General Discussion Triathlon Talk » L5-S1 protrusion, microdiscectomy, and 140.6 aspirations Rss Feed  
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2012-10-16 6:16 PM

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Subject: L5-S1 protrusion, microdiscectomy, and 140.6 aspirations

For starters, I know this has been discussed in several threads over the years (I think I've read them all).  Nevertheless, I'm interested in soliciting information from people who have experienced something akin to my current situation (I apologize for the length - if you get bored, skip down to the last paragraph):

I'm a 38 year old desk jockey, with many years of recreational & competitive cycling, just getting into Tri.

My 'A' race this year (as it was the previous 5 years) was Lotoja, a 206 mile bike race from Logan, UT to Jackson, WY in early September.  Following this, I was planning on shifting back to Tri full time, with a 1/2 IM distance race in October, then a short winter offseason followed by a lengthy build, culminating in IM Cozumel in 2013.

In early July, I strained my back while climbing on a road ride that incorporated some 20+ percent grades (it was on 'Empire Pass', as used in the last stage of the Tour of Utah this year).  I had a similar injury last summer, while climbing on my singlespeed mountain bike.  In both cases, I was making my way up a hill that was a bit too steep for the gear I was riding in, forcing me to utilize my upper body and back muscles to keep the pedals turning.  In both cases, I experienced a sore back for several weeks after the injury, but no additional symptoms. 

In late July, during my Lotoja build, I began experiencing what I thought was hamstring and glute tightness.  I did some stretching, and went to the massage therapist a few times, but otherwise continued to train as normal.  

In early August, I went on a lengthy (12 hours each way) road trip, during which the tightness transformed into a distinct pain, running from right buttock to the very bottom of my right hamstring.  The pain largely abated any time I stood, returning whenever I was seated.

I put on my web doctor's hat, and self diagnosed with (what I hoped was) Piriformis Syndrome.  I also scheduled a visit with a sports doc for early September.

By late August, the pain had become so severe that, after sitting through a movie with my daughter, I had to go to the emergency room (the local quick care had closed for the evening).  The Doc wasn't convinced that it was piriformis related, and prescribed Lyrica and Tramadol for pain management until I could see the doc.

Although sitting in my desk chair or a car seat was extremely painful, I had only minor issues when on my (road) bike, and those typically cleared up within 10-15 miles.

The hip and leg doc that I was scheduled to see had me perform a few range of motion exercises, determined that the injury was not piriformis related, and referred me to the clinic's spine guy.  The spine guy's PA offered a cortisone epidural (which I accepted) prescribed an MRI, and told me that I should be able to complete the ride.  The epidural didn't seem to do much of anything.

I finished the race, but the combination of painkillers I was taking contributed to severe dehydration and cramping.  True to form, my leg didn't bother me after the first 15 miles or so.  The drive home from Jackson, however, was extremely unpleasant.

I had my MRI a week after the race, and met with the doc a week after that to discuss.  It showed "At L5-S1, there is a focal right central disc protrusion. This protrusion abuts and compresses the traversing right S1 nerve"  The Doc essentially told me that I could do nothing, and that 70 % of disc protrusions are reabsorbed within 12 months.  However, he further told me that constant pressure on the nerve for more than 9 months will generally lead to permanent nerve damage.  He then stated that he could perform a microdiscectomy (and described the operation in brief), noting that it carried a 95% success rate, and that it would require only one night at the hospital with me able to walk out the next day, and that recovery is typically 'six weeks of restricted activity - no lifting anything over 15 lbs, and a back brace to support the back'.  Alternate treatments (PT, accupuncture, etc.) were not discussed.  I decided to schedule the surgery to secure an appointment, with the understanding that I could cxl at any time.

After doing some more research, I became alarmed to learn that many folks who had gone through the surgery were no better and that the success rate quoted in peer reviewed studies tended to fall off rapidly after 2-5 years, that some who had gone through with the surgery after years of sciatica had complete relief (thus belying the '9 month' window for permanent damage theory),  the doc had not bothered to mention the average 2 week recovery time before returning to work (for non-physical occupations).  I felt that I had been rushed into pursuing surgery, and decided to cancel the surgery and seek out the best doc I could find (within my network) for a second opinion.

I also discovered the McKenzie method, and began practicing its exercises on a daily basis.  After doing so, the pain changed from a constant agony whenever I was sitting (7-8 out of 10) to a completely unpredictable companion...occasionally almost absent (1-2), other times moderate (4-5), and still others a return of the constant agony.  Throughout all of this, there would be instances of flaring (usually when standing up after sitting for a long period of time) to an unbearable, stars-before-the-eyes inducing lightning bolt (11 out of 10).

That brings me to today - I see the new doc in a little less than two weeks.  I'll ask him all of the questions that I didn't ask the previous doc: options, long term prognosis, time off of work, etc.  My overall quality of life has degraded to the point where I need to take some kind of action to address the problem - I refuse to passively accept that this is the new norm.  I've been largely refraining from exercise until I hear from the doc what I should and should not do.  I've sold my old, very aggressive road bike (S Works e5), and picked up a more relaxed ride (Scott CR1).  I'm afraid to run, and have frankly been too depressed to get the motivation up to hit the pool (never my favorite thing, even in the best of times).

For folks who have gone the microdiscectomy route, how long were you sidelined entirely?  How successful was it?  How long did you wait until you resumed S/B/R, and how long until that resumption could be deemed 'training'?  How long did you wait until your next race, and how did it go?  For those who chose an alternate treatment, what did you do?  Did it work?  How long until you experienced relief? 

Thank you in advance for wading through all of this, and for your responses.

 

SYJ



2012-10-18 7:23 AM
in reply to: #4456661

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Subject: RE: 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 Smile). 

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!!  Smile).  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.

2012-10-18 2:35 PM
in reply to: #4456661

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Subject: RE: L5-S1 protrusion, microdiscectomy, and 140.6 aspirations

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

2012-10-23 2:30 PM
in reply to: #4456661

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Subject: RE: L5-S1 protrusion, microdiscectomy, and 140.6 aspirations
80% of them resolve in 3 months.  Ask about an oral tapering dose of steroids and/or an epidural injection before jumping in with surgery. Both of those work nicely for this problem. 
2012-10-31 6:53 PM
in reply to: #4456661


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Subject: RE: L5-S1 protrusion, microdiscectomy, and 140.6 aspirations
I'm new here but I've been where your at. 15 years of powerlifting and strongman contest beat me up. I refused surgery until I couldn't get any more epiderals so I saw a surgeon. I knew the back was bad for a long time. Let me tell you get the surgery ASAP you won't regret it. I had my l5,s1 microdiscetomy. L4 lumbar decompression trimming the vertebrae. It's considered out patient surgery your in there for less than 24 hours. Took a week off from work but didn't need to. Started cardio for the first time in my life 2 weeks later. Light lifting followed. My only regret is that I didn't do it sooner. Pain free lifting and running if I could only swim you guys would be in trouble. Lol. Good luck. Any questions feel free to ask
Mark
2012-11-08 1:23 PM
in reply to: #4456661

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Subject: RE: L5-S1 protrusion, microdiscectomy, and 140.6 aspirations

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



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