Herniated L5 - S1

[KIRinPNW]

In August I saw my GP about back pain that I've had for about 3+ years. Classic symptoms of herniated disc (right side leg pain w/pins and needles in my foot) which were confirmed through an MRI at the L5 - S1 location. Looking at the MRI he said it was a mild case.

First question for my fellow crips:

For some reasons I don't want available on the web, I lied to my GP about the length of time I've had this pain. I told him I've had it for a few months, but its obviously been longer. How greatly will this impact his diagnosis?

Second:

Cortizon shots have been a waste of time. However, PT and anti inflamms are working. The GP said apart from surgery, which I am trying to avoid in lieu of its success rate, I have to sit and wait and let time take its course. It could take 1+ year(s). Is skiing completely out of the question this season?

I did a little searching and came up with this: http://tetongravity.com/forums/showt...herniated+disc I am not quite in Meat's realm of misery although I was for about a month a year ago. PS. Meat, congrats on your recovery!

Cheers,
M

[Vinman]

first question, it won't impact the diagnosis at all and people lie to theri docs all the time.

rehab can help, ask about some traction

[KIRinPNW]

Thanks, Vinman. Traction meaning the table and upside down hanging? I do it it now and it seems to help.

I guess I'm just being impatient like most gimps... Oh well, nothing new.

[schindlerpiste]

An MRI will show degeneration of the disc. There is no need to lie. The picture is worth 1000 words.

Go to an ortho. He may recommend anything from exercise, to a TENS unit to epidural (3X) injection to muscle relaxer to surgery. There are plenty of options. Also, in recent years, surgical intervention has become MUCH less invasive.
Is there impingement on the thecal sac? Do you have numbness, or pins and needles sensation in the toes of one foot? Any BM probs? Just about everyone has a herniated disc, there are different degrees of herniation.

[TBS]

I was diagnosed with "significant" herniation of s1-L5 when I was 23, the result of a collision playing soccer. I have kept it at bay for another large number of years thru stretching, core training. aleve, and sac'ing up when flairs occur every few years with rest, muscle relaxers and steroid shots. It used to bother me a lot more often when I was still racing bicycles - all that time in the saddle, and the muscle imbalance between quads and hamstrings are not good on the low back.

If you can work thru it with PT and anti-inflam meds, then you can likely stay reasonably healthy with core training and stretching.

What anti-inflamatories are they giving you BTW? I found Celebrex to be only marginally better than three Aleve.

[KIRinPNW]

Relafen, Nortriptoline (sp?), Pabst Blue Ribbon (sp?)

They definately seem to help because when I'm off them I seem to seize up and get super stiff and the pins and needless and spasms flare up. The more people I talk to mention that I should lay off core excercises until I've healed. This is frustrating to me because I've been injured for three years so healing seems extremely relative.

Telebob, how old are you now? I only ask because I'm 24 and I wonder about worse back problems down the road.

I appreciate the help

[Theodore]

Any suggestions for the same thing but higher up? I'm pretty sure I'm dealing with this on my C8... and it sucks. My arm hurts all the time, I sometimes don't have the ability to flex my triceps, constant tingling/numbness in my fingers on my left hand and my forearm cramps VERY easily now.

What kind of PT is usually given out for these injuries?

[skideeppow]

I had l5 s1 disk lamination surgery. Dr Coremand in vail streadmand hawkins did it
I had a major crash when I was 24, fractured the wings off my vertebrae. At age of 3o I was training for 24 hours of aspen, heavy back loading and had the same searing pain you talked about (oct). Had a cortizone injeciton and got rid of the numbness and pain. Started strengthening multifidus and transverse muscles in my back. Later that year in a skier cross course i came up short trying to clear a triple, broke both skis and did my back in for good. Total herniation (jan). The numbness and tingling you refer to can be dealt with. YOu know you need surgery when you lose strength of your foot. I had drop foot (when you can not control your foot) and was walking funny. If you let this persist (the drop foot) you can kill the nerve very quickly and lose all function of your foot.
Sounds like you can get away with rehad, do this shit religously. Should take a couple months to take the pain and numbness away. If you get the drop foot you are bound for surgery.
I had the surgery and skied 6 weeks later, have been pretty good ever since. that was 6 years ago.
One last thing, do not skimp on doctors. YOu need to see an neurologist or ortho back specialist. DO NOT GO TO SOMEONE WHO DOES NO SPECIALIZE IN BACKS. Dont go to a guy who does back, hips and knees. The back is a serious part of your body and you dont want to fuck it up. Mike Brown, the US downhiller abck i the 80's had the sam back surgery as me and opted out of Steadman Hawkins because his insurance did not cover it, he was walking with caines two years after the surgery and has never been the same.
Good luck and pm me with any questions. I stay on my rehad to this day.
sorry about the spelling and grammer, i am at work and in a rush

[TBS]

Telebob, how old are you now? I only ask because I'm 24 and I wonder about worse back problems down the road.

I appreciate the help

In chronological terms, let's just say I have a kid your age and leave it at that. In psychological terms, I'm 17.

[KIRinPNW]

I take it that would mean in psychological terms I haven't been conceived yet?

Deeppow thanks for the advice. I will certainly drop a line if I have any more questions.

[TBS]

Any suggestions for the same thing but higher up? I'm pretty sure I'm dealing with this on my C8...

Theo, you are very special if you have a C8 (but you knew that, right?) - almost everyone else in our species have only seven cervical vertebra. Funny you should mention this area though.....I ended up having c6-c7 fused two years ago...annotated post op-xray attached. This was after four years of increasing pain and loss of motion....it's real special when your entire right upper body feels like you just stuck a nail in an AC outlet. After chiropractors, pts, and epidural steroid injections, I went under the knife. It wasn't that bad - back on my bicycle in two months, paddling loaded kayaks on multi-day tours in three.

[doublediamond223]

I fractured L5-S1 playing football 4 years ago. It SUCKED. I got out of it with rehab, but I have to do ab/core exercise consistently to keep it at bay. If I try to do any heavy lifting, it flares up again. Not fun...

[berko]

While there is no C8 vertebra, there are C8 nerve roots; but they dont control the triceps.


http://www.msu.edu/user/vosskurt/Mis...es/musnvrt.htm

[flatNshallow]

I had same diagnosis - mildly herniated L5/S1... 4 months of PT which focused on streching and core strength and I was pretty much ok... still have occasional flair ups but my symptoms are not as bad as what you describe. (For me its an intermittant pain in my left hip which bascially leaves me limping and unable to put my full weight on my left side - lasts anywhere from a few minutes to a few hours - goes away as suddenly and unexepctedly as it appears and there is no pattern to how often it happens.)

I've not pursued more drastic solutions and my game plan is to stay the course unless it gets MUCH worse... so my suggestion is see the otho, hoepfully get a scrpt for PT, and stay on your stretching / conditioning plan and avoid surgery as long as possible. (While the incidence of bad out comes has gone way down, if you don't get cut you run no risk of a bad out come...)

If you can live with it, do.

[BC13]

M, Sorry to hear about the back. I've been there before - twice.

Herniated L4/L5 10+ years ago. Tried everything (PT/Chiro/AI drugs/steroids/pain meds) but I was pretty much in the condition of Meat in your attached link. After about 6 months I finally went under the knife. I had immediate relief of all nerve pain (electric pain from ass cheek to knee) and regained the strength in my left leg quickly. I did however continue to suffer from horiffic muscle spasms for about another 2 or 3 months until a physiatris (sp) prescribed amitryptaline for me to help the "myofacial" pain. The drug is apparently a anti depressant that can help with certain pain for some unknown reason. It worked and in 3 months (got off the pills after that b/c they make you wicked tired) I was about 95% of what I had been and was good to go for any activity.

About 4 years ago I popped L5/s1 while undertaking the incredibly arduous task of tying my friggin shoes! Again pain was horrible - crawled for a week and then got some relief. Through all the above treatments minus the amitryptaline I have been able to avoid surgery to date. I am however considering it b/c I am unable to run without being crippled for 2 weeks, and as a result have put on about 30lbs.

Q1: The only downside to giving the Doc the wrong time line is he/she will treat the injury as though it is relatively new and thus be under the impression that rest and therapy might do the trick, as (supposedly) symptoms of a herniated disk will dissapear within 6 months of the injury for most people. Your Doc thinks you are in the 6 month window and thus might hold off considering more invasive treatments. Since you seem to not want surgery it is no big deal.

Q2: Your body will tell you if you can ski pretty quickly. I skied with leg/ass/back pain with no problem. However, if you have ANY weakness or numbness in the leg dial it way down or better yet forget it entirely. I skied with buddies one day when my back was flaring up and my leg felt weak (like your arm does when you hit your funny bone) but did not hurt much. We were just carving high speed GS turns on a groomer when my left leg totally gave out at the Apex of a right turn. I did not catch an edge or do anything wrong, my leg simply could not hold the g's necessary for that turn. I was fine but I was through skiing that day. If I would have had my leg buckle in another spot I would have been in the trees had bigger issues.

Good luck with the back and heed SkiDeepPow's advice re: choosing a surgeon. Ideally, you want someone who has performed thousands of these surgeries.

[KIRinPNW]

Awesome advice.
I seemed to be able to ski last season and that was around the time I was getting intense bouts of spasms. The only thing that really hurt was hitting troughs when things were getting tracked out, or worse, skiing in flat light hitting troughs coming across the hill.

Thanks again.

[irul&ublo]

A couple of things...

There will shortly be a broad study coming out from NIH, finding that spinal fusion surgery is not anymore effective than more conservative therapies, in the overall population. It also concludes that the use of instrumentation is of no worth whatsoever.

At a young age, it is likely, in the absence of severe neurological defecit, that surgery will do no more than what time and appropriate less invasive therapies would do.

Also...be careful of having your GP read the MRI films. Is a "herniation" what the radiologist observed, or his using loose terminology? You should get a referral to an ortho or neuro surgeon.

[irul&ublo]

A couple of things...

There will shortly be a broad study coming out from NIH, finding that spinal fusion surgery is not anymore effective than more conservative therapies, in the overall population. It also concludes that the use of instrumentation is of no worth whatsoever.

At a young age, it is likely, in the absence of severe neurological defecit, that surgery will do no more than what time and appropriate less invasive therapies would do.

Also...be careful of having your GP read the MRI films. Is a "herniation" what the radiologist observed, or his using loose terminology? You should get a referral to an ortho or neuro surgeon.


EDIT: You might also ask for a PT referral.

[Theodore]

While there is no C8 vertebra, there are C8 nerve roots; but they dont control the triceps.


http://www.msu.edu/user/vosskurt/Mis...es/musnvrt.htm

Thanks for that link... pretty cool stuff. According to that chart... my damage is C7, 8 and T1. I've had extensive pain, cramps, & muscle spasms in my left pec, shoulder, shoulder blade, elbow, forearm and my pointer finger, middle finger and thumb have been tingling since early July... Matter of fact, I had a passive doctor tell me I had dislocated the shoulder.

Forgot about the # of vertebra haha... Maybe I'm part 3 toed sloth.

[TBS]

Thanks for that link... pretty cool stuff. According to that chart... my damage is C7, 8 and T1. I've had extensive pain, cramps, & muscle spasms in my left pec, shoulder, shoulder blade, elbow, forearm and my pointer finger, middle finger and thumb have been tingling since early July... Matter of fact, I had a passive doctor tell me I had dislocated the shoulder.

Forgot about the # of vertebra haha... Maybe I'm part 3 toed sloth.

Unfortunately, this sounds familiar. Spasms in the pec feel like the muscle is firing 20X/sec? Feel like someone taped a wire to your shoulder blade (aka brachial plexus) and stuck the other end in a wall socket? Feel like someone is trying to stick a hot nail in your elbow? Do you drop stuff because you can't feel it in your hand? These symptoms are much like what I had with c6-7 before the xray posted earlier.

I recommend getting yourself to a neuro-specialist type of doc - ask "would an epidural steroid injection help?". If they give you a blank look, run like hell. If they say "yep, it might", then talk further. I had two of these - late December and late January - before the fusion. It's a fairly quick procedure, excellent drugs both during and after, you can be back on snow in two days, and they got me thru 30 days of skiing before surgery, including two major yard sales.

Good luck dude

[Theodore]

Eff. I haven't dropped anything, but everything else sounds about right...