Did your back get better?
October 1, 2013 6:47 AM   Subscribe

So I've been at least preliminarily diagnosed with a herniated disk at the L5-S1 level. This is after a couple months of back and leg pain and an attempt to treat it with oral Prednisone. The Prednisone worked for a few days while I was on it but the pain came back after the course was over. Yesterday, I went back to my GP and he gave me the diagnosis and referred me to a neurologist and is arranging for an MRI. My question is: have you been through this, what was your treatment and how did it go?

The GP mentioned surgery but also chiropractic treatment, epidural injections and/or physical therapy. What did you do, if anything, to treat your injury and how successful was it? If you had surgery, how long did it take to get back to work/normal life afterward?
posted by octothorpe to Health & Fitness (26 answers total) 3 users marked this as a favorite
Skip the Chiropractor, that did NOTHING for me. I went three times a week, with TENS and I got very little relief.

I also did physical therapy in the pool, three days a week. Meh. I do gentle stretching exercises and they help keep me limber.

I went to an orthopedist, who gave me two epidural injections of cortisone. There were three weeks between the injections and I've been pain free for nearly two decades.

My disks ruptured (L5-S1) and a piece was sitting on my sciatic nerve. I had no reflexes in my left leg/foot.

Skip the neurologist, go directly to an orthopedist.

I could have saved two years of ineffective treatment and suffering.
posted by Ruthless Bunny at 6:56 AM on October 1, 2013 [1 favorite]

I've been through two back surgeries for disk problems. The last one was a rupture of the T10/11.

The MRI will be key to how your future unfolds. If it's just a minor herniation, some appropriate therapy will help get you back toward normal. However, it's doubtful that you'll ever be able to get things back to the pre-herniation condition. The disk will always be a weak spot. You're looking at a lifetime of being very aware of how you're moving, twisting, etc. and just how much load you're putting on your back. There are some specific exercises you should be doing to strengthen the muscles that support the back. Also, specific stretches.

I would avoid chiropractic like the plague, and I'm honestly amazed your GP even suggested it.

Depending on how bad the herniation is, you might be looking at surgery. Back surgery isn't fun.
posted by Thorzdad at 6:58 AM on October 1, 2013 [1 favorite]

The last time I posted about this. And, yes, for me, my back did get better. A few years after surgery, I still had periods of pain and needed more physical therapy, but I haven't had pain in YEARS [knock on wood, ptu ptu, and all that] and either lift weights or run every day.
posted by atomicstone at 7:06 AM on October 1, 2013

I had a herniated disk that ruptured when I was in my late teens and had surgery on it (fusion). It was an ordeal but the pain from the surgery/recovery were a relief compared to the sciatic pain I experienced prior. This was in the late 1980's when I was 18 years old. My mother had essentially the same surgery on two disks just two years ago and her recovery was much faster and less complicated than mine (a smaller incision and she was upright, walking and actually sent home the same day).

I had all kinds of treatments and therapies for a year before I had the surgery. My disk had disintegrated so what I really needed was an MRI (ultimately I got a myelogram). That will let you know where you are at with your disk and what can be done. I have had no problems since, btw. Good luck!
posted by marimeko at 7:18 AM on October 1, 2013

I herniated the exact same disk a little more than a year ago. I was in far more pain than you -- I was unable to do anything except lie perfectly flat on my back for more than a month, and the painkillers did nothing. The effects of a herniated disk vary greatly depending on where the herniation is exactly (my orthopedist told me that many people have hernations and don't even realize it because it doesn't happen to be pressing on the nerves.)

Surgery is a last resort -- you only go there after you've tried everything else. Except chiropractic. Absolutely don't try that. There's a very real risk of the spinal manipulation further damaging the spinal cord. I would seriously reconsider ever going to that GP again if he suggested that as a possibility.

After a month of bed rest failed to improve me at all, I had a spinal epidural, which was like magic. I was perfect for, I'm guessing, two or three weeks, and then went bad again but this time with extra sciatica. A second epidural lasted long enough for me to start doing physical therapy, focusing on abdominal strength and, somewhat counterintuitively, hamstring stretches -- in the long run the stretches have proved to be much more effective than strength training was. It took a couple months of PT before I could describe myself as pain-free.

But every time I start to slack off on the PT I start to feel the pain edging back, and I have to be much more conscious of how I hold my body at all times -- there have been several near misses where I picked up something too heavy, or spent time hunched under a too-low ceiling, and was in some discomfort for days or weeks afterwards. Sneezes are still pretty terrifying. I have excellent posture now. I've also become pretty dextrous at picking things up with my toes instead of bending over.

Sorry. Back pain is no fun at all.
posted by ook at 7:21 AM on October 1, 2013 [2 favorites]

I'm just now recovering from a herniated disc in my neck (C7) that put my left arm in agony for a month. I was out of work for a week, in bad pain for a month (even through a vacation), in minor pain for another couple months, and still feeling it in my arm (though not in a painful way) several months later.

A chiropractor will do nothing for it. I went to one out of desperation, before I knew what exactly was wrong with me. Oh, she claimed she could help, she even told me things were getting better, she assured me we were making great progress. She sure was confident that she was gonna cure me. In reality, she did nothing, and once I was diagnosed I realized there was nothing she could have done for me. I'm not saying all chiropractors are bad, and there is some evidence they can help with lower back pain, I'm just saying there really isn't much they're going to do in this case.

I went to both an orthopedist and a spine specialist. The spine specialist gave me an MRI (not as scary as I thought, and I'm a bit claustrophobic) and confirmed what he already figured, that I had a bulging disc in C7 and some minor bulges in the others. He said a good percentage of adults have bulging discs but in most cases it's not an issue.

He scheduled me for an injection, which in the case of the spine is a bit of a procedure, but when I went to get it I said that things were improving a bit so he decided to wait and see.

What helped:

Physical therapy. I'm not 100% sure it's helping, but it isn't hurting. It's also nice to be doing something. So even if it's not helping the disc it feels like I'm taking control.

Yoga. Like PT, I'm not sure it's helping, but it doesn't hurt and it feels good to do it. Take control.

Medication. Gabapentin. It's used to control seizures in epileptics but is also used to treat nerve pain. Totally helped in my case. I'm still taking it several months later and my arm is mostly pain-free. No side effects that I can tell.

Time. It's been a few months and I still have a stiff neck and I can feel something down my arm, but I can function and I'm mostly pain free. I have a feeling I'll be able to predict the weather for the rest of my life though. It seems to get worse when it's humid.

My spine doc said the discs don't really shrink but for most people the nerves work their way around them over time.

Good luck. It does take time but it will get better.
posted by bondcliff at 7:21 AM on October 1, 2013

I had a disk ruptured and a piece was sitting on my sciatic nerve. I would sneeze and blackout from the pain. Had surgery (cut it off) and felt 100% better. It's been 10 years and I've been doing great!
posted by bleucube at 7:26 AM on October 1, 2013

For me, pain education was the most helpful treatment (once unable to walk, now able to do everything). Explain Pain is great. This TED Talk (Why Things Hurt from Lorimer Mosely) is a good start.

Think twice about doing an MRI. This article gives some good reasons, including: On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions... Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.
and from this blog post:
And there is now some research showing that the early use of an MRI as a diagnostic tool for back pain may make outcomes worse. In this study, it was found that MRIs were associated with increased likelihood of disability.

Don't go to a chiro and don't let any caregiver hurt you (under the guise that that is good for you or it has to hurt before it gets better). Your nervous system is on high alert right now, and you want to sooth it, not give it more reason for alarm. A physical therapist may be helpful (link is about knee problems, but it is plausible that the same would hold for back problems, see also this study).
posted by davar at 7:52 AM on October 1, 2013 [1 favorite]

Wow....this is timely. I am pretty sure I herniated that same disk while doing squats at the gym. This was last August. I knew when it happened. I was able to get myself home and I was in a fair amount of pain for about 24 hours. Then it started to feel better each day.

I did not go to a doctor. But I have a few friends with the same problem. They solved it by doing PT. They showed me how to do it. It made a big difference. I am working out again---but I will never do squats again. And yes...when I do hamstring stretches (on that device at the gym where you lower your upper body and then raise it back up) my back feels amazingly good. When I have slacked off on the stretching my back starts to feel tweaked again. Driving always makes it feel bad.. I usually stretch in my office after the 30 minute commute. So, my herniation is obviously not that severe compared to what others have described here. But I can absolutely say that stretching has made it much much better.
posted by Seymour Zamboni at 7:57 AM on October 1, 2013

I had a problem at the same spot. It finally got so bad the only thing I could do for relief was stand on one foot holding my other foot up behind me. I couldn't sit or lie down.

Here's my answer in another AskMe on this topic. The short version is, I had a partial laminectomy and it's been great ever since.
posted by under_petticoat_rule at 8:00 AM on October 1, 2013

I herniated my L4 and L5 discs about 10 years ago, and can still recall the precise moment: I was stacking firewood, which meant bend, pick up, twist, throw, repeat about 100 times, and then bend, pick up, twist, thr...gaaaaaah!

I was in such excruciating pain that I couldn't walk or get out of bed. The short-term fix was a cortisone shot, which worked wonders. Then I got an MRI and the image looked like someone had stepped on a jelly donut. My neurologist initially recommended surgery, but I got religious about physical therapy, and that did the trick.

But I've been pretty lax over the past few years about doing the prescribed exercises, which is lame, because they only take 10 minutes a day. So I'm almost always aware of my lower back, and I always have to watch how I move. When I really feel the pain and tightness returning I do the exercises.

That said: I still have no reflex in my left leg, and there's an area on my left thigh where I don't feel anything. Also, my left leg is noticeably weaker than my right, which means it tired faster when I cycle or run, and limits those activities more than just getting physically tired.
posted by bassomatic at 8:41 AM on October 1, 2013

I went to a physiotherapist for what I thought was some kind of damage to my right leg (crippling pain and weakness). He told me it was a herniated L5-S1 disc, gave me a little massage, a little TENS, and told me to stay flat on my back in bed for (IIRC) three weeks, then start a specific set of gentle stretches to regain flexibility. I did that. My back and legs work fine now. I'm just much, much more careful about avoiding twisting lifts.
posted by flabdablet at 11:06 AM on October 1, 2013

Same herniated disc-- L5-S1. I have had pain for nearly 1 year, progressing with each month. Pain started in my butt and crept down my leg over time. Now my foot feels like it is asleep with pins and needles. Tried cortisone shots-- got some relief, but it never lasted more than one week, tried PT, nothing helped. In 10 days I am getting a microdisectomy and hopeful that it will kill the pain.

My decision to do surgery was not easy-- I really wanted to avoid it. However, it got to the point where I was in pain walking more than 2 blocks, could not make it through the day at work without laying down on the floor for 20 min every few hours. Sitting in a pedicure chair hurt, not being able to dance at a friend's wedding....avoiding travel. When pain starts to rule your life like that and conventional measures are not working, its time to consider surgery.
posted by psususe at 11:45 AM on October 1, 2013

Same level, wasted years on chiropractic quackery. Eventually it ruptured and I had a microdiscectomy. That was 12 years ago. I had a rough rehab due to the delay in getting effective treatment, but eventually got myself sorted and have been more athletic post-surgery than I ever was before. I am getting to the point now where I need more frequent PT visits--the fact is that I have only a slender sliver of disc there now and it's going to cause more problems as I age--but without the surgery I never would have had these wonderful active years.
posted by HotToddy at 1:48 PM on October 1, 2013

Davar's link to that study is what all the physical therapists and GPs I've talked to have said about back pain--namely that pretty much regardless of what's physically present in your back, you may or may not have pain. Some people with debilitating back pain have no ruptures and other people have ruptures and no pain.

Physical therapy has worked wonders for me. It does require regular work and maintenance. To this day, I spend 2 minutes in the morning and about 5-10 minutes at night doing my exercises. If I'm religious about it, I'm pretty much pain free. My phycial therapists all rely on the McKenzie method. (They told me that scientific studies support its efficacy.) (Book on the method here: http://www.amazon.com/Treat-Your-Back-Robin-McKenzie/dp/0959774661)

When you start McKenzie method when you're first in lots of pain, you do the exercises a LOT. Like once every hour. They do bring relief though and it was empowering for me to have something I could do to alleviate my pain. I didn't get PT until after I'd been living with pain that shot all the way down my leg for about 9 months. The sooner you try PT the better. And the odds of making anything worse, or living with side effects from PT (other than maybe some sore muscles) are really low. Find a good physical therapist! Do the exercises religiously. Try more than one if the exercises they give you aren't helping.
posted by purple_bird at 2:07 PM on October 1, 2013 [2 favorites]

I herniated my l4/l5 discs in early July (by twisting a bit too sharply while opening a fridge door. It's the little things that get you...) and am doing decent now, but was in agony for a good while.

I went to see a physiotherapist even before seeing my GP (physio was closer and offered the quickest opportunity of pain relief, I avoid pain medication for other reasons). Physio gave me immediate relief via traction and gentle, careful stretching. Eventually went to my GP to get a diagnosis: disc herniated with sciatic nerve involvement. My left leg was stiff and painful for weeks. My husband had to help me do everything, which is not what I had hoped out of our first year of marriage...

I was in daily physio for two weeks, went back to work as soon as I could reasonably stand and walk a bit on my own with a cane (this took about 6 days, but I should have taken longer), and I tapered off physio from there on. I now do two sessions a week of clinical Pilates with a physiotherapist in a very small group, which is similar to a physio session but with greater autonomy.

My physio forbade all kinds of exercise except in a clinical setting for the first two months, then introduced gentle swimming and short jogs. I'm still fairly limited in what I can do, my left leg is still a bit numb and painful, and I don't know if my back will ever really feel the same. Surgery is a possibility down the line, but for now I'm focused on Pilates, lifestyle modifications so this doesn't happen again, and physiotherapy.

This sucks, and it might leave you with the kind of pain that's not enough to show outward signs, but definitely enough to limit your daily activities. If anything, having a cane for the first few weeks helped heaps because people were much more careful not to bump into me, I was able to claim the disabled seat on public transit when I needed it, and it was a visual cue to others that I was a slow walker and couldn't really lift anything.

Feel free to memail me if you want to talk. I hope you have a speedy recovery.
posted by third word on a random page at 2:34 PM on October 1, 2013

No firsthand experience but I did spend the better part of four days in the hospital with someone who experienced a similar issue. In that time, every doc who cycled through said in one form or another: WALK, WALK EVERY DAY and that it's far and away the best thing you can do for your back.

That was more than a year ago. PT taught him a ton, mostly about how critical core strength is to protecting one's back. He still does the exercises he learned on the foam roller. He switched to a standing desk and never looked back. He stretches his calves on a 2x4 at his desk. At home, he uses a strap to stretch his hamstrings. These things ease his back. When he's feeling a little sore, he'll use a heating pad if at home or a ThermaCare heat wrap when out. And he walks.
posted by AnOrigamiLife at 2:48 AM on October 2, 2013

I, too, am a little surprised your doctor mentioned chiro, to the point that I'd look elsewhere. The doctors who treated me were blunt in how much they disliked chiropractors, to the point of explaining the damage they could do in a case like mine.

For my own horror story, I did pretty much everything wrong: ignored the initial symptoms until they became dramatically worse, had surgery, got a staph infection, didn't really follow through on my pt, then, two years later was involved in a violent car accident which herniated the disc again, requiring more surgery.

In short, don't do what I did. If surgery is necessary, follow through on your pt religiously. You might even be able to avoid surgery with good pt. I recommend looking for a Mckenzie trained therapist, mine was absolutely amazing, and had I listened to what he said, I would have recovered completely.

As for how important it was to really follow through? I haven't really had a pain free day in the last thirteen years. Get it taken care of, and follow through.
posted by Ghidorah at 4:42 AM on October 2, 2013

I have ruptured and herniated discs (L4-L5, L5-S1). They were diagnosed almost 5 years ago, when I was an otherwise healthy 24 year old male.

NSAIDs didn't help very much. Painkillers interfered too much with my daily life. Muscle relaxers provided little to no relief. Physiotherapy helped for flexibility, and core strength. Swimming has been great for me. I had three epidural steroid injections which were critical for resuming day-to-day life.

My triggers are sitting too long and twisting while bent at the hips. I have a convertible sit/stand desk, ($20 IKEA DIY model) and I try to maintain extreme mindfulness of my posture.

I try to make time for swimming 4-6 days a week, which I attribute for much of my progress. I also make sure to thoroughly stretch my hamstrings 3-4 times a day. Tight hamstrings give me the kind of posture that exacerbates my lower back pain. I found McKenzie technique material to be helpful. There is a great deal of overlap between McKenzie technique material and certain yoga poses.

MeMail me for a full run down of my diagnosis and progress if you like. Good luck!
posted by KevCed at 12:52 PM on October 6, 2013

Response by poster: Thanks everyone. I'm seriously encouraged by your responses. I'm still waiting on the MRI before I can proceed medically. It took the doctor's office all week to call me back to say that the insurance company approved and she didn't call me until 4 PM Friday after the radiology lab had closed for the weekend.

I'm going to start the McKenzie workouts as soon as the book arrives and try to hit the pool at the gym this week. Medically, I'll try to push for the epidural shots and then physical therapy, hopefully with a McKenzie trained one if I can find that.
posted by octothorpe at 5:08 PM on October 6, 2013 [1 favorite]

Response by poster: So following up, I had an MRI which confirmed the herniation and saw a surgeon who proscribed first a steroid for a week and then a non-steroidal anti-inflammatory for thirty days. The steroid didn't do much but the non-steroid, meloxicam, works much better. I have good days and bad and I'm still not about to run a 10K but I'm at least functional. I asked about physical therapy but they wanted to hold off on that for a few weeks while the meloxicam works.
posted by octothorpe at 12:18 PM on October 31, 2013

Response by poster: Lots has happened since my last follow-up:

1. The Meloxicam stopped working after a few weeks.
2. Had a few months of physical therapy that basically did zero.
3. Had an epidural steroid injection right before Christmas that did zero.

Finally after six months of being constant pain, I scheduled surgery.

I had the surgery on Tuesday morning to clip the bit of disk that was pushing on my nerve-root and now feel awesome and better than I have in a year. I'm not taking any pain meds right now except for an Aleve this morning and other than a little tingling in my right foot and some tenderness at the incision, no pain. I can't lift, twist or bend for a month and I can't drive for two weeks but I'm so much more mobile than I have been and so much happier.

The paradox of all this is that while nothing worked but surgery and trying all those things that didn't work wasted time, if I hadn't done them, I'd never know if the surgery was needed or not.

Two interesting bits of trivia:

* I have an extra lumbar vertebrae, most people have five, I have six.

* I the nerve root that was causing the pain turned out to be a con-joined nerve root with two bundles of wires coming out of the spine where most people just have one. That may have been why it was so unresponsive to treatment, there's just more nerve that then for most folks.

They said that it'll take as much as six months for all of the residual effects to fade away but as it is, I feel like I'm ready to run a freaking marathon (Not really).
posted by octothorpe at 10:52 AM on January 31, 2014 [1 favorite]

Wonderful! I'm very happy for you!
posted by HotToddy at 11:58 AM on January 31, 2014

I'm sure they would already have told you this, but that disc is going to be something you'll always need to be a little more careful with than before it herniated.

You're dealing with what's essentially a jelly-filled cartilage bag that holds up your entire upper body, and the bit you've just had shaved off was part of a cartilage wall that's already partially given way once. Cartilage is incredibly slow to heal because most of it doesn't have a blood supply - all the nutrients it needs have to diffuse in from outside, and that just takes forever - so the less stress you can arrange to put on that disc from now, the better off you'll be.

Hang onto the memory of the pain you had before surgery, and use that to motivate you to follow up on all their physio instructions even if you don't now feel you don't need to any more. Because you really, really don't want to have to deal with the aftermath of that disc deciding to blow out properly.
posted by flabdablet at 2:06 AM on February 1, 2014

Response by poster: A month after surgery, I'm still feeling pretty good. I do get a little pain sometimes and my right foot gets a little pins-and-needles but at least 90% better than before. Going to talk about physical therapy next week, they didn't want me to do anything like that for the first month. I was good about keeping active but not doing any lifting and they're happy with my progress.
posted by octothorpe at 5:45 PM on February 23, 2014

Just remember to listen to the PT. The thing that was drilled into my head was that the sensation of a stretch was fine, but if I experienced any pain symptoms whatsoever, I had gone too far, and should return immediately to stabilizing exercises. The pain symptoms is all your back and nerves can do to tell you you're causing more harm than good. Go slowly, stick with your rehab, and talk, seriously talk about activities you'd be better off avoiding from here on out.

And congrats on that feeling of waking up after surgery, being pain free for the first time in months. It's a wonderful moment, like waking up from a nightmare.
posted by Ghidorah at 3:23 AM on February 24, 2014

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