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Lumbar MRI Results

Been having a lot of pain that has kept me from deadlifting and squatting for the most part since June of 2012. I messed my back up a bit in a meet and have gone to 5 different chiropractors and spent a good chunk of change trying to get it better. No dice, so finally broke down and told the chiro to get me an MRI last week. Here are the results:

-L2/L3: Mild disc desication (loss of height) with mild diffuse disc bulge.
-L4/L5: Disc desication with broad based posterior disc bulge. Also annual tear within the disc annulus
-L5/S1: Disc desication with broad based disc PROTRUSION, causing moderate/severe impingement upon left neural recesses and foramen

Also my L3 is slightly forward (retrolisthesis) of L4, and L5 is slightly forward of S1

I’ve got an appointment with the chiro on Tuesday to discuss my way ahead, but I think it is going to involve a practitioner with a bit more degree of experience than my chiro. I’m thinking at least a Physical Therapist, but maybe talking to a spinal expert as well?

The L2/L3 thing I think is minor and doesn’t even give me problems, but the L4/L5 and L5/S1 is where the real problem lies.

Any advice?

Sorry to hear about your issues; from the posts of yours that I’ve read, you’re a heck of a lifter. A “good” practitioner needs to look at these results in the full context of your symptoms and exam findings. If you have neurological symptoms or findings (leg pain or numbness or weakness), the impingement of the neural recess and foramen at L5/S1 is your biggest concern. The rule of thumb is to treat such an injury conservatively for two-four weeks. “Conservative treatment” might mean chiropractic, physical therapy or medications.

If you don’t have measurable progress within that time frame, it’s appropriate to consider more invasive treatment. A consultation with a neurosurgeon might be appropriate. IF your main complaint is just back pain (no neurological involvement), the tear in the annulus of L4/5 disc is likely your issue. These things are quite painful. What’s worse, they are tough to deal with; there probably isn’t a quick fix. If the chiropractic care hasn’t helped much, I would try to find a really good PT. Good quality exercises will probably have the highest likelihood of success. Good luck! Let me know if I can help in any way.

Thanks Dr. J, you the man!

I dont have any numbness or pain in my legs, which is great. There is occasionally (I mean VERY rarely) a bit of pain in my glutes, but it doesn’t radiate down past that. So yeah I don’t think there is a lot of neurological bits going on.

I have however always suspected that my inability to deadlift well (my squat was higher than DL for the longest time, and they were fairly even when I got hurt) was due to some sort of impingement keeping me from firing my glutes properly. But then again, that could just be muscle tightness which may have actually contributed to the bulges and impingements. Not sure which is the chicken or egg here.

But as far as pain, I think you’re right it is probably coming from the annular tear. I think I remember reading at one point that you could get an injection of nutrients into the disc that may help things? I guess that is something that I would need to talk with a spinal surgeon about, but do you have any experience with that and success rates?

I’ve been doing the conservative approach for 8 months now, with little to no progress (definitely no long term progress) to show for it. I think a bit more aggressive approach is probably warranted at this point. Perhaps a Physical Therapist is also warranted?

Avoid surgery at all costs. Get Stuart McGill’s books. Also, James Rainville (see e.g., http://www.everydayhealth.com/healthy-living/webcasts/oh-my-aching-back-your-basic-back-care-guide-transcript-9.aspx).

The occasional glute pain is likely referred pain from the discs themselves. Yes, I do think that a good physical therapist would be a good addition to the care plan. I also agree with seekonk about McGill’s books. I quote from them pretty frequently. I’m not familiar with the injections of nutrients that you mentioned, but because I haven’t heard of it, I’m skeptical. I certainly don’t mean to imply that I know EVERYTHING about healing injured discs, but I think I do a descent job of keeping up with the literature in terms of treatment options.

The occasional glute pain that you have is likely referred pain from the disc injuries and not neurological. Yes, I do think that a good physical therapist would be a good addition to the care plan. I also agree with seekonk about McGill’s books; I quote from them often. I’m not familiar with the nutrient injections into the disc that you mentioned. I don’t purport to know EVERYTHING about healing disc injuries, but I think I do a decent job of staying current on the research. Therefore, I am skeptical about these things that haven’t been mentioned in the literature.

as a general rule of thumb the disk don’t really heal all that well if at all. what type of chiro care have you gotten? have all the dr pretty much done the same thing? i would think if you haven’t tried already you should try an SOT or cox flexion-distraction. also a good chiro should be giving PT exercises, older ones might not be to inclined to give any but most of us(haven’t graduated yet) at least learn how to prescribe them.

[quote]boldar wrote:
as a general rule of thumb the disk don’t really heal all that well if at all. what type of chiro care have you gotten? have all the dr pretty much done the same thing? i would think if you haven’t tried already you should try an SOT or cox flexion-distraction. also a good chiro should be giving PT exercises, older ones might not be to inclined to give any but most of us(haven’t graduated yet) at least learn how to prescribe them.[/quote]

He said chiro not Dr :wink:

Most Chiro’s I’ve known (yes probably old school) were more about the 2-5 minute crack and pay than the full treatment. I guess teaching exercises isn’t as cost effective.

Good advise from Dr J, you’ll probably find exercises will be one of the best ways to manage your condition with a specialist opinion as a back up. Just remember they may want to slice and dice you as that’s what they do so hopefully conservative methods work for you.

[quote]Mr Stern wrote:

[quote]boldar wrote:
as a general rule of thumb the disk don’t really heal all that well if at all. what type of chiro care have you gotten? have all the dr pretty much done the same thing? i would think if you haven’t tried already you should try an SOT or cox flexion-distraction. also a good chiro should be giving PT exercises, older ones might not be to inclined to give any but most of us(haven’t graduated yet) at least learn how to prescribe them.[/quote]

He said chiro not Dr :wink:

Most Chiro’s I’ve known (yes probably old school) were more about the 2-5 minute crack and pay than the full treatment. I guess teaching exercises isn’t as cost effective.

Good advise from Dr J, you’ll probably find exercises will be one of the best ways to manage your condition with a specialist opinion as a back up. Just remember they may want to slice and dice you as that’s what they do so hopefully conservative methods work for you.[/quote]

its not just old school, a 5 minute visit pays off student loans a lot faster than 15 minutes…plus is a lot easier lol. you just have to be a good consumer. most people think that that if their back makes lots of noise it was a good session while in fact most chiros know that the noise doesn’t really mean anything

[quote]boldar wrote:
as a general rule of thumb the disk don’t really heal all that well if at all. [/quote]

Yes, but the pain goes away. I think about 50% of adults have disc abnormalities on MRI but only a minority have pain or disability from it. So the outlook is not as bad as it may sound.

[quote]seekonk wrote:

[quote]boldar wrote:
as a general rule of thumb the disk don’t really heal all that well if at all. [/quote]

Yes, but the pain goes away. I think about 50% of adults have disc abnormalities on MRI but only a minority have pain or disability from it. So the outlook is not as bad as it may sound.
[/quote]

True, the majority of disc injuries do settle down. Probably as the inflammation associated with the injury settles down and you regain proper movement patterns.

Thanks for all the thoughts guys–I am on board with your direction. It seems that the annular tear is probably the source of most of my pain, since it is likely or even probable that I have had the bulges/protrusions for years. I guess my best bet is to let that annular tear scar over and heal (or help that process along with medical intervention) and hope that the bulges/protrusions don’t limit my strength too badly once I get back to it.

Well that and making sure I am doing the correct mobility/foam rolling/stretching routines to keep that area from locking up again.

I had my appointment with the back specialist last Thursday. She was really cool and took the time to sit down with me and talk about what is going on and what her recommendations are. She was basically flat out with the fact that my hernia was huge and a surgeon would have absolutely no reservations about operating on me. But she also recommended I take a bit of a more conservative approach first and avoid it if necessary. After discussing my options, I decided to go with the cortisone injections.

They gave me the shot (two actually, one into each nerve) right there in the office and it was painless and over in about 20 minutes. Unfortunately, for whatever reason, I am in more pain today than I have been. It is radiating down my leg and ass and is really uncomfortable. It’s not an overwhelming sensation, but more just like a dull throb that I know I didn’t have before. I’m going to eat some aspirin here in a few to see if I get any relief from that.

She had mentioned a lot of people don’t see any relief for a few days, so hoping that comes soon if it is going to. My guess is the injection aggravated what is already going on in there and this is part of the healing process.

I go back in 2 weeks for a follow-up, at which point they will give me another one if I want it (followed by a 3rd 2 weeks later if warranted, which is the most for a 6 month period).

I’m also going to be following a protocol recommended to me by Liquid Mercury for rehab.

Finally, she had mentioned that this shot is diagnostic and if it doesn’t provide any relief there may be other issues other than just the visible hernia. My money, if so, would be on the SI-joint…we’ll see I reckon.

Good luck!

get well soon big guy

[quote]VTBalla34 wrote:
Been having a lot of pain that has kept me from deadlifting and squatting for the most part since June of 2012. I messed my back up a bit in a meet and have gone to 5 different chiropractors and spent a good chunk of change trying to get it better. No dice, so finally broke down and told the chiro to get me an MRI last week. Here are the results:

-L2/L3: Mild disc desication (loss of height) with mild diffuse disc bulge.
-L4/L5: Disc desication with broad based posterior disc bulge. Also annual tear within the disc annulus
-L5/S1: Disc desication with broad based disc PROTRUSION, causing moderate/severe impingement upon left neural recesses and foramen

Also my L3 is slightly forward (retrolisthesis) of L4, and L5 is slightly forward of S1

I’ve got an appointment with the chiro on Tuesday to discuss my way ahead, but I think it is going to involve a practitioner with a bit more degree of experience than my chiro. I’m thinking at least a Physical Therapist, but maybe talking to a spinal expert as well?

The L2/L3 thing I think is minor and doesn’t even give me problems, but the L4/L5 and L5/S1 is where the real problem lies.

Any advice?[/quote]

Man, that sounds tough.

OP - do you get issues affecting the front of your body as well? Does your abdomen feel compressed? Or do your sides feel compressed? Or is the pain only/mainly in the back?

As well as your issues affecting disc height, do you find that the loss in height means the bottom of your ribs is now closer to the top of your pelvis, thus making bending to the side painful or uncomfortable?

[quote]lunk wrote:
OP - do you get issues affecting the front of your body as well? Does your abdomen feel compressed? Or do your sides feel compressed? Or is the pain only/mainly in the back?

As well as your issues affecting disc height, do you find that the loss in height means the bottom of your ribs is now closer to the top of your pelvis, thus making bending to the side painful or uncomfortable?[/quote]

No for the most part its just in my lower back…no pain in the front…

I also have some right shoulder issues but I dont think they are directly related

[quote]Dr J wrote:
Good luck![/quote]

Thanks Dr. J.

What do you make of the sudden increase in pain/numbness symptoms following the cortisone injection? Is that possibly just my body relaxing everything back that and my now-ingrained movement patterns aggravating it now that the layer of inflmmatory protection is removed? Or what?

Also, the “nutrient” injection I mentioned earlier turns out to be prolotherapy which I understand is an injection of dextrose and sterile water around the area to help it heal.

To be perfectly honest, I don’t have a good answer to that question. I deal with patients that get the injections and have never heard of that response before. For the most part, it has either helped or not helped, but I don’t recall any getting worse.

The prolotherapy sounds good in theory, but again, I don’t know enough about it to recommend for or against it.

Sorry, I wasn’t much help this time around.