Sciatica, Leg Pain, Radiculopathy
Posted on: Mon, 11/10/2008 - 07:41
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21 Yr Old with Bulging L4-L5, L5/S1 discs - Very Scared please advice
Hi,
My name is Matt and I've been suffering from sciatica coming up to 6 months. It started very very mild, and gradually got more painful until the point where it was interupting my daily work. I saw a chiropracter for several weeks with numerous adjustments with no relief, the problem just continued to deteriorate. I then saw a Physio for several weeks with the same outcome. But on that note, some exercises I was instructed to perform gave mild relief.
Several months down the track with a number of vists to chiro's/physio's/normal doctors, the doctor had me take a CT scan. This revealed I had these 2 'mild' bulges with no other associating problems in the l4-l5, l5/s1 discs.
To describe a typical day at work. I wake up, most of the time feeling good. There's minor discomfort in my leg and buttox but nothing I'd be concerned about. The drive to work is 30 mins up and 30mins back. Until very recently I didn't use lumbar support pillows. By the time I get to work, it's irritated somewhat, but I can live with it and I don't require meds yet. Half hour into the day which involves a lot of shifting seats and relocating computers into cars shelves and workbenches (I work as an onsite tech for a computer store), I'm starting to feel some serious pain and as a routine I pop 3 ibuprofin tablets with coke (caffeine addicted.. does this contribute?) in preperation for the pain. Depending on the severity of my lifting and shifting, the meds relieve the pain to the point where I can still lift and bend without being in excruciating pain (without, I have ot suffer through it). I'll try not to drag on because I'm guessing lots of people here know what the pain is like. But by the end of the day, even with another dose of 3 pills taken midday, I'm in horrible pain and I cant wait to get home (driving home is endless) and just lie stomach flat on my bed for 15 mins. It's the ONLY position I can be in where after 15 mins - 30 mins I'll be 97% painfree.
I don't want to lie on my bed all evening so once but buttox/leg/back muscles have relaxed from lying down, the pain is again bearable and I'm able to sit. Sitting for long periods (even with occasional stand up breaks) become extremely irritating after some hours. Going to sleep is what I look forward to most some days because I get some serious relief.
I'm currently seeing a physiotherapist (different than my original) who has a technique called 'McKenzies Remedy'. I've been given 2 simple instructions, do a back arch exercise in the lying flat on stomach position (I won't go into details of the exercise because theyre different for every person I assume) and if I do it when I'm currently in pain, it gives significant relief (including a 15 min lie down afterwards). But, if I do anything OTHER than lie down, it becomes irritating.
I'm sorry if this is going so long and not well structured.. but I just need to know one really important thing for me.
I'm young and really eager in the industry I'm working in (IT) but that one way or another involves a LOT of sitting down.
As of seeing the new physio, and taking days of work, with ice packs and a lot of lying down (just music and reading books) the pain is really low and not at all bothering in comparison. But as soon as I sit for a couple of hours it becomes irritated again and it flairs up really bad.
Currently I'm going for regular swims (brings relief to some degree and hopefully keeps me fit), doing that one but effective back stretching exercise to rebuild that curve in my lower back. And trying to stay calm and lying down. And it's allowing me to skip taking meds.
But this leaves me immobile ALL day. As soon as I get active (other than swimming and slow controlled walks) it gets irritated.
The main concern I have, is that I was told that pain should recede up the leg as the condition improves. Currently it runs right down to the back of my foot (not as painful int he foot, but pain none the less). And although I can achieve almost pain free without meds by lying down and back arch stretches, everytime I irritate the condition the pain returns right down to the foot.
I just need to know if there's hope for me. For the first time I'm seeing relief in the exercises and from relaxing (which my boss would enver let me do before). But I want to be able to go back into a job eventually where I'd be requried to sit for 8 hours.
PLEASE tell me I can achieve this painfree? I will gladly do any routine exercise and stretches and try and maintain a new improved posture. But is there hope? I've read so many horrible stories about bulding discs causing life long pain.
I actually cried on the way home today.. I don't want to live in pain....
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Welcome to Spine Health. Well the good thing is, that you are young and eager to do whatever it takes to beat this. The fact that your body responds to the physical therapy is a plus.
You're right, many members here have a similar story or experience. The key thing to remember though, is this is YOUR EXPERIENCE and you are living it.
I wish I could look into a crystal ball and tell you that everything will work out great. I can't do that. I'd be a billionaire if I could. When I first hurt my lower back, I figured that as soon as things settled down, it would be fine. I figured I'd make things strong and that would be that. No such luck. HOWEVER, when I had people telling me that my life as I knew it was done and over with, I refused to listen (and still do). I personally believe that I can achieve whatever I set my mind to. The key is in how I achieve it. Used to be I'd go from point a to point b in a straight line. Well I can't do that anymore. I still get to point b, I just make a few twists and turns along the way.
Hang in there.
"C"
"Be careful about reading health books ... You may die of a misprint."
I think your doctor should order an MRI; the regular CT doesn't quite catch everything. Did they every mention any degeneration in your L4-S1 discs? It's not uncommon to have that accompanied by bulging discs, in my experience. I have both in my cervical and thoracic region, and more extensive problems in the lumbar. I had a microdiscectomy for L4-5 herniation last year, and this year I had a 2 level fusion from L4-S1 for recurrent L4-5 herniation, L5-S1 disc bulge compressing the nerve and severe DDD, L4-5 vertebral slippage, and facet joint arthropathy.
Just like Haglandc said, we have no idea how things will turn out for you, and we can only hope for the best. Take care
Microdiscectomy/ laminectomy, 2 level TLIF Laminectomy w/ instrumentation.
Meds: Fentanyl 75 mcg, Norco 10/325 mg, Cymbalta, Zanaflex, motrin.
Been there, done that.
I agree 100%.
It's quite possible that it's an herniated disc. In which case a Neurosurgeon would recommend a Microdiscectomy. Just a guess of course.
I think you've covered most of these already, but here are some non surgical options:
stretching
ice
injections
continued chiro adjustments 12-24 visits
pain meds
accupuncture
But none of that is likely to work if you're past the 6 week mark. You need that MRI.
Stay positive. Odds are you will be fine.
~~~
3/27/08 L5-S1 Microdiscectomy
6/27/08 L5-S1 Microdiscectomy
Current Status = Re-reherniated. Next surgery:
12/01/08 L5-S1 Microdiscectomy
Thanks for your replies.
The physio made a follow up call this afternoon since our first appointment last friday. Because I've resigned from work, I'm able to take extra care with my back. I went for a half hour walk this morning, trying my best to walk correctly (opposed to my old posture) and by the end I was surprisingly ok. It had flared up to some degree, but the pain was minimal and receded fairly quickly after 15 minutes rest. I went straight to the pool afterwards and did a number of laps doing a basic froggy paddle style swimming because I feel it bends my back in a good way and hence I imagine the muscles I want to strengthen are working. That further relaxed me and when I got home I just lay down mostly which kept me almost painfree.
I described to my physio that I was feeling comfortable (keeping in mind I completely restrict myself from as much forward bending as possible as that shoots pain down my leg right away) and told him that compared ot a normal day at work I was in heaven. But I expressed my concern that after sitting for an hour I was in a lot of pain again and wanted ot know if I can ever achieve being able to comfortably sit for longer periods.
He said that because I'm currently in an acute stage, we need to get the pain and possible inflammation under control. Meaning, relaxing and avoiding all things that irritate it so that healing and regrowth can properly occur without interference. And that sparked some hope in me. I'm going to buy a laptop computer so I can avoid sitting even moreso (though ironically, the drive to this physio is 1.5 hrs up and 1.5hrs back, but I use a lumbar pillow now and know to take breaks).
Is a herniated disc different than a bulged disc? Worse or better?
I notice in your signatures that you've undergone a number of surgical procedures. Were these successful? How reliable are they? Is it something I shuold consider, or should I continue (the only recently started) 4-6 week recovery process suggested by my physio. I would like to avoid surgery as much as possible, so it's probably best that I try the physio's way first. Im just afraid of doing more permanent damage to my spine.
Also, were your L4-5 S1 bulges or herniated discs, and were they considered mild or major? How are you feeling right now?
Cheers again for the replies.
in my mri i had 2 herniations. l4-l5 and l5-S1. according to the report i had a small herniation in my left side where i had pain, and a huge herniation severely pinching my right nerve root. but mysteriously there was no pain in my right. every doctor i went to asked if i had pain in the right leg.
some people have herniated discs and have no pain. some people have normal mris and have severe back pain.
Hi Bj,
When you say strengthening my core, what area's/muscles are you referring to? The physio told me that once the immediate pain is under control, he'll advance throught he process. I will ask about aggressive physio therapy, I'm fairly fit and I'm willing to go through whatever process is required now that I am not obligated to any job for a while.
"stop popping pills. you need to know what kind of pain you have, if its nerve pain from the pinching- exercise it. if its pain from inflamation- rest it. If you have pain that is relieved from exercise, then its nerve pain. if you have pain that seems to be aggravated from exercise, then its inflamation-rest it."
It's hard for me to answer that. The half hour walk this morning caused some irritation. Easily bearable pain but aggrevation none the less. But before I jumped in the pool, I was slightly sore, and by the end I felt a lot better. So the 2 different types of exercises got different results. I spose swimming is a lot more relaxed whereas walking is a bit more rough.
So a good recommendation would be for me to start a walking regime? perhaps half hour at night and half hour in the morning? I'll skip the meds a few days again to see how I respond to something like that. What muscles does it build?
Also, would certain weights at gyms help?
How are you feeling now? Can you sit for several hours without flare ups? Can you bend and lift without flareups? Does pain recur if not following strict rules or are you able to act freely and be less careful?
Regards,
Matt
EDIT: Also I should add, that as of the last few days I've been able to REALLY 'rest'. Before this my boss did not understand the seriousness of my illness until I showed himt he CT scan results. I was always coming home from work in complete agony and rest at night would not help the next day. My job was very stressful also, which now I'm feeling a lot more relaxed both mentally and physically. Regarding your comment about rest, I really hope that extra rest and relaxation will help the process.
the core muscles are your abdominal obliques and lower back. everything around your waist is your core. search "reverse hypers" "planks" on google. these exercises dont put alot of stress on your spine. you can also try "stability ball wall squat". squatting is good for your back, only if you can do it without pain. squatting will work out your glutes, quads, and lower back. remember dont do these exercises if you feel pain. if you strengthen your abs, lower back, glutes and legs, walking will be much easier.
if swimming feels better, keep swimming. focus on pedaling your legs.eventually you should start to walk then jog then run. keep swimming, and try some walking. if walking is rough dont over do it, start slow. try a step climber, see if this is easier then just walking. its a long process and it takes time. Just dont over do it. ive reinjured myself many times because i didnt listen to my body.i would over do it thinking i was man enough to take in pain. bad idea. when you body tells you to rest it just rest it. but dont be lazy and sit around all day.
walking/jogging/running builds muscle all over your body. especially in your legs. look how jacked those track oympians are.
when i first got hurt, i couldnt walk at all. i couldnt sit at all. the only comfortabl position was laying on my side ina fetal position.
when i started exercising, i did i everyday and it did not work. my body couldnt handle it. so i exercised one day and rested one day. on my rest day i would do light stretches throughout the day. it took me 9 months to heal. the first 3 months i couldnt do anything. 4-6 i started to walk. by the 9th month i started to run.
today i am pretty much pain free i can do anything. i can bend forward but i never bend without bending my knees. i use proper body movements when picking something up or bending over. i can sit withou flare ups. but if sit too long, my back muscles tense up and goes into a spasm. i would say my pain level is 0-1 out of 10. but i always try to be active.
swimming is good but strength training is key.
the stronger your body is, the easier it is to move. the more you move your body the less pain you will have.
remember not to over do it. rest if you need to rest. sleep well. and take it slow. Slow is the operative word here.
i also did alot of cycling. this was after 8 months into my injury. when i was physically able to sit on my bike without any pain.
I'd say herniation is worse, in that it's more likely to hurt and less likely to go away. Here ya go:
A bulging disk does look different from a herniated disk. A bulging disk is one in which the outer layers (annulus fibrosis) of the disk simply bulge into the spinal canal. The bulging typically affects a large portion of the disk. Bulging disks are more common than herniated disks and usually cause no pain.
In contrast, a herniated disk is one in which the inner part of the disk (nucleus pulposus) has leaked out of the disk through a crack in the annulus fibrosis. This is also referred to as a ruptured disk or slipped disk. The typical appearance of a herniated disk on imaging studies is a small area of the disk hanging out into the spinal canal. Herniated disks are less common and may cause pain.
http://www.mayoclinic.com/health/bulging-disk/AN00272
My Re-reherniation is at L5-S1. I'm somewhere in between mild and major. My 1st & 2nd time involved a good amount of nerve compression. It doesn't happen to be as bad this time. No pain meds required, thankfully.
Most Microdiscectomy’s are successful. Over 90%. Those of us with multiple Micro's, reherniated the disc at some point. It's not that the surgery failed per say, IMHO. In my case I am genetically predisposed to reherniation (& herniation of course). Plenty of wear and tear over the years as well. Though there was no specific injury for any of my herniation. They just appeared like a deer in the headlights.
My advice to you is to GET AN MRI and have a neurosurgeon look at it. If it’s bulging or it’s a small herniation that is still attached, then it could go away with time and treatment. You are young after all. However, if the piece is detached, then surgery may be your best bet. I think you should continue with your Physio. You should be okay damage wise. But I think we’re guessing without an MRI.
Good luck to you.
__________________
36 years old
3/27/08 L5-S1 Microdiscectomy
6/27/08 L5-S1 Microdiscectomy
Current Status = Re-reherniated. Next surgery:
12/01/08 L5-S1 Microdiscectomy
Hey,
I am seeing my physio again tomorrow afternoon. I'll ask him if I should investigate whether I have a herniation rather than a buldged disc. I'll also ask about what exercises I can do to specifically target my 'core' that won't aggravate my condition and mention the terms used above.
I've now got the freedom to spend my time as I choose, so I want to do as much as I can to help the problem, but as BJ mentioned, to not overdo it.
Thanks for your support guys, I feel a little alone in this as noone around me knows the pain I have experienced, they think I'm overreacting or exagerating, and my GP (who doesn't specialize in back issues) said my problem is irriversable except through surgery and that pain management would be my best option. You guys have shown me that I have hope in beating this problem with perseverance and dedication.. so I'll give it exactly that.
Regards,
Matt.