What do you know about back injuries/treatments/etc?
May 12, 2011 8:14 AM   Subscribe

Back injury = drugs, discs, and MRIs?? Oh my!

6.5 weeks ago, I injured my back at the gym. I was doing deadlifts, came up on one, and something felt like it snapped in my back (the gym trainers believe I overcompensated for the heavy weight by turning/twisting somehow). There was intense pain, I couldn't walk, and I felt like I was going to pass out. With the help of the gym staff, I was at least able to get home. I spent most of the first week laying on my back taking muscle relaxers and ibuprofen. Since then, it has definitely improved, but I still hurt a lot sitting for any length of time, getting up from a sitting position, and beginning to walk after sitting. It hurts randomly at other times as well. I spend my entire working life on my feet, which is at least better than if I were sitting. I use a back brace off and on for support, as my doctor recommended. I also sometimes use a cane to help me stand and walk at first. I am still taking muscle relaxers, which don't always help. I have continued to go to the gym, working with my trainer on exercises that put the least amount of stress on my lower back. I often leave these sessions with a "tight" feeling in my back, but it usually isn't painful.

I returned to the doctor today after about a month from my last visit and she is talking about an MRI. While these sorts of injuries take time to heal, she is concerned with the fact that I have had tingling in my feet. She did what I believe is a disc test where I was laying down and she moved my leg upward until it hurt. I did not do well. If the insurance approves it, she would like to do the MRI, a test I have no experience with. She also talked about herniated/bulging discs and what that might mean in the long-term. None of it sounds like much fun and at this point, I fear that me and my cane are going to be friends for awhile.

My overall question can be summed up... What is your experience with back injuries such as this, MRIs, back injury treatment, etc? I have never experienced a situation like this before and everyone else that I have talked to makes it sound like they were recovered well before where I am now.
posted by itsacover to Health & Fitness (23 answers total) 3 users marked this as a favorite
The first time I had real back pain, I was just pulling on a boot. I think the damage had probably been done over time and as a result of other things, but it first came on with a pretty minor incident. (I couldn't get out of bed for three days and hobbled for weeks after.) So you may have already had a lot going on in your back, just didn't have anything to trigger it until that day.

MRI's can tell you what the disks are doing and how bad it is, but most of the time doctors want you to try physiotherapy before anything more invasive. The PT is generally based on making sure you have a really supportive core so your back takes less stress.

One of the best things about PT was the TENS unit. They can do TENS treatment in the clinic or prescribe a TENS machine for you to take home. This is incredible relief.

Probably a lot more advice you might get will depend on what exactly is going on in your back, what MRI's might show. Bulging disks are different from disintegrating disks etc.
posted by galadriel at 8:22 AM on May 12, 2011 [1 favorite]

The MRI is a diagnostic test to let your doctor see what's causing your symptoms. I'm actually nursing a back injury right now, and imaging let my doctor know that it was a muscular injury rather than something skeletal like a herniated disc. I would do the test and see what's going on there.

Have you seen a specialist, or are you just seeing your GP? There are experts in this sort of problem, and you would probably benefit from a referral to a specialist. I'd also ask your doctor about physical therapy. I know you have a trainer at the gym, but for this type of injury, you should really be working with someone who is an expert in rehab, and doing only the exercises that person says are beneficial and safe.

I'm about 2.5 weeks post-injury now, and I still have a lot of pain, but I feel better knowing that there's a plan in place to get me back to where I was before. Ask a lot of questions. Ask your doctor what the likelihood of success is for treatments she suggests and what the next step will be if that treatment doesn't work. Ask about all available options so that you can decide. Do your own research, and ask questions about what you find. Your doctor is an expert in medicine, but you should be an expert about your own body so that you can help her figure out how to help you.

I'm happy to chat further by MeMail if you'd like to commiserate. Good luck!
posted by decathecting at 8:23 AM on May 12, 2011 [1 favorite]

There are a variety of possibilities here. If it is a disc issue then there is going to be a fair amount of rehab, mobility and strengthening to be done before things will return to normal and even then you may still have the occasional issue. However, lifters have returned after much worse than you describe and still remained competitive for years after.

It is also possible that you have a muscle injury. This is the best possible outcome as it is relatively easy to rehab. I recently got over one of these (same reason, too... bad form on a heavy deadlift on a day I was too worn out to be in the gym). It took a couple months but I'm actually in better shape than before, in regards to pain and mobility.
posted by Loto at 8:34 AM on May 12, 2011 [1 favorite]

Sorry, itsacover. Apparently, this is very common -- most of my male friends in their thirties and forties seem to have some sort of back problem. I slipped a disc about ten years ago, didn't immediately treat it, and I'm still suffering from the pain on a daily basis.

An MRI is a good idea, and so is a specialist. If you're claustrophobic, see if you can get an "open" MRI, which keeps your head out of the tube.

I've tried physical therapy and muscle relaxants. Exercise and dieting helps with the pain, but the best relief I have found is in the relaxation of regular meditation. I'd recommend taking this very seriously right now -- maybe you'll be able to avoid long term pain. Pain in the legs is an indicator that a disc is impinging on a nerve, which is not a good sign. Good luck.
posted by muckster at 8:35 AM on May 12, 2011

If you're having sensations in your feet, you definitely need to do the MRI, at the very least. A herniated or ruptured disc is not something you want to ignore or allow to get worse. I ruptured a thoracic disc just over a year ago and had to have some serious surgery to fix it and get me out of extreme, debilitating pain.
posted by Thorzdad at 8:37 AM on May 12, 2011 [1 favorite]

Excuse the back 101 lesson here, but it sounds like you may be a little foggy on it. (Your doc should have done this, but sometimes it's hard to pay attention.) Your back is made up of a string of vertebrae (bones) and spongy disks, with the spinal cord as the string. Your spinal cord is a bundle of nerves that convey commands to the muscles and signals (pain, heat, cold) back to your brain. Sometimes those spongy disks get distorted, and sometimes they develop weak spots in the casing and bulge a little (this is what is called a herniated disk). Sometimes these bulges run into the spinal cord, and the nerves don't convey their information (tingling, numbness) or they are permanently On (pain). Sometimes a muscle spasm in the muscles attached to the vertebrae pulls them out of alignment, which can result in similar symptoms.

Tingling in your feet is a sign of nerve impingement, which can get better with rest, but sometimes doesn't. An MRI will show if there are any herniated disks, or if the problem is muscular. An MRI is, essentially, an X-ray for soft tissue. A standard X-ray will show if bones are displaced, but they don't work well for soft tissue. For an MRI, you will lay on your back and be slid into a big tube feet first. Depending on where you are, you may be able to use an Open MRI with no tube There will be lots of noise (even with the earplugs). In a couple of days, your doc will have the results.

An MRI will show the doc whether it's structural or muscle damage, and will allow her to determine the best course of treatment. (F'rex, doing PT for a muscle spasm will do no good if it's actually a herniated disk.)

Youi may want to skip the gym for a couple of weeks, and rest your back. "Tightness" in your back is not something you want when it's already inflamed. Are you taking any antiinflammatory meds, or just the muscle relaxant?
posted by jlkr at 8:39 AM on May 12, 2011 [3 favorites]

I'm studying bodywork - when people come to me with the kinds of issues you're presenting, over that period of time - I'd recommend them to go to the doctor and get it scanned. As mentioned above- muscles heal much easier than discs, and the types of PT and work that will help are different.
posted by yeloson at 8:41 AM on May 12, 2011

Two things they don't always tell you about MRIs: they're HOT. Ask for ice packs. The other thing they don't tell you is that they're LOUD. It isn't so bad if you're expecting it, but if you have anxiety or PTSD you might get triggered.
posted by desjardins at 8:43 AM on May 12, 2011

Best answer: I have a hard time with doctors and hospitals and such, but the MRI is really the easiest thing ever. My MRI is cold and, yes, loud. I recommend wearing sweat pants and a tee shirt, a sports bra with no metal if you have one, shoes you can slip off and on easily, and bringing a sweater/pullover (no metal), warm fluffy socks, and sweat shorts so that you can change for a variety of temperatures. You can also bring some drug store earplugs, but my MRI tech always has some for me.

My MRI routine goes something like this:

They ask a series of questions about do you have any medical implants, have you had any accidents with metal, do you work in a machine shop or cut metal... Do your clothes have any metal, did you remember to take out any piercings, do you have any tattoos which might have metal in the ink... Sometimes they run a handheld metal scanner over me for good measure.

Then there are the standard medical questions, do you get claustrophobic, when was your last period, is there any chance that you're pregnant. They have me pee in a cup and dip a pregnancy strip in it to make sure (this is for research so they take Every Precaution, I understand that genuine medical reason MRI techs may not do this--ask ahead of time so you know if you should have a full bladder or not, and make sure that you pee before you get into the MRI regardless!).

If you need a contrast MRI you may get an injection of contrast fluid at this point. I've never done this so I can't really tell you about it. I know there's some slight risk of having an allergic reaction to the contrast material, but for most people it is not a problem.

They take me into the MRI room, give me ear plugs, lay me flat on my back on the MRI table (usually with a pillow under my knees and a pillow under my head), give me a rubber squeezy thing which rings a panic bell if I squeeze it, tuck a blanket around me, and push the MRI table into the scanner. Then everyone else goes back into the control room while the scanner is working. There is a speaker/microphone setup so they can talk to me and hear me answer. Depending on what they're doing and what the setup is, sometimes they play a movie for me while the scanner is going.

Since I do research MRIs sometimes I'll do other stuff (pushing buttons) or be in there for up to two hours. From what I know of medical MRIs you're probably only going to be in for 15-20 minutes and you won't have to do anything except hold as still as possible. After they're done they pull me out, unwrap me, and that's it. I'm usually a little wobbly from holding still for so long.

The only real downside to an MRI is if your insurance won't handle it.
posted by anaelith at 9:21 AM on May 12, 2011

I've just recovered from an irritated disc (the second time I've experienced such an injury--I totally understand that "snapping" sensation!), and wanted to second people here by saying that you need anti-inflammatory medication (the muscle relaxants don't really target a disc injury). I had the best results with Aleve. I would also suggest looking into acupuncture. I know a lot of people think it's hoodoo magic, but it really is the only treatment which truly eliminates any back/neck/shoulder pain I've experienced. I'm not sure why or how it works, but it really is remarkable. Chiropractic treatment has reduced my back pain; acupuncture makes it disappear. Just a thought, and not something I'd recommend as a replacement for care from a "regular" doctor (more as a complement). Gentle daily stretching is also key--my favourite was a sort of modified cobra pose: lie on stomach and raise body on elbows (or head on fists) as far as is comfortable. This position will take all the pressure off your back and prevent further squeezing of the disc. On that note, sitting is the very worst position. Try to avoid it as much as possible.

Good luck!!
posted by Go Banana at 9:30 AM on May 12, 2011

In case you get there, I had a microdiskectomy 10 years ago (holy crap, 10 years ago!) once I lost muscle control in my toes due to a slipped L4/5 sitting on my sciatic nerve-the insane pain wasn't going to make them do the cutting, though-and even then, the surgery I had was waaay conservative. It's true, longitudinal studies show people seem to do just as well going either route, but after months (!) of the kind of debilitating pain that was making me go insane, the relief was immediate, even w the rehab still necessary. I still occasionally have short flare-ups, but I'd do it again in a heart beat. And sooner. YMMV.
posted by atomicstone at 9:52 AM on May 12, 2011 [1 favorite]

Sorry to hear about your back.
I can relate to your conditions, definitely get an MRI as others have stated, and stay away from the gym. I have sharp shooting pains and tingling in my left leg due to a bulged disc (actually I have about 7 total in my spine) which impacts my nerve.

The one thing about back injuries is some heal and some don't and you don't want to make anything worse by continuing to stress it.
For the pain in your leg, see a neurologist, but an MRI is something you should do asap
posted by handbanana at 9:56 AM on May 12, 2011

Lots of good info upthread, so I will just relay this; my SO injured his back a few years ago, and was told by our chiropractor that it was muscular, and has been doing chiropractic care, ibuprofen, TCM poultices, icy-hot patches, and self-directed exercise/PT. Finally got fed up living with the pain a couple of months ago. He switched to a sports-injury specialist (who, it turns out was an olympic team doc & who now treats pro athletes); he immediately recommended an MRI, which revealed 3 bulging discs. Treatment so far has been an epidural/steroid shot in the spine, plus 3 weeks of supervised PT, with vast improvement already. All this is to say that he lived with daily pain for a few years because he wasnt more agressive about his medical care. Dont let that happen to you.
posted by vignettist at 10:00 AM on May 12, 2011

Where is the pain? I herniated a disc (L5-S1) last December with a sneeze. I tried chiropractors, drugs, and finally saw an orthopedist who sent me for an MRI. That just confirmed that it was a herniated disc (causing severe, crippling sciatica) and I went for the epidural steroid injection at the beginning of February.

That made my pain significantly worse (which is supposedly rare) and I ended up having a microdiscectomy a few weeks ago. My activities are restricted until the first of June, so I will have dealt with this for six months by the time it's all said and done.

If I could have had the MRI sooner, maybe I could have had the surgery sooner and gotten all this taken care of before. But what's done is done.

I don't wish this pain on anyone. So many people just wanted me to wait it out, but it just wasn't getting better. I can't even remember how many drugs I took (steroids, anti-inflammatories, painkillers, muscle relaxers) just to manage the pain.

I hope you can get this dealt with quickly. Good luck!
posted by pyjammy at 10:04 AM on May 12, 2011 [1 favorite]

I had a similar type injury and it took me 6 months to get back to normal. I did a lot of pt and stretching and none of it was particularly helpful. What finally got me back on my feet was doing a lot of walking. Of course I have no way of knowing if what was wrong with me is wrong with you, but walking did it for me. Good luck with it.
posted by PaulBGoode at 10:05 AM on May 12, 2011

Also a TENS machine and a heatpad can be your best friends
posted by handbanana at 10:05 AM on May 12, 2011

FWIW - I've had three back surgeries due to a congenital defect in my lower spine area (L3-L4 and down) that causes massive recurrent disc herniation. I've had my problems since my early 20's (now in my early 30's) and I know it's scary to think about this pain not going away. I am probably on the more extreme side of 'back issues' but if it makes you feel better, I live a very normal life, and I am about 98% impairment-free!

I think the MRI is really a good next step. If you are still feeling not quite right after some rest and OTC meds, then it's time to step it up. Especially if you are experiencing tingling or any kind of sensation issues in your legs/feet. I think people associate back pain with pain in just the back, but it's actually the nerve impairment that I think is worse.

An MRI is a very painless test. I don't know the rest of your history, but I am guessing you won't have to have contrast, because you have no previous surgery in that area, and therefore, no scar tissue.

If you are claustrophobic, look for an Open MRI center. Otherwise, when making your appointment, ask if the MRI center provides headphones or other sound-muffling devices, as the MRI is loud and can last 30-50 minutes. Many MRI centers put you in a hospital-type robe, but if you are cold, they will give you a blanket.

There are many different issues that can be causing your pain - but don't be afraid. Getting it treated NOW rather than later is going to cause you a lot less stress. If the doc recommends PT, go for it. If you feel you aren't getting the right sort of care, consider going to see a Neuro-doctor, who might be able to explore other non-surgical/conservative treatments for you. You might want to ask your doctor about some anti-inflammatory medicine. This is just my opinion - if the doctor suggestions Lyrica for any reason, please read up on some of the side-effects, as they can be rather strange.

Unless your doctor says otherwise - keep moving! I wouldn't recommend lifting or anything strenuous, but gentle walking (no inclines!) and other gentle movements can often help more than hurt. Gentle stretching each day can elevate some pain as well.

Good luck - and take care!
posted by carmenghia at 10:12 AM on May 12, 2011

For the nerve pain I was given gabapentin, and it is a wonder drug. I also tried lyrica but it is non generic and just a bit different than gabapentin with more pronounced side effects.
posted by handbanana at 10:23 AM on May 12, 2011

Oh yeah, I also took gabapentin (Neurontin) but it only worked for a couple of weeks. But it did really help with the nerve pain for that time. But if you're not experiencing sciatica (or nerve pain) I wonder if it will help.
posted by pyjammy at 10:37 AM on May 12, 2011

Same here, but its a rather safe drug and with increased dosage I've found the sweet spot for that ailment.
I had a steroid injection that was rather worthlessm but I need to get another. If that fails the doctors were discussing burning the nerve.
posted by handbanana at 10:49 AM on May 12, 2011

Anytime I hear someone say "back pain," I say "read Sarno." Specifically, Healing Back Pain, by John Sarno. Twenty years ago, I had put up with months of wicked and worsening back pain--I couldn't go anywhere without my ice packs. Someone shoved this book in my hands, and I read it just to shut them up. I read it in one sitting, and about 1/2 way through the book, the pain started to let go. Over the next few weeks, I re-read bits of the book, and the pain left entirely. Hasn't come back.

I wouldn't claim that this is all you need to do. But, if you do it together with the MRI and whatever medical treatment you and your doctor decide is appropriate, it will at least eliminate whatever component of your pain is caused by fear, stress, anger, etc., and will give the medical treatments a better chance of working well for you.

Hope you're feeling better soon.
posted by Corvid at 1:20 PM on May 12, 2011 [1 favorite]

I have a herniated disc in my neck.

The MRI is no big deal, you will lie on a stretcher thing and get put inside a tube where IT WILL BE VERY LOUD for 15 minutes or so. They also have "open MRI" machines if you're claustrophobic. I will say that I am NOT claustrophobic, but the MRI made me wonder if I might be. It is not painful in any way, just kind of annoying since you have to lie very still, it takes a while, and did I mention that it's VERY LOUD?

I had weeks of muscle relaxants and months of physical rehab therapy, which involved a very cool spinal traction/decompression machine, TENS (which was so relaxing I regularly fell asleep) and exercises. None of this was painful or frightening, just inconvenient, but it worked very well.
posted by biscotti at 5:17 PM on May 12, 2011

Best answer: At 6-ish weeks, you're suffering acute back pain. Acute back pain is fairly common. It is also relatively common (relative to other chronic disabling conditions) for acute back pain to turn into chronic back pain.

It sounds as if you can live with acute back pain, but are afraid of developing chronic back pain. There are three things that I know of that are highly correlated with chronic back pain: inactivity, depression, and being involved in a lawsuit related to the back pain. Current wisdom is that inactivity and lawsuits are causative factors, but really, all three are just correlations (pesky ethics boards won't let us cause potentially chronic back problems for us to figure it out :) ).

So be suspicious of people advocating any kind of decreased activity (especially at 6 weeks in)-- although trust your doctors on this, as there may be specific reasons for you to limit your activity. If you are involved in a lawsuit, seek settlement as early as possible. If you feel that you may suffer depression, seek treatment for it now rather than waiting until your back problems resolve.

It sounds as if you are currently on muscle relaxants and ibuprofen for pain relief. Ibuprofen is an NSAID, so don't add aleve or other NSAIDs on top of it. Acetaminophen is probably safe to add on, depending on any other medical problems you may have. Heat packs and ice packs are very effective for some people; experiment with both and use them how they work for you. There are additional options: local anti-inflammatories, opiates, probably other stuff. If your pain isn't being tolerably controlled, bring this to the attention of your doctor, because there is more that you can try.

Musculoskeletal injuries sometimes take a long time to heal-- especially as you get older. It is not unknown for these kinds of injuries to take years to fully heal. If your pain is not disabling, try not to stress it too much-- it might get better, even after a very long time.

Big risks r/t back pain are nerves getting pinched. This usually shows itself as inability to move some muscles, inability to feel someplace (the tingling they're worried about), inability to pee or poop. Tingling is worth telling your doctor about. Numbness, paralysis, or problems with excretion are worth going to the ER over (after you're sure it's not just that you sat on your foot causing it to fall asleep).

They'll be looking at your MRI for structural abnormalities. If they find some, they may or may not be r/t to your symptoms; sometimes people have asymptomatic abnormalities in their spine, and these are rarely treated. Your doc will probably pass off the MRI to a neurologist or neurosurgeon for a consultation.

If there are abnormalities, they may or may not want to do some form of surgery (depending on the specific abnormality). If there is an abnormality and you want surgery, you can find a surgeon willing to do it-- there's always somebody willing to do it, you just have to look around sometimes.

With what you're describing, I wouldn't pursue surgery yet unless your doctor told you that it's medically necessary. Back surgeries are a mixed bag. Sometimes, they lead to drastic, immediate improvement. Sometimes, they don't do anything, or lead to worsening of symptoms. Most often, they lead to acceptable improvement in symptoms.

If you are not healing at a rate fast enough, and you're not going in for surgery, I would recommend trying to find a physical therapist, especially one that works with a lot of people with back pain. A skilled PT can help a lot, but it can be hard (and painful) work for you at times. Yes, unfortunately, sometimes the right thing to do with back pain is also the painful thing to do.

I think most CAM therapies function as placebos, but there's nothing wrong with a good placebo. If you've ever been interested in accupressure, this is a great time to see if it works for you. Accupressure is (almost totally?) safe, but some alternative therapies carry some risk (chiropractic, accupuncuture being examples), so discuss alternative therapies with your doctor.

Best of luck. This can be very scary to face, but I think for most people, the scariest part is the long-term future. Just take it day by day.
posted by nathan v at 3:20 AM on May 13, 2011 [1 favorite]

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