MRI: L4-5 Disc Herniation

Thanks for the thorough response Bushy! Man if you were close by, I’d actually come pay you for some treatment!

Anyways, I looked up the posterior superior iliac spine area, and that is the best spot to describe my pain area. It also extends a little bit to the sides as well.

Interesting thing too, I went to my chiropractor today, and since I told him my condition was not getting any better with the adjustments, we tried something new. He set me face down on an adjustable table, and strapped me down. He proceeded to “pull my spine apart” by having me hold on to handles, while pulling my legs away from me.

Then he pumped my legs, so there was flexion at the lowerbody (kneeds straight. There I felt a pretty good level of pain. This got me thinking. I can’t even get into a pike position. Is there any correlation.

Upon further testing, I found that it also hurts when I place the posterior superior iliac part of the spine against the fall and and lean forward, while exhaling.

Thanks Bushy

Do you know how it happened?

Bushy, I’m almost certain it isn’t the spine, the pain is a dull aching one. It feels like I’m pulling on strained muscles or ligaments that connect to my hip. When my chiro used the flexion distraction procedure, I didn’t feel discomfort in the spine itself, but what seems like the QLs or whatever muscles/ligs thats surround the hip.

Oh and sorry about the wall test confusion.

My posterior superior iliac bone isn’t flat on the wall when I lean forward. Instead my some part of my buttocks remains contact with the wall. My feet and positioned a little forward, so that the wall and my lower body form a 45 degree angle. I keep my lower body set and lean my upperbody away from the wall.

tw0scoops,

I got injured while squatting ATG after a long lay off.

As for your test, I can not replicate the pain, but I feel a lot of tightness in my spinal erectors.

I understand bushy,

But the pain feels more like a muscle or ligament strain when I get into that position. There is no sharp pain or anything, but a dull aching one.

Ill be seeing an ART practioner today to see what’s up.

Bushy,

Yeah, sorry, I got kinda confused. Yep, I too think the ligaments around the lumbar spine is the cause of my pain.

I went to the ART practioner and he did a couple things which didn’t help my pain, but did free up my right piriformis a little bit. He proceeded to lay me face down. Pushing down to keep my pelvic flat, he asked me to do a pushup and said that my flexibility in that range was 20% lower than usual. He asked if that alleviated some of the pain, which it did, leading him to suspect a disc irriation. Not a disc bulge or herniation. He also did other series of tests to test for an inhibition or weakness of certain muscles, and said I tested strong, which is a good sign.

In my regular chiro today, I had an update checkup with the muscle tension scan, and my lumbar tension was very high. He explained that when the L5/Sacrum is out of place, the muscles will bunch up or spasm to prevent any further misalignment. I need to go back in monday for a further review and feedback.

Now this may be irrelevant, but I can’t seem to get into a pike position. In the MM video, they out like a calf stretch which requires you to get into that particular position. I found that I didn’t have enough flexibility to do so. This and the fact that the ART guy told me I was 20% less mobile in that area makes me wonder if these things correlate with my condition. Which muscles must be flexible for the pike? I can only think of the hamstrings, calves, and hip flexors. I want to say lower back, but I know we aim for lumbar stability rather than mobility.

Thanks Bushy for your help. It’s much appreciated.

Bump this thread. I’ve been lurking on here because I too have L4-L5-S1 herniations and currently spasming psoas that is messing me up. Everything else wants to start tightening up because of this so fighting the chain reaction by constantly stretching. The side lying Quadratus lumborum stretch with a little mod for the psoas (pulling the upper leg back) seems like it helps quite bit. Thanks

I too am cuious to see peoples results. I too have lower back injury that seems to come and go. I have pain in my tail bone area and left hip region.

[quote]acidhell wrote:
I ve been having low back pain for around 1 year now. I am 22 years of age. Its not unbearable by any means, just annoying dull and i feel my back stiff and the pain gets worse when i bend over (but sometimes the pain pattern changes and the pain doesnt get worse when i bend over!). There are days though, that tying my shoelaces becomes difficult!

I got an appointment for an MRI. It came back and the diagnosis was that i have a disc herniation in the L4-L5 and the L5 nerve is being pinched. Oh boy, i am too young for this shit…
I have no clinical signs of sciatica (leg pain) or neurological damage et and one would certainly expect that I SHOULD have had!

From the info i ve been skimming through this whole time, there are a lot of false positives with these tests, since 6 out of 10 adults will have some sort of herniation or disc buldge in their MRI’s and could be completely asymptomatic. And vice versa, you could be in excruciating pain and yet have no signs of herniation. So this gets complicated. What is actually causing the lower back pain?

I know the annular disc tissue is avascular so it has no healing properties and that means i am fucked for life. My dad had also had back problems for a lot of years. He was getting regular steroid injections and nsaid’s and stuff. I dont wanna do the same, as they only mask the symptoms, and i want to have a perfectly healthy back, since im an athlete. Doctors know nothing about athletes, and how insane it is to tell them to quit exercise or weight training.

I ve tried physical therapy , the McKenzie stuff. Initially they seemed to offer some sort of relief, but they stopped working soon after.
I ve been going to a Chiropractor who uses the activator method, and however crazy this may seem, my back pain vanishes and diminishes greatly!!. But unforunately this is only temporary. As soon as i get back to training, the low back pain/stiffness comes back.

I ve also been wondering if this back pain/stiffness is somehow linked to my multiple hamstring injuries this year on track… I really believe there is a link.

The good news is that I CAN squat and heavy too. So i am in no exruciating pain or anything, its just a dull chronic annoying thing in my low back (nerve pain) with no sciatic nerve involvement. The pain sure doesn’t get better after squats but it doesnt get much worse! Deadlifts though, are TOUGH. And i get a spasm whenever i try to go even moderately heavy…

I ve tried to take a break 3-4 weeks, and the pain will still get back as soon as i do any sprinting or weights

I know there are lot of back pain sufferers here, so i was hoping for some advice!
And sorry for my bad english, its not my native language:D

[/quote]

Most 20 year olds have a disc herniation. Discs wear out in a lot of people by the age of 30. MRI findings often correlate poorly with symptoms. The chances are that you have a trigger point in your paraspinal muscles or your QL in that region. Get “The Trigger Point Therapy Workbook” by Clair Davies. There’s also a very real chance anger in your subconscious is manifesting itself as back pain, as Dr. Sarno and others have hypothesized. Has your pain gotten worse since your MRI?

[quote]thetruth24 wrote:
Bushy,

Yeah, sorry, I got kinda confused. Yep, I too think the ligaments around the lumbar spine is the cause of my pain.

I went to the ART practioner and he did a couple things which didn’t help my pain, but did free up my right piriformis a little bit. He proceeded to lay me face down. Pushing down to keep my pelvic flat, he asked me to do a pushup and said that my flexibility in that range was 20% lower than usual. He asked if that alleviated some of the pain, which it did, leading him to suspect a disc irriation. Not a disc bulge or herniation. He also did other series of tests to test for an inhibition or weakness of certain muscles, and said I tested strong, which is a good sign.

In my regular chiro today, I had an update checkup with the muscle tension scan, and my lumbar tension was very high. He explained that when the L5/Sacrum is out of place, the muscles will bunch up or spasm to prevent any further misalignment. I need to go back in monday for a further review and feedback.

Now this may be irrelevant, but I can’t seem to get into a pike position. In the MM video, they out like a calf stretch which requires you to get into that particular position. I found that I didn’t have enough flexibility to do so. This and the fact that the ART guy told me I was 20% less mobile in that area makes me wonder if these things correlate with my condition. Which muscles must be flexible for the pike? I can only think of the hamstrings, calves, and hip flexors. I want to say lower back, but I know we aim for lumbar stability rather than mobility.

Thanks Bushy for your help. It’s much appreciated. [/quote]

Stop going to the chiro.

[quote]lplaw wrote:
I too am cuious to see peoples results. I too have lower back injury that seems to come and go. I have pain in my tail bone area and left hip region.[/quote]

The piriformis refers pain there.

Bushy, I’ve been following this thread and I, like others, appreciate your informed, helpful responses.

I was wondering if you could clarify something for me. I’ve been diagnosed with a protruding L4-L5 disc as the reason for my back pain. What I don’t understand is, at the stage when a disc is bulging or protruding, will the disc eventually return to normal? Talking to my doctor, it was unclear to me.

A lot of ‘treatment’ we discussed involved making the pain go away, but not what would happen to the disc. The pain itself was never terrible; I went in to the doctor because I’m worried about further injury. Basically, I’d like to know if the disc itself will ever be so that I can DL/Squat heavy on it safely again.

[quote]acidhell wrote:

I was advised to go under the knife in the future (microdiscectomy) but i refused of course. ( after all the research i ve read on pubmed, i conclude surgery is definately not a good option esp. in my case).[/quote]

First I want to say I ditto just about everything Bushy has said.

Regarding microdiscectomy studies, I found only two good ones when I looked 5 years ago. Results showed that surgery patients achieved a certain level of pain relief a bit sooner than than controls. Also slightly higher percentage of surgery patients achieved “complete” pain relief. Furthermore, the treatment protocols followed by the control group were NOT leading edge. To me it was a no-brainer to skip this surgery. At the same time, a friend with a severe herniation and causing sciatica and leg weakness, who was told she HAD to have the surgery, decided to skip it and is now doing fine.

You asked a couple questions about the cause of the pain. Some disc injuries cause pain; some don’t. You can’t tell by looking at the structure what pain the patient will feel. Acutely, I believe a lot of pain is caused by the compensations like muscle spasms. (For me the muscle spasms were impossible to reduce, though if I were in the same position now I’d ask my doctor for stronger pain meds and I’d take more of them.) Chronically, pain is caused by more long-term compensations and also pain sensitization. Psychosocial factors are associated with chronic back pain, but I haven’t seen research that shows a causal role or how that would work. Mental stress definitely ramps up the pain, probably by increasing overall muscle tension.

[quote]
I ve researched the stuff, and i believe most of the back pain is related to hypertonicity and or inhibition of certain muscles (your brain cant recruit them properly).[/quote]

I had these same issues.

Hypertonicity following spinal injury is not fixed by stretching. If you do convince the muscle to lengthen/relax temporarily through some sort of isolated static stretch, the CNS will roar “No way” a few hours later and lock it down harder.

Instead – do soft tissue work. I did a lot of self trigger point therapy following the book by Claire Davies (also recommended elsewhere in the thread). Addressing some trigger points in the QL was all but miraculous.

For inhibited muscles, I recommend 1) the exercises in Stuart McGill’s book; 2) some of the moves in the Maximum Mobility DVD; and 3) Pete Egoscue’s book Pain Free.

Also, overall activity that doesn’t put too much stress on the spine helps convince the CNS to work these things out. I did a lot of walking, but I’m not surprised that sprinting is really helpful. Anything where your spine has to be stabilized and where there’s no danger of compression+flexion.

However, you must also stop any lifting activity that exacerbate the injury. Otherwise, believe me, it can and will get a lot worse. Stuart McGill’s book shows some exercises to avoid. Some of them are no great loss to your program, but others, particularly all the great leg ones, probably need to be modified in form and loading. When you have pain/hypertonicity/inhibition, I believe that you shouldn’t do them at all until there’s some healing and those issues are fixed. This is because compression+flexion causes disc injuries, and particularly when some muscles are inhibited and others are hypertonic, even with the most careful attention to form, your lumbar spine can for a split second flex, too fast for you to notice but enough to keep causing trauma to the disc. And to even more discs. :frowning: