Other/Mixed L5-S1 disc compression; "On-line" assistance request due to location

[Miguel]

Good day folks,

Just had a scan done and found out my discs are compressing my sciatic nerve, causing an uncouth amount of pain.

Background: 35 year old male, decent shape.
Low Back injury, 2006: Muscle strain. Picking up someone to fireman's carry. One month light duty (military), pain followed me around for years.
Low Back injury, 2008: Sever muscle strain. Poor squatting form. 3 weeks light duty, upon return from deployment, electro-therapy on low back for 2 months, pain followed me around for years.
Low back injury, 2015 December: MOI inconclusive (I suspect the ruck runs), doctor's diagnosis was piriformis syndrome. 3 weeks of limping around due to sciatic nerve pain.
-Changed my training paradigm, have been doing ROP since Jan 4. Monday, 6 June, did some heavier than normal snatches, no pain, felt great. Tuesday, 7 June, woke up with sciatic nerve pain, which steadily got worse. Went to the ER yesterday, 9 June, and got a scan. The doctor drew me a picture showing that the disc between L5-S1 was much thinner than the others and was compressing my sciatic nerve. He recommended me rest and visits to a kinesiologist.

The reason I am asking for on-line help is because I am currently stationed in Chile and there is little to no "expertise" down here, and the list of folks who accept TriCare in my area is even smaller.

Today I am a bit more mobile, I have reacquired more than a few "comfortable" positions, as opposed to writhing in pain no matter how I contort myself. I can stand and or walk around for about 20 seconds before the pain makes me "take a knee".

Any help or advice is greatly appreciated and sincerely welcomed. Thank you for your time and efforts.

 

[banzaiengr]

Miguel, given your circumstance, I would try finding a decent masseuse and see if that helps until you get back state side. Have them really work over your glutes and hamstrings.

 

[Steve Freides]

@Miguel, please read "Treat Your Own Back" by Robin McKenzie. His approach is very much in line with StrongFirst; the book is short and inexpensive.

You really should find someone local - there must be.

-S-

 

[Steve Freides]

I am moving this to Training -> Other. This section is just a listing of medical professionals.

-S-

 

[Miguel]

I am moving this to Training -> Other. This section is just a listing of medical professionals.

Sorry sir.

As for the book, it is in my cart to purchase, but it won't arrive for about 3 weeks. Too bad there is not a kindle version.

IRT to massagephysical therapists, there are three, one of which is a veterinarian. I asked for more info, but things move slow. I am hesitant to "trust" modern medicine down here when compared to services offered back home, but something is better than nothing. I will see what I get back.

Thanks again for your time.

 

[Steve W.]

Miguel,
There may be some relevant ideas in your previous thread about training a friend:

Low Back Pain Help, Please and Thank you

Some authors/researchers whose material might be useful:

From a structural/mechanical standpoint, Robin McKenzie and Stuart McGill.

From a more neurological/pain science point of view, Lorimer Moseley.

If you google them, you will find a bunch of products aimed at both patients and clinicians, as well as a lot of freely accessible content and commentary by others on their work.

Good luck.

 

[Abdul-Rasheed]

@Miguel I am sorry to hear of your pain, friend. I wish you speedy recovery. Awesome, immense help here in StrongFirst. The thread Steve W, posted is gold.

 

[Craig Fern]

Sorry to hear about your pain but wanted to let you know that there is a kindle version of McKenzie's books.

7 Steps to a Pain-Free Life: How to Rapidly Relieve Back, Neck, and Shoulder Pain - Kindle edition by Robin McKenzie, Craig Kubey. Professional & Technical Kindle eBooks @ Amazon.com.

good luck

 

[Steve Freides]

It's on Scribd - see if you can get it via taking a free trial of the service. FWIW, my wife subscribes and says, to her, it's worth the cost.

Robin McKenzie - Treat Your Own Back

-S-

 

[Steve Freides]

The book @Craig Fern mentions is an updated version of the one I recommended - it's also good.

-S-

 

[Anna C]

Sorry to hear about the pain, Miguel. Hoping for a speedy recovery.

 

[Tarzan]

Welcome to the club Miguel, it's not a very exclusive club, anyone can join.

The Mckenzie method gives me a lot of relief too. I've got a fractured vertebra that never healed properly as well as disk problems, so it will never be a cure for me but it's better than anything else I've tried and I've tried a lot.

You don't have to wait for the book, it's all on youtube. The basic principle is to simply extend your back (bend backwards) to counter the excessive flexion (bending forwards) that we all go through too often. Apparently Robin McKenzie discovered the principle by accident when a back patient he had layed face down on a chair and put his back into hyper extension and fixed his own back by accident. Those results would not be considered typical though, it normally takes several days or sometimes weeks of doing the exercises before you get relief.

Watch a few vids and get started ASAP



A common sign that the exercises are working is that pain centralises or moves closer to the spine. If that doesn't start to happen within a few days then maybe the excercises won't work for you. And take care, don't force any painful postures.

 

[Steve Freides]

I will add a few words based on my own experiences with the McKenzie exercises, and with the understanding that I am not dispensing medical advice here.

A common mistake I hear about and see is people assuming the McKenzie exercise is similar to a "superman" or similar movement - it is not intended to be an exercise in _active_ spinal extension, but rather _passive_ spinal extension instead. Use your arms to raise yourself, and keep a focus on having a long, and relaxed, spine.

The newscaster's mention that these exercises may not be appropriate for more severe injuries is spot 0n - everyone should get the thorough medical evaluation she suggests, and I therefore do not recommend doing these on your own without that thorough medical evaluation.

I am one of those people who suffered a back injury, and for whom the McKenzie exercises were prescribed to be performed every hour I was awake. For me, they worked.

Just my opinion; your mileage may vary.

-S-

 

[rickyw]

The doctor drew me a picture showing that the disc between L5-S1 was much thinner than the others and was compressing my sciatic nerve.

This isn't advice, just some thoughts:

Though the L5-S1 nerve root is part of the make up of the sciatic nerve (which is made up of the L4-S3 nerve roots aka the lumbosacral plexus), it is not the sciatic nerve itself. The sciatic nerve originates lower than L5-S1.

The piriformis muscle is a common place for impingement of the entire sciatic nerve. The hamstrings can impinge it as well, but less commonly so.

An interesting side note: A small percentage of the population have a split piriformis, with the sciatic nerve running between it....this theoretically may lead to a greater risk for sciatica..

Keep in mind, there are people out there with degenerative discs who do not have radiating pain...though imaging is useful, we cannot always rely solely on imaging to deduce where a patient's pain is coming from...

Therefore, with a thorough physical exam, a good physician will likely be able to better deduce whether your symptoms are truly originating from the L5-S1 nerve root, or whether they encompass the entire sciatic nerve...which could significantly modify the treatment plan...

 

[Steve Freides]

Keep in mind, there are people out there with degenerative discs who do not have radiating pain...though imaging is useful, we cannot always rely solely on imaging to deduce where a patient's pain is coming from...

This is an important point. If I recall correctly, most people's L5-S1 disc shows significant compression by their early 20's - that's early, and it is doesn't correlate with any sciatica or lower back pain at that point.

-S-

 

[Steve W.]

This is an important point. If I recall correctly, most people's L5-S1 disc shows significant compression by their early 20's - that's early, and it is doesn't correlate with any sciatica or lower back pain at that point.

-S-

Keep in mind, there are people out there with degenerative discs who do not have radiating pain...though imaging is useful, we cannot always rely solely on imaging to deduce where a patient's pain is coming from...

Pain science work such as Moseley's is very useful to explaining why the relationship between pain/functional impairment, and tissue damage/structural pathology is so complicated.

 

[Miguel]

There may be some relevant ideas in your previous thread about training a friend:

Duh! Thank you sir, I had forgotten all about that one. Funny, what excruciating pain does to the mind.

I am sorry to hear of your pain, friend. I wish you speedy recovery.

Thank you kindly for the well wishing, Mr. Rasheed. I hope your presses are coming along nicely.

Sorry to hear about your pain but wanted to let you know that there is a kindle version of McKenzie's books.

Big Thank You, sir. It is already on my phone!

The book @Craig Fern mentions is an updated version of the one I recommended - it's also good.

And based on those recommendations, I now own it and am reading it as often as possible.

Sorry to hear about the pain, Miguel. Hoping for a speedy recovery.

Thanks, ma'am. I hope your bicep is treating you well.

Welcome to the club Miguel, it's not a very exclusive club, anyone can join.

Do I get a patch or decoder ring? =]

Watch a few vids and get started ASAP

Done and done, thanks again, sir. I watched about 7 of them.

I am one of those people who suffered a back injury, and for whom the McKenzie exercises were prescribed to be performed every hour I was awake. For me, they worked.

Just my opinion; your mileage may vary.

Well sir, the McKenzie methods are working, albeit slowly, but progress is being made. I can stand and walk and if the pain comes on, remaining static and over correcting for posture helps get it manageable.

This isn't advice, just some thoughts:

Though the L5-S1 nerve root is part of the make up of the sciatic nerve (which is made up of the L4-S3 nerve roots aka the lumbosacral plexus), it is not the sciatic nerve itself. The sciatic nerve originates lower than L5-S1.

The piriformis muscle is a common place for impingement of the entire sciatic nerve. The hamstrings can impinge it as well, but less commonly so.

An interesting side note: A small percentage of the population have a split piriformis, with the sciatic nerve running between it....this theoretically may lead to a greater risk for sciatica..

Keep in mind, there are people out there with degenerative discs who do not have radiating pain...though imaging is useful, we cannot always rely solely on imaging to deduce where a patient's pain is coming from...

Therefore, with a thorough physical exam, a good physician will likely be able to better deduce whether your symptoms are truly originating from the L5-S1 nerve root, or whether they encompass the entire sciatic nerve...which could significantly modify the treatment plan...

I read about this, sir. Where the nerve can run through the piriformis or become impinged due to swelling of the piriformis. You said, "good physician"... I'm not asking for medical advice, but where does this leave me? In every meeting with medical professionals down here I am less and less impressed.

At the onset of this episode, and for the entirety of the last episode, I foam rolled and lacrosse balled for every waking hour that I could. I got little to no relief last time, and zero relief this time. Is there anything I can look/feel for that would be a better indication of what the real problem is?

I will say that the McKenzie methods have been helping, and the last few days I have been in the prone for typing (class work and right now). Looking at the "Day with Stuart McGill" videos again, it really hit home what Brian Carroll said about posture and loading. I will say that while walking or training, either under load or not, my posture was fantastic, but for the rest of the day, and sometimes hours each night, my posture was terrible. This was highlighted even more from reading "7 Steps...", in regards to sitting and even sleeping. The one and only pain free position I could find prior to the reading, was one of the pictures in the book depicting poor sleeping posture.

The more I thought about this, the more that I believe I made a hasty judgement call when I said it was my 40kg's fault, well, my ego's application thereof. As I read and watched videos about back health, I realized I have been doing it to myself, and certainly not with the bells. Each night, I would spend 2-4 hours hunched over (literally hunched over, small stool, small desk, ROUNDED back to the point of "man, my back...") doing homework or trying to learn something here on the forum. I thought back to my last training day, which was awesome, and then what I did the rest of the day. I spent about 4 hours in front of my computer doing homework and then another hour for class (online seminar). So now I can honestly say there is no question as to the mechanism of injury, its Me! I've been doing it to myself. I never really put much thought into "casual" posture.

I want to thank you all for your time and efforts. All of your comments and advice/suggestions are sincerely appreciated.

 

[MikeMoran]

@Miguel you may want to move your PC setup to the floor and lay down while you work on the computer if that is possible. I try to do all my reading that way. At work I cannot as I have desk. If that is the case than maybe set a timer and get up and stretch and straighten out for a few minutes.

 

[Miguel]

Sir, I've been pretty much in the prone for the last 2 days. =] Solid and sound advice.

 

[rickyw]

I'm not asking for medical advice, but where does this leave me? In every meeting with medical professionals down here I am less and less impressed.

My brother is down in Chile too, struggling with a similar dilemma..

Is there anything I can look/feel for that would be a better indication of what the real problem is?

It is just too hard to accurately say without being able to evaluate you. Posture, movement patterns, etc, are always worth looking into. Mckenzie protocols have been helpful for many.