Advice on disc protrusion

[Sonj]

Hi there. I'm not actually a physio, but am working towards getting into Uni to study physio. Came across this site and thought I'd ask for some advice about a problem I am having with my back.

9 months ago I was out hill-walking and experienced tightness in my left buttock, and back of knee (lateral side), as I walked downhill I experienced a nerve type pain in the inguinal area also. This pain came on and off over the next month but I just thought I'd strained a muscle or something and kind of ignored it. Then I drove to the Lakes (5hr) did some rock climbing (carrying lots of gear!) and drove back home. 3 days later was VERY sore in left leg, stabbing in bum and radiating pain down back of thigh to knee.

Went to GP who thought I'd poss torn a ligament and he put my down for some NHS physio. While waiting, I booked in for some private physio. She thought I'd fatigued deep muscle in back which was irritating sciatic nerve and causing radiating pain. Had massage and Ultasound which greatly helped but the pain returned a few days later. On second visit, nothing she did helped. She said that my nerves were extremely sensitized at that point and there wasn't much more she could do and recommended I go see an Osteopath. I wasn't too keen on this, so waited for my NHS appointment.

When this came, they diagnosed a slight bulge in disc (L5 I think) and gave me back extension exercises to do (cobra pose- 10 reps every hour) This helped and I was in much less pain. The therapist said I could continue with my hillwalking. I went down to Wales to do some walking and 3 days there I became very painful again so came home. I hadn't been doing my extensions as much as I should have either, naughty!!! By the time I got home, I was in excruciating pain, evil stabbing from buttock right down to toes. Therapist said to continue with the extension exercises. Only problem was these exercises now caused MORE pain. Even moving back ever so slightly sent the stabbing pain down my leg. This went on for a few weeks with the therapist insisting this was the right exercise for me, and me trying my best to do it, but suffering much pain. Got fed up, as it seemed to be making things worse, and I booked an appointment with a Chiropracter.

By this point as well as stabbing pains down my leg, I was getting a stabbing in the sole of my foot and an intense gripping pain in my lower calf. The chiro diagnosed bulge in the disc, inflammation of the facet joint and tightness in my SI joint, he thought that the SI prob had probably caused the disc problem. After just one manipulation the stabbing pain down my leg disappeared. I was left with just the calf pain, foot pain and a burning in my thigh. The calf pain would be very bad at times, like something was twisting inside. On a scale of 1-10 it was around 7ish. Now, I have been seeing the Chiro for around 5 months now and the calf pain has gone and the pain is now focused mainly deep in my bum.

He thinks that Piriformis is very tight, and also TLF is tight but doesn't seem to be doing much to be trying to release them. I have started to do stretches at home and over the past week have got much relief. I am still sore and tight in my bottom when I walk, tho it does ease after a short time. And during the night, I wake in pain every few hours. I'm sore first thing in the morning but it eases as the day goes on, only to get sore again at night. Pain is now at a level of between 2 when good and up to 5ish when bad. I still cannot hillwalk or climb without it flaring up, and when it does flare, the calf pain comes back again. I have recently been for an MRI and am waiting for an appointment with the Ortho consultant. My GP had a nosey at the results on his pc and says that I have a large disc protrusion but there is no evidence of it compressing the nerve root. Now it seems to me, that my muscles are possibly spasming to protect my nerve root from being compressed. Am I correct in assuming this???

What my query is, is that I am wondering what will happen to the protruding disc? Will it eventually go back into place or will it continue to degenerate. If it is the case where the disc is beyond healing, then does this mean that I will continue to suffer until it degenerates completely??? 9 months seems an awful long time to be having this problem for, esp when the 'experts' keep telling me I will be better in 6wks, then a couple of months, then perhaps half a year. Sometimes it seems that the pain is only better because I am avoiding doing things. I never sit down, I eat lying down, I study lying down. The only time I sit is to drive my car. And to drive any distance longer than 20mins in the car I have to take 30mg of dehydracodeine to cope. I cannot hill walk or climb without a flare up of the pain. And I have not slept properly for the past half year and this is affecting my studying now. Any advice??? Do you think the Ortho will want to operate if there is no evidence of nerve compression? And I think the main thing I'd like to know, is will this blasted disc ever heal or will I just have to put up with it and manage the pain until it has degenerated completely. I will put these questions to the Ortho and to the chiro when I see him next, but just after some more opinions really, though I do know you can't really give me much advice over an internet forum! Oh, should also add, that I go for an hour long walk in the morning, followed by 2more 20min walks during the day and eve. When I am lying down to study, I get up and stretch and move around every half hour also. And I try to stretch out my piriformis, TLF, gluteals, hamstring and calf 3x a day. Hamstring on affected leg is VERY tight.

Phew, sorry for long winded post!

Thanks in advance for any tips on what will become of my disc

Similar Threads:

• L5/S1 disc protrusion treatment options help
• Muscle Tear And mild Disc Protrusion
• Spondylolisthesis and disc protrusion
• L5/S1 disc protrusion ???
• Spinal stenosis and disc protrusion

[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