T Nation

Possibly Herniated Disc


#1

My husband's and my 22 year old Russian friend has been having a mild back pain for the last couple months, in and out of the gym. He's been bodybuilding, not professionally, and training for street fighting since he was around 15 years old. He goes to see a doctor here and they tell him either he gets surgery or he'll never be able to lift again.

Mind you, my Russian isn't good enough to understand medical terminology without help but from what I understood the doctor said that his very last disc didn't allow fluid to pass to somewhere and something about a nerve being pinched.

I was wondering two things...

Do you guys feel the doctor could potentially be exaggerating or overreacting due to not working with athletes or people who train, etc.?

I really suggested to him we grab his MRIs and see a sports specialist. The problem is I don't know what kind of sports specialist. Do you gusy know what kind of doctor you take someone to with an injury such as the one I (poorly) described?

Thanks for your thoughts.


#2

If it's a herniated disc, that is bullshit. I have 1 herniated disc and one bulging (verified by MRI) and lifting weights has helped, not hurt my condition. Try and find a good chiropractor (theres tons of quacks out there) and a good physical therapist. The fighting is going to fuck with his back alot more than the weightlifting. Especially if the fight ends up going to the ground. It's stupid, unexpected movements that fuck with my back the most.

As far as lifting, I have to stay away from the following exercises because the disc that's fucked up is in the lower back:

Don't do:
deadlifts
squats
Bent Over rows
Leg Presses
Seated Cable rows

Replaced them with:
Hyperextensions
Front Squats
Seated Back Row
Single Legged Leg Press
1 armed seated cable rows


#3

I have had 2 herniated discs.

I go into considerable detail about them because I had surgery for the first one and not for the 2nd.

The first one over 20 years ago when I did minimal working out and occasional jogging started bulging and putting me in extreme pain. I was put on bed rest for 3 months (the worst possible recommendation) and was told I could never jog again. I went to the top physical therapist in Houston.

After a couple of years, I tried to start gently jog again and within two weeks the disc herniated and it was extremely painful to walk or sit down. I went to one of the top back surgeons in the US (located in Houston)who said I needed surgery.

His idea was to clean out the inside of the disc. He ended up operating twice within a week b/c he thought he may not have cleaned it out completely and some debris was left on a nerve. Whereas before the surgery, I suffered from extreme pain shooting down my right leg, I now suffered shooting pains down my left leg that grew increasingly worse. I was now living in Hartford Connecticut and I went to the best physical therapist there --helped not a whit.

I then moved to Baltimore Md. After several variants of osteopaths etc., and increasing pain to the point that I was unable to sit down literally, my new internist recommended this physical therapist that was well-regarded in Baltimore -- the one that all the doctors themselves went to.

Though Houston is an outstanding medical center, Baltimore is the top in the country because of Johns Hopkins Medical Center. The level of care here -- where I still live is incredible. Except for various very specific areas -- Hopkins is #1 or #2 in nearly every medical problem. It is the best city to grow old in.

The Baltimore physical therapist was able to diagnose immediately the cause of my pain. as a result of the surgery which cleaned out the herniated disc on the lower right of my back, there was an imbalance between the two vertebrae around it, causing the vertebrae to tilt down to the right.

As a result my standing and moving about would cause the vertebrae to rotate out on the left side and press on nerves. The solution, he said, was to train my back muscles in the area to push in and keep in place that vertebrae. 3 times a week for 2 years, I went in while he put my body through certain routines to train the muscles to hold the vertebrae place. I would occasionally have attacks of pain when I moved in some jerky movement but seeing him I had instant relief.

Over time the sessions were cut back to two/week then one a week and then as needed if I did something jerky -- but it usually only need a couple of weeks of sessions with him before I was pain free.

This physical therapist also said I absolutely had to start working out -- and sent me to a trainer whom he treated for her own back problems and that is when I started lifting weights. It was very light then as she was not really body builder-oriented but I developed some "tone" etc. but over time I gradually moved to lifting heavier and heavier until i was doing full-fold body building lifting. I was training with Swolecat (RIP), etc.

My physical therapist intimated that the herniated disc could have been dealt with without surgery, though he did not want to directly criticize my having surgery. He also suspected that I would never be able to travel far from a major city because of the risk of attacks. 4 years after he started treating me, I never had an attack again.

10 years later, I herniated another disc. In this instance I was going to follow his advice and not get surgery and just go to him (and he had a brilliant woman who worked with him who did a lot of the therapy.) He also sent me to physiotrist (sp?) who use to be a bodybuilder himself.

An MRI showed that this time the disc that herniated was on the side. The physiotrist looking at my x-rays said I now had degenerative disc disorder and that disc was going to pop sometime -- it wasn't my working out that caused it. (He showed me the xrays and explained everything.)

I was in excruciating pain but I could not take a break from work for critical reasons. So for 3 months, I was on some pain pills, A tens unit at night (which sends little electric currents through patches on my back) and during the day I wore a lidocaine patch to numb the pain in the area.

I went to physical therapy twice a week for 3 months -- at this point I so trusted my physical therapists and I was so overwhelmed by stuff going on at work that I did not get in detail exactly how they were treating me.

3 month later the pain was gone, I was off the lidocaine patches, tens unit and pain pills. And I started back to lifting weights and getting back to where I was before the 2nd herniated disc

I am female and was 40 years old when the 1st herniated disc happened and I was 59 when the 2nd one happened.

Older studies have shown that people who have surgery for back problems fair no better than those who don't. I am not up on the more recent studies.

Bottom line for me is don't have the surgery but have one h*ll of a physical therapist and physiotrist.

But honestly, I have been through a fair number of physical therapists in many cities -- I have a knack for finding who is the best in any medical situation -- and I will tell you -- my 2 PTs that I work with (I am getting older so more problems come up) -- I have never seen or heard of any that come close to them.

But even without a great PT... with pain management -- you should recover in 3 to 4 months and then get back to lifting weights. But build gradually.

Hope this helps.


#4

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#5

Thank you so so so much for replying, all of you. And thank you Justitia for taking the time to write that out. I am beginning to feel much better about this.

One problem though, it may not be a herniated disc. He said something about fluid being blocked and a nerve being affected.

Are there any chances he has an injury so bad that he will never be able to train again?


#6

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#7

Agreed. Just the mental imagery some doctors will paint with spinal injury often results in enough worry to create pain.


#8

Thank you again for taking the time to answer my question. I guess we need to just start looking for some good doctors now.


#9

I had a c6-c7 herniated disc diagnosed by MRI at 35 yrs old. I had constant pain and tingling in my left arm with relief if I raised my arm above my head which seemed to take the pressure off the nerve. I tried corticosteroid injections and rest with no relief. My left tricep and upper chest went flacid without the ability to contract and no strength what so ever.I had surgery, a partial laminectomy and discectomy from a posterior approach. I did not have to wear a c-collar and started to train 4 weeks later with all the stength coming back to my left side after a year of very cautious training. Everything went well for 7 yrs until a second c6-c7 herniation on the right side while I was pounding in fence posts and I had the same symptoms. I went to my Family Doc and immediately started a high dose decadron pac, similar to one people take for poison ivy but a little higher dose. The pain and tingling was gone the next day but flacid tricep and upper chest persisted. I decided not to have surgery and took 2 weeks off from training with weights and started running and BW exercises. I became very lean and slowly regained the feeling and strength on my right side. It took 1 1/2 yrs to get all my strength back in my right tricep and chest without surgery. I am very cautious and aware of jerky movements and anything that causes any pain. The only weight movement I have a hard time with is shrugs . I hope this long post can help somebody.


#10

I have a herniated disk in my neck. Even with the help of a Chiropractor, and an ART practitioner, my pain was getting to the point I could not handle it. Taking an oral corticosteroid is when things started improving. Since then I have had 2 cortisone injections into my spine, and those seem to have helped me even more.

The spinal surgeon I consulted agreed with me on using a more conservative approach to treating this problem, and told me that less then 15% of people with bulging disks actually needs surgery. Things have been slowly improving until August 1. Had a little reversal when I went on vacation, and am still having problems, though not barely as bad as it was.

Decent access to a decompression machine can be helpful. I know there is research showing the benefits of decompression on the lumbar spine. I did not find any research on the cervical spine, which is my problem. More weight can be applied to the back then can be applied to the neck. But then again the home cervical traction machines are cheaper to buy then a full body one.

Oh yeah, if a Chiropractor tells you he can cure cancer, walk out. Actually he will more likely say he doesn't cure cancer, but by adjusting the spine, your body heals itself of cancer. This is bullshit, even though he may believe it. (Or she, or even nowadays... it.)

I believe the best help I have received is from an evidence based chiropractor, who is also trained in physical therapy, and ART.


#11

I have been where you have are and know the frustration. I was told by a PT that was also was a BB that while you are training or doing everyday things and have tingling or that nerve pain that is different than muscle pain than stop doing that activity right away. While I went through recovery I learned the differnce between nerve pinching and localized neck pain which seemed to be different in that if I was pinching the nerve, it hurt in my tricep and not my neck.
I trained primarily with DBs to keep my strength balance between right and left sides of my body while using 10-12 very controlled reps on every upper body movement. I am also very careful not to hyperextend my neck during any movement.
My PT told me that periphial nerves will regenerate about 1-2 cm per month if stimulated so I did a higher frequency but lower intensity for a good 6 months and I was eventially able to increase my weights. Both arms are 17 1/4 cold at 48 yrs old and my last herniated disc was 6 yrs ago with no problems since, but I am always aware of my neck position. Good Luck and hang in there, it will get better if you train smart.


#12

Mine caused pain from my neck, radiating all the way down my arm into my forearm. My Triceps muscle shriveled up, weakening me to the point that I was struggling with 8 lbs, and my left arm shrunk down to 14 inches. The last time my arm was under 15 inches was over 20 years ago.

My strength is slowly coming back.

The tips of my index and middle fingers are numb, and have been for 8 months. (Actually that was what made me first go to the doctor.) I am down to weakness, and numb fingers, with only intermittent pain, so I am moving in the right direction.


#13

No, unless he listens to these idiots and believes them.

Pray tell what "fluid" is being blocked? What is blocking it? And EXACTLY WHAT structural injury is supposed to be doing the blocking?

Of course nerves are being affected. Doctors induce panic the way they talk about nerves. Nerves can be compressed from bulging of the discs themselves, or from muscle spasm. Either way, it is certainly miserable. But it is harmless. I recently injured something, I'm not sure what, but I think my piriformis or sacroiliac joint. I soon had muscle spams literally from head to toe on my left side. Shooting pain, radiating pain, burning pain, you name it. All from nerves being squeezed by hypertonic muscles. Nonetheless, once the inflammation calms down, the injury itself heals, and the muscles relax to normal level of tension, the nerves will be fine.

The average healing time of a disc injury is 6 months. But they do heal. Pain-free function returns faster if you 1) reduce inflammation quickly (ice and NSAIDs), 2) increase blood flow and stability through walking, 3) get plenty of nutrients needed for healing (protein, vitamin C, zinc, chondroitin), and 4) get core stability function working again (not by standing on wobbly things, but by resisting movement in the spine). Also, it is critical to avoid movements that would re-create the injury, usually some form of compression+flexion or maybe compression+flexion+twisting.


#14

I concur with all the above postings. My L5-S1 herniation MRI was looked at by a "top" orthopedic surgeon (and many of my fellow nerdy medical student classmates), who truthfully told me that surgery was pretty fruitless. However, if symptoms progress to what an above poster mentioned (muscle atrophy) or loss of urinary continence then extreme impingement is occurring and surgery may be warranted.

My worst pain was about a year ago, and with diligent core stability and slow progression on squats and deadlifts I am pain free about 99% of the time. I still mainly front squat and my deadlifts usually are done from very low pins or a couple of plates stacked on the ground. I'm not quite back up to the lower body strength I was at before the injury, but things have been progressing in the right direction.