant.

It started off quietly. Felt like a pulled muscle. But as I kept running and doing step aerobics the symptoms kept moving down my left leg. Eventually I had tingling and numbness in the outer half of my left foot, which just kept getting worse. A Chief I worked with (I was in the Navy at the time) stated point blank "it's your sciatic nerve". He was right.

I know no one wants to hear this, but for me, surgery was the answer. I tried a number of different treatments; nothing worked. I saw three different surgeons who all had access to my MRI info. They all understood that they weren't going to be working on me; they were simply offering second opinions. They all said the same thing -- "if that was my MRI I would be checking myself into the hospital today". The same for their family members.

I opted for the surgery and have never regretted it. Pre-surgery I was having to ration Percocets, because the Navy, in their infinite wisdom, required service members to put on a uniform and schlep down to medical (and wait around for hours in excruciating pain) to get a refill for pain meds for things that were obviously serious medical conditions. No one else could pick it up for you, you couldn't get it at a civilian pharmacy, and you couldn't show up in civvies. Thanks, but the pain of all that made rationing the pain meds a better option. I've known active duty cancer patients that had the same experience. It was ridiculous. Hopefully, things are better now, but I have my doubts.

So I had a L5/S1 diskectomy/laminectomy in 1993. The bulk of my pain was almost immediately relieved. When they did the surgery the surgeon noted that my nerve was *really* compressed, and that whatever sensation I got back in 6-12 months was likely going to be it. I still have tingling/numbness on the outer portion of my left foot, but other than occasionally overdoing it in the yard, working on a car, etc. I've basically been pain free for 17 years.

I'm not saying surgery should be your first choice, I'm merely suggesting that you don't rule it out. Every situation is different and very few Internet medical opinions ever suggest back surgery. For me, I feel it was the right answer, and I have no regrets.

Good luck!

--Marcus

[wildboar]

The ONE thing that has provided relief has been cycling. I am pain free on the bike, and after a few hours, I'm feeling pretty good for a while. Surprising...

This is not surprising, being stretched out on the bike and losing a bunch of weight is what ultimately finished off my left leg sciatica 15 years ago. The doctor told me to just chow on the ibuprofen, so for an entire summer/fall I did that while suffering through long hours of standing on a concrete floor working at the car wash. By November it had gotten so bad I finally went to a chiropractor who used the "activator" clicker device and it made a huge difference once he started hitting those trigger points. That provided a temporary solution that got better as time went by, but I still remember laying on an ice pack on the floor of my dorm room wondering if I would ever be able to walk without pain again. By the time spring rolled around, the chrio had given me enough relief that I was able to get back on the bike and really stretch everything out.

If I knew then what I did now:

Read:
Mindbody Prescription by John E. Sarno, MD (http://www.amazon.com/Mindbody-Prescription-Healing-Body-Pain/dp/0446675156/ref=sr_1_1?ie=UTF8&s=books&qid=1270525558&sr=8-1)

He explains the truth about "bulging discs" and such.

Trigger Point Therapy Workbook (http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Treatment/dp/1572243759/ref=sr_1_1?ie=UTF8&s=books&qid=1270525831&sr=1-1)

This will show you all the trigger points to release that tension, the same places the chrio hits with the activator device.

Finally, go see a chiro that uses the activator, you will know right away if it's working or not. If that doesn't suit your style, find a good massage therapist, bowen therpist, ART "active release therapy" person etc. Sciatica is a pretty common ailment that these people deal with all the time.

[DHallerman]

I'm not saying surgery should be your first choice, I'm merely suggesting that you don't rule it out.

I have a different spine problem, a herniated disc in my neck.

And so far, the epidural injection and PT have helped some, but it's still painful to ride my bike, bend my head back on the bike.

More pain after than during a ride, though.

My orthopedist up where I live has talked about surgery, an artificial disc to replace the broken one.

And next week I'll be seeing a doctor at a NYC hospital for a second opinion.

So, I'm one not ruling out surgery.

Dave, who says he's put replacement parts on a bike so why not in his body

[OtayBW]

First - let me say thanks to all who have responded here. I fully understand that this is an internet forum, but the information and advice that I have received IS helpful. In the end, it is I who essentially must take responsibility for deciding on the course of my treatment, and in addition to the advice of doctors, therapists, etc., part of my making an informed decision is the anecdotal advice that I receive from friends - including on-line friends. Of course I have to evaluate things and keep perspective, but all this information is definately helpful.

Having said that, a couple of comments:

I am definately going to keep anything with *ectomy, *otomy, or *oscopy out of the picture until all other options are completely exhausted (although if anyone recommends *oscopy for this problem, I believe I will seek advice elsewhere...).

I actually have a consult with a surgeon next week, but beyond that, my next step is to find a good sports PT. Not so easy, as good recommendations are hard to find. Unfortunately (or strangely) my primary doc would not recommend one, even when asked. He just wants me to go to the surgeon and epidural guy. Maybe he's not telling me something, but I find this unusual and I will inquire further....

I will also try an acupunturist. What the heck? Always wanted to go check that out and now I have an excuse.

Probably will also try a chiro. Never been too keen on these guys, but what the heck. Not a fan of the bone crunchers, so maybe I can find one of these low-force (activator?) guys.

And a note to DHallerman: I also had bulging C5-C6 quite a while ago. Went through some of the stuff that I'm going through here, although this thing I have now is really more of a problem. It kept me off the bike for ~5 years back in the '90s, largely because of the pain with bending the neck back on the bike, as you say. A PT/cyclist friend treated me, and it was ultimately traction that relieved the compression on the neck. Internet advice I know, but FWIW...

So, once again, thanks for all of y'all's experiences and recommendations. I generally hate this phrase, but 'it's all good'...

[54ny77]

good luck.

there's some informative info on this thread.

[benb]

Shot in the dark but you might get someone to look at your alignment in terms of feet-knees-hips.

I have low arches.. I get lower back pain if I don't use orthotics far before anything else will hurt. If I go long enough it would eventually immobilize me. As long as I wear the orthotics and do my stretching & core exercises I'm 100% pain free.

When you go into a good orthopedic/sports medicine/whatever doctor with back pain they ought to pick up on that though.. that's what happened with me.