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  1. #1
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    L2 / L3 herniated disk

    I was run over HARD this weekend by the Pain Train. A trip to the ER concluded with IV demerol (may I have another?) and a diagnosis of a herniated disk. Going to have an MRI tomorrow to see what's what...

    So, who else has this condition? How did you treat it (surgery, chiropractic, whatever...)

    How much does cycling aggravate the situation?

    Why does this suck so much?

  2. #2
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    L4/L5 Here

    I feel for you. I had a herniated disc (L4/L5) in Feb. '03 (work related injury). I was in constant pain 24hrs a day. After 3 mos. I opted for surgery. I'm glad I did it. I went in on a Sunday morning and was released that following Monday afternoon. I was still under a doctors care for about 6 mos. (Funny the doctor never prescribed physical therapy for me). My doctor didn't recommend using an indoor trainer either until I was fully recovered.

    In that time of inactivity I gained 30lbs., was diagnosed with Type II diabetes, high blood pressure, etc.

    I'm all better now I lost the extra 30lbs. (and losing), my doctor finally took me off my diabetes medicine, etc.

    good luck and hope you feel better
    You'd think we were here for something other than fun. - Ishmael

  3. #3
    DraftMaster
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    Don't know what area of the country you live in, but here's a link to Dr. William Dillin of the famed Kerlan-Jobe Orthopedic Clinic in Los Angeles. In 1988, Dr. Dillin performed a successful microdiscectomy on me for a herniated disc at L4/L5. I had excruciating leg and back pain and the surgery eradicated the pain completely. I let him cut me again for neck surgery in 2002 for a dangerously fragmented disc at C4/C5. Once again, complete sucess. I was riding my bike and rock climbing again in 6 weeks. He's the spinal expert to the Lakers, Dodgers, Angels, and Kings. I would trust my life to this man, and I did... TWICE!

    http://www.drdillin.com/bio.htm

  4. #4
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    L5/S1 for me!!!

    last November, 2006....all of hte sudden...whamoo!! excruciating pain in my left leg..couldn't sleep...could barely walk...took it like a man for about four weeks until the numbness was just too much...went for surgery. recovery took a few months and there's still residual tightness in my left calf...riding feels good though and I've returned to doing most everything I did before...although I avoid most heavy lifting now.

    for surgical types, do it because there's a potential nerve damage...don't put it off if its serious (sounds like it might be). I could recommend a good surgeon if you're in the NW area..Dr. Nemecek at OHSU...microdiscetomy...was only in the hospital for about six hours...on my back for about four days afterwards before turning to work part time for the first week. about two bouts with PT..mostly stretching and light strength building...

    I've heard from others that cycling is variable...hurts some...helps others...

    don't put treatment off though...get it taken care of and get several opinions on what that treatment should be. My herniation was massive and I'm only 32...
    Not banned yet.

  5. #5
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    My personal experience is misdiagnosis. Something to keep in mind. After whiplash (thanks to drink & drive Michelle from down the street) I was told L4/L5 area herniated disks.

    Chiropractic & body work & years of careful recovery, no herniated disks. New chiropactor, very careful treatment, deep muscle bodywork, refused surgery, made my own evaluation of the data. Did take years for me to start the recovery with deadends. 93 to 2000 with pain. 2002 I was almost pain free.

    Cycling - position difficult to evaluate. A stretched out position that really feels too aggressive and long and deep and leads to a stiff neck makes my back feel great the next day. So I'm still working on the position. On the bright side, I have to go 45 miles before I even think about my back. Which (in my book at least) represents incredible success. From walking with a cane to out of the saddle slamming up the hills.

    But if I'd actually had a herniated disk . . . I'd probably be deeply evaluating surgery.

  6. #6
    BS the DC
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    Quote Originally Posted by Oxtox
    I was run over HARD this weekend by the Pain Train. A trip to the ER concluded with IV demerol (may I have another?) and a diagnosis of a herniated disk. Going to have an MRI tomorrow to see what's what...

    So, who else has this condition? How did you treat it (surgery, chiropractic, whatever...)

    How much does cycling aggravate the situation?

    Why does this suck so much?
    I'm a chiropractor. I've had a herniated disc myself. I treat herniated discs every day. What worked for me and most my patients is chiropractic adjustments, spinal decompression, and McKenzie exercises. Mild cases respond well to this type of care alone. Moderate cases often require oral or epidural steroids. Severe cases may require surgery.

    The forward flexion of cycling will aggrivate most herniated discs. Some will experience relief. For one patient, cycling was the ONLY time he had no pain at all.

    It sucks so much because there is pressure directly on the nerve.
    "The team wasn't just riders. It was the mechanics, masseurs, chefs, soigneurs, and doctors. But the most important man on the team may have been the chiropractor."

    - Lance Armstrong, Every Second Counts

  7. #7
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    2x Herniated L5-S1

    Both happened while running, but I think that they were agrivated by stress. The first was in 1997. It started with crippling pain that was managable after a week. I suffered for 16 months while trying chiro, stretching, steroid injections and PT. I finally had surgery, and it was great, but I am glad that I gave the other therapies a try before going into surgery.

    Next was about 2003 same disc. This one started with discomfort and moved to severe pain after a 2 months. I was carried out of my house to have a discectomy. Same surgon. So far every thing is fine.

    In my case I was glad that I waited and evaluated my options before going the under the knife. I was told that I was not doing any damage by waiting (at least the first time).

    For me biking always provided some relief. I also started swimming more. That may be the best way to exercise and not strain the back.

  8. #8
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    I'll chime in too. I injured my back several times at work and then one day whamo while water skiing. I believe it was an L3/L4. my MRI show a huge herniation. The neurologist did not push surgery. But after PT and steroid treatment I was still experience severe pain, foot drop and numbness. I had surgery and it helped a lot. Being an idiot I had a second herniated disk (confirmed by MRI) from jumping off a cliff while skiing. Met with the neurologist and this time PT seemed to help. My advise is not to rush to surgery. Give time and PT a chance to work. Yoga was very helpful for me in developing an awareness for my body and improving my posture. I have recently returned to biking and I have had some back pain. One leg is weaker than the other and I need to give it time to catch up. I have been able to slowly increase my distance and the pain is not persisting. Best of luck.

  9. #9
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    Wait and see. My husband (who is a chiropractor) has conservatively managed his lumbar disc issues for more than 20 years. (caused by powerlifting...unusal crosstraining for a cyclist) Ice packs everyday, careful sleep positioning, muscle stim and occasional chiropractic treatment when it flares up. He rides a hardtail mtb as well as road without much trouble. Riding his horse and the tractor seem to bother him more than the bike.

    Good luck with the MRI, perhaps the ER diagnosis will turn out to be overblown.

  10. #10
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    Low Back Pain

    Another Chiropractor here. I have been in practice 18 years, and seen literally thousands of cases of back pain. Most cases respond to conservative care, ie chiropractic, stretching, physical therapy, core strengthening. My opinion is to try conservative care first, you can always have surgery if that does not work. I would give chiropractic a trial run, 4-6 weeks. If you are unresponsive, or worsen, it isn't for you. You should start to feel improvement within a couple weeks, most often sooner. Surgery is permanent, and doesn't always work either. Some of the saddest cases I have ever witnessed have been failed back surgery patients. However, I have to say the surgeons have greatly improved their success ratio over the years. I would say in 18 years of chiropractic practice, probably less than 50 of my patients have had to resort to surgery.

    Being on a bike puts you into flexion, which opens up the posterior part of the disc, and can cause bulging depending on your posture and biomechanics. That bulging can push on the nerves or even the spinal cord, depending on what is occurring. Those nerves are connected to surrounding musculature and the lower extremity muscles. Pressure and inflammation of those nerves causes spasms of those muscles, which can be severe and very painful, as you have experienced...

    If you have any specific questions, I would be happy to answer, you could PM me.

  11. #11
    Failboat Captian
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    After many, many years of very abusive skiing, I finally did mine in by laying hardwood floors in my house. Bent over a 5lb hammer for a few days. After I finished installing the floors, I was under the bathroom sink, putting the plumbing back together. I had had mild back pain prior, but this time, I stood up and then SLAM, I crumpled to the floor like a sack of potatoes.

    I had the MRI and they said it was a bulging/herniated disk in the L4/L5. They sent me to PT. I basically strengthened the crap out of my core, especially the abs, and all has been well for the past 5 years or so. Strengthening the core starightens your spins and keeps the disc from pushing out and hitting your nerves. I get very mild pain once in a while, but it doesn't last more than a few seconds. If the pain lasts more than a few minutes, sit ups will eliminate the pain for me almost immediately.

    That said, I'm pretty tolerant to pain. I blew out an ACL one morning on my first run skiing, and continued to ski for the rest of that day (didn't think I exploded my ACL the way I did), and skied on it that way for the rest of the season.

  12. #12
    RoadBikeReview Member
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    I would definitely consider spinal decompression along with chiropractic. You can google it and read about the benifits...much cheaper and possibly much healthier than surgury.

  13. #13
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    Thanks for the replies.

    After five days from the onset of symptoms, I *finally* got the ins co to authorize an MRI. The results indicate there are THREE disks with 'significant abnormalities' (that doesn't sound good).

    I'm being referred to a pain management specialist who will supposedly outline my treatment options.

    At this time, I'll definitely leave surgery on the table as a last resort option. I read up on the spinal decompression technique, sounds like something worth pursuing.

    The Serotta Ti frame bike that I just finished building sure looks lonely, wonder how long before I can saddle up again...

  14. #14
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    L4/L5 here

    32 years old and over the last five years I have had 3 diffrent chiropractors. I've tried the spinal decompression with no success. The dvd and all the hype sounds good but they do exagerate the results. Insurance covers very little and you end up spending several grand by the time it is done. I used the DRX-9000 it is the big name and seems to have the best track record. I finally tried the cortisone shot and my pain is still there but to a lesser degree.

    I am looking into surgery next.
    J
    Light travels faster than sound. This is why some people appear bright until you hear them speak.

  15. #15
    RoadBikeReview Member
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    Clay C and BSDC,

    Thanks you two, for the free professional advice. Nice to have experts in various fileds on these forums to help out as you have.

    Have a great one.

  16. #16
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    lumbar disc injury

    Thought I would put in my 2 cents. I am an orthopaedic surgeon. In general you should always pursue non-surgical management as long as possible. There are several reasons to conider surgery early. If you have constant numbness and weakness in the leg you may develop permanent neurologic problems. If you develop difficulties with bowel or bladder function you should have immediate surgery. In almost all other cases non-sugical management is the way to go. Each practicioner (Chiro or MD) will have their own protocol which will include rest, anti-inflammatories (advil etc..), chiro treatment, PT, and occasional cortisone (epidural) injections. Disc decompression is a newer technique which is somewhat controversial. If you hang upside down you get essentially the same effect. There is a fair amount of PR about the technique as it is profitable, but I would give it a chance if you are interested. There was a very good study which looked at several hundred patients with acute disc herniations. Half were treated with surgery and the other half without. At two years they were functioning and feeling the same, the difference was that the patients who had surgery felt less pain more quickly. The long term concern is what we call degenerative disc disease. Once you remove the disc the spine may more likely develop arthritis (DDD) down the road. The key is to treat based on your symptoms. Remaining physically active is helpful, but you have to be smart about it. No heavy impact activities (running, tennis, basketball etc...) The forward position of cycling is usually painful as it places more pressure on the disc, but if it is not make sure to remain in the saddle and keep your abs engaged. I hope this helps a little.

  17. #17
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    Ortho,

    I see you're new. Glad to have you aboard and thank you as well for the professional advice.

  18. #18
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    Here's my follow-up report...

    After carefully weighing options, I chose to have the microdecompression discectomy, a minimally invasive surgical procedure. This involves drilling a hole in the vertebrae, moving the nerve aside, and trimming off the bulged portion of the disc.

    This procedure seemed to offer getting me back to being active with the least downtime. As orthowill mentioned, there was some concern regarding persistent numbness from the knee down which helped convince me to go this route . The operation was performed outpatient which factored greatly into my decision. I was home nine hours after checking into the hospital.

    Recovery has been fairly pain-free. The first 72 hours there was some noticeable soreness/achiness, but all in all nothing too bad.

    Four days post-op I was in the pool doing light workouts. Day five, I walked four miles. At six days I tried the bike...only made 9 miles as reaching out over the bars pulled at the incision a little. There was no post-ride soreness, so I've been slowly pushing the mileage up. Today (12 days post-op) I did 28 miles...all flat, climbing isn't happening yet, and tried to keep things at a relaxed pace.

    Still waiting for the nerve trauma and numbness to completely subside and my sleep patterns are kind of erratic. Other than that, I'm feeling pretty good.

  19. #19
    The Gimlet Eye
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    L4-L5 and L5-S1 for me.

    I had the same surgery back in March. Had a nasty bout of spinal headaches post op, but everything else turned out fine. No more leg pain, the back still aches a little when I'm very active but I think that's to be expected.

  20. #20
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    L3-L4 and C3-C4

    L3/L4 was herniated back in 1999, I tried chiropricter for a little over a year, and I thought it was working, but it never got better, actually got worse. Finally had surgery in 2000. In 2002, I started having pain in my sholder blade, which I thought was a pulled muscle. I continued to shoot my bow (not cycling at the time). After my right arm finally started getting numb down into the fingures, I went to the doctor. After a few days a an MRI and nerve damage test, the doctor said it looked like someone stepped on a jelly donut in my neck, the disc had ruptured. Surgery insued rather quickly after that.

    5 years later, all is well. I have been riding for a year and a half, and have dropped 30 pounds. Back and neck are fine now and I hope to continue to drop more weight and keep stacking the miles on.

  21. #21
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    disc rehab

    You will rpobably hear this over and over, but the key to protecting the lower back is maintaining your "core" strength. Keep your abs strong and your low back strong and flexible. Be careful on the bike that you don't exert too heavily for the first six weeks and recurrence of the herniation can occur if the disc has not healed. The best way to think of a disc is a jelly donut. Some of the jelly squirts out when the disc herniates. If you have a microdiscectomy the remaining disc in preserved, but the donut portion or rim of the disc needs to seal over (takes about six weeks) before your risk of recurrent herniation is reduced.

  22. #22
    RoadBikeReview Member
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    Quote Originally Posted by boyd2
    Both happened while running, but I think that they were agrivated by stress. The first was in 1997. It started with crippling pain that was managable after a week. I suffered for 16 months while trying chiro, stretching, steroid injections and PT. I finally had surgery, and it was great, but I am glad that I gave the other therapies a try before going into surgery.

    Next was about 2003 same disc. This one started with discomfort and moved to severe pain after a 2 months. I was carried out of my house to have a discectomy. Same surgon. So far every thing is fine.

    In my case I was glad that I waited and evaluated my options before going the under the knife. I was told that I was not doing any damage by waiting (at least the first time).

    For me biking always provided some relief. I also started swimming more. That may be the best way to exercise and not strain the back.
    L5/S1 buldging discs. I opted for icing for an hour a day and stretching. No meds or other treatment although it did take a couple of months.
    For my next trick I will now set myself on fire!

  23. #23
    BS the DC
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    Quote Originally Posted by redjeepjamie
    32 years old and over the last five years I have had 3 diffrent chiropractors. I've tried the spinal decompression with no success. The dvd and all the hype sounds good but they do exagerate the results. Insurance covers very little and you end up spending several grand by the time it is done. I used the DRX-9000 it is the big name and seems to have the best track record. I finally tried the cortisone shot and my pain is still there but to a lesser degree.

    I am looking into surgery next.
    J
    The DRX-9000 is a rip off to the doctor and the patient. The machine costs the doctor about $100,000. The marketing for these machines is overhyped. The treatment plans are long and expensive. I've heard of people paying $4000-5000 out of pocket. There is absolutely nothing to suggest that these machines have a better track record than similar equipment that is FAR less costly to the doctor and the patient.

    I use a $15,000 machine that is every bit as effective. Insurance covers it with little or no extra expense to the patient. I think the secret to conservative care is not to do chiropratic, then spinal decompression, then steroids. I think it's important to combine all the treatments at the same time with McKenzie stretches and exercises for best results. If I can't get someone significantly better in two weeks, it's time for an MRI and a surgical consult.
    "The team wasn't just riders. It was the mechanics, masseurs, chefs, soigneurs, and doctors. But the most important man on the team may have been the chiropractor."

    - Lance Armstrong, Every Second Counts

  24. #24
    BS the DC
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    Quote Originally Posted by orthowill
    Thought I would put in my 2 cents. I am an orthopaedic surgeon. In general you should always pursue non-surgical management as long as possible. There are several reasons to conider surgery early. If you have constant numbness and weakness in the leg you may develop permanent neurologic problems. If you develop difficulties with bowel or bladder function you should have immediate surgery. In almost all other cases non-sugical management is the way to go. Each practicioner (Chiro or MD) will have their own protocol which will include rest, anti-inflammatories (advil etc..), chiro treatment, PT, and occasional cortisone (epidural) injections. Disc decompression is a newer technique which is somewhat controversial. If you hang upside down you get essentially the same effect. There is a fair amount of PR about the technique as it is profitable, but I would give it a chance if you are interested. There was a very good study which looked at several hundred patients with acute disc herniations. Half were treated with surgery and the other half without. At two years they were functioning and feeling the same, the difference was that the patients who had surgery felt less pain more quickly. The long term concern is what we call degenerative disc disease. Once you remove the disc the spine may more likely develop arthritis (DDD) down the road. The key is to treat based on your symptoms. Remaining physically active is helpful, but you have to be smart about it. No heavy impact activities (running, tennis, basketball etc...) The forward position of cycling is usually painful as it places more pressure on the disc, but if it is not make sure to remain in the saddle and keep your abs engaged. I hope this helps a little.
    I agree with everything except "If you hang upside down you get essentially the same effect." I find inversion tables are best for thoracic disorders and inappropriate for most cervical and lumbar disc problems. Cervical and lumbar disorders respond best to specific decompression machines. These machines allow appropriate positioning, controlled tension, and intermittent patterns that produce better results than static traction in some cases. That said, I don't think the controversy of spinal decompression is in the technique. The controversy is in the cost and marketing of the ultra high dollar machines like the DRX-9000 other machines costing over $50,000. Similar machines can be had for $15,000 or less and are being marketed and sold in less controversial ways.
    "The team wasn't just riders. It was the mechanics, masseurs, chefs, soigneurs, and doctors. But the most important man on the team may have been the chiropractor."

    - Lance Armstrong, Every Second Counts

  25. #25
    BS the DC
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    Quote Originally Posted by orthowill
    You will rpobably hear this over and over, but the key to protecting the lower back is maintaining your "core" strength. Keep your abs strong and your low back strong and flexible. Be careful on the bike that you don't exert too heavily for the first six weeks and recurrence of the herniation can occur if the disc has not healed. The best way to think of a disc is a jelly donut. Some of the jelly squirts out when the disc herniates. If you have a microdiscectomy the remaining disc in preserved, but the donut portion or rim of the disc needs to seal over (takes about six weeks) before your risk of recurrent herniation is reduced.
    I totally agree with Dr. Orthowill. The problem now is someone let all the air out of your tire and the tire is going to tend to wear faster now. Core stabilization and strength is critical. Stretch your hamstrings to allow you to bend more at the hips which will put less strain in your spine. If you could find someone who knows how to use The Stabilizer, it's an excellent tool. Dying bug and swimmer exercises strengthen the core without straining the back like sit-ups and back extensions can. Good luck with your recovery
    "The team wasn't just riders. It was the mechanics, masseurs, chefs, soigneurs, and doctors. But the most important man on the team may have been the chiropractor."

    - Lance Armstrong, Every Second Counts

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