Best practices for living with a spine that hates you a lot
August 21, 2015 8:36 AM   Subscribe

My spine thinks I am a jerk. The feeling is mutual. I'd like to hear how others are handling similar medical conditions.

I have 6 herniated discs and moderate cervical stenosis. One of the discs, L5, has been well sorted with steroid injections. The other 5, which are C4-7 and T1, are trying their best to ruin everything forever. I've had 4 steroid shots in that area over the past two years and while they still have a measurably good effect, it is waning more dramatically than I'd hoped.

Surgery is not on the table right now and idk if or when this will change. So currently I need to figure out how to deal with severe end-of-day pain in a more constructive way than just taking muscle relaxants, as they are also having a deleterious effect on my quality of life. (muscle wasting, making it fucking hard for me to work out, making me weak and noodly in the morning, etc)

The most recent shot has sorted out the unpleasant side effect of not being able to use my left hand, but I still end up in pretty bad pain every day, no matter what my activity level, by around 10pm or so, which makes it difficult to fall asleep. The pain is pretty much 100% from iron hard muscle spasms in my left trapezius (i think? idk what else there is between neck and shoulder blade), which then causes severe migraines. My neurologist is actually getting concerned about the amount of imitrex I'm taking; it's up to 3-4x a week.

On a good day I can accurately anticipate the pain's onset and take a flexeril (I'm on 10-30mg per day) in time to deflect it, but what I'd really like to do is figure out how to modify my life/activities such that the muscle is like "hey maybe i won't be a dick today after all". What am I missing? Is it more activity or less? Is it laying down a lot? Is it heating pads even in the intense heat of summer? Or do I just need to keep on taking more and more muscle relaxants? (ugh) Do I need to sit around in one of those ghastly foam collars after 9pm? Is it naps? I like naps.

Right now I'm lifting moderately heavy 3 days a week (approved by doctor, no overheads) and doing yoga 3 days, plus stationary bike cardio on lifting days. I don't do any neck-stupid yoga poses, ever. A friend is (practicing) giving me acupuncture. I'm avoiding being in heavily airconditioned environments, and getting 8-10h of sleep per night. I feel great and pain-free when I wake up in the morning. What else should I be doing? Or what should I avoid? I know you are not my doctor(s). It's more important to me right now to hear from people who are actually coping with it IRL.
posted by poffin boffin to Health & Fitness (22 answers total) 8 users marked this as a favorite
I haven't had precisely your issues, but I have arthritis in my spine and C2 and C3 have autofused as a result (plus lots of pain at the C-T junction). Like you, things seize up over the course of the day. What turned out to be most effective for me was working with a physical therapist, both for massage/manipulation during sessions and for learning self-massage techniques I could do at home. Oddly, I also discovered that steady-state cardio on the elliptical gave me much better range of motion and relief from pain, at least for a little while.

Sorry you're going through this. It's miserable.
posted by asterix at 8:54 AM on August 21, 2015 [2 favorites]

An aunt is dealing with some lumbar disc stuff right now, and she takes a bath every evening. But, she has one of those walk-in sit-down upright bathtub models, so I don't know if getting in and out of a standard tub would be an issue for you - if it is, maybe you could add handrails or other assistive devices. Other people I know with disc issues go the home jacuzzi tub route or regularly use their gym whirlpool (where there are steps and handrails to get in and out). I'm sorry you're in pain.
posted by Iris Gambol at 9:00 AM on August 21, 2015 [1 favorite]

Speaking on behalf of my non-Mefite fella, who has similar issues: like asterix, he had to trade the stationary bike for an elliptical. Also yes, lots of laying down. Basically at any time when he can be laying down, he tries to be. The worst thing is for him to be at work all day and then scrunched up on a sofa or something. If he does some good stretching and then lies down, real flat, for a good 15-20 minutes in the evening his muscles are much less dickish about everything.
posted by We put our faith in Blast Hardcheese at 9:01 AM on August 21, 2015 [1 favorite]

I'm not a doctor. You have a doctor. But. Do you have a pain specialist? Cause that's a thing, and they seem to have all sorts of non-obvious approaches of the sort you are looking for.
posted by Stewriffic at 9:12 AM on August 21, 2015 [3 favorites]

have you tried a strain of herb that tends to not evoke paranoia? (Remembering one of your comments re weed a while back)
posted by angrycat at 9:27 AM on August 21, 2015

Best answer: if your major pain is of the cervicogenic migraine type, may be worth talking to your neurologist about trigger point injections/dry needling or even botox shots for it. both are well supported by the medical literature and have less side effects than muscle relaxant meds.
posted by genmonster at 9:45 AM on August 21, 2015

Response by poster: I do have a pain management doctor AND a spine orthopedist, yes. The pain management guy is content to give me the shots until the end of time, plus flexeril, as much as I want, forever; the ortho guy is also aboard the shots train, but wants me to stop taking the flexeril. I have tried to stop taking the flexeril (gradually) but it was agonizing beyond any words to describe it. I guess I could get a 3rd opinion.

I'm pretty wary of weed tbh. The trial and error portion of finding something that doesn't make me really paranoid is very daunting. I also don't feel great about introducing something into my daily life that can lead to increased lethargy/decreased motivation to be active, because I am capable of extreme sloth without any chemical assistance.

I am seeing the spine ortho guy again in 10 days for my shot followup and my neurologist on the 10th for my quarterly checkup so I will see about these other injections, which sound very interesting.
posted by poffin boffin at 9:58 AM on August 21, 2015

Best answer: I don't have your spinal issues, but I am climbing out of (actually currently I'm mostly out of) a 2+ year hole involving almost body-wide immobility and pain that various doctors and physical therapists were unhelpful in diagnosing or treating. This is not a suggestion for the big-picture problems you're facing, but most of my recovery came from seeing a Muscle Activation Techniques practitioner. Particularly since you mentioned muscle wasting and weakness - and also from your previous mentions of crazy tight quads - I think there's a chance that MAT could help at least some of your issues/give you some relief. This video is Greg Roskopf (the guy who came up with the technique) talking about his background and how and why he developed MAT. Apparently Payton Manning signed with the Broncos so he'd have easier access to Greg, and lots of pro athletes swear by this technique, and it's had really profound effects for some people. My dummies-level understanding of the approach is that a) when some muscles are weak or stop firing, others go nuts trying to compensate for the weak/non-firing ones to make sure that the primary goal of 'stabilise the joint' is met, b) getting non-firing or poorly firing muscles online and strong again will help (whereas just focusing on the tight muscles is infinite and will treat the symptom but not solve the underlying problem/s and might actually contribute to making things worse), and c) MAT gets non-firing muscles to fire again really well, working appropriately with people at any level of functioning and being really careful with gentle incremental challenges so you don't lose progress by doing too much too soon.

Happy to give more details of my specific muscle problems and my experience with MAT in memail.
posted by you must supply a verb at 10:13 AM on August 21, 2015 [1 favorite]

Not sure what to tell you about paranoia, but I have a friend with a herniated disc (L-something? Not sure) who has been prescribed both Flexeril and, for when it gets pretty bad, a course of methylprednisolone, and he finds that a little pot works way better at relaxing the muscle spasms than the Flexeril, which just wiped him out and leaves him not able to do anything useful for 12 hours.
posted by leahwrenn at 11:38 AM on August 21, 2015

My back is not as bad as yours. I've had a rupture and discectomy at L5-S1 and have a herniation at L4-L5. Here are some of the things I've done to help:

- I saw a physiatrist, who had some novel ideas about how to treat it. I had been doing traditional physical therapy and he was pretty critical of the way most physical therapists seem to think that strengthening is the answer to everything. He thought that often the problem was a muscle got itself into a feedback loop of spasm-pain-spasm and the way to address that was to knock off strengthening for a while and focus on trigger point therapy and flexibility. I did this and had excellent, long-lasting results (For reference, my back was so bad that it had actually pulled my kneecaps out of alignment and I had fluid buildup from the inflammation caused by that. All better now!) My point though is not this one guy's approach but that a physiatrist often comes at things from a different angle than an ortho or pain mgmt doc.

- I take magnesium citrate tablets for muscle spasm and they are WAY more effective than flexeril for me.

- Aquatic therapy was amazingly helpful for the longest time until my skin decided that it didn't like being in the treated water. But if I could do it, I would be there every day.
posted by HotToddy at 12:20 PM on August 21, 2015

100% from iron hard muscle spasms

Muscle spasms can be caused by mineral deficiencies, such as potassium or magnesium. Such minerals also tend to be important to skeletal health. Perhaps a supplement for calcium, magnesium, and potassium would help. If you need magnesium, you probably also need calcium. Both can help the muscles relax. If you need calcium, you probably need to take it with vitamins D and K for best absorption.

I used to have a lot of joint problems. It was helped in part by taking gelatin supplements daily for a year or two to help feed the cartilage. Cartilage gets no direct blood flow. So it gets all of its support via osmosis and thus is slow to heal.

A lot of pain killers (including steroids) are also anti-inflammatories. Inflammation is associated with infection. I worked hard to kill off chronic infection and that has helped dramatically reduce general pain. It took a long time to get to the point where my joints substantially improved, but they did eventually improve.
posted by Michele in California at 2:05 PM on August 21, 2015 [1 favorite]

Response by poster: Yeah I take magnesium as (sadly failed) prophylaxis for my migraines. Unfortunately it has no notable effect other than making me poop with somewhat greater urgency than usual. I've been taking it since March 2014 so if something beneficial is going to happen I would like it to happen soon. (but i'm afraid to STOP taking it because what if it IS making my migraines better and they would be actual death without it. sob.)
posted by poffin boffin at 2:15 PM on August 21, 2015

Magnesium glycinate is more readily absorbed than other forms and it is less likely to have a laxative effect.

The way the body uses magnesium means it really needs to be taken with calcium or you aren't doing much. For best results, you need to take it with calcium in a 2-1 ratio (I don't recall which one should be twice as much). The most commonly available chemical form of calcium supplements has poor bioavailability. I believe that is calcium carbonate. I used to take calcium citrate as something more readily absorbed.

Also, if it a potassium deficiency that is the culprit causing muscle tension, more magnesium won't help.

It took me a long time to improve my issues with chronic pain and joint problems and restless leg syndrome and etc. Researching bioavailability was one of the keys to making progress using a nutritional approach.

I'm sorry you are suffering so much.
posted by Michele in California at 3:42 PM on August 21, 2015

Try taking Epsom Salt baths. I've found them to help when my back is aching at night.
posted by pushing paper and bottoming chairs at 5:29 PM on August 21, 2015

I'm so sorry, poffin boffin, that sounds awful. My chronic pain is different (though it was originally misdiagnosed as being slipped disc related before it spread to other areas) so YMMV, but the single most helpful thing for me has been this book about trigger point therapy (which also discusses the injections mentioned above). I think anyone dealing with significant chronic pain could benefit from it.

I've heard people dismiss trigger point therapy as woo, but I have found it really, really helpful with my pain, and the understanding of anatomy and kinesiology that goes along with it is helpful as well. The book is a bit wonky and in-depth (there are more user-friendly introductions), but for me more information is better and it's helped me not only with self-massage for trigger points, but also with being better able to communicate my pain to doctors, PTs, etc. I really can't recommend it enough. Pain sucks and I hope you find relief.
posted by rafaella gabriela sarsaparilla at 5:42 PM on August 21, 2015 [1 favorite]

(by "single most useful" I meant most useful DIY thing in addition to all the doctors, PT, medications, etc.)
posted by rafaella gabriela sarsaparilla at 5:47 PM on August 21, 2015

My husband has spine problems, though not in his cervical/thoracic spine. I second the trigger point therapy book recommendation above. Deep tissue massage seems to help him quite a bit. We took a Pilates class for about a year and a half and that seemed also to help keep his pain at a much more manageable level. Rolling on a foam roller is painful but effective if done daily. Attention paid to ergonomics at work = less pain in his back/leg/foot at the end of the day. To this end he even bought his own office chair.

I'm sure you know this, but typing/computer work wreaks havoc on the traps. Try to take breaks every hour and stretch.

I'm sorry you're going through this. Chronic pain takes a lot of energy to manage, and it sounds like you're doing all the right things. It's frustrating for my husband when he feels like he's done all the exercise/stretching/rolling/meds he's supposed to do and The shit still hurts.
posted by little mouth at 6:49 PM on August 21, 2015

They've got low-THC / high-CBD strains of marijuana now for people who want the pain relief benefits without the experience of getting high. I tried some a few months ago and while I was unimpressed by the pain relief (it was only as effective as a couple of Tylenol), I can confirm that it did indeed lack the usual psychological effects of smoking weed.
posted by Jacqueline at 11:55 PM on August 21, 2015 [1 favorite]

My aunt, who has dealt with chronic pain and spine problems for years, is evangelical about how much seeing a physiatrist has helped with her back pain. She said the approach is notably different from that of most doctors/orthopedists, but also more science-based than most chiropractors, and she saw startlingly positive results in a short amount of time.
posted by a fiendish thingy at 7:37 AM on August 24, 2015

I've been living with a spine that hates the metal implanted in it for a while now. The last two years, I've had a lot of that trapezius / thoracic pain that kicks off migraines, and boy I know what you mean about end-of-the-day pain. So, similar to you, I think.

I'm going to type out a bunch of ideas that together seem to help me. First, environment: make sure your pillow, bed, desk ergonomics, monitor height, car seat and shoes are all sufficiently comfortable and supportive in -your- right ways. I have a foam pillow with a head cradle, and actually sawed 1/2" off the back of it to get its height -just- right; a memory foam mattress. My office chair is a Steelcase that has a mesh-only back that cradles me just the right amount of gently. I have a half-pipe pillow for the car that is magic for me, and only recently discovered that putting it vertically behind my spine is wonderful and helps me sit upright, prevents the bucket-seat-crouch neck. My car was chosen for its drivers seat, but -- do whatever you have to. Shoes have to be supportive, no exceptions. I'm also pretty fussy about chairs (like the random ones in meetings or classrooms).

Daily yoga is the centerpin of my spine comfort. It's not that any one session or exercise in particular does it -- it's the daily accumulation. In particular for me:
1. Sun salutations. In downward dog, voluntarily shrug and flex your shoulderblades up and down. Also in dd, move your shoulders left & right laterally.
2. Warrior 2, paying attention to the back shoulderblade pulled backwards.
3. Triangle, top shoulderblade back.
4. Laying down spinal twist. Pay attention to stretching pecs here; they oppose your traps and play a part in that pain. Also stretch your pecs against a wall
5. Supine shoulder stretch, and in this position, try to lift your chin to the ceiling a few times -- will isometrically work your thoracic spinal muscles.
6. Neck stretches -- ear to shoulder, using the hand on that side to gently assist. Nose to armpit, same side hand gently assisting.
7. Foam roller: use vertically against a wall with your back, rolling side to side across those traps.
8, don't forget your hamstrings or calves. Tightness really does go everywhere.

Some days I need to lay flat on the floor for ten minutes in the afternoon. If that helps prevent the end-of-day thing, do it. I tend to think more activity is helpful, but certainly also resting when you need it. What I need, or even knowing what I need, is a moving target.
posted by Dashy at 11:03 AM on August 24, 2015 [1 favorite]

Response by poster: Yeah, I need to get a new mattress anyway so I will see if I can find something better than my current one, which might be a smidge too soft. But otherwise I'm not driving or office-sitting or anything like that. I only wear trainers for mild overpronators plus my orthotics. I've heard everyone's mefi evangelism on getting rid of orthotics but it's never worked out for me, the pain from not using them is so immediate and immense that it's not worth it. It's frustrating because I feel like I'm mostly doing all the right things and the results are still telling me it's all wrong.

also the best most satisfying yoga position right now is wide legged foward bend, like you're about to do a tripod headstand but no heads are stood upon. (madness!) if i hook my arms behind my knees instead of letting them dangle forward i get a full release in my neck and t-spine and it's amazing.
posted by poffin boffin at 12:20 PM on September 5, 2015 [1 favorite]

I know someone whose chronic lower back pain is named "Suzie" and she talks about how Suzie is doing, etc.
posted by aniola at 9:38 AM on May 29, 2016

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