T Nation

MRI = Herniated Lumbar Disc


#1

Well, I am fucked. MRI says herniated lumbar disc. My whore of a doctor didnt know the details, though. So I dont know which disc or if it about to severe my fucking nerve.

So, docs, what do I do? What can I do to protect myself from long term serious damage until I find a job, and put in 6 months to get past the probation period.

Im looking for anything, guys. I appreciate any and all comments.

ps- thanks guys for the encouragement to get the MRI.


#2

First of all, even if you aren't in the profession of PT, performance enhancement, etc., I would recommend reading McGill's 2nd book on back fitness (can't remember the name right now).

Did you say you don't have any insurance right now?

Let me know what your situation is and hopefully I can help!

Stay strong
MR


#3

DA MAN,

Well, I would request a copy of the MRI report and check with your Doc again, as they should get the films/report etc.

Obviously treatment rec. would be based not only on what the MRI shows, but how well your symptoms correlate with what is on the films.

I am only checking in tonight (I'll be hitting the gym in a few minutes), but I'll be doing my regular Prime-Time shift tomorrow. See if you can get more info and then catch me online tomorrow for further advice.

Also, it would be helpful to know:

1: Where is your pain located?
2. What movements/postures/exercises etc. make it better/worse?
3. Any leg symptoms?
4. Any pain with coughing/sneezing?
5. Better/Worse in the morning/evening with inactivity/activity?

Any info would help me provide more useful info. What kind of treatment have you had and what do you have available to you?

Take care,

Ryan


#4

In college I herniated my L4 and L5 discs from wrestling. I also used to compete in olympic lifting. I basically stopped doing anything that used my back (rows, pulls, squats, etc) for about 6 months. I ended up getting cortisone shots (3 of them spaced 2 or 4 weeks apart, I forget and doing tons of hypers, reverse hypers, swiss ball crunches and such.

I really think in the event of a herniated disc you have to look at the long term here, yea I shrunk and lost size/strength from taking a while off those lifts and stuff but I can walk/run etc these days and even do some deadlifting in the low 400s. If you can afford or have access to one, I did tons of ice and electronic stim machine to the back once or twice a day, which seemed to help with the blood flow and pain. Take care and good luck with everything


#5

Hey guys- thanks for the replies. I am going to go to the medical imaging place tomorrow and get the films and a better explanation. My doctor is useless.

Yeah, i got a big fat goose egg for insurance, Mike.

I will drop back in tomorrow with as much information as possible concerning the reading and the questions Dr. Ryan asked.

Thanks again guys.


#6

Hey guys- thanks for the replies. I am going to go to the medical imaging place tomorrow and get the films and a better explanation. My doctor is useless.

Yeah, i got a big fat goose egg for insurance, Mike.

I will drop back in tomorrow with as much information as possible concerning the reading and the questions Dr. Ryan asked.

Thanks again guys.

I would also like to ask about anti inflammatories, though. Are there any that wont make you dead? With my luck, I will be the one that has his heart explode.

Is there any kind of hope that I wont end up living on drugs or being severely limited? I know a few people that have had disc problems, and none of them were ever the same....


#7

It's all about being smart, getting the right therapy, and taking your rehab like a full-time job. Assuming you don't have anything really out of the ordinary going on (other than the disc), I would think you could come back, possibly even stronger than ever before. I've seen it happen more than a few times.

Stay strong
MR


#8

Here's something that might change your life should you be smart enough to take it.

"Don't let anyone cut you until you see Dr. John Sarno or one of his followers."

Lets just say his recovery rates and thoroughness are off the chart compared to anyone else you see in the world.

Take it or leave it.


#9
  1. Do some reverse hypers.

  2. Do some more reverse hypers.

  3. And then some more.

(if you don't have access to a reverse hyper, then take the money you would spend on health insurance, and buy your own)

Then repeat steps 1 - 3.


#10

Everyone- Thank you. I appreciate everything.

And I have to say sorry- I was seriously shocked and depressed yesterday, so i wasnt exactly socially acceptable. My bad.

Ok, now on to the actual situation. Here it be:
Moderate Herniation of the left pericentral L5-S1 disc effecting the left S1 nerver root. Remainder is normal.

Other information:
1) I know I have underlying muscle imbalances from the PT I did. My glutes are SERIOUSLY lacking.
2) Calves are freaky tight and knotted
3) I have noticed that my left hip tends to shift forward in front of my right hip when i stand
4) My right foot is seriously externally rotated- like 40degrees.
5) I have broken my right ankle 3 times and hurt it more times than I can count. It lacks stability and flexibility in a major way.
6) Doing the typical diagnostic movmentslike bend forward, backward, side to side, touch your toes, etc never really produced any pain. 99% of the time they did nothing, but once in a blue moon they would hurt in my lower back on the left side and on the left glute and around to the left hip region.
7) Those are the regions where I tend to experience pain in general - my lower back on the left side and on the left glute and around to the left hip region.
8) Once in a while I will get a bolt down my left leg on the outside
9) Sometimes that pain goes into the left calf
10) I tend to be stiff in the morning
11) I tend to be in pain at the end of the day. It tends to come and go throughout the day, but most of the time I hurt by the end of the day.
12) Triggerpoint therapy seems to help somewhat

Questions if I may.
What does moderate herniation mean? I hear herniation and automatically think protrusion.

Are cortisone (or the like) a likely treatment? If so, can a GP do them or do I need a specialist to hit the right spot?

Are there any oral anti-inflamatory meds that wont dead my punk ass? Like I said, if side effects exist, I get them.

So, I ask for your kindness and help. Thanks.


#11


Here is a good (stolen) picture that describes my pain distribution pretty well. I tend to get pain in the L5 and S1 regions of the picture- which makes sense...


#12

DA MAN,

Well, 'moderate' doesn't give any specific info other than that it could be better (mild) or worse (severe). Usually they will give an estimated size (i.e 3-4 mm). Basically, the disc between your L5 vertebra and the sacrum (S1) is bulging back toward the spinal canal and a little to the left (left paracentral). It is bulging enough that it is apparently encroaching on the left S1 nerve.

Also, the term herniation isn't specific either. It doesn't let you know to what degree the annular fibers have been torn or the status of the nucleus. If the imaging facility still has a copy or you have time, I would have them look at the films again and comment on the size and the status of the annular fibers and nucleus. You paid to have the procedure as well as the reading, so make sure that you are satisfied.

Now, based on the symptoms you describe, it sounds like the nerve is not being impinged very much or the leg symptoms you describe would be more constant or you would have numbness /tingling along that same area. That is good news. Also, the fact that you can perform a full ROM without pain is another good sign. I think with proper RH and workout program, you should make good progress.

The most important thing is to avoid significant spinal loading, with the low back in a flexed position. Also, avoid repetitive spinal flexion and prolonged sitting.

I think you should try to find a good chiro or PT in your area that can not only provide palliative treatment, but also teach you a good lumbar spine rehab exercise program. It shouldn't take more than a few sessions to teach you the exercises.

I would try to explain them, but it would take an article sized reply.

You can PM me a fax number and I can send you a couple.

Also, check with Mike and Eric, I think they have a few articles that discuss low back exercises, but I don't remember the names. Also, search the archives on this site there are a few other low back articles.

How long has this been bothering you?

What part of Ohio do you live in? I grew up in Marion.

Keep me posted.

Take care,

Ryan


#13

Thanks a million, Dr. Ryan. Disregard the whining on your thread.... I will definitely get to the imaging place tomorrow and get a full explanation of size/extenet. Thank you for the info on how the MRI is read.

The dern thing has been bothering me for a year now. I thought I had it beat a while back, but no such luck.

Im from the lovely city of cincy. free police beating and racial tension with every visit!

Thanks again, things sound better than i first thought.


#14

DA MAN,

Cincy isn't all bad, at least you have the Bengals and Reds....Oh wait...I mean at least you have Bearcat basketball. I grew up a Reds and Bengals fan and still follow them. I actually went to UC my freshman year before transferring to OSU. The Bearcats went to the Final Four that year.

So did you bet the over or under on Griffey Jr's season ending injury. The over is looking good at this point.

Keep me updated and I'll do what I can to help you out.

Take care,

Ryan


#15

You can and will rehab this to 100%. Others have done it. So will you:

1.) Reverse Hypers

2.) 45 degree regular hypers

3.) Ironmind Hip Belt Squat & 2 cinder
blocks

4.) Weighted Chins and Dips are your
new friends

5.) Drag the sled

6.) DMSO gel complexed with 2 crushed
Aleve tabs, nightly

7.) Light mini band good mornings for
time

8.) Visit eliteftsdotcom for more tips

9.) Stop listening to doctors

I won't offer luck, because now - you don't need any.


#16

Yeehaw. Thanks for the help everybody. I got my MRI prints and they make me sad.... I talked to the dern people at the imaging center and all they would do is tell me what was on my paper, which says
"L5-S1: There is disc desiccation with broad-based disc herniation, left paracentral. This displaces the left S1 nerve root. There is no significant canal or foraminal stenosis. There is only minimal enhancement of the posterior margins of the disc on sagittal post contrast imaging"

I can understand 3 words of that. I need to looksy up these here words so I can figure out what the crap they are talkin about.

If this doesnt help, which Im sure it doesnt, I have the films. Can I scan them in without destroying them? From my laymen examination it looks like it protrudes 10mm. It is a wide one, and the part that hits the nerve is extruded quite a bit less and just barely touches the dark point I am guessing is the nerve.

Any more thoughts would be greatly appreciated.


#17

DA MAN,

Well lets see if I can help.

First, a disc is made of two different types of tissue. There are many rings of fibrocartilage known as annular fibers. These rings provide strength and stiffness to the disc and surround the gel material known as the nucleus. This gel has a high water concentration. As you age or the disc is injured, the amount of water in the gel decreases and as a result the disc loses some height and the gel has a thicker consistency. They call this 'dessication' (drying out).

Broad-based= wide: Most people will develop some broad based bulging as they age due to the above noted loss of fluid from the nucleus. This is analagous to letting a little air out of a tire, it will be wider.

The width is not as big a problem as the depth it protrudes back into the canal.

Left paracentral= the bulge goes back to the center and more to the left.

The good news is that you don't have any spinal canal stenosis (narrowing)
or foraminal stenosis (narrowing of the hole where the nerve exits from between the two vertebra).

The statement about the change in signal in the outer area, probably represents some acute irritation of some outer annular fibers. I'm guessing that the problem has been there awhile and you recently reaggravated a few outer layers which will result in pain and symptoms.

Based on the symptoms you indicated, I see no reason why you won't respond well to treatment and a good RH program.

Some of the exercises listed by Max could be part of a RH program. Obviously they are more intense than some of the beginning RH exercises. Depending on your condition you may need to start slow and build up.

Let me know if you have any other questions.

Take care,

Ryan


#18

Dr. Ryan

You are my new hero. I cant thank you enough for your insight.

I do have a couple questions, however. Considering my glutes are dormant, I am thinking I should concentrate on them. My back has always been the strong link, I dont know if that is a cause or effect, though. Due to this I am cautious in doing back movements because my back always runs the show.

I am thinking of utilizing some of the more basic exercises from "get your butt in gear" and "neanderthal no more." I have a question about frequency, though. My PT had me doing rehab work mutliple times a day, whereas NNM and GYBG are quite a bit less frequent. What do you think about frequency and intensity?

I am going to do as much research as I can in the following days, so I am likely to have more questions, but I will try to keep them to a minimum. again, thanks for everything.


#19

DA MAN,

I'll look back at GYBIG and NNM exercises and see how demanding they are. Usually from a neurologic standpoint the more frequent you perform the exercise, the quicker the motor learning process. From a muscle standpoint, you want to allow adequate recovery time to avoid overtraining and reduce the risk of injury.

Let me know which exercises you plan on doing.

Take care,

Ryan