Herniated disk and MRI results - any experts out there?
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Hello everyone,
I have a very slow-to-heal herniated disk, and after seeing a chiropractor, physical therapist, massage therapist, Orthopedic MD, and getting an epidural cortisone injection - and still dealing with the problem - I figured I would post here to see if there are any experts out there or people with firsthand experience with similar issues. I have attached the results of my MRI.
Here is the story:
1. I had a long stretch of pretty significant training, beginning with the 2010-2011 EN Outseason leading up to IMLP in 2011. Then two HIM races in 2012, and IMLP again in 2013. Three OS's, run focus blocks, etc. Trained pretty much straight through all this, with the exception of 2 to maybe three weeks off per year (one at the end of the OS, then time off after IM races).
2. For the most part injury free through all of this. Although I do have back issues it seems like once a year or so. It is usually like a muscle spasm thing that goes away in a few to ten days (worse case). However, I did battle what I thought was piriformis syndrome and a numb left foot on long bike rides during 2013 - in retrospect I wonder if that was early symptoms of what was to come? Could a herniated disk cause those issues?
3. Got through IMLP 2013 without an issue, and went into a run focus. My running had never been better. Then in early October I did a backpacking/fishing trip in the Adirondacks. The following Monday I noticed pain in my back (lower spine) when bending over to pick up dumbbells at the gym.
4. Thought nothing of this, and continued with the run focus, with some biking and swimming mixed it. Over the course of weeks, the back issue morphed into severe pain/muscle spasms across my left glute. There was NO pain while running, and very little to no pain while biking, especially after warmed up. But at night in bed the glute would seize up, cramping around my sciatic nerve, causing severe pain.
5. I went to an orthopedic MD, and he diagnosed me with gluteus medious syndrome, and said to rest it, ice it, NSAID's, etc. I did, but it continued to get worse. Even though running and biking did not hurt at all during activity, it seemed worse on those nights following workouts. Absolutely agonizing pain at night in bed!!! So I stopped doing everything except walking and stretching. It continued to worsen. Chiropractor and message did not help. Agonizing pain at night, but it generally would loosen up during the day.
6. Finally got the orthopedic doc to order an MRI, which showed a "partially herniated disk" as he put it. Results attached.
7. Got an epidural cortisone shot about two weeks ago, which helped greatly, especially sleeping at night, but still not cured. Glute pain still there, especially in the morning, and back still hurts if I bend over a certain way. Note I never had shooting pain down my leg - mostly localized to the glute area, but very intense. While better, it has now been 2.5 months and still not healed.
8. I am seeing a PT about once per week, and continue to stretch. I have not done much core work yet because I don't want to aggravate it further.
So my questions are:
1. What do the MRI results mean? How severe is this, and is it likely to heal on it's own?
2. Am considering a second orthopedic opinion. I'm thinking surgery is not a good option at this point however. Would a second epidural be worth it? Any downside to that?
3. Any recommendations on what to do? Swim? Core work? More rest?
4. Could me periformis, numb foot issues in 2013 have been an early indicator that something was up with my back?
Thanks all for your input!!
I have a very slow-to-heal herniated disk, and after seeing a chiropractor, physical therapist, massage therapist, Orthopedic MD, and getting an epidural cortisone injection - and still dealing with the problem - I figured I would post here to see if there are any experts out there or people with firsthand experience with similar issues. I have attached the results of my MRI.
Here is the story:
1. I had a long stretch of pretty significant training, beginning with the 2010-2011 EN Outseason leading up to IMLP in 2011. Then two HIM races in 2012, and IMLP again in 2013. Three OS's, run focus blocks, etc. Trained pretty much straight through all this, with the exception of 2 to maybe three weeks off per year (one at the end of the OS, then time off after IM races).
2. For the most part injury free through all of this. Although I do have back issues it seems like once a year or so. It is usually like a muscle spasm thing that goes away in a few to ten days (worse case). However, I did battle what I thought was piriformis syndrome and a numb left foot on long bike rides during 2013 - in retrospect I wonder if that was early symptoms of what was to come? Could a herniated disk cause those issues?
3. Got through IMLP 2013 without an issue, and went into a run focus. My running had never been better. Then in early October I did a backpacking/fishing trip in the Adirondacks. The following Monday I noticed pain in my back (lower spine) when bending over to pick up dumbbells at the gym.
4. Thought nothing of this, and continued with the run focus, with some biking and swimming mixed it. Over the course of weeks, the back issue morphed into severe pain/muscle spasms across my left glute. There was NO pain while running, and very little to no pain while biking, especially after warmed up. But at night in bed the glute would seize up, cramping around my sciatic nerve, causing severe pain.
5. I went to an orthopedic MD, and he diagnosed me with gluteus medious syndrome, and said to rest it, ice it, NSAID's, etc. I did, but it continued to get worse. Even though running and biking did not hurt at all during activity, it seemed worse on those nights following workouts. Absolutely agonizing pain at night in bed!!! So I stopped doing everything except walking and stretching. It continued to worsen. Chiropractor and message did not help. Agonizing pain at night, but it generally would loosen up during the day.
6. Finally got the orthopedic doc to order an MRI, which showed a "partially herniated disk" as he put it. Results attached.
7. Got an epidural cortisone shot about two weeks ago, which helped greatly, especially sleeping at night, but still not cured. Glute pain still there, especially in the morning, and back still hurts if I bend over a certain way. Note I never had shooting pain down my leg - mostly localized to the glute area, but very intense. While better, it has now been 2.5 months and still not healed.
8. I am seeing a PT about once per week, and continue to stretch. I have not done much core work yet because I don't want to aggravate it further.
So my questions are:
1. What do the MRI results mean? How severe is this, and is it likely to heal on it's own?
2. Am considering a second orthopedic opinion. I'm thinking surgery is not a good option at this point however. Would a second epidural be worth it? Any downside to that?
3. Any recommendations on what to do? Swim? Core work? More rest?
4. Could me periformis, numb foot issues in 2013 have been an early indicator that something was up with my back?
Thanks all for your input!!
0
Comments
Jim, as a PT I would recommend to see a neurospecialist, as Robert said. In a "perfect world", disc herniation typically heal on their own in about 8-10 weeks. But in the real world, that typically takes longer because of all the stresses placed on the spine. A good PT should be able to help you progress with core strengthening to help reduce the herniation. Personally, I believe in a combination of flexion and extension approach. There are many physical therapists who only focus on one movement approach, however both have their advantages, as long as it remains relatively pain free. Especially if there is a slight nerve root compression, you do not want to irritate the nerve root any further. Also, not sure if you are, but placing tension on the nerve root is not recommended. Rather than tensioning it, flossing should be done to allow the nerve to glide in the neural sheath. PM your email, I'll send you correct nerve flossing exercises, if you are not already doing them. Good luck.
The problem is that in some cases neither one alone, or even the two together will cause the herniations to actually receed. The injections will definitely give relief if well placed, by helping reduce inflammation, but the relief is often short lived because the underlying mechanical issues are not addressed by it.
Having said that I'll answer your questions:
1. The MRI means the disc(cartilage padding) between the 4th and 5th bones in your "lumbar" spine (low back) is protruding 2-3 millimeters beyond what it should, putting pressure on the nerve passing between the bones there ("focal compression....of the nerve root"), and narrowing the opening for the nerve root ("narrowing of the neural foramina"). Also the surface where the spinal bones meet.... the "facet joints", are thickened ("hypertrophic"). This will happen due too poor joint mechanics like I described above. Severity? Moderate. Heal on its own? No. Even if symptoms subside, the underlying issues will still be there.
2. Surgery? I would exhaust EVERY non-surgical option, which leads me to suggesting finding someone (usually a chiropractor) who does "non-surgical decompression therapy". This is a specialized treatment that only some chiropractors/PT's do, which can be very effective for disc issues. It's done with a specialized table (the specific model doesn't matter too much I've found) that delivers a very precise/gentle series of pulls/releases upon the spine. This often times can cause the protruding disc to "receed" off the nerve root. It's important to mention that the affect upon the spine/disc with this therapy is different than with ordinary "traction". The tables are more advanced, and can actually achieve a negative pressure within the disc, causing the protrusion to decrease. A series of treatment sessions is needed, but in practicing for 20 years, it's the most effective non-surgical option I've seen.
3. What to do? See above......combined WITH PT and gentle chiropractic spinal manipulation. A second epidural should only be used as needed to relieve pain while you're pursuing the other treatments in my opinion.
4. Definitely yes. Usually the muscle imbalances, joint restrictions, and progressive tears in the annular (cartilage) fibers of the disc.....which lead to allowing the center gelatinous part to "protrude" outward......all gradually develop, with intermittent periods of symptoms.
Hope this helps.
Hey Jim,
So sorry to hear this. I’m certainly no expert but have had herniated discs on multiple occasions so I’ll just share my N=1 experience. How cool that EN has an assortment of ACTUAL experts weighing in on this for ya!
In any event, I went through a period of 3-4 years about 10+ years ago where I had herniations at L4-L5 and L5-S1 on three separate occasions confirmed by MRIs. In each instance the onset was simple squats and/or running. Random, I know… but that’s what set it off for me. In each instance I was able to return to normal activity after a period of rest, cortisone shots, steroids and PT.
What I learned after the third round of PT was key for me: hamstring and hip flexor flexibility plus a solid core was (almost literally) my cure. Since that third round of PT 10+ years ago I’ve been almost back pain FREE by simply maintaining my core and flexibility routine prescribed by that one perceptive physical therapist. Occasionally I start to feel a niggle and realize I’ve slacked off on my routine and am able to self-correct.
In your case I would just offer:
1 – I’d let the inflammation simmer down before beginning any core work. I believe my PT had me start with stretching and then when I felt almost pain free we started the core work.
2 - KEEP LOOKING for the solution and keep the faith. A good physical therapist and,as previously suggested, a chiropractor may hold the key for you.
3 – Think about what may have set it off. It may not be obvious but being aware may help you avoid a recurrence.
Hopefully you’ll find the key for you! Best of luck and keep us posted.