Disc herniation - Some thoughts (Long)

[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-

 

[Arthur Epperson]

Inversion

You might try hanging upside down on an inversion table. I have chronic low back problems and this has helped me tremendously.

 

[stevewcosta]

Sorry to hear that. After a bad car accident 7 yrs. ago (4 hern. discs in back, 1 in neck, ligament damage in knee), I went from incredible shape to feeling 60 (was 30 at the time). Controlled weight training is vital for me. My advice is to incorporate low weight training which you probably do already etc. and don't arch the back so much on serve. Do you have a 2hbh? I find my one-handed gives me zero pain but the torque caused by 2hbh would be out of the question (also stay away from golf--king of the back killers---tried to hit 2 balls last yr. and was out of commission for a week). Back injuries are terrible. Something as simple as putting a shoe on without being careful can re-injure your back. Good luck.

 

[courtrage]

'healing back pain' by john e sarno, MD, did wonders for me. car accident 5 years herniated two lumbar discs and would flare up on me from time to time over the years and now i have no issues since march. this last time in march i finally decided i had to do something about it cause i couldnt walk for a week and after that i was leaning to one side when i did start walking again...looked into spinal decompression but at 5-10K$ i'm glad i didnt do it cause a 15$ book on CD from amazon did the trick. i'm 28 by the way. thats why i looked into treatments like decompression cause i thought i would only get worse when i got old...like well into my 30s and up!

 

[netman]

Sorry to hear that. After a bad car accident 7 yrs. ago (4 hern. discs in back, 1 in neck, ligament damage in knee), I went from incredible shape to feeling 60 (was 30 at the time). Controlled weight training is vital for me. My advice is to incorporate low weight training which you probably do already etc. and don't arch the back so much on serve. Do you have a 2hbh? I find my one-handed gives me zero pain but the torque caused by 2hbh would be out of the question (also stay away from golf--king of the back killers---tried to hit 2 balls last yr. and was out of commission for a week). Back injuries are terrible. Something as simple as putting a shoe on without being careful can re-injure your back. Good luck.

Sorry to hear about your accident. You have a much worse scenario than me. I admire you for staying at it and getting back into tennis.

I hit a 1HBH. Never could master the 2H. Agree on the serve. I dropped my kick serve completely and have gone to a more abbreviated motion, sort of like Roddick's. That really helped a lot. I hear you on golf. All my friends play and I can't because of the back torque.

You hit the nail on the head on back injuries. Folks who have never had a serious one don't understand how painful they are and how easy it is to trigger them. Every time a friend of mine goes down with one they always tell me that now they understand what I've been telling them about the pain and frustration.

Thanks again for the input.

-k-

 

[netman]

'healing back pain' by john e sarno, MD, did wonders for me. car accident 5 years herniated two lumbar discs and would flare up on me from time to time over the years and now i have no issues since march. this last time in march i finally decided i had to do something about it cause i couldnt walk for a week and after that i was leaning to one side when i did start walking again...looked into spinal decompression but at 5-10K$ i'm glad i didnt do it cause a 15$ book on CD from amazon did the trick. i'm 28 by the way. thats why i looked into treatments like decompression cause i thought i would only get worse when i got old...like well into my 30s and up!

Got all Sarno's books. He is definitely on to something. The NY Times article being circulated here is basically stating what he has been saying for years. But be careful as I stated in my original post. It is still a mechanical injury and it can still flare up. Sarno acknowledges this in his books, that you will still have episodes. Basically all he is saying is live with, manage it and don't let it control your life. Good advice for any chronic condition.

If you haven't read any of Dr. Stuart McGill's books they are worth a read. He is a leading expert on low back injuries, what causes them and how to rehab them. He has 2 books that should be in every athlete's library: "Low Back Disorders - Evidence Based Prevention and Rehabilitation" and "Ultimate Back Fitness and Performance." He is the guy the world's top athletes go to when all other efforts to fix their backs have failed. He is not a surgeon, but a biomechanics expert who has been studying the spine for over 20 years. His web site is located at:

http://www.backfitpro.com

You can only get the books directly from him, unless you can find them used. Fascinating stuff and will really help anyone understand the workings of the spine and how so many different body systems effect it.

-k-

 

[ollinger]

Agree strongly about surface. I play nearly all my tennis on Har-Tru and my back problem of 12 years ago virtually never bothers me. I was away on a trip to Arizona last week and played on hard court -- could barely straighten up for about 2 days after I played.

 

[courtrage]

Got all Sarno's books. He is definitely on to something. The NY Times article being circulated here is basically stating what he has been saying for years. But be careful as I stated in my original post. It is still a mechanical injury and it can still flare up. Sarno acknowledges this in his books, that you will still have episodes. Basically all he is saying is live with, manage it and don't let it control your life. Good advice for any chronic condition.

.....

-k-

i got his fourth book(newest one) and then his second book...they were the only two on CD. i thought 'episodes' were all still mindbody related and not due to the 'mechanical' issue? i've listened to both books at least 2-3 times and i didnt hear much on having other episodes... ?

 

[desilvam]

Agree strongly about surface. I play nearly all my tennis on Har-Tru and my back problem of 12 years ago virtually never bothers me. I was away on a trip to Arizona last week and played on hard court -- could barely straighten up for about 2 days after I played.

Since I am stuck with hard courts here, I have to use extra padding in my shoe.
I use well padded shoes + extra insoles + Gel soles for heel + padding from my ankle brace. .

 

[desilvam]

Great post by Netman. I am saving this thread for reference.

Also agree with stevewcosta on the tennis style changes required.

I have changed my game from:
Topspin serve + S&V
to:
Simple 'no body rotation' slice serve, slice/under spin/flat on both flanks and rarely S&V anymore.

My topspin on both flanks are pretty good, but I use topspin only for passing shots.
My serve motion still has too much back arch in it (emulated stich). I am slowly trying to cut down on back arch, with an increase in knee bend.

 

[netman]

My serve motion still has too much back arch in it (emulated stich). I am slowly trying to cut down on back arch, with an increase in knee bend.

Definitely watch some video of Roddick. He gets tremendous power from his legs. When I watched him in slow motion I really understood what an abbreviated motion he has. Monfils is another player with this type of motion. I'll never hit monster serves like these guys but it has really helped take the torque off my low back.

 

[netman]

i got his fourth book(newest one) and then his second book...they were the only two on CD. i thought 'episodes' were all still mindbody related and not due to the 'mechanical' issue? i've listened to both books at least 2-3 times and i didnt hear much on having other episodes... ?

I have his video and he references how there will be flare ups, but don't let it get you down. The one area I disagree with him, is his assertion its all in your head. Thats like telling someone to shake off a fractured arm because there is no clean break. To make that kind of statement is too ignore mountains of evidence on spine mechanics and aging.

I personally feel the strength of his argument works in those cases where there is no quantifiable evidence of nerve impingement or a major disc prolapse. The human nervous system is definitely a very low precision measurer of the source of pain, particularly the further inward you move. Whereas fingertips are incredibly precise, as you get into the core of the body things tend to be more diffuse. Like when your appendix is inflamed and ready to burst and all you feel is pain throughout the abdomen and lower chest with no specific pinpoint of pain. Same thing seems to happen with the spine. And I also agree that the brain has an incredibly long capacity for remembering where pain occurred, even long after it is gone, thereby making folks thing they hurt when they don't.

I've found a mix of McGill and Sarno to very effective in dealing with my back. But if Sarno is working for you don't change. The goal is to stay active whatever it takes.

 

[courtrage]

I have his video and he references how there will be flare ups, but don't let it get you down. The one area I disagree with him, is his assertion its all in your head. Thats like telling someone to shake off a fractured arm because there is no clean break. To make that kind of statement is too ignore mountains of evidence on spine mechanics and aging.
...

I've found a mix of McGill and Sarno to very effective in dealing with my back. But if Sarno is working for you don't change. The goal is to stay active whatever it takes.

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...

 

[jwardb]

At the risk of bringing up what are by now (hopefully) just bad memories let me say 'thanks' for this old post. And may I ask: how long before you started hitting again?

 

[Posture Guy]

Glad to see this thread resurface.

I'll try to keep this short. I was in a near-fatal car accident back in 1992, a guy pulled off the median of I-10 right in front of me, I never had a chance to take my foot off the gas. I went from 70-0 in less than a second. Then a few seconds later someone hit me going about 45. Not a fun night.

I went through physical therapy 5-6 days a week for almost two years trying to get my body back. Was told I'd never run or play tennis again. And the way I felt, it seemed they might be right but I kept looking for ways to come back. Fast forward 6 years later and I have two bulging discs, one herniated, and my back pain is so bad I can't tie my own shoes. Through an Internet search I found the book "Pain Free" by Pete Egoscue and thought it made the most sense of anything I'd read up to that point (and I'd read a LOT looking for a way to get my body back). Very long story somewhat shorter, I worked out of the book for a month or so then decided to make the investment of money and time to start working with one of the Egoscue clinics, and a year later I was running and playing tennis again, pain free. I'm now 50 and I play at a 4.5 level with no back pain whatsoever and an xray shows that I have no arthritic change in my back and virtually no loss of disc height at any joint segment.

the change was so profound I ended up going through their training and becoming a practitioner, ultimately opening an Egoscue clinic in Austin, TX. It's the most effective thing I ever found (and have yet since seen) for helping people with back pain return to normal function. You do NOT have to accept pain just because you play tennis.

I also am a big fan of Sarno's books, there is no question he is addressing a component that is relevant for a number of my clients. Wasn't my issue, but I've seen it help a number of people.

You can see a picture of my car and read more about my story on my blog if you're interested.

http://egoscueaustin.wordpress.com/2007/04/08/my-story/

Just sharing my story and experience, hope it can help some of the folks in here.

 

[Andreas1965]

Had two herniated disks the first one in 1998, the second around 2002.

Refused to undergo surgery, did physio extensively, took as much painkillers I could and tried to be active again as soon as possible. That time roadbiking was my major sport, I was racing and training 'bout 6 days/week. Around 15.000 km/year.
So it really hit me in the balls to be unable to ride bike from one second to the other. But this was my best motivator to overcome pain! In week 3 I grabbed my bike and went for a short, painful ride. Each day now on was better than the day before. Finally I could sit on the bike for 5-6 hours again.
Tennis was no option in the first 6 months, my orthopedist strongly advised not to do this.

Today? It's ok, but never will be perfect again. Right now I'm sitting by the pool in a beachchair and my left calf/foot hurt a little. I know this feeling, it's coming from my spine.

I can play tennis as much as I want, it'll hurt after anyway. Cycling is painless.
I learned to stop thinking or worrying about my back, try to focus on other things.


---
I am here: http://maps.google.com/maps?ll=26.132393,-80.105580

 

[kevo82]

Nobody from here had a surgery? Everybody got better without surgery?

I am 5 weeks after surgery

Many thanks to Rick for showing me the Egoscue posture videos.

I should have already started the recuperation program, but I will wait one more week, to see the result of a new MRI, to be sure everything is perfect before making effort.

Things are going better, I am more flexible than last weeks, the leg is getting better with less tinglings and numbness.

Sooner than April, I don't have any expectations about playing tennis

Before the micro surgery from 5 weeks ago, I had an Idet procedure in August, which is a minimal invasive procedure that burns inside of the disc.
This made everything worse, but I guess that now I won't have a risk of herniation, if the disc is burned in the middle.

I will see how things are going with the posture and recuperation program

 

[TennisMaverick]

Nobody from here had a surgery? Everybody got better without surgery?

I am 5 weeks after surgery

Many thanks to Rick for showing me the Egoscue posture videos.

I should have already started the recuperation program, but I will wait one more week, to see the result of a new MRI, to be sure everything is perfect before making effort.

Things are going better, I am more flexible than last weeks, the leg is getting better with less tinglings and numbness.

Sooner than April, I don't have any expectations about playing tennis

Before the micro surgery from 5 weeks ago, I had an Idet procedure in August, which is a minimal invasive procedure that burns inside of the disc.
This made everything worse, but I guess that now I won't have a risk of herniation, if the disc is burned in the middle.

I will see how things are going with the posture and recuperation program

My surgeon dikked me. Took two years for my multifidus muscles to fire properly. My sciatica was so crazy intense, that they couldn't believe that I went that long without meds and no sleep for weeks. Two cortisone shots in 14 days, and then the knife 10 days later. They were supposed to clean-up the disk only, but it had already healed. They took out a huge chip of disk from the exit hole of the sciatic nerve, which was where the pain came from, then they grind down three vertebra, L345, to improve mobility, and recessed ligaments on one side ONLY--A-hats--just to get in there, none of which was explained pre-surgery and all of which caused for two years plus of PT, and three more injections.

I've been pain free for these almost 4 years, since I walked into my room from recovery, which is the only good thing, but my right side is weak, and it fatigues when I play, especially from topspin OHBHs and the lower body rotation. Make sure to do all of the plank(s) and other core exercises, bird dog, etc., electrical stim helps the muscles fire and get back to normal as well. After my multifidus muscles were 90%, I started to do a little, but very little running, which helped to equalize the muscularity of both sides. But if jail would not be the result, my surgeon would have been thrown out a window. And he is chief of back surgery in the hospital where vets from all over the country come to fix their war related back injuries because this hospital is considered the best in the USA and he's supposed to be the man.

 

[kevo82]

But if jail would not be the result, my surgeon would have been thrown out a window. And he is chief of back surgery in the hospital where vets from all over the country come to fix their war related back injuries because this hospital is considered the best in the USA and he's supposed to be the man.

So they said the only procedure they will do to you is cleaning the herniated fragment, but they also made laminotomy?

A friend made the surgery 2 weeks after me, and he had an incision of 4cm and the doctor made not just the removal of herniated fragments, but also laminotomy and thermo coagulation.

My surgery was only the removal of the herniated fragment and cleaning of the area. The disc was not touched, and the incision was 2cm.

He is also feeling fine, but he had a bigger hernia, with 2 big herniated fragments.

I made the surgery in Istanbul at Anadolu John Hopkins hospital, and he made it in Munchen Germany.

The best surgery in USA I think is made in Chicago, where Higuain from Real Madrid made the surgery and now it's perfect.

GOD, I hope everything will be fine and I finished with this drama

 

[kevo82]

I've been pain free for these almost 4 years, since I walked into my room from recovery, which is the only good thing, but my right side is weak, and it fatigues when I play, especially from topspin OHBHs and the lower body rotation. Make sure to do all of the plank(s) and other core exercises, bird dog, etc., electrical stim helps the muscles fire and get back to normal as well. After my multifidus muscles were 90%, I started to do a little, but very little running, which helped to equalize the muscularity of both sides. But if jail would not be the result, my surgeon would have been thrown out a window. And he is chief of back surgery in the hospital where vets from all over the country come to fix their war related back injuries because this hospital is considered the best in the USA and he's supposed to be the man.

7 months after the surgery...I played tennis 2 weeks ago for the 1st time in a year. It felt great, I played without any pain (except when I tried to smash and serve), but 2 hours after the training I was feeling pain and the whole day after I was blocked.

But...after 2 days I was feeling perfect...it must helped my deep muscles to gain strenght so I will try to play again.

What I don't think that it's ok, are the timglings and weakness in my left leg! And numbness in my toes, that I feel sometimes.

I also feel that my back it's very stiff and I have pain almost all the time in the muscles on the oposite side of the surgery.

Now I re-read this topic, and when I've seen the insertions and origins of multifidus and quadratus lumborum muscles that Macerick talked about, I realised that these are the exact muscles where I had pain all this time after the surgery.

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.

Too bad that TennisMaverick got banned...I would like to know how many months after the surgery he felt this numbness, and if this got away eventualy.

I hope he will be back and send me a PM.

Salud!

 

[netman]

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]

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]

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]

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]

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]

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/showthread.php?t=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*]

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*]

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]

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.