Injury Report: Ross Randolph L5-S1 MRI Images (Bulging Disc)
Not sure who else has had to go through something like this but appreciate any advice or lessons learned.
On the morning of July 22, while walking down a hallway at work a sneeze triggered a HUGE amount of pain emanating from my lower left back / posterior which (almost literally) knocked me down. I haven't been able to stand or sit more than a few minutes ever since (it's been almost 2 weeks). I'd been in the middle of a training cycle in preparation for IM Santa Cruz 70.3 and didn't have a known pre-existing injury in the area. In retrospect, in the week or so prior to the sneeze I had noticed my left kinetic chain (i.e., from achilles tendon up to my hamstrings) being a little tighter than normal. (I've always had difficulty with flexibility, especially on my left side.) At the time I didn't think much of it and still not sure if it has any relation.
After a few chiropractic appointments offered no benefit & a visit to primary care (prescribed Hydrocodone-Ibuprofen 5-200 mg) still didn't get me back on my feet, I've since gone to urgent care associated with orthopedic specialists who changed my prescription to a 7-day MethylPREDNISolone (4mg) regimen until I see the orthopedic surgeon next week to look at options.
The last 2 weeks have been one of the most humbling, frustrating & debilitating periods of my life which has me questioning not only my future in triathlon but athletics in general. (And sneezes now scare the crap out of me!) My racing goals have changed to get-back-to-function-in-life goals like standing, walking & sitting.
I know we have several doctors on the team so have attached a near-complete set of MRI images I had last Friday. Not looking to replace the professional advice I'm already getting and acting on, but always appreciate others' opinions who have experience with this sort of thing.
My primary care doctor said I have a "moderate" rupture of the L5-S1.
Axial Images:
Comments
Is there another set of images like the one third from the bottom but with more white in the center of the spine. The medical accurate description would be the axial T2 images. That third image from the bottom shows a sizable left L5-s1 HNP (herniated nucleus pulposus)
If you can’t walk on your heals and toes with your left leg surgery is probably better sooner rather then later.
6 weeks is the magic number within which 85% of people will have some significant relief from pain.
PT and epidurals are both good options if no weakness.
I would comment here, but there is a wicked smart spine surgeon answering above me(@Robert Sabo ). Listen to him and get on this pronto, get a 2nd opinion (quick) and get it done... you will live to fight another day. Sorry for your pain, I've had a herniation and fortunately got away with a shot, but man that was almost the toughest thing I lived through.
I hate the statement you have to get a second opinion but I know the system. I do have a preference for Neurosurgeons over orthopedic spine surgeons. I am biased though. Let me know if I can answer any other questions. @Ross Randolph
@Robert Sabo - if i listened to the doc who i went to for a Cardiac check up in 2012, I'd be living with an ICD in me. It's bad enough that he scared the shizz out of me for a year. THREE much more informed cardiologists came to the same OPPOSITE conclusions than he did. One even pointed out the faulty application of standards for RXing an ICD that "Dr Wrong" utilized.
No offence, but I would ALWAYS get a 2nd opinion today. That said, I agree with your view of a neuro vs ortho in this issue
I'm dealing with a bulging disc at L4-5 myself and it's no fun. Saw an orthopedic spine specialist who is an ironman himself and also has dealt with same kind of thing. It's slowly getting better, i.e. less nerve pain, and found bending my knees and leaning forward helps decrease pain with a sneeze! I opted not to get any shot, and will wait it out a bit more to see it PT, etc. helps resolve things.
I'm working my way through a book by Robin McKenzie that's been quite helpful in understanding the back mechanics with some helpful exercises. https://smile.amazon.com/Treat-Your-Back-Robin-McKenzie/dp/0987650408/ref=sr_1_2?keywords=treat+your+own+back&qid=1564781216&s=gateway&sr=8-2
There's some things you can do yourself, but of course, follow the advise of the WSP and your physician(s). 2nd opinion for sure.
There's nothing like this kind of pain, so my prayers are with you!
My boyfriend has had very similar issues over the past year or so. His MRI also showed a bulging disc around L4/5. He swears one aleve gelcap/day has helped quite a bit. He also found these gel inserts for his shoes. He’s a bike mechanic so he is on his feet all day for work. Usually the only way he will see a doc is if he is taken there (lots of ER docs - SIGH). I agree with the second opinion votes so far. I offer his experience as potential band aids while you get better info and a plan sorted. I’m so sorry for the pain. 😐
I had a buldged disc at L5-S1 during the summer of 2007. When they went to do an MRI on it, I cried while I was in the machine -- it just hurt so much to stay still while they were doing the procedure. The doctor said that I could do PT or surgery and that the long term results were very similar. I took the PT route. That did not 100% resolve it and we ended up doing an epidural to get calm down the nerves in my bacj after about a month of PT. I had the MRI on August 3 and the epidural on August 29, 2007. It took 3-4 days for my back to calm down after the injection. After that, I turned the corner.
I was able to ride the entire time. I was a single sport athlete at the time.
Knock wood, I have not had a repeat of this incident.
THANK YOU everyone who has chipped in with advice & their experience. Love the mojo and value this team! Quick update on my condition as of 8/9 (3 weeks after injury):
@Julia Herrmann appreciate your experience; I've spoken to others who do the same as your boyfriend. I'm a manager at a manufacturing plant and am on my feet a lot (but also at my computer and in meetings for long stretches). I also use orthotics and have found the Superfeet (Green) inserts really help my posture.
Thanks for the update! I'm continuing to send healing thoughts your way.
Injury Update 9/5/19:
Saw the spinal surgeon on August 26 for post-cortisone epidural follow up appointment. I was prescribed 8 sessions of physical therapy but due to some ongoing numbness in left leg (very weird, no numbness in the hip/thigh down to ankle but have numbness in outside of my left foot and my left pinky toe - also every once in a while on the bottom of my foot) he wants to do a electromyography (EMG) to test for nerve damage. I have that test scheduled on 9/25.
I have been walking and light stretching. No 'pain' per se, but if I push in the soft tissue area just below my hip on left side toward the back but above the butt I can definitely something is not right. It doesn't hurt and no shooting pain or anything, but I can tell it's not healed - it's tender and gives me a little nausea when I push on it (my guess is without the cortisone shot I'd be crumpled over in pain if I did that?). I'm thinking that's where the herniated disk is located.
I've also done a few swims (no flip turns, easy push off from wall). Lower back and leg seemed to do fine but being out of the pool for so long created some stiffness/soreness in upper back. I've been missing my chiropractor big time (I'm usually on about a 3-4 week cycle for routine adjustments) but doctor said absolutely no spinal manipulations.
I've been shopping around for physical therapists that specialize in sports medicine (and triathlon). I found one in Vacaville (California) and plan to give it a try. (Good reviews online.)
The good news is there is no pain. Also, I sneezed (twice) today. That's literally the first time since July 22. The anticipation was enough to stifle a few initially, but my dusty house ensured I wouldn't get away this time. Luckily survived both of them.
@Ross Randolph -sounds like you are turning a corner in a good way.. Keep us all informed!
Very glad to hear you're making progress and I hope the tests come back negative. Sending positive and healing vibes your way. Hang in there...you will be back.
When I read the “I sneezed” I thought “omg no!!!” 😨 But glad to hear it was a-ok and you are moving in a positive direction. ☺️
I had an epidural in my back way back in 1996 (if my old brain recalls correctly), pre-tri, and it helped my back tremendously. The only other thing I've done since then is PT and core work (through various iterations over the years).
Hope it works for you as well as it did me!
@Ross Randolph as long as you can do something to get some endorphins you'll make it thru this. Good luck with the PT. I can ask my PT here in the Sacramento area if he knows anyone in East Bay if yours doesn't work out.
Is Sarah and company planning on Kona?
I wouldn't be to worried about a little numbness in your foot. I agree with the PT all the way. Sounds like everything is all good and heading in the right direction.
Thanks everyone for the ongoing support & feedback. Great to have so many teammates who've 'got my back.' Good luck at Kona, @Robert Sabo and yes @Sheila Leard both Sara and my girls will be there in Kona - Sara's 2nd time as a competitor while the ladies get to cheer her on. The boys and I unfortunately will be staying behind and will watch online like everyone else, but I'm planning to be back on the Big Island in May 2020 for the Hawaii 70.3. Definitely interested if your PT has any triathlon-specific PT recommendations in North Bay.