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Ups and Downs

Posted: Mon Mar 28, 2011 11:15 am
by EngineerDoug
Hello all,

I've been lurking and posting here over the last year and thought I would give you an update and perhaps compare my experience with others. In short, I have an L5 protrusion that gives me modest/intermittent back pain. Seldom do I get symptoms down the leg, and I have no numbness or weakness. I've been doing core work ever since the injury 14 months ago, and have managed to put a lid on my discomfort that way. It's safe to say that I have improved slowly, and I often have periods of a week or several where there is only minor discomfort. The problem is I keep getting small flareups. I had one last fall and submitted to an epidural. I didn't think the epidural did much of anything for me. I had another one in early January and could not see any immediate results. One very interesting thing about the second epidural, however, was that I did not feel any pain radiating down the nerve when the shot was given. The first time in October I could feel pain all the way down the leg when I got the shot. So my doctor told me that I must have done some healing by the time I got the second one because pain down the nerve is a sign the nerve is not happy. He told me to just keep working out and give it time.

I see a physical therapist every 2 weeks and he has taken a similar stance. He tells me to take Celebrex when I have flareups to manage inflammation and keep going. He has also told me that it could take up to another year for this to stop bothering me. Maybe the darn nerve is healing and just has not yet decided to stop complaining.

We all know nerves are slow to heal, but somedays this is hard to take. The last few days the back has been cranky and I honestly don't know why. I can't put my finger on something that I did to aggravate it. I am also frustrated because my injury was never very severe, especially compared to many of you out there. I never had weakness, numbness, or pain that never goes away. I also find it hard to deal with the fact that some days exercise will make me feel better, and somedays worse. I will have days when I have a little tightness and after my workout I feel fine. And then other days when I fell worse, even after a walk.

Going a little nuts here with this...any similar experiences?


Posted: Tue Mar 29, 2011 10:01 am
by nth_dimension
Hi Doug,

I replied to one of your older posts. My experience is probably pretty similar. The most consistent thing about my journey with LBP and sciatica has been the sheer inconsistency of it! My issue started a little over a year ago. Since then its been up and down. Left leg sciatica, mostly below the knee, alternating with lower back pain. It has always been pretty mild. I've never taken so much as a day off work. At its worst (back in July I has some calf pain that was killer), it was a drain on my spirit and I didn't perform at a high level, but again, I kept on plugging away.

Here is one thing I've noticed.... I can be in a good flare-up, and will have something social to do. A dinner-party, or something like that. Leading up to it, symps will be nagging away at me and I'll be upset by it... but normally very soon afterwards and during whatever I am doing, I AM FINE. Anything like this seems to unfold this way. A lot of it is mental and I really am working on that angle.

Anyway, there have been several periods lasting weeks and even a couple months where there were virtually no symptoms.

I'd say 20% of the time, I've had annoying symps, 60% mild symps that don't really slow me down, but are a bit of a bother, and perhaps 20% of the time, 100% OK.

I think the key is to keep on living. Yes it hurts at times, but every time it does, you have to remember that it will get better again. It doesn't last forver. Keep exercising, keep moving, and keep being healthy. I think for people in our case its a matter of time and positive attitude.

Question - do you find your symptoms move around? ie: if your leg hurts, does it switch to yuor back for a while and you notice the leg pain improve or go away?

Posted: Tue Mar 29, 2011 12:14 pm
by EngineerDoug

My symptoms move around a lot. Sometimes I get tightness/discomfort near the spine where my L5 problem lives, with no leg symptoms. Sometimes I have no back pain, but mild leg symptoms. The leg symptoms move around a lot - they can be pain in the foot, or tickling in the shin, or a vague sorness where the sciatic nerve passes behind the knee. Invariably the leg symptoms are very mild and if these were the only thing I had to contend with, it would be easy to ignore them.

You are right about the mental aspect. A lot of it is in the head. That is to say, when I am having a good spell, some minor discomfort doesn't really bother me. It's when you tell yourself that you have slid backwards that the curtain of doom falls on you.

I've done so much reading about this subject and it almost seems strange that some folks have really mutilated a disc and healed up (it seems) more quickly that I have. I know my issue is relatively mild because the nerve is not pinched enough to cause weakness or numbness. It just seems to get "tickled" by the protrusion. Apparently these darn nerves are so sensitive that once you tickle them it starts a little avalanche of irritation that takes days to subside. As I mentioned, I do take Celebrex for flareups, but it takes something like 3 days for the Celebrex to build up and take effect - so I am told. I don't want to be on meds for the rest of my life, but sometimes I wonder if I should just shut up and take the anti-inflammatories for a few months. One thing I do know is that inflammation can be stubborn once it sets in. I've had my share of athletic injuries and seen how long it can take to get rid of minor damage.

The literature on spontaneous disc re-sorption is very interesting as well. You tend to conclude from these studies that minor herniations/protrusions do not elicit the immune response that seems to be responsible for absorbing the offending disc material. Maybe the lesser the injury the less urgent the body's response to heal?

Another thing I wonder about is, whether my problem is primarily the disc or the nerve. You can read about some folks who get disc tears and these in themselves give pain. My doctor keeps telling that neurologically "I look great", so I keep puzzling over that one.

I've also wondered about the issue of flexion versus extension. I read Dean's ebook many months ago, and many folks get great relief from the extension style exercises. I regularly do a flexion stretch - the Yoga prayer pose and it feels fine when I do it. I know if I go in the opposite direction - the Cobra - that I will get a hard pinch that has got to be the nerve getting compressed. So it's touchy experimenting with different stretches because you get different recommendations from different sources.

If I tally up the positives, I can say that my sitting and standing tolerances have generally improved. I am now able to sleep on my right side most nights without left side pain. And I responded better to the epidural injections in January than I did last October. Sometimes I surprise myself with the things I am able to do on a good day.

Anyway, thanks for listening and I appreciate being able to talk to somebody who is on the same track. I'll be checking the forum now and again if you want to share more. Have a good day.


Posted: Thu Jul 21, 2011 8:08 am
by nth_dimension
Doug - how have you beed?

Curious to know how your recovery has gone.

Posted: Thu Jul 21, 2011 11:56 am
by EngineerDoug
Well. in general I think I am doing better. The progress is so slow, however. I had another flare-up in late April and visited my doc. He suggested another MRI to see where I stand. The MRI did show that I still have a tear that has not yet healed, and he suspects this is what is bothering me. He was very positive on several fronts, however. He believes my response to the epidurals shows the nerves have done a lot of healing. He also has ruled out any problems with the facet joints - they show normal wear and tear but nothing problematic. The tear is just going to take a long time to heal.

We discussed what's next, and he suggested that I be more agressive with my PT/exercise. He is, as I might have mentioned, a former college football player and a "survivor" of a back injury. He had an epidural ~15 years ago, and still looks like an NFL linebacker at 49 years of age. The point here is that he works his abs for 20 minutes every day. He told me to "go after it" and work the abs every day - and don't be afraid of a little discomfort for a while. He suggested I work though it even if the exercise bothers me a bit. Obviously I should not push through it if I am really in pain, so this is a fine balance.

So for the last 6 weeks or so I have been following his advice. I do 20 minutes of core work each day, followed by 40 minutes of recumbent bike. I find, so far, that this makes me feel better after the workout than I did before. My days are, on average, pretty good. The symptoms do seem to be slowly fading, but boy is it slow. I feel like I am on the very last plateau. I do take a Celebrex maybe once every 10 days or so when I feel the soreness kicking in, because my doc told me not to be afraid of taking it as needed. The whole idea seems to be that the exercise helps healing, but you have to walk the balance between healing and irritation. I know I was working out intensely last year with mixed results, but maybe I wan't yet ready for that level of exercise back then.

If you take careful stock of how you are feeling you can pick up on small indicators that you are making progress. For example, I notice that I am much more able to sleep on my right side than I was a year ago. Little things like that tell me I am doing better.

Posted: Fri Aug 26, 2011 9:19 am
by nth_dimension
Glead to hear it!

I still get the odd day or two, here and there, where I have a little lower back pain, or sciatic nerve symptoms, but most days I am pretty good. I've upped the exercise levels considerably, and you know what? It doesn't seem to make anything worse. Its either better, or about the same.

I'm on that last plateau as well. Hopefully I continue to improve.

Some Updates

Posted: Thu Nov 17, 2011 10:02 pm
by EngineerDoug
Hello all,

I've been fighting a lumbar injury for the last couple of years now, and I thought I would share what I've learned. I could also use some encouragement and/or experience to help me understand my issue(s).

To sum it up, I have low level left side back pain with no leg weakness or numbness. Very rarely do I get any leg pain, and if I do it's really just twinges. The back pain comes and goes, and some days are worse than others. I've been on an exercise program that includes core stabilization such as planks and bird dogs. I also include walking and stationary bike as well as stretching and inversion.

I am under the care of a physiatrist and he has administered x3 epidurals over the space of 6 months. These really didn't seem to help. I also had cortisone applied to my facet joints, but this seemed to help for only a few weeks. The way my pain moves up and down, it's hard to really tell what affects what. It varies so much from week to week.

My MRI shows some facet wear as well as bulging discs at L3, L4, L5. Nothing too terrible for a 52 year old active male in otherwise very good health.

The problem is I just don't seem to be getting better. I have days when I feel like I have turned the corner and my back is just an annoyance, and then I have days when I have to reach for Celebrex. The Celebrex doesn't help much, either.

The only guidance I really get from my doctor and physical therapist is to stay out of extension and keep my core strong. I am wondering if they really know what is giving me pain. Could it be that the disc bulges and facet wear are not the problems? I hear stories of folks who have benefited greatly from the cortisone - people who have much worse injuries than I do.

Or could it be that this thing is just going to take more time to heal? Iis it really the nerves, and they will just take more time to stop being irritated?

I have also tried traction - I have a teeter table. Some days traction hurts a bit. I don't know whether I am doing myself harm, or whether I should stay with it for a while.

All in all, I am pretty much confused about what I should do. I am more than willing and able to work hard and push through discomfort if it will help me in the long run. Any similar experiences? Any advice?