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Old 03-07-2011, 08:07 AM   #1
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L4/L5 herniated disc

This is my first post and I wanted to share my story so far. First of all, this site is awesome - such great information! Around mid-December, I started having a lot of tightness in my lower back and then gradually started feeling twinges in my left glute. Around mid-January, the pain worked its way down my leg to my calf and then around my ankle. After taking 800mg of Advil around the clock for 4-5 weeks, it finally got bad enough for me to go to the doctor. I was given muscle relaxers, told that it probably wasn't a disc issue, and sent home. A couple of weeks later, I couldn't even sit in my office chair for longer than 15 minutes and spent a lot of time on the office couch with ice and heating pads. I was miserable - the worst pain I've ever felt. Not to mention, I have a 32 lb. 20 month old, so slowing down wasn't an option.

I visited another doctor who promply ordered an x-ray and MRI. The MRI showed a mild to moderate "protrusion" of the L4/L5 disc that was putting pressure on the nerve root - hence the left side sciatica. I was then sent to an orthopedic spine specialist who pretty much jumped right to recommending surgery, but not before asking "How important is exercise to you?" before telling me I had foot drop. I told him that I'd really rather try some physical therapy first and he said ok and scheduled a followup for a month later.

I could barely move during my first visit to the physical therapist. She gave me some isometric exercises to strengthen my back and abs and suggested I try a round of oral steriods for my sciatica. This was the BEST advice I've gotten. I'm now finishing up my 14-day round of steriods and have been to the therapist twice. She started me on McKenzie exercises and because the inflammation has been greatly reduced, I can actually stretch out my back. I have been able to sit at my desk and actually function during the day. The pain is still in my leg and I'm taking Tylenol throughout the day, but it is definitely manageable at this point and no where near what I would consider worthy of immediate surgery. My PT even questioned whether I had foot drop after checking my leg/foot strength and determined that I probably couldn't do the "heel" walking test because my leg was in so much pain. Also, my left hip was about 1 inch lower than my right...so yes, my foot was "dropping" every time I tried to walk because it hit the ground harder. My PT gave me a "lift" to put in my shoe and I think that has helped a lot as well.

I have an appointment with another orthopedic spine specialist after asking around for recommendations. Apparently, this new doctor is amazing and very well-respected. I'm looking forward to hearing his opinion and am definitely more educated and open-minded now to have the discussion about whether PT is still the correct route or if he really thinks that surgery is the best option for me. My husband and I would like to have another child so that plays a big part in my decision.

Thanks everyone for sharing your stories and I'll update after my appointment next week. I know how you feel and it's miserable...I've never been in so much pain in my whole life (childbirth included). I think there's a lot to be said for educating yourself and surrounding yourself with medical professionals who are excellent in their field and will listen to you and your concerns!

 
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Old 03-07-2011, 09:01 AM   #2
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Re: L4/L5 herniated disc

I just wrote an equally long reply and managed to accidentally delete it. So, I'll try to summarize what I said....I was welcoming you to the board, and praising you for taking the time to learn about your health issue, research the doctors, and gather information. This is particularly important with spine issues as there can be quite a variance in opinions regarding treatment, and surgery is almost always considered "elective." The exceptions to this are for a situation called cauda equina syndrome (when there is loss of control of the nerves controlling the bladder or bowel) and a sudden loss of muscle strength...such as foot drop.

What you describe does not sound like a classic foot drop. It sounds like your reflex may be somewhat compromised, but with a true foot drop, there is a complete lack of dorsi-flexion. The patient cannot swing the leg through, resulting in dragging the foot or the foot "flopping" when walking. There are, of course, varying degrees of foot drop....

I commend you for seeking a number of opinions from spine specialists. Surgery should always be a last resort, after all conservative treatments have been tried and have failed. Always remember that surgery does not come with any guarantees. It is not like having surgery for a gall bladder or appendix, where the surgeon goes in, removes the diseased organ, the patient recovers from the surgical procedure and moves on.

Spine surgery is done to relieve nerve compression or to stabilize a segment or segments of the spine. It is not done for pain relief, although that is always a desired outcome! In the case of a herniated disc, if you are getting results from the oral steroids and exercise, chances are good that you will be able to heal the issue without surgical intervention...and five years down the road, statistics show that you will be in the same place whether or not you have surgery.

Another common treatment method is the use of steroid injections...the purpose of these is to shrink any swollen tissue that may be compressing the spinal nerve, and to help the disc herniation retreat back into itself. People can and do heal herniated and ruptured discs without surgery. My husband ruptured L5-S1 eighteen years ago...and was able to avoid surgery, through PT and faithful back and core strengthening exercises ever since! So I know it is possible!

It is a good idea to see several spinal specialists and to decide who you will go to if you ever need surgery in the future. That way, if your situation should become an emergency, you would know who to call and you'd already be a patient so you could get in more quickly...rather than taking your chances at the ER.

It sounds like you have a good PT and that the McKenzie exercises are working for you. I encourage you to keep it up, and to be very good to your back -- avoid any activities that involve bending or twisting at the waist, pushing, pulling, reaching up overhead or to the side and be very careful lifting anything heavier than a gallon of milk...I realize that's a problem with your baby! Be careful carrying bags of groceries -- ask for them to pack light! Drink lots of water, use good body mechanics and posture and take frequent breaks at work so you are not sitting for long periods.

You can ice the area 15-20 minutes at a time every hour around the clock for pain. Sometimes a heating pad will provide more comfort. At this point, it is more what feels good to you. And be sure to walk for exercise. It is safe, keeps the spinal nerves stretched out and helps blood circulate to this area that does not have many blood vessels serving it.

Once your disc heals, it should not have any impact on another pregnancy.

Good luck in healing your disc. I look forward to hearing what the new surgeon recommends to you.

TT

Last edited by teteri66; 03-07-2011 at 09:05 AM.

 
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Old 03-07-2011, 09:48 AM   #3
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Re: L4/L5 herniated disc

Thanks so much for your reply tetonteri66! I definitely have changed the way I hold/pick-up my toddler. He's able to walk by himself so I let him walk a lot and hold his hand. I also have started changing more diapers on the floor rather than lifting him up onto his changing table and I let him crawl up the stairs in our house. Changing over to a toddler bed has helped SO much since I don't have to dead lift him over the side of the crib. Honestly, I think he enjoys all of the new freedom and feels like a "big boy"! Trust me, I will do SO many things differently if we have another baby! Long gone are the days of carrying the massive baby carrier in the crook of my arm!

I cannot wait for this to be over so I can get back to normal exercising. I plan to really focus on stretching, etc. I'm thinking Yoga or Pilates - I'm going to ask the doctor for his opinion. I believe that staying optimistic will help a lot and if it does come down to surgery, I'm going to do my best to stay positive with that as well. At least I'll know that I did everything I could before going that route!

 
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Old 03-07-2011, 10:42 AM   #4
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Re: L4/L5 herniated disc

Let me just caution you to be patient. The mistake many make is to take on too much too soon as soon as they start feeling better. There are a couple good DVDs for yoga for those coming back from back injuries. You need to avoid any of the twisting positions and anything that has repetitious movements...doing one thing over and over and over. I would discuss this with your PT as well as your doctor. If your PT knows a lot about orthopedic injuries, she can be a wonderful resource.

Toddlers are infinitely adaptable. You can modify almost any activity if you take the time to think about it and make adjustments...as you are finding out! Instead of a shoulder bag (diaper bag) use a backpack -- that way the weight is centered over your spine and your legs are doing most of the work...same with carrying a heavy purse -- no no!

There are a number of very good books that will give you ideas of core and back strengthening exercises -- check your library if you don't want to accumulate your own library. I could start my own back book store, I've ended up with so many!

 
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Old 03-07-2011, 04:11 PM   #5
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Re: L4/L5 herniated disc

Good luck. I think you are coming along well, and you haven't yet reached the 12 week mark yet by my calculation. With the amount of improvement you have so far it's hard to see what advantage any surgical procedure would have. It took me 12 weeks, nearly to the day, to become pain free and the improvements were gradual. I had 3 epidural steroid injections which I had put off, but in final analysis think they did help.

Now in my 4th week of recovery, I've changed my exercise habits. I do swimming every other day, some stationary cycling, and some body weight exercises and beginner Yoga. I can't bend well due to tight hamstrings and I do a 6 minute leg stretch with each leg at the end of the workout. No longer do deadlifts, squats or bent over rows. Don't really miss that.

I don't have much information about pregnancy after a bout of sciatica, but sciatica seems to be common symptom during pregancy as I understand it.

 
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Old 03-08-2011, 08:19 AM   #6
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Re: L4/L5 herniated disc

f4tune81, I've also had the shots recommended to me but I opted to go for the oral steroids first. They've definitely helped, but I'm on my last 3 days of the 14 day pack and I can tell that it's starting to wear off. The calf pain is coming back, though not as forceful right now, so I'm hoping there has been some improvement there with the exercises. If the next doctor suggests the shots, I'll probably take him up on that since I've responded well to the oral steroids. Other than that, I'm dreading the rainy weather that's coming in tomrorow - it always makes the nerve pain worse!!

I do have one question, however. What kind of progression/change did you notice in your pain? Did it slowly move out of your leg and up into your back again or did it gradually diminish all over? I know the purpose of McKenzie is to centralize the pain, and I've noticed more pain in my back rather than my leg, but I was wondering what your experience was with healing. Thanks!

 
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Old 03-08-2011, 05:45 PM   #7
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Re: L4/L5 herniated disc

I'm so glad the oral steroids were helping your pain. I know sciatic pain is completely unbearable and torturous! Like others have said, please do be careful especially when you feel better. I have a lot of spine problems, one being nerve pain that radiates across my entire pelvic girdle/hips/groin areas on both sides. I always have this pain, but sometimes something happens and it gets so bad I can't walk. Back in October thru January, I started having several ESI's done. The last one I had was in my lumbar spine and I felt sooo good, I couldnt' believe after so many years, I had almost no nerve pain in these areas. I think because I felt so good, I was overdoing things. I was walking normal, walking a lot, doing a lot of things. Then 13 days later it was like i was hit by a freight train and the pain became so severe I couldn't walk again. It was so much worse than before. I did get another injection, which helped again, but i was extremely careful in what I did. Since then, the pain's come back slowly, but back to my normal amt of pain (about 5 on a scale of 1 to 10), not the off the charts pain. For me, the ESI's help a great deal, but only for about 2 weeks until the steroids wear off. But then again, I have a lot of different areas of compression in my spine and have already had spine surgery.

Anyway, I really hope that your progress continues and the exercise keeps helping and that it will never come down to surgery for you. I wish you LOTS of luck!

 
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Old 03-09-2011, 09:12 AM   #8
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Re: L4/L5 herniated disc

Just got back from my 3rd PT appointment. I wish I could lay on the table with the elec. stim. machine and the heating blanket all day! If I haven't said before, I think my PT is amazing and so helpful. I let her know that since the steriod is wearing off, I'm getting more pain in my calf again, but it's nothing like it was before the steriod. I'm also having a lot of tightness and pain in my glute. She did some massage and tweaked a few of my exercises to help out. I don't have to wear the heel lift anymore since my hips have evened out, but I'm still shifting to the right a little (probably because of the pain). I'm now working on distributing my weight evenly and hopefully that will help as well. I was also given strict orders to discontinue any exercise that illicits any sort of pain. She said that this is not a "no pain no gain" situation and that I should only be doing exercises that feel good.

So now, I'm keeping up with my PT at home and waiting on my 2nd opinion Dr. visit on Tuesday. Fingers crossed that I have improved and I'm only looking at maybe a round of steriod shots, more PT, etc.

 
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Old 03-09-2011, 02:39 PM   #9
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Re: L4/L5 herniated disc

Lindsay, let me congratulate you on your determination and perserverance. I truly hope that you will be able to totally avoid surgery. Your pt sounds very knowledgable and that goes a long way. Continue what you are doing and hopefully, everything will go well.

Oral steroids really help with the inflammation to the nerves, but the bad thing about them is that you can have rebound pain when you stop them as I found out the hard way some years ago. I think perhaps you will find the injections helpful. Many times they have helped me for as long as 3 months. But a word of caution....steroids can cause problems such as bone thinning, high blood pressure, cataracts, and more so it is extremely important that whoever will be doing the injections knows what oral dose you were on and for how long. Most doctos will only do 3-4 injections in a year and I'm not sure how the oral steroids will affect that.

Best of luck to you....I'm looking forward to learning how that appointment with the new doctor goes.

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Old 03-09-2011, 07:47 PM   #10
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Re: L4/L5 herniated disc

Hi Lindsay,

Glad to hear that you are making progress, slow though it may seem. Do you use a heating pad at home? I bought a far-infrared heating pad and it was the best thing I ever did, other than having my recent fusion surgery! I used it several times each day for the past year or so.

You have noticed how important good body mechanics and posture are, particularly since you had the imbalance of one hip being higher. I discovered that I have favored one side for years. Many women stand with most of their weight on one leg, with the other leg turned out to the side. This is terrible for our spines. I am learning to stand squarely on both feet with my weight evenly distributed. Also, train yourself when sitting to keep both feet on the floor, rather than crossing one leg over the other. I have to constantly check myself, because things I've been doing for a lifetime are hard to break!

It is very easy to try a new exercise and cause a flare. The pain in your buttock may be from the piriformis muscle. The sciatic nerve runs right underneath it, and in a few people, right through the muscle. If the piriformis gets tight, it can irritate the nerve. It is a common pain generator. You can read all about it online, and can ask your PT about it. She can show you exercises to stretch it out.

Keep up the good work. Sounds like you're moving in the right direction.

 
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Old 03-10-2011, 05:30 AM   #11
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Re: L4/L5 herniated disc

Thanks for all of your encouraging comments, everyone. Maltluver, I had a little "aha - so that's what it is" moment when I read your post last night. I couldn't understand why my leg and back were hurting so bad again last night. I think it was part weather and part my body adjusting to not having the steroids anymore. I'm still able to sleep well and I can lay on the couch with little to no pain at night so at least that's something!

I actually have been using a rice bag rather than a heating pad. You may have heard of them but my mom made one for me a long time ago. It's pretty much two hand towels sewn together like a pillow and it is filled with white rice. You can microwave the whole thing and it holds heat really well - and molds to any part of your body. It's really, really great and perfect if you need to sleep with heat because there are no plugs, etc. involved.

I've been working to stretch out the piriformis muscle when it gets really tight. That really does seem to help and generally only bothers me in the morning when I've been sleeping in one position for too long. Other than that, I'm back on the Advil this morning since the steroids are over and doing pretty well so far. Countdown to Tuesday is still on...looking forward to seeing the new doctor!!

 
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Old 03-14-2011, 06:55 AM   #12
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Re: L4/L5 herniated disc

I plan to discuss this with my doctor tomorrow, but I was wondering if anyone with a hernaited disc had a problem with knots in their back. I've noticed lately that my leg hurts the worst when I can feel a very hard knot in my lower back. It's not on my spine at all - it's to the left and closer to the upper portion of my glute. If I put a lot of pressure on this knot and massage around it, I tend to feel much better and my leg pain subsides.

Is this a result of the herniated disc or is it possible that I have developed a painful trigger point that's causing most of my sciatica? I have zero back pain until this knot comes back and I've noticed that even my McKenzie exercises are painful when the knot is there. It has been 8 weeks since the leg pain started so I want to be careful that I'm not blaming my continued pain on a disc that has possibly begun to heal, and I now have another issue I need to address. Thanks!

 
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Old 03-14-2011, 09:00 AM   #13
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Re: L4/L5 herniated disc

I had a herniated disc at L4/L5 causing massive knots in my back, muscle spasms.

Be careful. I was on the floor changing the diaper of our 1 year old. When I lifted him up, knees on the ground and only using my arms....the herniated disc in my back exploded sending me and baby to the floor. It was the most painful thing I've ever felt.

I've been stabbed and having a herniated disc pop is 1000x worse than being stabbed. Best of luck to you.

 
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Old 03-15-2011, 08:01 AM   #14
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UPDATE: L4/L5 herniated disc

After waiting a month, finally saw a 2nd orthopedic spine surgeon that came highly recommended to me by friends and family. LOVED HIM - he was so nice and took the time to explain everything to me. Best part - he doesn't think I need surgery at this point, which makes me want to kick the other doctor I saw a month ago. I have no neurological symptoms and no weakness or loss of reflex on my bad side (I can even toe and heel walk just fine) - just pain, which has begun to taper off. He wants me to do PT 2x a week for the next 6 weeks and then come back to check my progress. Also, he thinks that as long as I strengthen my core, I shouldn't have any problem with a pregnancy - but no getting pregnant until I'm completely rid of my symptoms. He didn't even think at this point that I would need the steroid injections and he even wants me to back off the ibuprofen as much as possible. So, fingers crossed that PT really helps out over the next 6 weeks and can get rid of all of the pain (and medication)!!

Also, as a side note, he told me a couple quick stories that put things into perspective. He said that he's had a patient with the worst herniated disc and nerve compression that he's ever seen with NO SYMPTOMS (that reabsorbed with no problem), and someone who has been in bed for 3 weeks in terrible pain with the smallest herniation he's ever seen. So, your pain and real and valid no matter what the MRI says...everyone's spine is different. I have a large herniation, but also have a large spinal canal so I am able to function better than someone who has a more narrow canal.

 
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Old 03-15-2011, 04:10 PM   #15
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Re: L4/L5 herniated disc

I'm happy that you found an ortho that you really like and most importantly, took time with you and explained things. It's always better to put off surgery as long as possible, if one can, and try everything else first. I've had many times where I'm sure I had a herniation b/c I had such severe nerve pain and over several weeks it went away on it's own. I've also had many times where the nerve pain didn't go away. Sometimes the pain is gone just as quickly as it came on.

I will keep my fingers crossed for you that only PT and time will help you!!! But if not, there are plenty of other options to try, just in case. Good luck and keep us updated.

 
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