Advice on disc protrusion

[monkey]

Sonj, a bit more time and you will get there. Remember, it is actually the static loading positions that cause the symptoms, movement is good. Discomfort and stiffness in the AM and after sitting or sustained flexion are usually the last to clear. The classic phrase is hurt does not mean harm. If you over do things you may make yourself a bit saw but that does not mean you have restrained your disc. It is normal to have some flair ups on the road to recovery, these are usually short lived. Why not try a 20 minute walk with your sack tonight and see how you feel? As my mother always used to say: "procrastination is the thief of time".

[Sonj]

Hi, Re the static loading positions, not sure about that one because it was always 2-3 days after walking down steep ground with or without a sack that I'd be in agony, due to the disc being continuously compressed on each step downhill. I have carried a heavy sack for over 20 mins now (prob about half an hour to 40mins) just not down any steep ground for that length of time. I'm carless at the moment so can't get to the hills but as soon as I get some more wheels I'll be seeing how I get on. Oh re the static thing again. I reckoned that bending to pick up my heavy sack and swinging it up and round onto my bag was probably not good, so I've been finding a high point each time for the sack and kind of backing into it to put it on or else getting a friend to put it on my back for me.

That's good to know that the little pain I'm feeling are usually the bits last to go, guess it shows I'm on the right track. The chiro did also say that forward flexion would be the last thing to come back but he did reckon also that I might never be able to touch my toes again. (lol, this has made me a bit stubborn and determined to prove him wrong) Ok, so I know being able to touch your toes isn't an important thing in life, lol, but I was always very flexible before this injury and having good flexibility, esp in the hip, is good for climbing. I think it's with my hamstrings being so tight at the moment that makes me less flexible, they are loosening and I'm getting more stretch in them, but gawd it's taking forever!

[Sonj]

UPDATE

Well it's nearly 3.30am and I am unable to sleep as I am in alot of pain, worse than ever before. I don't know what has happened. Last Monday I had some acupuncture and was a little sore the day after but for days after that the little flickers of discomfort I was getting were pretty much gone and the pain in my buttock that I had in the mornings was all gone. Then one evening I had a bit of a stabbing pain in my back which lasted only briefly and I didn't think much of it. At noon today I had an appointment with the Chiropracter for a massage and manipulation. Left feeling good and got a lift home from my friend as I am still without a car. 10minutes from home and my back and leg started to hurt. When I got home I had to limp to the house and lay down to stretch out. Within an hour I was in agony and I couldn't stand up. Forced myself up as I needed to go upstairs to use the toilet but I couldn't walk upstairs and had to crawl up. Then my daughter had to pull up my trousers as I was unable to. Managed to get downstairs again and lay back down. I phoned my GP and he was able to fax a prescription to the local chemist in the village where I live and he kindly came to my house with some Tramadol. Lying on my front the pain is bearable but as soon as I move into any other position the pain is bad. Later I had to use the bathroom again, and again I had to crawl upstairs and needed help. Luckily my ex boyfriend had come to take my daughter for the evening and was able to help me. I got stuck at the bottom of the stairs and could not move for the pain. Everytime I tried to take a step the pain would stab in my back and down my leg, just as before but much much worse. The pain was so bad I was crying in agony and hyperventilating. He had to carry me through to the living room and I had to grit my teeth and force myself through the pain to be able to lie back down. He has gathered things for me so that I can lie here for the next 24 hours and not have to go back upstairs for anything as I cannot walk. Even crawling now is very painful. The tramadol is helping a little as long as I stay lying on my front and every so often I am crawling to the kitchen to get ice to put on my back which is soothing it somewhat.

I phoned the chiropracter and told him what had happened and he thinks that the manipulations have perhaps caused things to get a bit inflammed (or very inflammed IMO as I cannot walk!) He is hoping things will settle back down again but if not, he is going to come to my house tommorrow to see if he can help me. I just don't understand how this can have happened as I was feeling so good since the steroid injection. He doesn't think that the injection has worn off, as he thinks the pain would have come back more slowly and not hit so suddenly the way that it did. I don't think this is just a small flare up that will die down as the pain is worse than it has ever been before, hopefully I am wrong.

I'm tired of all this as I was doing so well. My flexibility was improving also and I was starting to be able to sit down and was even able to stretch out my hamstrings from a sitting and standing position.

Surely if I was still healing but just having a flare up the pain wouldn't be so sore. It has been 14 hours since the pain came back and it hasn't lessened any. Ocassionaly I can manage to roll over slowly onto my back and flex my bad leg at the hip and knee and pull it towards my chest and this gives a very slight relief, opening up my spine more?

One thing I wondered about that the MRI showed up, was that the endplate of the L5 vertebrae was dented? How could a prolapsed disc cause denting to the vertebrae? I know endplate material is softer, but is it so soft that disc material could dent it? Is a dented vertebrae the same thing as a compression fracture or is it a different thing? These were all questions that I forgot to ask the Ortho when I saw him.

[monkey]

Hi sonj,
Sorry to hear you are bad again. Loads of issues here.
Main question: why did you have further treatment from the Chiropractor if you were feeling so good? I do believe that he has helped you more than anyone else up to now, but you get to a point when natural recovery is best. There is a risk in manipulating a disc protrusion.
As I said previously, the majority of people with disc problems have flair ups of symptoms. Standard advise would be to give yourself a couple of weeks (don't panic the initial severe pain should start to settle), if you are not starting to improve after 2 weeks try and get another epidural as this did help you last time.
Disc protrusion into the end plate is relatively common and may have happened to you previously. This usually happens when the end plate is weaker than the annulus. It is often an incidental finding and can be seen when there is a previous history of Scheuermanns disease and are described as Schmorl's nodes. However, Scheuermanns usually does not effect lower lumbar spine. Schmorls nodes are often asymptomatic and I would not worry about this finding on you MRI.
Give yourself a few days for the intense pain to subside and then try and get up and mobile again. Please don't let this flair up cause you to get all that fear back, you are likely to recover and if you are not recovering then you still have the option of the epidural.

[Sonj]

Thankyou, on day 3 now and I am still lying here unable to walk ( I have liquid morphine for the pain and it is helping only a little. I try to get up onto my knees are crawl around every so often and also pull my legs up as before to try and get some mobility. I tried to stand up again a while ago and managed to take 4 steps but had to go back down again as the pain is excruciating. The chiro came to my house and gave my back a very gentle massage and used some vibrating machine thing on my back which he said should ease any muscle spasm and it was very soothing. My friend also gave me some acupuncture yesterday and when the needle went into my sacrum the pain went away completely straight away, but it came back again as soon as the needle came out. I was still seeing the chiro once a month just for maintanance sort of thing and when I left the other day he was happy for me to go away for 6 weeks.

I have a friend who is coming down every day to get me food and empty a chamber pot which I am having to use, all rather humiliating but there you go.

My GP advised me that if the pain did not settle again I would have to get back in touch with the hospital. My main worry is that I go for another injection and eventually I need to have another one again. I have been told I can only have 6 injections. I am scared that even after having 6, I may just be delaying the enivitable of needing surgery. I thought flare ups were meant to be less painful than the original injury, but this is far far worse.

Re the schmorl node thing. The chiro reckoned that when I originally injured my spine it is possible that I fell onto my bottom (which I did do a few weeks before the pain started) and this compressed my spine so badly that the disc ruptured. As well as protruding laterally onto the nerve root, he said it would have protruded upwards, fracturing the L5 vertebrae. Obv this has healed ages ago and he said this is what the denting is that has shown on the MRI. Of no significance now obv if it was a fracture as it would have healed a long time ago, but I was curious nonetheless.

My daughter will be coming home on Monday and I am still incapable of caring for her and unsure of what it is going to happen now. A few weeks ago I said I wouldn't get another steroid jab as I hated the side effects but by god I would happily put up with the side effects to stop this pain

[monkey]

Sorry to hear you are still in so much pain and it must be difficult to try and remain positive. Sonj, you had a good response to your first epidural why are you thinking so negatively about the prospects and that you "may" need as many as 6 and then have sugery. People do recover from disc prolapses it just takes time. Everything should be geared towards helping you through this bad spell. Obviously if your pain does not settle over the next few weeks or with another epidural then surgery is an option.
Let us know how you are at the end of the week and I really hope you can report some improvement.

[Sonj]

Hi, I guess the negativity is just worry about having a course of injections only to end up needing surgery anyway and I wonder if I'm not just best to have the surgery and get it over with. I know I won't know if they will heal this permanantly until I try but I'm just getting so sick of it all now and the thought of going thro another while of being ok after a jab only for it to reoccur again is unbearable. But yes, I should be thinking more positively. Just finding it quite hard just now cos of the pain, lack of mobility and lack of sleep.

It's been nearly a week now and there has been a little improvement. I had to stop taking the morphine as it was doing very little for the pain and just making me feel very sick (I threw up) and horrid. Out of hours GP came to my house and gave me Fentanyl patches and these have made a big difference to the pain level. I am using them with the CoDydramol for breakthrough pain and also using some Ibuprofen gel when the Codeine wears off but it's not time to take more. The gel is affecting my gut and I feel sick and raging heartburn and am using herbal Slippery Elm powder to rememdy that as I find things like Rinitidine and Lanzaprosaline(or whatever it's called!) abs useless. Feel like a walking pharmacy, lol!

So, I can now stand and shuffle/limp across the living room and I'm doing this every so often, usually before it's time to take the painkillers or it leaves me in agony for about half an hour. But atleast I'm starting to be able to walk for a tiny bit longer. Still pulling up my legs and going for crawls too! My knees were going very red and sore from the crawling so my friend and I have fashioned knee pads from sponges and pairs of tights, lol! The ortho has squeezed me in to see me on Thursday and an ambulancey thing is being arranged through my GP to get me to the hospital. I have been trying to contact the pain clinic re another injection but nobody is ever answering the damn phone and they havn't got back in touch when I left a message but it has been a Bank Holiday so hopefully they will get back in touch today.

My icky shoulder feels like it's burning up too cos of lying on my front and having to crawl. I feel a right mess just now, lol! Oh well, atleast I can still laugh at myself, you just gotta sometimes. My daughter is home now and my friend is helping me to get her meals and stuff. Her father is being a BLEEP!!! and totally unreliable! Thank goodness for good friends!

[Sonj]

UPDATE

I have been to see the Orthopaedic consultant and he was saying to me, that in cases like mine where the inflammation keeps on reoccuring and getting worse each time, then it is more than likely that this will keep on happening and just getting worse. He believes there is little point in having another injection and reckons that having surgery is the only option left to me.

I am now able to get up and walk some and have been managing to get outside for the past 3 days. My leg feels very odd, like I have to focus all my attention on being able to move my leg. It took me 20 minutes to walk what would normally take just a few minutes. But boy, it's great to be mobile again!!! I had some more acupuncture on Thursday and it has def helped and it has even taken away the pain I was getting in my shoulder. The pain is now under control with the Fentanyl patches, codeine and Ibuprofen gel and various other stuff for all the side effects!!

The surgeon said he unfortunately couldn't operate in the next few weeks as he is on leave but I'm assuming that as soon as he gets back he will want to operate ASAP. He will be doing a keyhole discectomy and I will only be in hospital overnight. He said as long as there were no complications (which he doesn't forsee) it should take 4-6 weeks for me to recover and be able to drive again and there is a 90% success rate. I asked when he could see me climbing again and he said that as soon as the 6weeks were up, I should go for it as soon as I felt fit and well enough. Seems all positive.

I also enquired about the denting to the vertebrae and it would seem that my GP has been misinforming me yet again!! He said there was no denting whatsoever and that the 'acute endplate changes' referred to the fact that the inflammation from the disc was making my vertebrae inflammed also. So this clears up the confusion I was feeling over that because I was rather baffled as to how and when I could have fractured my vertebrae. Mentioned above that I had fallen onto my backside a few weeks before my troubles started but it wasn't a bad fall and there was no pain/bruising/swelling at the time. So that's that bit cleared up anyway!

Thankyou for listening and for all the advice over the past few months. Hopefully once I've had the surgery I can move on from all this and get my life back on track

[monkey]

Good luck sonj. I hope all goes well with the surgery. The majority of patients who end up having to have surgery are pleased with the results if they have been wanting relief from sciatic pain. Let us know how you are after the surgery and what exercises and advise you found most useful. Look on the bright side, you will make a cracking spinal physio specialist with this experience.

[Sonj]

Hi, I will do and thanks again. A quick question, if a client had come to you for a problem like mine, what sort of treatment would you give them? How often would you see them to start of with? Would your treatment revolve around fortnightly appointments, giving one exercise to do at home (because a back extension is commonly given to disc herniation patients) And that is all? Or is it more common for a physio to have a more hands on approach -ie lots of different muscle testing etc, things like massage/acupuncture/ultrasound included in treatment, on top of the exercise therapy. Or are all these things that a physio will learn to do after training, like follow on training sort of thing. Curious, as I did become somewhat disillusioned by the treatment I was given and was wondering if this was common practise within the NHS because the private physio I have normally had was certainly more of an indepth treatment.

[sdkashif]

It is really pity for you that you have not recovered despite a number of treatment stretegies adopted. As far as I guess that you have followed many specialities at the same time while getting treatment. Failure to resolve your problem may due to improper treatment compliance or improper supervision. An other reason that could be not following the proper backs precausions. The disc disease is recurrent as healed (although healed) is in degenerative form and has a liability to manifest itself again if proper stretegies are not followed. Usually as a routine after being recovered from the disc lesion, the patient is advised to develop his back musculature, particularly extensors for maintaining the lumbar lordosis to prevent the recurrence.

However, if your consultant is satisfied that only operation can resolve your problem, you must follow his advice as a last resort. Keep us updating about you.

[Sonj]

Hi there. I did do everything that was advised of me, apart from right at the beginning, where I was feeling alot better so stopped doing the exercise as much as I should have. Then, when it got sore again, I realised the importance of keeping up and not being lazy with it all and I had been very careful to do everything that was required of me as all I wanted was to get better. I don't know if I should have been climbing, tho everyone (the Ortho, the Chiro and the Doctor who gave me the epidural) all said that it was okay to do so. I do think that everything that could have been done, has been and the improvement after the injection was remarkable, and the further improvement in my muscle strength and flexibility was very good indeed! From practising Herbal Medicine myself many a year ago, I do understand that not every patient can be helped with every practise, some just don't respond as you would hope them to. I hope the surgery will fix things and I can get back to normal again. Very much looking forward to being able to get back to exercising to a good level again and to getting a good core strength back to hopefully prevent anything like this ever happening again

[Sonj]

I just heard last week about my operation and it's not until the 5th of September. So still 7wks to go.

I can walk LOADS better now. My propreoception seems back to normal now too. Things got very odd for a while, when I was walking sometimes it felt as though I was struggling the way you do when you walk through water but that's all gone now. I'm managing to get a good pace again when walking ,but still have a slight limp when walking as fast as I can and it seems like my calf and foot twist in medially.

Pain wise I am still using the Fentanyl patches and having acuptuncture 2x a week now. That has been a godsend! Quite amazing actually how effective it is. I had been getting headaches too and stiff neck and shoulders, one session with the needles seemed to clear that and I was left feeling positively hyper when one of the needles came out the bottom of my head, most odd!! Anyway, I havn't had any top up painkillers for a week now and only really getting dribs and drabs of leg pain.

Don't seem to have any pain in my back now at all and when I cough there is no pain whatsoever. One day I sneezed too and braced myself for the pain, but it didn't happen? No pain whatsoever, which was strange but then the day after I sneezed again and it was sore again. I wonder if what position you are in, affects wether sneezing is going to hurt?? This lack of pain is making me wonder if my nerve root is no longer being compressed and is now going to start healing naturally. But at the same time my calf muscle went a bit wonky. It wouldn't contract properly, whenever I tried to forcefully contract it, it just wouldn't work and my calf just sort of hung there. I kept stretching it more and more over a period of a few days, and then the contraction came back, but the muscle would quiver and then collapse again. Kept up with the contractions and it seems fine now. My thigh ( hamstrings?) has started to atrophy. It looks a good bit smaller than the thigh on my good leg. So it's all kinda confusing me. I thought pain when sneezing and coughing was a sure sign of disc involvement and nerve compression??? So I was kinda hoping that with my coughing being pain free and me being able to walk much better and not being in much pain at all that the nerve was no longer being compressed. (I do have to keep reminding myself that I have a 50mg patch of fentanyl, so am still on opiates for pain relief. Sometimes I forgot it's on and I feel pain free but maybe the pain would be there alot more without the fentanyl?) But if the nerves are healing, then why am I getting muscle atrophy occuring now? And it's not just through misuse because my good thigh is weaker than it used to be, but just a normal weakness that you would expect from a year of not hillwalking/climbing/being active etc, whereas on my bad leg it is noticalby a good bit smaller (I measured it yesterday, lol! And there is a 3cm difference in diameter of good and bad thigh and I'm gathering this isn't normal cos I've never had a difference in muscle width like that before) Will this all sort itself out after the op??

Also, the muscles above my knees are aching like mad. Everytime I need to get something from low down I squat to get it, rather than bend. When I go to stand back up again, just above my knee is sore. I'm thinking my good leg is overcompensating for my bad leg cos this one seems worse. And also cos my hamstrings seem very weak now, possibly my quads are having to compensate even more (or something along those lines) Anyway, any good stretches for my quads to stop them from aching so?

Interestingly as well, I havn't had a manipulation since my back went again. When I've seen the chiro he just gives me a massage and uses a thing called an Activator on me (supposed to open up joints). Now the only time I've had so much pain relief was with the steroid jab (I don't feel as well as I did with that, but not too far from it at times!) It's making me ponder wether the manipulations were actually preventing me from healing all this time? Anyway, I have decided that after the op I would like to go back to getting some physio as I think I'm gonna need a damn good exercise program to get my legs and back, back on track again more than I need any more manipulations etc.

[Sonj]

ooops, that should have read, acupuncture 1x every 2wks and not 2x every week!

[PhysioAuckland]

Hi Sonj,

I have recently submitted an article on low back pain prevention. This includes information on lumbar disc injuries.
Click on the link to see the article.
Also check out the website of our Physiotherapy Mt Wellington clinic.
Hope these few tips help.
Unfortunately this maybe a little late as I realise your original post was from 2007.
Anyway, if you have any questions feel free to email me. I may have some more resources on low back pain.

Alex