L5-S1 protrusion, microdiscectomy, and 140.6 aspirations

I feel your pain.  Literally.  Well, almost.  My story:

I'm a 43-year-old desk jockey.  Long running background since high school...started doing tris in 2010.  Was training last spring for a series of Olys at an HIM training level, and tweaked my knee running somehow.  Went through MRIs, cortisone, etc. to no avail.  Had arthroscopic surgery last August.  Knee improved some but still couldn't run even after four months.  I would up doing something to the other knee compensating, so now both knees are tender and I basically can't train.

I was bringing down the Christmas decorations last December, and because my knees were so messed up I couldn't lift correctly and would up injuring my back.  I went to my GP and he just game me Tramadol and Flexiril and said I had a bulging disc; I knew something else was wrong.  I sought a 2nd opinion from a well-respected spine surgeon and he gave me prednisone to see if we could get the pain down.  That worked a little bit but not much, and once it wore off I was in tremendous pain again.  He prescribed an MRI and it found some bulging discs, some of which were probably degenerative in nature from being an athlete for 30 years at 6'3" 210 lbs.  His prognosis was basically rest and pain meds until it healed, with no definitive time frame.

Frustrated to no end and still in great pain (yeah, I get the 11 out of 10 scale thing, and I also had the most problems sitting in a car), I went to see a chiropractor.  He reviewed the MRI, did some x-rays and some tests, and we discussed the spine surgeons prognosis.  My chiro's exact words were "he is wrong".  Oh, boy. 

My chiro prescribed basic chiro treatment with elec stim, manipulations, Graston, and advil as needed.  We also started some real basic stretching and PT for my back (one-leg balance drills, back bridges, and planks were the most prominent).  I saw some decent improvement over the next 8 weeks. 

I asked whether swimming could be introduced and he said have at it, taking it slowly at first.  The first length was painful and then some improvement.  I think I did 400 yards total that first one and I couldn't do anything that hyperextended my back (like forward kick drills).  I kept swimming, slowly increasing the swimming load until I got to about 6K yards a week in March/April.  I also started going for long walks with my wife, and then I tried to bike a little, and then power walk on an incline as little. 

In the meantime, we had plateaued with my treatment with the chiro, and he had initially indicated about a three-month treatment program for 75-90% recovery.  We definitely weren't there, and I had a lot of instability in my hips popping in my lower back.  So, he sent me to another spine surgeon who performed more detailed testing like flexion/extention x-rays, etc.  Bingo!  New diagnosis.  Spondylolisthesis.  What the hell is that, I asked.  Basically, it is shearing of two vertebrae because the connective supporting bone structure has failed, either through trauma or degeneration (or both in my case). 

My doc said you need surgery (spinal fusion L4-L5) because of your desire to continue being an athlete, but wanted to try a more conservative approach first while we decided when to have the surgery (because it has a six-month recovery period).  First step was a steroid injection.  My back really flared up (so it was actually worse), so my surgeon gave me another round of prednisone and my back started to improve.  I took that opportunity to intensify my PT program and introduced strength training, both upper and lower body.

Since then, I had a 2nd epidural in August and have continued to improve.  I got a new bike fit that solved my knee problems for the most part.  I'm now training 6-8 hours a week and am about to re-introduce running on a couch-to-5K program, with the hope of returning to triathlon "glory" next summer.

So to summarize, I've managed to avoid surgery (which I REALLY don't want) through very dedicated core training, plus I had to learn how to do certain things in my daily life differently, like:

1. I have a lumbar support in my car
2. I lift objects differently, and I have to be really cognizant of engaging my core
3. I MUST do my core and strength training as my #1 priority workouts of the week to be able to do other things
4. I stop training immediately for a couple of days when things flare up (knees, back, shoulders, whatever)

My advice to you would be to find a chiropractor who specializes in dealing with athletes and try some passive therapy first.  Then slowly introduce core work and do as much cycling as you can tolerate.  Add in some incline walking as you can.  Get back in the pool gently and just swim some laps easy (note:  I don't like swimming either ). 

These injuries take time to heal...I'm ten months in and I would say my back is 90% most days with some occasional flare-ups but they're nothing like the hell.  Back in January I wanted my back cut open and fixed, the recovery and risks be damned.  I'm glad I was patient.  Me (and my family!) dealt with a lot of pain, frustration, and worry through this process.  And some REALLY dark days and thoughts about the future.

I also know that I'm probably permanently limited in some things and that 90% is about where we're going to top out.  But, I can also swim and bike to my heart's content (subject to my other many limiters, including my lack of swim talent).  I can run a little bit.  I can strength train and do core work as long as I'm careful about what I do.  I can do most of the stuff around the house, with some modifications on how I do it.  I can't carry my daughter up to bed anymore (but she was getting to big for that anyway pre-injury!!  ).  My blog/training logs give all the details, starting back in January for my back and all the way back to June 2011 if you are bored and want to follow the whole story.

I hope your back recovers to where you are able to reach your goals, even maybe if you have to modify them some, or delay them.  Back pain is hell, and anyone who has never had it has no idea about how bad in can be.  Good luck and PM me if you want any more info.

Mike,

Thank you for the reply.  I've always been part of the "Chiros are quacks" school of thought, but I think that's because good ones are so difficult to find.  The more I learn, the more it looks like I may be best served by finding a good one to help guide things along after the 'conventional' therapies have done their best.

The goal re-setting is a tough one.  Doing a full IM before 40 rapidly progressed from a random thought to a hard and fast goal.  Quitting - especially before I've really begun - is not something I'm comfortable with.

I wish you the best of luck in your continued recovery.  I may well take you up on your offer to touch base as I make my way through this mess...

Thanks again,

SYJ

Well, I had the second opinion - essentially, "what the other guy said, only worse".  He spent a good hour reviewing the MRI with me, and pointed out that this was likely a full herniation, with nucleus pulposus outside of the annula (you couldn't see it in the frame bisecting the disc itself, but in the next (lower) frame, you could see what appeared to be a floating mass).  

I've scheduled surgery for January 16, and in the meantime will be getting some nerve root blocks and starting a course of gabapentin to manage pain.

I'm determined to still do my 140.6 before 40 (I have until May, 2014), and so am looking into IM Cabo in March of 2014.  Also still planning on doing Lotoja (again) in Sept. of 2013.

SYJ