T Nation

Herniated Disc At L5-S1 Advice (MRI Included)


#1


ok so ive been diagnosed with an l5-s1 disc herniation pushing on a nerve root causing moderate sciatica in my left leg only....im including an mri of the sag to show it but im also including an ax mri of what looks to me like an entirely blown disc, anyone with mri reading experience please tell me what this ax image is actually saying because it looks damn odd compared to the others...anyway my story here is ive tried chiro (dumped 2 grand) and physical therapy along with cortisone steroids, now my doc is recommending surgery but the initial results look good (pain free) the later results look terrible (re operations and surgerys etc etc) i love lifting and i continue to do so however this is severly disabling for me seeing as it is emotionally as well as physically stressfull, im looking for some honest thoughts and opinions on what i should do and maybe someone who could help me out. thanks i hope we can figure this out.
to add some background information im almost positive my hips muscles are very messed up as they feel tight 24/7 also my piriformis muscle might be somewhat to blame aswell because when i do a few of those stretches the pain is gone for a short time,my hams are tighter than humanly possible and i finally learned all this over the course of a year however i realise i might be a lost cause because i spent an entire year figuring this out...i hope someone can help me but i wont lie im a mess right now and just looking for someone who can help me out, and save me from the inevitable

oh and btw i took like 4 months off from the gym no help as far as pain goes :frowning:
been injured for 14 months now YUUUCK

also if anyone has some core exercises or routines that will help me id love to hear them

BBB WHERE ARE YOU?! :frowning:


#2

anyway heres the ax image and wondering why the f it looks weird both left and right side look like they are pushing WAY out which cant be because i would imagine my right leg would be killing me just as much as my left if both sides were as bulged as this looks…either way im no doctor my sports med doctor said she didnt see anything to indicate right side pushing on a nerve but maybe she didnt see this pic LOL

sciatica tests on right side are negative however it does hurt from time to time, could be posture related due to over compensation unsure


#3

Sciatica is the worst thing ever for sheer misery.

But don’t worry, tons of people have this same injury. I’ve seen uglier bulges than that one, honestly, and they healed.

I opted for no surgery after digging up the literature that showed

  • about 1 in 10 people appear to benefit from the surgery by having less pain, and a little bit sooner than those with conservative therapy
  • but surgery increases risk of future instability of the spine and then resulting pain from that

If I were ever to get surgery, I would research the heck out of the surgeon’s track record, because I believe there is a huge difference in quality of different surgeon’s work. I figured that given the risks of surgery, and how much research it would take me to find a good one, I might as well just go the conservative therapy route and be patient.

Disc injuries should take around 6 months to heal. 14 months is a long time, so I don’t know what’s going on, but chances are your training was not letting it heal or was making it worse. 14 months in pain also suggests your chiro and PT are no good. Don’t waste any more time or money with them.

And don’t stretch your hamstrings.

Where are the sciatica symptoms in the left leg? Is it in the side of the hip, IT band, lateral calf, and little toes?

I have had herniation of L5-S1 causing sciatica of the left leg, and I have some movements and stretches that rapidly helped. If you’re interested, shoot me a PM with your email and I’ll try to send them.


#4

hey i sent you a pm, the pain is on the outside of the left leg going along to the outside left calf, also hits the outside tendon behind the knee, slight tingling in foot, here and there very slight however…


#5

[quote]PowerCrazy wrote:
hey i sent you a pm, the pain is on the outside of the left leg going along to the outside left calf, also hits the outside tendon behind the knee, slight tingling in foot, here and there very slight however…[/quote]

That axial image doesn’t actually correspond to the L5/S1 disc space. Do you have another axial image?


#6

yes i have all the axial images HOWEVER i have no clue which one is l5 if you could tell me i could easily find it


#7

this it?


#8

ok sorry again but i think i found it just by not being dumb and looking at the nerve canals this one looks like it might be the one, well one of 2 i suppose


#9

[quote]PowerCrazy wrote:
hey i sent you a pm, the pain is on the outside of the left leg going along to the outside left calf, also hits the outside tendon behind the knee, slight tingling in foot, here and there very slight however…[/quote]
Yup, sounds familiar. Sent you a PM.


#10

[quote]PowerCrazy wrote:
ok so ive been diagnosed with an l5-s1 disc herniation pushing on a nerve root causing moderate sciatica in my left leg only…im including an mri of the sag to show it but im also including an ax mri of what looks to me like an entirely blown disc, anyone with mri reading experience please tell me what this ax image is actually saying because it looks damn odd compared to the others…anyway my story here is ive tried chiro (dumped 2 grand) and physical therapy along with cortisone steroids, now my doc is recommending surgery but the initial results look good (pain free) the later results look terrible (re operations and surgerys etc etc) i love lifting and i continue to do so however this is severly disabling for me seeing as it is emotionally as well as physically stressfull, im looking for some honest thoughts and opinions on what i should do and maybe someone who could help me out. thanks i hope we can figure this out.
[/quote]
You have two discal pathologies (as seen on the sagital view). The posterolateral herniation of L5/S1 and the endplate fracture/schmorls node at L3/4. The loss of disc height at L3/4 may be contributing to the sciatica, since nerves which are compressed at more than one location (example, L4 spinal nerve being compressed, combining with an L5 nerve in the lumbosacral plexus to result in one (tibial) nerve that is only ‘tweaking’ because of the combined impingement.

Of course, the impingment at L5/S1 may be entirely enough by itself to cause the symptoms.

Right. Here’s the deal: You have to do the hard work yourself. Foam rolling/self myofascial release on a DAILY basis is prescribed in your case. Relax the hip muscles and remove a further source of nerve compression. This should certainly help reduce your symptoms, but here’s another news flash: your spine cannot be properly stabilised by hips that are tight, hypertonic and exhibiting poor neuromuscular health.

Sort your foundations out before you ask us for anything ‘fancy’, OK?

Also, I have written reams on this very topic (search ‘L4/5 lumbar MRI’) and you’ll see what I mean and what some of my (previous) thoughts were on the subject.

Buy McGill, buy ‘magnificent mobility’, study them, empower yourself and you will probably know more than the so-called ‘experts’ that (i the UK at least) clog up the health service and who rarely seem able to help the patient in achieving a favourable outcome.

GOOD LUCK! I have been where you are (almost). Now I lift with no back pain, though yes, I no longer perform heavy deadlifts.

You can resolve this, but YOU have to become your own expert, I’m sorry to say.

Oh and ditch your chiro. He/she sounds like another ‘expert’ who never actually got to grips with the subject matter.

BBB


#11

I have, or had a pinched nerve in my neck. Caused severe weakness in my triceps, and terrible pain running down my arm.

Chiropractic didn’t seem to help, at least at first. For me an oral corticosteroid was the first thing that helped. But things really turned around with I got a cortisone shot. Actually 2 of them.

The spinal doctor mentioned surgery to me, but agreed with me that taking a more conservative approach was the better way to go. And that quite a lot of these problems just seem to go away on their own. (Not sure if this is in reference to my specific problem, or all protruding disks.)

I think my second Chiropractor, (who is also trained in ART, and physical therapy,) was a factor in my improvement. I did notice benefits when I followed his advice and suggestions, and problems when I forgot to follow his advice. (Subjective results like this are hard to prove.)

Also I have a decompression machine that I think helps. I was trained by another physical therapist to use it for a minute, relax it for 20 seconds, and repeat 9 more times.


#12

i find it funny that people keep telling me to stop trying to fix it myself and get the surgery (DOCTORS) and people who say your not a doctor so you cant do it (FAMILY)

i read through all 5 pages of that thread by the way and its hard to understand what could apply to me and what doesnt as you have answered like 30 million peoples questions

:frowning:


#13

[quote]PowerCrazy wrote:
i find it funny that people keep telling me to stop trying to fix it myself and get the surgery (DOCTORS) and people who say your not a doctor so you cant do it (FAMILY)

i read through all 5 pages of that thread by the way and its hard to understand what could apply to me and what doesnt as you have answered like 30 million peoples questions

:([/quote]
Yeah, I guess it got a bit technical, but the beauty of it is that in about 4 weeks of reading and studying, you could have increased your knowledge base sufficiently to understand it. Or not, the choice is yours.

Look, there is no quick fix to your probelm. Surgery will only result in a re-occurance of the pain in later months, rehab and self-therapy will take months of consistancy to effect worthwhile changes.

As I said above: work on tissue quality of glutes and read good spinal books.

Hop to it, my man!

:wink:

BBB


#14

is there any type of database of resources etc to look into? and is working out while like this a good thing or bad thing? what muscle groups should i work on etc? im sure im like the 99999 person to ask you and your probobly quite bored of saying things twice but from what ive read its hard to pinpoint exactly what can and will work. ive read through that thread twice now and still have a very limited understanding seeing as how alot of the technical stuff was also used in abreviation so i cant exactly look up stuff like QL or SI and get results


#15

I’m getting lots of PMs from back pain sufferers.

I always want to help, but it is time-consuming.

I literally have an entire bookshelf devoted to back pain and rehab-related stuff, from scientific papers to McGill’s books to the Maximum Mobility DVD to Gray Cook.

Plus I’ve bought a ton of other pain books from amazon – and returned them within the 30 days, 'cause they weren’t that great.

And I’ve done it all.

It all helps, but there are 3 things I’ve done which were FAR more helpful, far faster, than anything else.

I do not want to post other people’s copyrighted work publicly on the internet. But I have shared my instructions for these 3 things in a Google document, as well as pics of the moves and audio instructions, to get pain sufferers started on them ASAP. For those who want access, PM me your email address, and I will send you an invitation to view the shared files. (You may need to make a Google account in order to download them, or add them to your own Docs account, I’m not sure.)

I included the sources in my Instructions document, and urge everyone who benefits from the excerpts to buy the books.


#16

[quote]PowerCrazy wrote:
is there any type of database of resources etc to look into? and is working out while like this a good thing or bad thing? what muscle groups should i work on etc? im sure im like the 99999 person to ask you and your probobly quite bored of saying things twice but from what ive read its hard to pinpoint exactly what can and will work. ive read through that thread twice now and still have a very limited understanding seeing as how alot of the technical stuff was also used in abreviation so i cant exactly look up stuff like QL or SI and get results[/quote]

You need to start thinking laterally. I put ‘QL muscle’ into google and got exactly what I needed.

‘SI joint’ same thing.

‘Self myofacial release’, ‘piriformis muscle’, etc etc.

BBB


#17

it still would be helpful to have a roadmap of what to do. rather than just researching blindly i mean couldnt you say like, ok start by correcting this, this and this. im not saying spell it out for me but atleast give me some type of road map.

so far ANDERSON has been the best in this department


#18

[quote]PowerCrazy wrote:
it still would be helpful to have a roadmap of what to do. rather than just researching blindly i mean couldnt you say like, ok start by correcting this, this and this. im not saying spell it out for me but atleast give me some type of road map.

so far ANDERSON has been the best in this department [/quote]

Sorry but you are an adult. Can’t expect people to hold your hand and walk you through the process. And if I remember correctly, Anderson posted to get McGill, Magnificent Mobility, and Gray Cook. BBB’s first post included recommending McGill and Magnificent Mobility. Sounds like he offered pretty similar info. Now Anderson may have done extra info in a PM, but we wouldnt know that.

On topic, not sure of the percentage, but there was a study done that showed a good percentage of people with “positive disc buldge” MRIs were non-symptomatic. Message behind that - fix the symptoms, not the MRI/problem. You self admitted to tight hips, piriformis, hamstrings, etc. If you take care of those, do Self-myofascial release or go to get some Graston or ART, and do some research on proper rehab exercises or find a qualified practitioner, you will be much better off. If AFTER attempting and fixing those issues, you still have radiating pain, etc, then surgery may be needed.

I’d recommend somebody proficient in the FMS or some kind of movement screen to find your limitations and abnormalities. Find local people certified in some kind of corrective exercise specialization.

-LH


#19

im happy with your response as i said i dont want someone to hold my hand however a simple starting point was nice to see. anyway yes i admitted to those muscles being tight however i think maybe i should clarify a little bit, the hip muscles and piriformis muscle (do doctors not know about this my sports med just kinda brushed it off) probobly even the QL are tight along with tight hamstrings, however the problem is simply stretching them does not help it actually hurts more to stretch them. ive read around and have gathered information but i really havent seen much on how to loosen these up without stretching (i read strengthening somewhere?? but not sure).

myofacial release is promising and i could do that. also i seem to be less symptomatic after working out or while im working out then when im at rest

should working out be a no-no until the sciatica is gone and im symptom free?

thanks for the responses and im not trying to be a baby here im just trying to learn :slight_smile:


#20

[quote]PowerCrazy wrote:
im happy with your response as i said i dont want someone to hold my hand however a simple starting point was nice to see. anyway yes i admitted to those muscles being tight however i think maybe i should clarify a little bit, the hip muscles and piriformis muscle (do doctors not know about this my sports med just kinda brushed it off) probobly even the QL are tight along with tight hamstrings, however the problem is simply stretching them does not help it actually hurts more to stretch them. ive read around and have gathered information but i really havent seen much on how to loosen these up without stretching (i read strengthening somewhere?? but not sure).

myofacial release is promising and i could do that. also i seem to be less symptomatic after working out or while im working out then when im at rest

should working out be a no-no until the sciatica is gone and im symptom free?

thanks for the responses and im not trying to be a baby here im just trying to learn :slight_smile:

[/quote]

The problem with your questions are that nobody will be able to give you absolute answers without having more detailed info or being able to do a screen/evaluation themselves. You may benefit from more stretching where somebody else may benefit from more strengthening. As suggested already, go buy McGill’s books (http://www.backfitpro.com/) and check out Magnificent Mobility and/or Assess&Correct DVD sets and educate yourself. After that you should be able to distinguish where your goals should be.

Most people’s tissue quality is pretty poor, so a generalization would be to recommend self myofascial techniques (foam roller, etc) but I still would suggest finding a qualified practitioner who could do a FMS or other movement screen to assess your imbalances.