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Herniated disc - Is it all downhill?

sprynmrssprynmr Posts: 7
edited 06/11/2012 - 8:41 AM in Lower Back Pain
Figured out a had a herniated disc almost 3 years ago now. Its the L5-S1 I believe.

It doesn't bother me too much most of the time, even though I guess its a pretty badly deteriorated disc. Every 4 months or so I do something weird to tweak it, then it bothers me a lot for a couple weeks and dies back down. I only have a tiny bit of aching in my leg when it flares up, but mostly in my back.

I've been attempting to strengthen it for the last year'ish after PT taught me how.

Lately I've been trying to get back into really exercising more... but that seems to have caused it to start flaring up. I just saw a specialist and he said still wouldn't consider surgery. But man talking to him left me feeling bleak. Basically told me that it will keep deteriorating and likely get worse over time. And that the surgery still leaves you with pain. The fusion sounds awful. Almost like it doesn't really work out for anyone.

Does everyone with a herniated disc eventually get put out of commission activity wise? I don't want to be a crippled dad (no kids yet... just 28). I'd like to stay active. Play backyard football/baseball with the friends.

Does PT ever really get anyone back in the game? What's the deal with artificial discs... they seem so much smarter than fusions? Inversion tables? Decompression? Is a fusion a couch-sentence. Is it really just all downhill and pain management from here?

Frustrated because the rest of my body is fine. If it stays where it is I can handle it. if its only going to get worse than what can someone really do?


  • But mine was fine until I had a car accident, since then i've been in constant pain. Had fusion last year and (this is just my experience) it hasn't worked, if anything it has made it a lot worse.
    I have been told by several doctors that if everyone had an MRI 80% of people would show a herniated disc, but the vast majority are asymptomatic. It is only a lucky few who suffer from severe pain.
    Discs wear with age and as you age you will get aches and pains that's just getting old for you.
    From what i've gleaned over the years, the best way to prevent your back from getting worse is to keep your core abdominal muscles strong so that they protect your back and remain fit, healthy and active. Ensure you bend your knees when you lift something, always keep your house and work place ergonomically friendly etc.
    Weight plays a role too, the heavier you are the more strain is place on your back.
    Do those things and you have given yourself the best possible chance of not ending up requiring surgery or medication.
    This is just my opinion from self-educating and I am not a doctor.
    Hope this helps.
    Take care
  • I'm sorry you've had pain from that disc for 3 years. Have you had a repeat MRI lately? Have you been to a Pain Management Dr. yet for injections? Please get a referral from your Primary for a Pain Management Dr. and a second opinion from an Orthosurgeon and/or Neurosurgeon. Your PM Dr. may want to do more tests I would go back to your Primary for more referrals. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • dilaurodilauro ConnecticutPosts: 9,859
    There are many people who have herniated discs and continue without surgery.
    There are many conservative treatments available that can help you manage the situation.
    We can not provide the exact treatment, since we are not doctors.
    You should discuss all the options with your doctor.
    Your last set of MRI's, do you need more diagnostic testing, etc.
    Your doctor will be the one to recommend what is the best course of action.

    I have had multiple spinal surgeries to deal with herniated discs. I still have a problem with L4/L5 and have 4 herniated thoracic discs. There is no surgery in the future for handling those.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I am going on a year now and the other day my spinal orthopedist gave me the sobering statement that this is the best it may be for you. I keep hearing how I am not a candidate for surgery as my herniation is too small but very stubborn due to its placement. I was told by my last doctor how on the scale my herniation is a 2/10. Makes me feel kind of a wimp especially if you knew me as I still do but have been very active. We are just as posted the unlucky few, mine coming from a fall.

    I would not give up the PT and just keep trying to push yourself a bit more when you feel you are ready. Honestly that combined with the 2 epis got me from a cane to doing quite a bit now. My bench is getting about 250, my rows are hitting about 260, my leg press was 280 today. You have to really build a program where you build all your muscles while protecting your spine fro further injury. I was a former gym rat and now more like a gym mouse.

    Am I still in discomfort, yes but I am living a life atleast. I would also keep seeing other doctors. I have another doctor who has given me some options and I will be going for my third epi next week.

    In the end there is hope but just like many others including people with no spine issues you have an issue and have to work with it or around it depending on your point of view. I would not let what the doctor said get you into despair. Once we are in despair we have definitely loss the battle.

  • Appreciate the information and pep talks.

    Since it hasn't reached debilitating sciatic for me yet, or really affected my bowel or bladder control, I'm determined to improve this with PT.

    Its been about 3 years and I guess the good news is it hasn't gotten worse. Slightly better if anything. They said I'm lucky my herniation pretty much went straight back, and not too out to one side or the other. Probably the main reason I'm not in severe pain.

    I've also been told that surgeries will be improving in the 2-5 year time frame as replacement discs become more widespread (and hopefully covered by insurance). Those sound like a no-brianer to me when compared to fusions.

    I think if it starts to get worse I'll consider paying for decompression first... and then if I have to, the micro-lap surgery to remove fragments, before ever considering a fusion.

    I don't understand how artificial discs are just now starting to accelerate.

    Ah well.

    Thanks all,
  • I guess the FDA is a little more cautious than ruling bodies in Europe. The problems with artificial disks at this point in time is that there is a twenty year life span to the materials that are used to make them. Try as they might, they have not been able to create a bio-medical material that has a life span longer than twenty years. So, if you're a certain age, it might work out well for you, but if you plan on outliving your disc, it presents certain problems. This is one reason why surgeons are reluctant to implant them in younger patients.

    Also, when things go wrong with an artificial disc, the surgery to remove it is categorized as "life-threatening" surgery. They have not developed a slick way to be able to pull them back out without risking damage to surrounding tissue and blood vessels.

    That is another reason why doctors do not feel comfortable putting in a material that has a lifespan of 20 years when they cannot promise that they can just redo the procedure. They are putting patients at risk when they go in to redo an ADR surgery.

    I just wanted to mention that my husband ruptured L5-S1 about 17 years ago. He worked hard in PT and was very careful for a good six months, restricting most activities that might put pressure on that part of the spine. He was able to heal it without any intervention. And he has been able to avoid further problems all this time. I believe the key to his success is that he does his "back" exercises faithfully every single morning. Literally, he never skips them. I believe that is the reason he has avoided further herniation.

    Too many people do what they have to to recover from an injury or procedure...but eventually (maybe a month, maybe a year...) they revert to their old bad habits that caused the problem to begin with. To safeguard your spine and prevent further damage, you have to change your lifestyle.

    But there is hope. They don't do back surgery nearly as often anywhere else in the world. American doctors are much too quick to recommend it for things that can heal on their own. If you want to avoid surgery, to a great degree it is up to you....

    Good luck.

  • One other point that I think I failed to mention. I think occasionally when this flares up I have a little bit of bladder control issue. That is to say that I can still control it (on and off... not on when I don't want it to be) but that the off isn't quite as 'instant' as it should be.

    Is this a red flag that means I should knocking at the surgeons door, or is this something that can improve/resolve with PT?

    Given that none of my pain is severe, I'm inclined to continue down the PT path and see if that helps resolve it. How helpful/dangerous are the laproscopic surgeries where they remove the disc fragments?

    Thanks for the comments on the artificial disc. I didn't realize there was a lifespan on it. I suppose when you have material that can't heal itself or produce new cells... its harder for it to last as long as the human body. Sigh.
  • It has been 3 years and you seem to have under some control as I do not know how much it is making your life difficult.

    Continue with the PT but please make sure it is the right PT. Too many people approach too quickly, incorrect form or honestly the PT person is not very good. I would suggest you look at this site for some intro exercises and than try and add on while increasing mobility and functionality. I have found it best that you build your own program and be diligent about going. Listen to your body.

    I would suggest as gwennie stated not to run to adr cause as many can tell you hear there is no quick fix. Listen to your doctors and get multiple opinions until you believe in what they are saying.

  • Any bladder control issues should be mentioned to your doctor. I know that bladder issues are considered serious. He will let you know how severe it is. I believe the more severe issues concern when you completely loose control of your bladder. But please mention it to your doctor soon.

    I have not had any surgeries so I can not comment on it.

  • Yes and No, depending on how you look at it. It can be downhill, but it isn't for everyone and doctors always want to see if it will resolve on its own with conservative treatment. I have 2 probable lumbar herniations that go back as far as 37 years. They healed on their own and I've been able to use my back fully ever since, BUT, I've had unrelenting lumbar pain trying to get a decent night's sleep and in the early years, I'd bend over the wrong way and be stuck in that position with breathtaking pain temporarily and then I'd go on as usual. Now, at age 61, I have lumbar stenosis, degenerative scoliosis and intermittent sciatica in one leg. So, I guess you could say it was all downhill for me, but slowly and over many years.

    Unless I missed it, you haven't said that you've actually been diagnosed with a herniated disc or that you've been evaluated at all. Have you had an MRI? Been sent for PT?

    As far as surgery goes, from what I read there is always a hope that it will relieve pain but most surgeons will tell you that they do surgery to preserve nerve function and that there is no guarantee of pain relief. I am presuming they say that because nerve compression can be documented while pain is subjective by nature. They can frequently "fix" the physical problem but they can't guarantee that the pain will disappear completely.

    2009 Foraminotomy C6-72010 PLIF L4-S1Multi RFA's, cervical inj, lumbar injLaminectomy L3-4 and fusion w/internal fixation T10-L4 July 17Fusion C2-C5 yet to be scheduled
  • Yea I've had an MRI which shows a pretty ruptured disc L5-S1. That was about 3 years ago, but they didn't send me for PT for whatever reason (I guess maybe it was a surgery shop.)

    Since then I've had it intermittently. Most of the time it doesn't bother me except for maybe a slight ache. But then I'll do something physically to agitate it and have decent pain for a couple weeks before it fades again.

    Last time it flared up I did my first PT (about 6 months ago). It definitely helped, and I've continued a few of the exercises, but maybe not religiously enough.

    It just flared up again recently, so I went to see a different ortho doctor. He said the disc is pretty shot... deteriorated... but I don't think its gotten much worse in 3 years. They didn't do a new MRI.

    It'll probably fade down again (its already started to) but now I'm really worried about my back health for the rest of my life.

    Does one bad disc mean the others will eventually go because of the extra stress on them? That terrifies me. Luckily I also have anxiety, so anything remotely serious makes me worry a WHOLE lot.
  • I am not sure pretty shot is much of a diagnosis and I may see another doctor with lets say a bit more "half full than half empty" view of the future. Most doctors I have met believe that conservative treatment such as PT is the best way to go but back to gwennie's point is to be diligent and understand you do have an issue that needs to be considered daily. If you continue in your old habits more than likely you will put more pressure on other parts of your spine which will lead to eventual issues in other parts of your body.

    I am not a doctor but I do believe that with a diligent, intelligent approach to PT, posture and daily activity can allow you to recover and beat further progression of your spine issues.

    Do not worry the pain will remind you to keep doing it...lol. Also a good sense of humor helps.

  • Yea I might consider a second opinion. The doctor spent like 7 minutes in the room with me. Seemed rushed in rushed out. He didn't even really mention the laproscopic surgery... just mentioned something about fusions being painful and wrote me a script for PT.

    I'll take any suggestions for a doc around denver/boulder. Also looking for PT, but maybe found some good ones around Boulder.
  • If you can not find a good PT person in Boulder you can not find one anywhere. When I cycled people would go to Boulder a couple months a year just to train. I never had the chance but it is suppose to be amazing.

    You should have no issues finding a good trainer in Boulder. Just ask around and google and read reviews.

  • Where do you find PT reviews online?
  • type in a bunch of searches and than try and find review links
  • dilaurodilauro ConnecticutPosts: 9,859
    Is your doctor. As long as you have trust and confidence in your doctor, they should be able to recommend a good place that can work with you.

    I've been dealing with Physical Therapy Center and Therapists for over 30 years now, probably have been to 15 different sites and scores of therapists.

    What have I learned?

    - Find a Center that handles multiple areas of rehab.
    (Besides Physical, look for Aqua, Speech, Occupational)
    Because these centers are usually larger and may be associated with a hospital so that they can recruit more experienced therapists and have the latest equipment

    - Generally when you first go for Physical Therapy, they will do a 30 minute evaluation of your condition. Sometimes, I call this as their method of interviewing you. Now its your turn to interview them. Have them explain the different facilities they have at their center. Also find out who the different therapists are and in what areas do they specialize in.

    - When you start to see a therapist, they will become very close to you and know your body almost better than you do. Its very important that once you find this therapist, make sure that all your follow on appointments are with the same person. (Sometimes, there will be minor scheduling conflicts) I had this one therapist that I stayed with for almost 2 years. She knew more about my body and could spot something just the way I walked into the center.

    - Many times, physical therapists are very healthy people. Some times those are the ones that may want to 'push' you harder and harder. Initially, things will start out slowly and mild, but it will continue to build. There comes a fine line when the more aggressive physical therapy can do more harm then good.

    - Listen to your body.. No question that in the beginning the PT sessions may cause you more discomfort than relief. That may last as long as three weeks. Then you should start to see results.
    If during that time, you start to notice something more that is hurting you, bring it to their attention. Talk it over... It may just be pain from using areas that have recently been docile. But there is always a chance that something new is happening or something that they are doing is causing problems. If you are not satisfied with your discussions with your therapist, then I would talk it over with your doctor

    Lastly, you are the patient and you should be the one in control. But please always make sure that you have open two communications with your therapist. That way, there should not be any surprises

    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Ron gave you some great info there.

    I would just say that I have found from talking to others that people with spine problems fall into one of two camps, they either hate PT with a passion and call it Physical Torture or love it.

    I have found that the people who hate usually have a background where they were not very active before than spine issues and seem to look for more help from PM docs. The other folks who were active people before the spine issue usually take very well to PT and love it.

    But from my own experience and observations I have found the people to have the best success who use a combination of the two.

    Ron brings up the other point about discomfort vs. pain. This is something only you will know and be honest with your PT when you feel you are in pain. But do keep in mind that you are suppose to feel some discomfort which should eventually get better as you do more PT.

  • Thanks for all the info. What's a PM doc referring to?

    I didn't mind the bit of PT I did before. I just need to be more religious about the exercises this time and continue them for years.

    On an unrelated note I think I might have been imagining my bladder control issue. Hoping so anyway. When I start worrying about possible symptoms, I start seeing them... thanks to anxiety.

    I think I'm in a good position to improve my back a whole lot. And hopefully avoid surgery for a long time.

    Anyone have any experience with inversion tables? My Mom has one that she seems to like. Or if you take that even further, how successful is decompression therapy. Obviously the marketers say its almost a miracle, and I've seen scientific studies that say there's little proof it works. Have there been a lot of personal accounts of it around here?
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