L4/L5 disc herniated discs...Exercises?

[sailorboy]

Originally Posted by berserk87

"Vote democrat and move us closer to universal coverage".

Yay. Politics. On a forum that most of us visit to discuss cycling. I didn't think that this thread was heading that way. It's probably heading to a lockdown now.

Right, but having several pages of people trying to play internet doctor is a better option than a soapbox moment about the future of healthcare in this country?

my bad

[mistermo]

Originally Posted by berserk87

I'm betting that the worst doctor that would be treating you has more expertise than the combined lot of us.

I get your point and often feel the same about people coming here for non-cycling advice.

I came here because I searched for others with herniated L5S1 disks. Add me to the group. My PCP thought it was a tight piriformis muscle applying pressure on the psiatic nerve, since my left leg is nearly immobile. The pain is the worst I've ever had.

The takeaway from this thread is that I should devote myself to PT, strengthening my core, and becoming more flexible. It's good to hear this from others who have experienced the same. Think support group.

[buddybikes]

Originally Posted by mistermo

I get your point and often feel the same about people coming here for non-cycling advice.

I came here because I searched for others with herniated L5S1 disks. Add me to the group. My PCP thought it was a tight piriformis muscle applying pressure on the psiatic nerve, since my left leg is nearly immobile. The pain is the worst I've ever had.

The takeaway from this thread is that I should devote myself to PT, strengthening my core, and becoming more flexible. It's good to hear this from others who have experienced the same. Think support group.

Run don't walk to a good spine surgeon for advice, your statement here scares me: since my left leg is nearly immobile. You need an MRI. Do you have any issues with uninary or bowel? If YES, go to ER

PS: I could barely walk, sweating walking into PCP (not him but partner) complaining about buttock pain, etc they ordered MRI of my pelvis/hip. I mentioned hey what about my back....they said well ok, let's order MRI of that also. 6 weeks later I had l4/5 fusion.

[duff_duffy]

I’m not a PT but my new AI friend thinks this:

It's important to consult with a healthcare professional before starting any exercise program, especially if you have a herniated disc. The following exercises may be beneficial for L5 and L4 herniations, but it's important to modify or adjust them based on your specific needs and limitations:

Knee to chest stretch: Lie on your back with your knees bent and feet flat on the floor. Bring one knee to your chest and hold it in place with both hands. Hold the stretch for 15-30 seconds, then switch legs. Repeat 2-3 times on each side.
Cat-cow stretch: Start on all fours with your wrists under your shoulders and your knees under your hips. Inhale as you arch your back and lift your head and tailbone towards the ceiling. Exhale as you round your spine and tuck your chin towards your chest. Repeat for 10-15 reps.
Pelvic tilt: Lie on your back with your knees bent and feet flat on the floor. Flatten your lower back against the floor by tucking your pelvis under and squeezing your abdominal muscles. Hold for 5 seconds, then release. Repeat 10-15 times.
Leg raises: Lie on your back with your legs straight and arms at your sides. Lift one leg off the ground, keeping it straight. Hold for 5 seconds, then lower it back down. Repeat 10-15 times on each side.
Bridges: Lie on your back with your knees bent and feet flat on the floor. Lift your hips off the ground, squeezing your glutes as you lift. Hold for 5 seconds, then lower back down. Repeat 10-15 times.

Again, it's important to consult with a healthcare professional before starting any exercise program, especially if you have a herniated disc. They can help you determine the best exercises for your specific needs and limitations.

[meyatt]

All due respect, don’t make a spine surgeon your first visit, see a qualified physical therapist first. Even better, see two or three if the first one doesn’t work out — 95% of back pain resolves in people in 4-6 weeks without any kind of intervention. Physical therapy, proper exercises, and paying attention to your daily biomechanics (how you sit, the position you sleep in) will dramatically increase the speed at which you get better, and keep you that way.

Spine surgeons won’t really be concerned with you if you have mechanical back pain (e.g., your pain is actually in your back) — they typically operate on people who lose function / feeling in their lower extremities due to spinal column impingement. Even then, most of these cases self-resolve or require only modest intervention.

Fusion and discectomies are not suitable for localized back pain except under very particular circumstances.

Spend some time considering the pathology. When does it hurt, through what movements? You’ll have a better chance of understanding how it arose and a qualified physical therapist can help you sort this kind of stuff out.

For the very few, surgery is the right choice, but it should absolutely be your last resort. The surgical outcomes hover at a 50% rate and it’s basically carpentry with your vertebrae. Having one fusion makes it significantly more likely you’ll have another. What shows up on an MRI is often nothing to even write home about, and at times SI joint issues will masquerade as low back pain.

[DeBike]

I have had chronic spinal issues for about 40 years, including 4 surgeries. I have had a lot of good PT, and also had one therapist that I believe made my issue worse. If you want to get better, you likely are not going to get there on you own.
Other than that, I am not qualified to give anyone advice on how to treat a spinal problem. We are all different, and even people such as myself, that have been through PT many times, have learned what works for us, hopefully. That does not, IMO, give the patient the knowledge and experience to help others.

[sfo1]

Herniation and leg pain are often caused by the herniation bulging into the femoral nerve or sciatic nerve causing a lot of pain. PT is great but I don’t see how it remedies a bulge? As mentioned previously, a microdiscectomy is the cure (IMO and I’m no doc but went through the process). It’s outpatient, it’s quick and rehab is easy.

On the topic of no surgery and PT, get yourself an Olympic hex bar and some plates.

[meyatt]

Originally Posted by sfo1

PT is great but I don’t see how it remedies a bulge

You can take a hundred people off the street and give the an MRI, many of them will have MRIs worse than patients who undergo spine surgery, yet they experience no pain. The correlation is just not always so direct, and muscular issues can create tightness that mirrors the issue making things more complicated. Introduction of protocols like the McKenzie Method have pretty dramatically reduced the use of spinal surgery.

Don't get me wrong, surgery for some is the right route — but it was used a lot more liberally in the past and there's quite a bit more conservatism now about doing it.

[krooj]

Originally Posted by Lewis Moon

After a REALLY expensive set of MRIs and Dr. visits...I've been told that my left leg issues are due to herniations of my L4 and L5 discs. By the time I had gotten through all the appointments, the abject, searing pain all down my left leg and the inability to walk more than a 100 yds were getting WAY better...sometimes I think Dr.s just wait patients out.
Anyway, CX season isn't happening...but the doc wants me to do PT. To be completely honest, I've never had much use for PT in general...the exercises always seem to be aimed at 85 year old invalids and I get more use out of doing the exercises at home. Also, with the way my insurance is structured... PT is economically unsustainable at the rate the docs wants me to go.
So...can the cognoscenti here point me towards a set of specific exercises to strengthen/treat/stretch for L5 and L4 herniations? Just saying "Do Yoga" is not what I'm looking for...

Couple of questions here:

1. L4-5 / L5-S1 bulges or herniations? They are different.
2. Did they indicate the nature of the bulge or herniation? Do they result in any stenosis? If so, where?
3. MRIs do not necessarily correlate with a diagnosis - you give that same set of images to 5 different surgeons and 5 different radiologists, you'll likely get 10 different opinions. Crappy / lazy docs will take the radiology impression and simply parrot it back to you as their diagnosis. Good docs will take a look at you, your symptoms, your activities, lifestyle, etc... and they may discount the MRI altogether.

Lastly, do look for a PT, but try to find one that specializes in sports injury and deals with younger, active patients. A lot of PT clinics exist for insurance grift and won't give you any results, so find someone that will get to know you and really dig into the things that are unique to you - they will develop a plan that actually works. Spinal issues can be the result of muscular imbalances which can be exacerbated by repetitive activities like cycling; combine that with an otherwise sedentary lifestyle, and you're looking at tight, shortened hip flexors, hamstrings, weak glutes, and back.

I'm currently going through something similar, and what I discovered is that my right psoas is insanely tight, and digging into the trigger point in my belly replicates all the radiating pain, so I'm working on that muscle group.

[Turkle]

Originally Posted by krooj

Lastly, do look for a PT, but try to find one that specializes in sports injury and deals with younger, active patients. A lot of PT clinics exist for insurance grift and won't give you any results, so find someone that will get to know you and really dig into the things that are unique to you - they will develop a plan that actually works.

THIS. I am currently attending PT at VCU hospital at their sports medicine clinic where they care for injured athletes at the university. The quality of care I've received is by far the best experience I've ever had with PT. (Some are indeed outright scams.) So I think this is great advice.

Also, avoid chiropractors like the plague they are. Ugh.

[deluz]

Originally Posted by meyatt

You can take a hundred people off the street and give the an MRI, many of them will have MRIs worse than patients who undergo spine surgery, yet they experience no pain. The correlation is just not always so direct, and muscular issues can create tightness that mirrors the issue making things more complicated. Introduction of protocols like the McKenzie Method have pretty dramatically reduced the use of spinal surgery.

Don't get me wrong, surgery for some is the right route — but it was used a lot more liberally in the past and there's quite a bit more conservatism now about doing it.

This 100%. Surgeons do surgery and know nothing about PT. I went through many PTs finally found one in Australia that actually helped. All sessions are done over Zoom and have never seen him in person.

[Mr B]

This resonated with me far more once I’d had a back injury.

https://youtu.be/cbEEndKQCsw

Doing plank every morning plus some of the basic Foundation Training moves have helped me since an L5-S1 microdiscectomy. Ymmv

[deluz]

Originally Posted by Mr B

This resonated with me far more once I’d had a back injury.

https://youtu.be/cbEEndKQCsw

Doing plank every morning plus some of the basic Foundation Training moves have helped me since an L5-S1 microdiscectomy. Ymmv

I have been doing planks and also this single leg extension. Hold for 30 - 60 seconds. It has really helped my back and strengthened the core.

https://www.youtube.com/watch?v=1NEL9gsnT1Y

[buddybikes]

Ok, I will move my suggestion to a pain doctor that can order the appropriate scans. PT can't do this. OP said couldn't even extend leg, that sounds a bit messy.

[mistermo]

My process has gone like this:

1-acute left leg pain, mostly in buttock, radiating down leg. I went to Primary Care Physician since that's what 'the system' requires. He concluded piriformis muscle was exerting pressure on sciatic nerve. This seemed valid to me because I'd believed I had this problem before. Prescribed pain pills and muscle relaxants.

2-pain grew immensely worse. Seriously unbelievable. 20/10. PCP was booked and told me to go to Orthopedic office. Ortho was booked for a month. They told me to go to ER.

3-ER prescribed a lydocaine patch to help with pain. I told them this was nonsense since pain was nerve related, not topical. They were able to get me into a sports doc the following week.

4-Sports Doc saw me. Ordered MRI. Another week added.

5-Arrived for MRI. Couldn't lie flat, at all. Pain was too intense. They found another MRI across town that worked with bent legs. I went there.

6-Sports doc called two days later and informed I had herniated L5S1. He ordered an 'interlaminar lumbar epidural' steroid injection. I was told the wait would be a month. I raised hell and they found a place for the following week.

7-I had the lumbar epidural. After a week, not much improvement, but some.

8-Through a stroke of luck, I found a spine doctor who took me on, even though she's not taking new patients. She saw me last week and noticed prior doc had ordered wrong injection- ordered L2, missing L5 by a mile. Wasted time, expense, and more.

9-She's going to administer another herself this Thursday along with a nerve block of some sort.

This has been going on for 1.5+ months. I've got good insurance. I live in a major metro area with supposedly good health care. I'm in the 'privileged' class and work in health care field. Even with all these advantages, this has been a $hitshow. I can't even imagine what it's like for someone without these advantages.

I'm optimistic this is finally sorted out, but I've been to 4+ doctors before someone figured it out. I've got plenty more treatment, then PT, but I've been given more accurate information here on PL than by several of the doctors.