Disc herniation - Some thoughts (Long)

[netman]

Originally Posted by kevo82

But again, I am not worried about this pain, I am worried that even after 7 months, the leg didn't recovered the full power. The last mri scan showed that the disc it's on the limit of touching the nerve root, without compression (I hope), but because of the timblings and numbness that I feel sometime, I think it's not perfect.

Hi Kevo82. I'm the OP.

Have patience. Nerves can take a very long time to recover from trauma. Fact is they will probably never get back to 100%, but they will recover. I ended up not having surgery, so it took a long time for me to get back into the game. But I have been playing pain free for over 3 years now. Definitely have some weakness on my right side (the nerves affected) but I just changed some techniques to adapt.

The key thing to remember is "listen to your body". If it hurts, give it a break. I can tell you from hard experience that failure to back off when your back hurts or pushing it too long or too hard will cause problems and even a relapse. Use common sense, recognize you are working with a different back now, and adjust accordingly. Then you'll be back in the game for the long run.

-k-

[kevo82]

Yeah, thank you for the advice.

I have only one worry though: that the disc it's still pressing on the nerve root and it will never be able to heal.
I wouldn't have any worry if I wouldn't feel numbness sometimes (in the left foot, tibia and 2 toes). This is a sign that the nerve it's not free and it's compressed and stretched.

I also feel like a pinch there...I do not worry about the multifidus and quadratus lombarum muscles pain...just the nerve I don't feel that it's perfectly ok.

It's strange, because others have a disasterous result on the mri scan after surgery, but feel no pain or numbness...

[charliefedererer]

Originally Posted by netman

Hi Kevo82. I'm the OP.

Have patience. Nerves can take a very long time to recover from trauma. Fact is they will probably never get back to 100%, but they will recover. I ended up not having surgery, so it took a long time for me to get back into the game. But I have been playing pain free for over 3 years now. Definitely have some weakness on my right side (the nerves affected) but I just changed some techniques to adapt.

The key thing to remember is "listen to your body". If it hurts, give it a break. I can tell you from hard experience that failure to back off when your back hurts or pushing it too long or too hard will cause problems and even a relapse. Use common sense, recognize you are working with a different back now, and adjust accordingly. Then you'll be back in the game for the long run.

-k-

Wow netman. I am impressed.

Not only by your sound advice, but noticing and commenting on a 5 year old thread without missing a beat.

[tennis_tater]

Originally Posted by netman

Hi Kevo82. I'm the OP.

Have patience. Nerves can take a very long time to recover from trauma. Fact is they will probably never get back to 100%, but they will recover. I ended up not having surgery, so it took a long time for me to get back into the game. But I have been playing pain free for over 3 years now. Definitely have some weakness on my right side (the nerves affected) but I just changed some techniques to adapt.

The key thing to remember is "listen to your body". If it hurts, give it a break. I can tell you from hard experience that failure to back off when your back hurts or pushing it too long or too hard will cause problems and even a relapse. Use common sense, recognize you are working with a different back now, and adjust accordingly. Then you'll be back in the game for the long run.

-k-

As i noted in the other thread on the torn calf muscles, after all of my PT's and Ortho's being thrown for a loop as to what has been the underying cause of my calf issues, my ortho finally decided to order a new MRI since I haven't had a lumbar MRI in over 10 years. Anyway, the MRI basically showed what my MRI showed over 10 years ago - I have disc issues (2 bulges and 1 annular tear/hernation at three levels. Although I am having no back pain whatsoever, the doc thinks that the bulging and herniated discs are possibly pinching the nerve roots, which must in turn be the cause of the general leg weakness that I am experiencing in one of my legs. That being said, he is referring me to a spine specialist to discuss "options."

Here is my question. If a nerve root or nerve is being impinged/pinched, can a nerve conduction tests be conducted to determine if that specific nerve isn't firing? Is there a more definitive test I can do to find out whether the nerve is, in fact, being pinched and/or affected by the herniation istead of "the disc is protruding or henriated" and is "likely the cause." isn't there something or some test to specifically find out whether the nerve that controls the strength in my leg (calf muscle and foot muscles which have seemingly weakened over last couple of months) is indeed being impinged? I just don't feel like going to talk to another doctor about possible surgery options, even if its something as what has been made to sound simply as "cleaning the disc up" if there isn't more objective proof that the disc is touching the nerve and in turn causing/contributing to the lower leg problem.

That aside, for those with L5-S1 nerve impingments, I'm just curious how many of you responded to PT as an alternative to surgery? How does PT get the disc off of the nerve?

[Chas Tennis]

I have not had a back issue. A friend of mine has and claims that he gets knee pain from a pinched nerve near the sciatic area I believe.

Recently I came across a thread that discussed some of these nerve pinching injuries. I have lost track of it. I believe that it involved a tight piriformis pinching the nerve. To find the subject search terms such as sciatic, piriformis, piriformis syndrome, sciatic syndrome, nerve pinch sciatic, etc.,as well as those for the herniated disc. Of course, there are a 100 other things that may be causing your injury...............

http://en.wikipedia.org/wiki/Piriformis_syndrome

Since your back is injured and some stretches or exercises may involve heavily stressing the injured back - I'm thinking of hip flexors in particular since some connect to the lower spine - make certain to proceed under the direction of a well-qualified Dr and have closely supervised PT.

When recovering from a torn meniscus, no surgery, I asked my orthopedic Dr to recommend a specialist who could evaluate my knee posture for physical therapy. He found issues that would not have been otherwise brought up.

[r2473]

Originally Posted by netman

Hi Kevo82. I'm the OP.

Have patience. Nerves can take a very long time to recover from trauma. Fact is they will probably never get back to 100%, but they will recover. I ended up not having surgery, so it took a long time for me to get back into the game. But I have been playing pain free for over 3 years now. Definitely have some weakness on my right side (the nerves affected) but I just changed some techniques to adapt.

The key thing to remember is "listen to your body". If it hurts, give it a break. I can tell you from hard experience that failure to back off when your back hurts or pushing it too long or too hard will cause problems and even a relapse. Use common sense, recognize you are working with a different back now, and adjust accordingly. Then you'll be back in the game for the long run.

-k-

That's been my experience.

I had surgery to repair a snapped distal (elbow) bicep tendon. 16 weeks out now and the arm is 90% or better. Playing tennis again already at pretty much full effort.

But to do the surgery, they had to move a nerve or two in my arm. After the surgery, it was really bad. Felt like the whole top of the arm below the elbow was "asleep". 16 weeks later, there is still a spot ranging from the wrist just below the thumb to about the middle of my forearm. Only about an inch wide. Rest of the arm is now fine.

The surgeon is actually only interested in how my nerve heals (because he knows how the tendon heals) and really wants me to follow up with him at the end of November (when it will be as good as its going to get in his opinion...6 months postop). He said its about a 50/50 proposition in his experience and he's trying to see if he can figure out why some people recover 100% and others don't. Crossing my fingers that I'm one of the lucky half.

I was at a party a few weeks ago and randomly met a surgeon that also worked on the arm. She said nerves heal at 1mm per day (she told me to be patient ). At this rate, mine should have healed 112mm or a little less than 4.5 inches, which I'd say is fairly accurate.

[Posture Guy]

When I started with Egoscue as a client back in 1999, I had two bulging discs, one herniated. I was a candidate for a lumbar fusion. Had been doing PT, which was not and is not terribly effectively for this kind of issue. There are certain things traditional PT is great at, this ain't one of em.

Started up as an Egoscue client and was soon running and playing tennis pain free. Have never been back to the surgeon's office since, low back has been pain free since 1999. Am 51 now, back is stronger than ever.

Here's the thing: people focus on the disc that's out of place, but that is not the problem. The problem is the spine's misposition that is pushing the disc out of place. The herniated disc is just the end result of a long process. And if treatment is simply focused on the disc and not the process and the forces causing the herniation, then the end result will not be satisfactory in most cases.

[tennis_tater]

Originally Posted by Posture Guy

When I started with Egoscue as a client back in 1999, I had two bulging discs, one herniated.

I'm just curious, but did any of your diagnostic tests show that either of the bulging and/or hernitated discs were actually pressing or pinching on any nerves?

While I'm fine proceeding forward conservatively, when I initially had my back injury many years ago, all I had was back pain. I never had this "leg weakness" that has just all of sudden come about. I'm just concerned that the longer I let a disc pinch or damage the nerve, that it could result in irreparable damage to the nerve that won't be able to be reversed. Just curious whether you also had nerve impingement and if your therapy was able to relieve you of those particular symptoms.

[Posture Guy]

Tennis_tater....for me personally, I had no nerve impingement. Since opening our clinic in 2003, I've worked with hundreds of clients with that situation, though.

To me, the "irreparable damage to the nerve" argument is more theoretical than practical. I've yet to meet anyone who suffered such "permanent" damage. With the clients I work with, if the impact on quality of life as we proceed with the therapy is too severe, then one option is to get a micro-disectomy, and get as little of the disc removed as possible to create clearance from the nerve root. Then work on the postural issues that created the impingement in the first place.

But in most cases, we can resolve the impingement non-surgically.

[Frank Silbermann]

Originally Posted by courtrage

oh ok...i never saw the video...only problem i see is 'all in your head' has such a negative conotation...ie... 'its made up'...you and i know what it means though...also, physical conditions aside, i have noticed that personality predisposes people to that too...i stress over SO MUCH for no reason...think that is the cause of any 'flare ups' cause i notice weird anxiety or pain or whatever when i start thinkin about my getting married soon guess i just worry too much...

My son suffers chronic headaches after two minor concussions, but it's all in his head.

[jwardb]

That aside, for those with L5-S1 nerve impingments, I'm just curious how many of you responded to PT as an alternative to surgery? How does PT get the disc off of the nerve?[/quote]

First of all, sorry to hear that you're having to deal with this. It's a struggle. But the OP's original post is full of excellent advice -- at least in my experience.

I posted my story here (post #59)
http://tt.tennis-warehouse.com/showt...=354345&page=3

My MRI showed a 6-10 mm extrusion (i.e,. rupture) that "displaced the traversing right S1 nerve root..."

I did not have surgery. I responded very well to regular PT and have maintained a very regimented strength and flexibility program since then. (And I'm far more careful about posture.) Once I resumed competitive level tennis several months later, I played for many subsequent months with various frustrations and problems with technique that were ultimately connected to the loss of strength in my leg. I am almost exactly one year out from the injury and now playing at about 90% of where I was.

Mine is of course only one story. But, for me, the PT (and eventually swimming) were very helpful for getting me back on track as my back was healing. I am thankful every day for where I am now.

Good luck.

[kevo82]

This is one of the most severe injuries.

You never get 100% after, and because of the back problem, you will get injuries in other parts of the body.

I have no back pain after micro discectomy (almost 11months ago), but I have other problems. The leg it's weaker and if I have 3 days without stretching or strenght exercises (or tennis training), I get tingling and strange sensation in the leg.

If I play tennis, subconstientely I protect the left side of the back and I over use the right side, and one day after the training, I get intense muscle pain (quatratum lumborum).

So I have to choose between nerve tingling, or muscle pain. At least I don't have back pain.

And secondary I have some pain in the right hip. The same as Jo Wilfried Tsonga got injuried in the right knee because he was protecting his back (L5-S1 herniated disc). He had no surgery. This year, after Miami, I read that he was thinking about surgery, but after all he didn't had it.

I got the answer why Higuain got back so fast after the surgery...he had an endoscopic surgery, less invasible than micro discectomy, where it also removes some bone (laminotomy) and ligament. On the other hand, discectomy should offer more certainty that the herniation it's cleaned perfectly and no disc fragments are left.

After my micro discectomy, the back it's almost 100% but the nerve it's not, and I don't think it's because it takes longer to heal.

I think that it's either because the surgery was just to remove the disc fragments (without healing the disc) and the disc kept herniating, either because the surgery didn't cleaned perfectly all the disc fragments around the nerve.

I was thinking if another surgery (to clean all the fragments and herniation around the nerve root) would be a smart choice, but I don't know. When I keep working the muscles I have no nerve tinglings, but I can't do that forever. And even so, I still have weakness in the leg sometimes and I don't feel 2 toes at 100%

[*Val*]

Originally Posted by netman

As I write this I'm in week 3 of dealing with a massive disc herniation and the resulting radicular pain. I have enjoyed reading the other posts here on the topic and thought I'd add some more info since this is a chronic condition for me. This is the second time. Last one was 7 years ago. Unfortunately, once you do it, its probably going to happen again since back discs never fully heal since they have no blood supply. I've learned a lot over that time and thought I'd contribute it to the knowledge base building here on the forum.

(1) Conservative treatment is best. This is now being validated frequently in medical journals. It is no fun dealing with searing nerve pain for 2-3 weeks, but in 80% of cases, most pain is gone and disc material has re-absorbed significantly within 4-6 weeks. This is what happened for me the first time. There is little statistical difference in outcomes between conservative treatment and surgery even after only 2 years, so you should always exhaust all conservative options first.

Where on earth did you read that? Does not happen. Discs do not heal

[jwardb]

Disc resorption is a common phenomenon though it is not equivalent to 'healing' if the latter is understood to mean that the disc somehow repairs itself with a fully intact nucleus pulposus and annulus. OP never suggested the latter, only the former, namely, that the extruded stuff gets broken down by the body over time.

At any rate, Kevo, I agree that a 100% return to level is very unlikely in most instances, certainly mine. In my case, there's still lost strength in the affected leg (despite regular weightlifting) which makes me uncomfortable stepping into drive backhands during long points -- what was my best stroke has now become a liability at times. And, more generally, there are certain positions I just won't put my body in, whether it's a conscious decision or not. Really, it's grinding out long points that is now so much more difficult, regardless of fitness level...And I agree that compensating in various ways leads to other aches and pains and potential muscle strains. Getting old stinks!

[*Val*]

Originally Posted by jwardb

Disc resorption is a common phenomenon though it is not equivalent to 'healing' if the latter is understood to mean that the disc somehow repairs itself with a fully intact nucleus pulposus and annulus. OP never suggested the latter, only the former, namely, that the extruded stuff gets broken down by the body over time.

Well yes the protrusion can diminish over time but ASFAIK never to the point where there is zero protrusion (unless surgery is involved, which is the purpose of an operation), and the outer part (annulus) can never repair the hole properly. But to suggest that the protrusion will resolve itself in 4-6 weeks is quite laughable frankly

[Frank Silbermann]

I don't think anyone really understands lower back pain. Even with MRIs I don't think doctors can see a nerve being compressed by a herniated disk. All the MRIs show is where disks have herniated.

Everyone middle-aged has herniated disks. Most do not cause back pain. Some do. If one is compressing on a nerve badly doctors can try to clean up the worst one and hope that was the one. Sometimes it is. Sometimes it wasn't, and you end up just adding to your problems. If the doctor guesses right and fuses the vertebrae he prevent further injury at that spot -- at the cost of leaving you with a less flexible spine overall (which increases the vulnerability of other vertebrae). That's why surgery is considered a last resort, and usually only if there are elements of paralysis resulting.

For most people, the right kind of rehabilitation seems to be more effective that surgery. I don't think anyone knows exactly how rehabilitation helps, though -- how the body uses the midsection muscles to protect the spine. (In the early stages of recovery, carefully tiring the muscles might serve to reduce muscle spasm while waiting for the body to reabsorb part of the protruding disk.)

And who knows for certain that the hole through which the disk ruptured cannot at least partially close over time?

[tlm]

Originally Posted by netman

As I write this I'm in week 3 of dealing with a massive disc herniation and the resulting radicular pain. I have enjoyed reading the other posts here on the topic and thought I'd add some more info since this is a chronic condition for me. This is the second time. Last one was 7 years ago. Unfortunately, once you do it, its probably going to happen again since back discs never fully heal since they have no blood supply. I've learned a lot over that time and thought I'd contribute it to the knowledge base building here on the forum.

(1) Conservative treatment is best. This is now being validated frequently in medical journals. It is no fun dealing with searing nerve pain for 2-3 weeks, but in 80% of cases, most pain is gone and disc material has re-absorbed significantly within 4-6 weeks. This is what happened for me the first time. There is little statistical difference in outcomes between conservative treatment and surgery even after only 2 years, so you should always exhaust all conservative options first.

(2) Begin activity as soon as tolerable. Its probably only going to be slow walking at first and may only last 5-10 minutes, but getting up and going is critical to flushing out the inflammation and helping the healing process. Cross training is your friend, especially in the first 3-4 months after a disc injury. Ice should be your constant companion. If you love tennis, stay focused on getting back on the court. Its a great motivator to get you through the tough periods and occasional set backs.

(3) Live with it. It's never going back to perfect. Back discs not only lack a direct blood supply to help healing, because of this they continue to dry out and shrink as you age. Accept you have to modify your exercise routines, their frequency and intensity. You'll have good days and bad days, so get to know your body and listen to it. When the pain is outside the normal levels, pay attention and give it a little extra time to rest and recover.

(4) Be careful playing through it as recommended in the NY Times article posted here. I actually have used that strategy frequently with success and tried it this time. Had some leg pain early in the week. But had a big match coming up on the weekend, so went out Thursday and practiced. Back felt much better so played on Saturday. Woke up Sunday morning unable to walk and in so much pain I would have gladly amputated my right leg. This pain lasted almost 2 weeks. So you can make matters much worse if you don't know what you are dealing with at that moment.

(5) Tennis is brutal on the back, particularly the low back. No way around it. You twist it violently, pound it constantly with stops and starts, and flex and extend it without mercy. So strengthen the muscles that protect it. And give it a few days off when it tells you its had too much. If I've had a particularly rough match or series of matches in a short time, I'll take a couple days off, then hit with the ball machine without a lot of running or twisting to ease back into things.

(6) Clay is so much easier on your back than hard courts, its worth making it your primary surface if you have the option. When I play clay I can play 2 hours a day for 4-5 straight days with almost no pain. If I tried that on hard courts I'd be done for months.

Good news is I've been able to continue to play competitive tennis at a decent level for the last seven years. Can't play every day and singles has become a once in a while treat, but doubles is a great game and offers many challenges not found in singles. I've modified my service motion and slowed down my strokes a bit. Don't run down every ball. All simple adjustments that make it easy to continue to play and enjoy a great sport.

-k-

I strongly suggest for anyone with back problems to go to - lose the back pain .com and purchase their system it worked wonders for my cronic back problems.