T Nation

MRI Results - Lower Back


#1

After some long terms issues with my lower back I paid for an MRI scan and got the report back recently. Results below:-

"At L5-S1 the disc has degenerated, lost fluid and shows an inta discal tear with fluid from the nucleus pulpous passing through the annulus. This bulge is minimaly posteriorly but is not grossly effacing the exiting nerve root.

At L4-L5 there is a small disc prolapse which is extending laterally into the lateral recess and is effacing the exiting nerve root. At other levels the discs maintain a normal amount of fluid and are intact. The facet joints are normal. There is no evidence of spinal stenosis. The signal from the vertebral bodies is normal. The distal spinal cord, back muscles and retroperitoneal tissues are normal. The sacroilliac joints are normal."

The annular tear obviously means surgical intervention so I am planning a consultation with a neurosurgeon with a view to a nucleoplasty procedure (subject to NHS referral, etc).
I have been off the iron for 12 weeks. Have had numerous chiro sessions, as well as daily use of an inversion board - which appeas to have relieved some of the sciatic-like symptoms.

I can enjoy a relatively pain-free lifestyle, as long as I am mindful of posture, flexing, carrying objects, etc. I am planning some light weights, especially for upper body, as well as gentle rehab for core, stretching for improved flexibility, etc, in order to recover some of my previous level of conditioning I enjoyed.

So I am pissed but I knew deep down I had damaged the discs, so it wasn't a total surprise. The annular tear was worse than I anticipated as I reasoned a prolapsed disc(s) would gradually recover in time and with proper care/rehab, whereas the tear won't. At the same time, I count myself lucky as I am relatively pain-free.
Would love to here from anyone who has come back from a similar injury, with any advice regarding treatment/rehab appreciated.

JB


#2

From deadlifting with your lower back bent over, I suspect?

Well, I can't speak with any authority on the tear, but the good news is that I see nothing that prevents you from using non-disk machines that don't involve your lower back, such as bench, preacher curls, leg curls/extensions, seated calf etc.

And if I were you I'd seek out a sports physio with specific experience of back injuries, swallow the cost and I suspect your recovery will be fuller and quicker than you think.

BTW, what did you pay for your MRI ?


#3

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#4

I agree with BBB. annular tear doesn't always require surgery. In your case as well, where the annular tear is located L5/S1, there is no bulge grossly effacing the exiting nerve root. From the reading of your MRI, I'd lean more towards the L4/L5 where you do have a bulge grossly effacing the exiting nerve root because the cause of your symptoms.

What type of rehab and treatment have you received? What has the chiro offered? Any medication given by physicians? Epidural Steroidal Injections?


#5

Jaybee - MRI was £250 from a London clinic.

BBB/LevelHeaded - The nucleoplasty procedure is designed for prolapsed discs and not annular tears (as I previously posted in error). I am not aware if nucleoplasty is available on the NHS; I sure as hell can't afford it privately (many folks travel to India for the procedure, and I couldnt afford that either). I have been recommended a consultation with a neurosurgeon ahead of a orthopaedic surgeon (again privately), so I will seek advice then on what is available.
I am unaware what clinical options are available for the annular tear. I was also unaware that they could be corrected over time, i.e. without intervention, as BBB suggests.

I am desperate to train (even upper body alone, with bodyweight movements, etc, for lower if required). But what I don't want is to train on, get worse, and require something drastic like spinal fusion in 10 years time.


#6

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#7

The chiropractor suspected disc prolapse(s) and urged me to get the MRI scan. I have not spoken with the chiro since I received the scan results. I stopped having sessions following the scan due to (a) expense; (b) the fact I felt sometimes the manipulations were irritating the problem. As previously stated, I believe the sessions on the home inversion board coupled with extended rest has aided my recovery more.

Looking ahead, I do think I have an imbalance issue which probably contributed to the problem in the first place. And I recognise my flexibility is very poor and unless I work on it away from the gym the back issue wont go away.
Another factor (one I haven't mentioned so far, to be honest) is the psychological one. After more than 12 weeks off, I am actually reluctant to go to the gym and have almost a 'fear' of going back. I am hopelessly out of shape and frustrated by that, but I am ultra-cautious of suffering another setback. But that's something I can work on once I feel a bit stronger in the back area.

Any suggestions?


#8

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#9

Yes, that would make sense. I've heard a fair array of claptrap from some, including it could be pancreas issues and the like.... Well, I appreciate the offer but I now reside in deepest darkest west sussex these days, which is probably as far from Nottingham as Scotland!


#10

BBB and Levelheaded are correct annular tear does NOT equal surgery. What kind of symptoms are you having? Do you have any radicular symptoms? I.e. pain that radiates from the back to the leg (s). Also any numbness or lower extremity weakness?

beef


#11

At the height of the problem, last November when I quit lifting, I was having daily bouts of pain mainly in the right buttock, partially in the calf/ankle area, and slight numbness in the right foot. The pain in the buttock at times was quite bad - like throbing toothache in the ass! Currently, this has abated to the extent it is more like twinges now and then in the same areas. The numbness also appears to have receded. The lower back itself seldoms hurts since I stopped lifting. Although, there is the very odd twinge, burning feeling, or slight stiffness.
The sciatic symptoms now appear mostly when I walk, especially when carrying a bag(s), or sometimes if I stand for a period.


#12

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#13

Not to mention the possibility of 'failed back surgery syndrome'.

Surgery should not be an option unless you have progressive neurologic deficits: worsening weakness, worsening paresthesias, bowel or bladder incontinence, OR intractable pain.

When was the injury?

Are the symptoms better?

Have you had physical therapy, with a spine trained therapist?

Beef


#14

I'll join the "wait!" crowd: I was diagnosed with herniated disc 12 years ago (not training related). Recovery was slow and very painful (most of it was strong pain radiation to my right leg), but 6 months later, I was 100% pain free. Took me years to find the nerve to perform squats again.. I'll jump to the end: I'm squatting nearly 400 lbs nowdays.

Sometimes, it reminds me its there, and I take it easy for a while.
I was lucky: the doc was honest and told me that surgery is a "dangerous, last resort" if things don't get better.
Thing is, no one can tell you what will be Your progression. They just dont know. It was, indeed, very frustrating.


#15

BBB - fortunately you are one of the guys I most respect on here in terms of opinions! I am not resigned at all. Trust me, if this had happened 2 years ago when I lived in a total training bubble I would have been suicidal! Now I've mellowed a whole lot. I also appreciate the fact I am much better 3 months down the line, so reason in another 3 months I may be a whole lot better still. I mentioned surgery because I reasoned having it sooner may negate problems in later life, but I am hardly intent on going down that line.
What I would like is to enjoy a good weight-training lifestyle, i.e. pumping iron 4-5 times a week, and doing other stuff. I have also delayed signing up to be an RAF reservist because of this problem.
And I am keen to get up and see you but I'm in West Sussex NOT Surrey! However, if I can ever wangle it as part of a work assignment I will certainly take you up!


#16

Can you outline what you did to get back to fitness within that 6-month period?


#17

Well.. not much. I was having a long break from training anyway (priorities..), but even if not, I couldn't do anything, since even walking was painful. I dont remember the exact timeline, but at some point walking became painless, and when I felt its time, I returned to walking (hate running anyway), and rejoined a gym, being very careful and alert to low back stress. Used mostly machines for that purpose. As time progressed I gained confidence and returned to free weights.

you alrady know this is a long term game. Since even benching involves the back, I'd make a long-term strategic decision, and make healing a 100% priority. Since I also love training, I know this is not what you want to hear :slightly_smiling:


#18

I appreciate that. To be honest, I have had such a setback before when I had a nagging AC joint strain that just wouldn't shift. I tried ART, chiro, all sorts, but it would go. Eventually - 8 months after the injury - it just cleared up almost of its own accord. I started light rehab and rebuilt slowly until I was putting decent pressing load through it again. Then, of course, the back problem came!

But I understand you, I understand going back to the gym you are putting stress on the area even when benching. In fact, I still recall my final workout when I damaged the back again. It happened after slightly hyperextending while doing a high pull as part of a BB complex with a very light weight during a warm-up.

Recovery is the priority. I've been idle nearly 3 months so if it needs to be another 3 then so be it. Ce la vie.


#19

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#20

JB007 you have to be kidding me! Not taking BBB up on his offer! When I had serious (for me) sciatic pain I realistically considered going for a few sessions and I live in Toronto.