Shit! Ruptured disc?

[char]

I did 14 fire seasons. IMHO it's undoable with a bad back.

.

This.

13 years in myself. Back is "bad" but not herniated. I have sciatica come and go. Makes life fucking miserable when you are eating muscle relaxers at night so you can go back and do it all over again in the morning.

Look around at the old guys, most are beat up or have moved on the desk jobs.

If you are going to stick it out, do Physical Therapy like crazy.

Edit- I'm in helirappel as well. It isn't easier on the back.

[GoBig1776]

So, here is what a fucked up spinal disc looks like on MRI. I should also edit the title of this thread. My disc is herniated not ruptured.
Any of you medical people, help me out here, but this is how things have been explained to me and might help others with this injury:
The best analogy is that spinal discs are like jelly doughnuts. They have a tough fibrous outside with squishy crap in the middle. A herniated disc like the jelly doughnut that you put into your ski pack to eat as a mid morning snack. After getting smooshed between your water bottle and shovel handle, the doughnut is a deformed, but the jelly is still inside. The ruptured disc is similar, but your ski partner's husky laid on your pack in the car, then you took a fall before your morning snack. There was more force on the doughnut and this time when you grab the it from your pack, the jelly has squirted out and made a mess. Hopefully you put the doughnut in a bag before you put it in your pack.
Here is what happens with the shot. They numb you up, probably with lydocaine. Then they do a series of x-rays as the doc maneuvers the needle into position. The x-rays allow the doc to see the needle and determine when it is in the right spot. This hurts but not terribly bad. The shot is a mixture of lydocaine and cortisone. Lydocaine is an anesthetic and has two purposes in this application. First, it numbs the space near the disc when the fluid is pumped in, without this the shot might be very painful. Second, it helps the doc determine if he put the shot in the right place. If the patient reports that the injured spot goes numb, the doc knows he hit the target. The cortisone is a very powerful anti-inflammatory. It is supposed to shrink the disc and reduce the pressure on the nerve.
About five days out from my first shot, my pain is reduced considerably. The leg pain is mostly in my calf, not the whole leg. My right foot is still tingly, but much less so. My lower back actually hurts worse. The PT told me to expect this. She said pain at the injury site is better than pain and tingling in an extremity. I can walk a bit farther, my range of motion is slightly increased, and I can tolerate sitting and standing slightly longer than before the shot.
All in all, the shot was minimally invasive and did some good. I got to go do my exercises now.

[jma233]

There are plenty of folks out there with worse looking MRI's and no pain. The latest study I read stated that 88% of us have a disc bulge or worse and the vast majority of us don't hurt. The disc that is bulging is also dessicated (darker color than the others) which means that this disc is aging faster than the others. The technical term is disc degeneration, but the truth is that everyone's discs degenerage as we age and the process starts around age 10. It becomes a problem when one disc degerates much faster than the others and its no surprise that this was the disc that bulged. It's also possible that this disc may continue to give you problems down the road. Core strength and good body mechanics are your friend.

Its a really good sign that you responded to the cortisone injection. Many people recover with the injections and PT. Actually, some people think that time is the biggest variable since most people are back to normal after 3-6 months regardless what they do. Sometimes on repeat MRI's the bulge shrinks overtime but sometimes it stays the same size but the pain is gone. The key factor seems to be local inflamation of the nerve root...something undetectable with MRI.

Surgery is often indicated with intractable pain or if some muscles exhibit neurological weakness. Your PT knows to look out for weakness and there is a test called an EMG that can confirm it. In my case the weakness was in my glut max and was not detected for several years (the EMG didn't test that specific muscle). All of my problems since my back surgery are related to damage done to my glut max from the years of partial denervation. In my case, I wish the weakness was detected sooner and I had opted for surgery sooner. There are probably many more people who wish they never had back surgery and just gave it more time to resolve. Every case is different.

Good luck and heal fast. One last note, the PT routine that helped me the most was McKenzie style back extensions (you can youtube it...its like the cobra position in yoga) and dry needling. If you plateau with your current PT you can try another certified in either of those things....they both have websites with a list of providers.

[::: :::]

My spinal cortisone shots were awesome



for two weeks

(I hope yours are more effective for you - back issues suck!!)

[BC13]

It's not just skiing/sports you have to think about now.

Be really careful when you sneeze, be careful getting out of bed, careful with sex... You have to re-learn how to live your life without stressing your spine.

Sorry, but this injury is a motherfucker and you have to take it pretty seriously.

This is the truth. And anyone with real back injuries understands exactly what Yeti is talking about.

I've had two blown disks. The first was L4/L5. I had surgery 2 years after the injury and was able to get back to about 90 percent and continued all of my pre injury activities.

3 years later i blew L5/S1. The steroid pack got me out of the acute crisis and after 3 or 4 months I was doing alright. However, I had to give up running and basketball, as the jarring would irritate the injury and I would end up with another 2-4 week flare up. I did the PT path for about 3 years.

After years of OTHER, Chiropractic care, and meds I suggest you pay attention to what makes you feel better. Does laying on one side feel better than the other? Can you tilt your car seat back to reduce the pain while sitting?

The PTs seemed to focus on core core core - which translated to abs abs abs. For years I followed the about routine but found myself having fairly consistent set backs.

After having a set of twins I quit working out and doing abs - and my set backs all but vanished. I put on 30 pounds and developed a bit of a launch and the set backs disappeared. I still ski 30 + days a year with few back problems (an occasional muscle strain). What I believe is that a lot of us have overworked our abs and have thrown our cores out of balance. If your quads, glutes, back, abs or other muscles are overpowering the other groups you end up with your pelvis feeling "tilted".

My experience is antedoctal but is offered to suggest you pay attention to how your body responds to different exercise, rehab protocols, and excercise. Backs are as much art as science. It seems that every treatment has between a 40-60 percent of working - so pay attention to what works for you.

Good luck.
Sent from my SCH-I535 using TGR Forums

[neckdeep]

All of my problems since my back surgery are related to damage done to my glut max from the years of partial denervation. In my case, I wish the weakness was detected sooner and I had opted for surgery sooner. .

What are the long term issues with this? My whole S1-L5 myotome is messed up, especially below the knee. My glute has a numb patch but seems to have lost less muscle strength than the calf and ankle. You mentioned "dry needling"? Did accupuncture help stimulate the nerve to heal? Seems like the damage is sort of healing, though very, very slowly. Eight months post surgery, I have recovered some strength and I get tingling, itching, burning sensations in the numb areas sometimes that, I hope, is the nerve trying to "relearn" sensory info through the lesion. Haven't taken an EMG test yet. I can walk 5 miles now and no longer have a noticable limp. One month after surgery, it was a real chore to limp along for half a mile. My leg is way too weak for winter sports and my back feels fragile, but I'm not in pain, so things are better. Advice?

[Tuckerman]

Did you have a discectomy or the rounds of epidural injections?

Discectomy, but I just just re herniated it 2 weeks ago. Fuk I my surgeon says its a 1:10 on having to get the discectomy done a 2nd time. I asked for 3 weeks to fix it myself with TB500 and chiropractor.

[jma233]

What are the long term issues with this? My whole S1-L5 myotome is messed up, especially below the knee. My glute has a numb patch but seems to have lost less muscle strength than the calf and ankle. You mentioned "dry needling"? Did accupuncture help stimulate the nerve to heal? Seems like the damage is sort of healing, though very, very slowly. Eight months post surgery, I have recovered some strength and I get tingling, itching, burning sensations in the numb areas sometimes that, I hope, is the nerve trying to "relearn" sensory info through the lesion. Haven't taken an EMG test yet. I can walk 5 miles now and no longer have a noticable limp. One month after surgery, it was a real chore to limp along for half a mile. My leg is way too weak for winter sports and my back feels fragile, but I'm not in pain, so things are better. Advice?

Shit, I wrote a novel but my computer crashed. I'll try and hit the highlights:

1. Dry needling has been key for me in order to regain function. My gmax was the only denervated muscle but pretty much every other muscle in my pelvis and thigh became dysfunctional since my mechanics of gait and weightbearing were so 'off'. My rectus femoris, vastus lateralis, and tensor fascia lata responded quickly to needling and my glut med, glut min, and vmo are responding slowly. The gmax is responding very slowly but I'm definitely seeing improvement. It has become obvious that everything has to be treated in order allow my mechanics to be restored. Trying to strengthen with faulty mechanics wasn't working. The dry needling group I like the best are the Intramuscular Stimulation (IMS) group. I also like the Kinetacore group. They both have websites with a list of providers. Some states like CA don't allow dry needling so acupuncture is the only alternative.
2. Stetching the gmax was/is key but I've found that with denervation it can be tricky. I have to hold the stretch much longer than with a healthy muscle and sometimes stretching just causes my gmax to spasm and I have to hold off. Stretching after needling is a big no no for me because it always causes spasming. The stretch that works the best is the figure 4 stretch aka piriformis stretch.
3. Strengthening is also really trickly. Honestly, simply walking with perfect mechanics is probably my best exercise. My body wants to compensate around my weak gmax and some of the compensations are incredibly subtle. However if I'm able to eliminate the compensations then my gmax becomes incredibly sore and achy afterwards which i take as a good sign. If you read the literature about exercising partially denervated muscle it warns you to not overdo it, so I'm always walking the tight rope between doing too much and too little.

I'll shoot you a pm with my contact info in case I can be of further help. There is hope. Its been 3 years since my surgery and I've improved more in the last month than any other time.

[skideeppow]

Neck Deep and JMA are right on target. I had l4/l5 suegery in 2001, back on snow in 6 weeks. Had drop foot and no feeling in my foot either. Surgery 100% successful.

2007 had quada euqina syndrum, meregency back surgery and once again skiing 6 weeks later, Heli skied in Alaska for 8 days 2 months out.

Be careful of the shots, they mask pain. I had one, raced in the 24 hours aspen then blew my back up at last chance qualifier for x games skier cross.

I will add my $.02. If you have pain and no neru muscular deficit i would try and work through the pain with PT. I have a great regiment that I can send anyone who wants. I have it in PDF. I would do this 15-20 minutes a day, 2-3 times a day.

My back has been great every since. I am on the volunterr fire dept, emt and wildland as well. Crossfit 2-4 x a week and ski 4-6 days a week. Deadlift max is around 405

I am 45 and feel stronger and faster than when i was 30. See embedded video taken this sunday (Shameless self promotion)

[GoBig1776]

Deeppow,
Thanks for the encouragement and stoke. I'd love a copy of your workout. I'll send a PM with my email address.

Today, I had my third shot. This one was a double. The Doc had been putting the medicine in at S1, below the herniation, but today he went above and below. The shot at L5 produced a slightly different sensation when it in. The tingling and pain that come when the steroid cocktail was pushed in was more on the side on my thigh and calf and some tingling on top of the foot. The lower shot produces the same sensation, but more on the back of my calf and bottom of my foot.

The shots have done lots of good, but I still may be in line for surgery. I see the doc again on Monday and we will make a plan.

My pain has gone from a near constant 7/10 to a 2/10 with rarer and rarer spikes to 5/10. The tingling in my foot is still there but dramatically decreased. I am still weak in my right leg, but that too has decreased. I've been rocking my PT workouts and taking longer walks.

I went back to work at the ski hill last week and will be there tomorrow. Just as a patrol dispatcher but the folks there are being really cool to me. I can basically stretch and do my workouts, or just lay down to rest my back or whatever as long as I answer the radio and phones when needed. Big props and thanks to my supervisors and coworkers.

Last week was seriously good skiing here and it was great to be part of it again, at least in some way. It was awesome to hear the stoke from my bros and my wife. Not long and I'll be squishing pow again and sharing stoke myself.

[skideeppow]

I'll send these out this am for those who requested it

[skideeppow]

Just to add to what GOBIG was referring to on his MRI, and to add to it.

My MRI makes that look like a walk in the park. I currently have l5/s1 bulging and it almost impedes the entire spinal canal. I had pain but no neurological symptoms. I did my pt and started reading a couple of books by Dr John Sarno.

He is a DR in NYC, Jand his view is that all back pain is psychological. Although I do not believe in this 100%, i do think it has some merit. My last bought with back pain occured when I got married. Literally 5 days after the wedding, on my Honeymoon, i woke up and the pain was 95% gone. So i believe that stress does play a role.

Lastly, iceing also helped me and I recently found a great new product called Hyper Ice. They make a great compression belt with an ice pack that is included in it. You can wear it around the house, office etc and it creates some relief. The combination of compression and the ice, make for a very cold pack.

Good luck!

[HansJob]

PM sent to skideepow. This has been a very informative and encouraging thread. Many thanks maggots.

[skideeppow]

i sent out the pdf to all who requested.

[BigKuba]

Bumping a thread I had hoped to never need to.

Impinged L5 nerve from an L4-L5 bulge. Not my first rodeo (I had a thread on this in ~2008). I have skideeppow's set of exercises -- and add'l ones from my own PT -- have been good about stretching etc but this won't go away.

Missed 2 weeks of work because all I could do was lie on the floor
Haven't been able to touch a bike in 2 months
1st epidural helped, but I'm far from ideal - I can go to my desk-jockey job but am still an immobile limping curmudgeon
Less pain, but getting pins & needles on calf and foot, and the affected big toe and foot are slightly but noticeably weaker (drop-foot test)
2nd epidural scheduled for a week from now, hoping for the best

...but just in case, I'm starting to research and collect recommendations for microdiscectomy docs in Denver/Front Range. I know most of this stuff works itself out over time and I really don't want to go there, but might as well do my research. Whatcha got?

I like my current doc so far as my "back generalist." He has his recommended injection guys and surgeons, but I want to do my homework

Thanks, y'all. Back gimps unite!

[skideeppow]

Big k, dr chad prusmack in Denver, south of the city I believe is a back prodigy .. I've known him since he was 4 years old. He is abnormally bright and a great guy. I believe he is a neurologist specializing in backs. Really no need to look any further.

Second opinion is Donald Cornman at Steadman, Hawkins. He did my surgeries and I had great success. I would have used Dr P but Corman was closer to where I live.
Good luck, I feel for you.

[GoBig1776]

Kuba,

I took three epidurals, and lots of PT. During and after the epidurals, three in three weeks, the pain got worse and after the third, was when the pins and needles feeling in my calf and foot was worst. I was able to return to skiing after two months out and finished the season on snow, but was in a good deal of pain up until April. The pins and needles feeling in my right calf and foot lasted from January through mid-April. I joined a gym for the month of May, and got real serious about my PT and building strength. That was the best thing I did and wish I'd done it sooner.

Well, here it is July and I'm living/working at a ski field in New Zealand and trying to make up for the turns I missed in North America. I am pain-free most days, but occasionally have some right in my back and a little bit in my calf. When this happens, I am careful to take things down a notch.

Where I am going with this is that the epidurals and PT and time has worked for my injury, so maybe it will for you. I did end up doing a lot of research and had one consultation with a back surgeon, and I'm glad I didn't need to go that route.

Good luck, and keep us posted.

[skideeppow]

The problem I found with too many cortisone shots is that the long term effects can be very harmful. Most dr around here will not do more than three in a year. The cortisone rots soft tissue.
Who knows though.

[GoBig1776]

Also- forget about the bike for a while. My experience was that is put a lot of stress on my lower back. My doctor and PT would tell me not to bike, I'd take a short jaunt around town anyway, and end up in lots of pain for a few days. Six months out from the worst of my injury, I'm just getting back to biking, but only to and from town on an old Diamond Back. Definitely no real MTB rides or road rides.

[BigKuba]

The problem I found with too many cortisone shots is that the long term effects can be very harmful. Most dr around here will not do more than three in a year. The cortisone rots soft tissue.
Who knows though.

Yes, that's what I've heard from docs as well. The recommendation has been to get one, wait 2 weeks, if it partially helps, then get a 2nd. Going in for #2 tomorrow. Definitely not planning on making this a recurring maintenance procedure...

Also- forget about the bike for a while. My experience was that is put a lot of stress on my lower back. My doctor and PT would tell me not to bike, I'd take a short jaunt around town anyway, and end up in lots of pain for a few days. Six months out from the worst of my injury, I'm just getting back to biking, but only to and from town on an old Diamond Back. Definitely no real MTB rides or road rides.

That would be a bummer. That being said, before the latest flare-up, I had occasional minor pain that I could treat with taking it down a notch, stretching, and PT exercises. It was skiing that much more often made it worse -- I was fine on a bike. We shall see.

[BigKuba]

...update and rant

2nd shot helped a little, but only ~15%, so I went under the knife. Had surgery 3 weeks ago, taking it super easy and feeling absolutely awesome. Was back at work (office job) after 1.5-2 weeks, totally crushing it at walking normally and not looking like Stephen Hawking...

...until the other day I must have sat down the wrong way, felt something twinge, and now I'm back to muscle relaxants and profanity.

One comforting thought is that this feels different and like something I had experienced before -- lower down in my back, equally shitty on both sides, no radiating pain down the leg. So maybe it will go away with a weekend of rest and bedside whiskey. Bad news is that it is absolutely debilitating. It feels like cracking my back would fix it, but that's explicitly on the list of things I'm not allowed to do right now.

I was told to expect occasional pain due to scarring and other surgery leftovers, but this is almost as bad as the original problem.

Anyone else experienced this before? Any encouraging words, or should I start planning to get further surgered before my deductible resets for 2015?

[jma233]

It feels like cracking my back would fix it, but that's explicitly on the list of things I'm not allowed to do right now.

I was told to expect occasional pain due to scarring and other surgery leftovers, but this is almost as bad as the original problem.

Anyone else experienced this before? Any encouraging words, or should I start planning to get further surgered before my deductible resets for 2015?

The pain relief that comes with manipulation (back cracking) is thought to mainly come from relaxation of muscles in spasm (at least that was the state of the art thinking about 5 yrs ago when I researched it). You might try acupuncture or dry needling which can do the same thing. Shouldnt be contraindicated after surgery provided they stay away from the general area of the incision site

[skideeppow]

You doing nerve sliders? That helps with the scaring of the nerves.
Good luck.

[BigKuba]

Yup, I didn't know what those were called but I'm well familiar

CT scan found that I have a small crack in one of my vertebrae. When they do the microdiscectomy they have to carve out a window in a bone to get to the disc, and that weakens the rest of the bone. Apparently I must have laid down in bed too vigorously and that cracked some bone. Few more weeks in the back brace, whee! But since I got the brace <1 wk ago I've felt much better, so hopefully I'm on the right track...

[HansJob]

You doing nerve sliders? That helps with the scaring of the nerves.
Good luck.

What is/are nerve sliders? I want a new drug.