UKC

Help me please.

I have been struggling with back pain since November, I have seen several people for course of treatment and nothing is working. Short story below:

Went to Docs, MRI scan (eventually) MRI show L4/5 has slipped resulting in bulging disk, treatment offered = stretching (stretching) and surgery (which they won't offer me)

Went to a chiro - 8 weeks, lots of money, no improvement, not even slightly.

Went to a different chiro (comes highly recommended) too into his climbing to get regular appointments, yet again no improvement.

Went to a few physios and massage therapists - pain eased for a day or so but then back with avengance!


I have tried, resting, ice, stretching, climbing, doing nothing, ...... (the list goes on)

We're now in March and I'm supposed to be going away in May (climbing)

Can anyone help? The pain is getting worse and having knock on effects in the middle of my back, shoulder and neck.

Based in Derbyshire area.

Anyone?

In reply to BlakeyDerbyshire:
Hi
What you don't want is for the disc to burst which would force surgery....now I know someone where this happened because she was forced to go to physio etc....I would push for a second opinion and perhaps surgery? Have you seen any pain management people they can inject into the point of pain but not always guaranteed to work!
Good luck but push the NHS hard.......

In reply to BlakeyDerbyshire:

Firstly, sorry to hear that you are suffering - I know that it will be constantly on your mind. I've been there and come out the other side, my personal experience is as follows

Chiro was useless
Physio provided relief from the initial pain and made life bearable
The physio told me I had to take charge of the situation and manage it - recommended a good book on this.
Stretching and strengthening later banished the problem

If you e-mail me I'll give you all the details of my personal experience, I'm not interested in arguing the toss with anyone on here about right and wrong. I'm going out climbing now. Good luck............Jeff

In reply to Jeff Ingman:

pm'd thanks

In reply to BlakeyDerbyshire:

What are their reasons for refusing you surgey?

In reply to BlakeyDerbyshire:

I am not going to recommend anything specific as I do not know the full extent of your injury but a few things to consider (which you may well have already considered).
1. Getting the inflammation down is good, as you say you have tried ice but I would keep on using it (along with any anti-inflammatory drugs you feel happy using and come with a medical recommendation.) Anything that helps to loose the tension on the surrounding muscles.
2. alternate rest and gentle movement (Sports Injuries - a seld help guide by Vivian Grisogono ISBN 0-7195-4111-5 has been useful to me as it give good advice and offers suitable exercise for a range of injuries)
3. You need a GOOD physio/chiro I have tried many over the years and some are good, some are bad and I have had physios who have been worse than chiros. A professionally recommended practitioner is probably the best bet.
4. I don't know how old you are but these things can take a Looooonnnngg time to heal 12 months is not uncommon or years depending on the severity of the injury.
5. In the end surgery may well be the only option. But I would explore other alternatives first, in a cautious way, after all you don't want to make it worse

In reply to BlakeyDerbyshire:
I can empathise with you and hope you get some relief and improvements soon.
I had a prolapse of L4/5 but as it was central (ie into the spinal chord) an operation would not be done due to high risk of damaging the spinal chord. I don't know what yours is like, but
if you wish to pm me I am happy to discuss my experience.
Meantime, if the prolapse has not resolved itself fully, my advice is do not even think about going on a climbing holiday in May.

I found regular yoga practice to be only cure what worked for my back rain, not an over night cure but got there in the end.

i had surgery 2 years ago after being floored with sciatica caused by a proplapsed l3/4. as soon as they saw the mri they said there was no question, only surgery would work.
operated in preston. bloomin superb service by the nhs, granted, after a long wait.
so just to say surgery can work, i'm better than ever now.
gabapentin was the only thing to numb my pain as it was specifically a nerve painkiller.

In reply to BlakeyDerbyshire:

It depends a lot on the degree and site of the 'prolapse'.
I suggest taking your MRI results to a physio who uses the Mckenzie technique.
If the prolapse is small, they can teach you exercises to 'nudge' this back in, and strengthen suitably to prevent reoccurrence.
Quick fix manipulations, as you have seen can be short lasting and expensive.
You want to avoid surgery at all costs. It's not all it's cracked up to be, and micro discectomies have a poor outcome.

In reply to BlakeyDerbyshire:

Has the physiotherapist mentioned the McKenzie exercises? Or Robin McKenzie's book?

http://www.amazon.co.uk/Treat-Your-Back-Robin-McKenzie/dp/0958269203/ref=sr...

Chartered Physiotherapists
http://www.csp.org.uk/

In my experience the self-management mentioned above is extremely important. That is the advantage of physiotherapists over others: they are ready to help you to take charge of the problem and deal with it yourself.

Heat is very helpful and physios will often use IR. You can use hot water bottles instead.

Muscle relaxant is often an important aspect. Pain relieving drugs are required to allow protective muscle spasm to relax and let the spine move back into line. Forget oral Voltarol or whisky: this needs the real stuff. Oral DHC or intra-muscular Voltarol might be the starting point. Some individuals need more, but careful management is required for DHC, and similar, due to risk of habituation.

In reply to BlakeyDerbyshire:

I was in my late forties when I had the same problem, after my experience I would say surgery is your only option, going down the physio, chiro route only resulted in wasting lots of money with no beneficial results!

Why did they say surgery is not an option? I would get a second opinion because I had a discectomy and laminectomy and was pain free and back to climbing Alpine TD within four months from walking as though my shoe laces had been tied together and having to rest every 100 yards.

Having surgery has to be better than a life on class A pain killers IMO, also what I'd say is unless you have actually greatly suffered with this debilitating condition any other advice re resting, physio, etc is useless.

If the pain is getting worse it's obvious that you can't carry on as you are and unless there are certain contraindications for not having surgery, I would all but demand this.

In reply to Albert Tatlock:

'Beware the man with the hammer, as they always want to knock a nail in.'
If the symptoms are centralised and not spreading with altered sensation/power to the arms and legs then it's unlikely an NHS orthopod would operate. The risks of surgery include death, and paralysis.

In reply to BlakeyDerbyshire:

I have a herniated L4/5 disc. I went to Font a few months after the initial injury and was quite depressed that I couldn't try anything hard due to the pain involved when falling off.

I was offered disc fusion surgery through BUPA (lucky my job gives me that), but didn't fancy being off work for such a long period and was concerned about the risk of it making things worse. After a chat with the surgeon, he sent me off to physio who had me doing loads of McKenzie stretching. I was sceptical, but did as I was told (anything to get better) and saw a remarkable improvement.

It's nearly 2 years since I started the physio and, whilst I still get some pain, I'm almost fully active again. When I get twinges or the aching gets worse, I go back to the exercises. In the meantime I keep my core muscles strong through the usual exercises (planks, crunches, leg dips etc)

I feel that I might have to have the surgery at some point in the future, but for now I'm coping. Speak to your physio about McKenzie - there seem to be some doubters out there, but if it works for (and your physio confirms it won't make things worse) give it a go.

The pain moved around quite a lot for me too (still does), but that was mostly due to compensation of movement/posture due to my back hurting so much. My posture is pretty crap still, which means I still get twinges - they serve as a reminder to sit properly!

Good luck with it all and hope you get it sorted.

In reply to BlakeyDerbyshire:

Have you tired cup therapy and yoga they sound like silly solutions but that plus hamstrings & hip flexor stretches sound give you reduce pain, improved posture & flexibility.

I did the same some years ago & popped ibuprofen for 2 months nearly everyday & I've done the above to regain some of my control & pain management in this area. Good luck

In reply to BlakeyDerbyshire:

With the caveat that "your mileage may vary", I'll tell you what fixed my L3/L4 prolapse, which was giving me such serious pain around 10 years ago that I had to roll out of bed in the morning and get up on my hands and knees.

Two things: pilates, and some other core exercises, and stretching, particularly hamstrings. Oh, posture as well...three things!

Pilates/core - the logic here is that you should be using your core muscles far more in any number of tasks, like bending down to pick up a screaming baby! Without use of the core muscles, far more of the strain is passed to the back muscles, with the attendant stress/spasm/eye-watering pain I am sure you are familiar with

Stretching - an immense amount of stress is transmitted from your feet when you slap them down on hard pavements (or fall off boulder problems...). The more flexible your tendons, especially your hamstrings, the less is transmitted to your lower back.

Posture - I used to stand a bit like a Neanderthal...bad! You can check the right posture by standing against a wall, you should be able to stand with both your heels and the back of your head touching it. Assuming you have some sort of bum, your back won't touch but should be parallel to the wall. So, bum in, core muscles engaged. It needs work, a lot of work. before this becomes natural, and I find myself slipping into old habits, especially when tired. However, again it redirects stress away from that lower back, and has the added benefit of increasing your height by an inch or so.

All of this stuff needs training and your hard work, but believe me it's worth it. I have been pain free for many years now, and falling off highball problems onto mats is no problem, whereas before I shuddered to think of even coming off 6". Good luck!

In reply to BlakeyDerbyshire:

L5S1 here, 10 month in and told unlikely to see much improvement. It is bareable, but limiting, hardly running at all, climbing is ok, hoping biking will be. Trying to avoid surgery.

Best thing I have found is acupuncture, fabulous relief of pain. Getting it from nhs physio (free) is a bonus. Hot water bottle most evenings definitely helps too.

good luck

sarah

In reply to BlakeyDerbyshire:

I feel your pain. I have a radial tear across my L4/5 disc which has been leaking and been causing me all kinds of problems since 2011. My advice would be to give it more time,work on your static isometric strength and get your pain management under control. Every specialist I have spoken to said I was kidding myself if i thought i'd see any sign of recovery within 18-30 months. So don't be thinking of operations yet! The operation isn't to be taken lightly anyway as they go in through the front and have to move all your organs out the way. Your years away from that anyway unless you go private.

Seriously mate give it time. Look into Yoga or pilates and strengthen those lower back muscles and also stretch those hamstrings. Are your hips tilting forward or back? I've found static isometric holds have worked the best for me but this is going to depend on what type of hernia you have. I also take Amitryptyline which takes a bit of getting used to but it works for me where other really strong painkillers didn't. Give it a try

I still have flare ups but i can climb, lift weights and run a bit which is progress from walking like a cripple.

Oh yeah, in the early phase of my injury i did a lot of walking lengths in waist high water at the swimmimg pool. Plus a shit load of swimming. The swimming kept me sane i reckon.

Good luck and don't give up.

In reply to BlakeyDerbyshire:
I agree with a lot that's already been said by others' here. Don't waste your money on chiro's - once a disc is bulging it won't go back in no matter what people tell you and a poor chiro will only make things worse! It's a matter of stretching and strenthening various areas to support your back. I have slight bulging discs at two levels that occasionally cause neurological pain in my knee but a physio friend of mine said that I needed to stretch more, especially my hamstrings because most of my severe pain was coming from muscle spasms at the base of my spine (The tightness in my hamstrings was having knock on effect to my lower back apparently). Since doing this the muscle spasms have reduced dramatically.
Don't know anything about the mckenzie thing though maybe worth a look.
They won't tend to offer you surgery until you have substantial neuro symptoms from your disc such as leg pain, numb/ tingling feet etc.because just because you have bulging disc doesn't mean it's the cause of your pain; most back pain is muscular.(just depends how big the prolapse is and if it's compressing any nerves)
Don't rush into the surgery though; having MRI'd people for 8 years now I have seen good examples of discetomies and bad ones - last option!
Take Vitamin I (Ibuprofen) as well for fairly long course.
Basically bad backs are awful and difficult to treat quickly.
Oh and yoga's really good to apparently, as has already been said.

Hope you get better soon

In reply to BlakeyDerbyshire:

Sorry to hear about your back problems.

As a long term sufferer of disk problems in this area (and associated effects like stenosis) I have found the following helpful:

1) A good physio is important, ideally one with a specialism in sport injuries who is used to working with athletes - this ensures an understanding that it is not sufficient to simply be able to walk to the shops.

2) Activity (sensible) is very much your friend - this helps massively both psychologically and with freeing up muscle tension/spasm, plus I am convinced increasing blood flow must help. If you have an MRI you know the positions to avoid, so experiment (your physio can help). Typically I have resorted to turbo trainer (as a controlled environment) and built up from this. Finger boarding can also be OK,but go easy with anything involving one arm or added weight.

3) I have found self massage with foam roller and massage ball helpful to supplement physio work - show your physio what you plan to do though and discuss.

If you are 3 months into this, the tear in your disk should have healed (although there will be scar tissue there now). That just leaves the gel like contents that has 'bulged'. The body is very effective at breaking this down in time but if there has been nerve impact, this sort of recovery becomes harder to predict and the longer the nerve is being 'squashed' the greater the risk of permanent damage - I doubt this is your situation though if surgery is not being discussed. Again, it is worth discussing this with your physio who will check for loss of sensation or strength.

The good news is that (a) this will almost certainly sort itself out and (b) nothing is better for increasing motivation than an enforced lay off. Work hard at your recovery and use the opportunity for a strength based training phase (once fingerboarding is an option), then enjoy a summer of crushing......

In reply to BlakeyDerbyshire:
Hi, I had a disc prolapse about five years ago and now in the middle of my second episode. Seems like yesterday now that familiar pain has returned. The first time, like you I explored all the avenues, chiro, physio, etc etc. Had an MRI and was sent to see a neurosurgeon who told me I needed surgery.
As the months passed, awaiting the surgery, i did see some slight improvement and was eventually able to ride my bike, initially just up the road an back as it was still extremely delicate. At this time I could only walk with a limp, and not stand for more than a minute or so. Sitting down on a chair was much more uncomfortable than my bike for some reason. I spent much of the rest of the time lying down in the house and cycling. I carried on with the cycling and eventually the pain faded enough to start driving again which allowed me to go mountain biking.
It took about a year to get right and whether the biking made it better or worse ill never know but I was able to get better without the surgery at least. I even managed to go to the alps that year, carrying a huge rucksack and climbed a few 4000m peaks without any problems. The key for me, was that I had found something that I thought helped me recover. It seems like all back injuries are very specific, for some swimming helps, I know other people who carried on climbing, so it's about what's right for you.
This episode doesn't seem quite as bad and I'm following the same treatment as last time and although it's really frustrating and at times the pain has just wanted me to give up, I'm having faith that time will sort it out like last time. Other things I try are any exercise that don't cause pain. Planks, pressups seem to help with the core strength. I take glucosamine, use ice, rest, ibuprofen to help me get moving and just try and avoid anything that makes it flair up.
Good luck!

In reply to BlakeyDerbyshire:

http://www.amazon.co.uk/Sarah-Keys-Back-Sufferers-Bible/dp/0091814944/ref=s... - I have found the exercises in this very helpful.