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  • L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

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    Old 12-11-2012, 10:34 AM   #16
    p0506img
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    gmak, I appreciate your responses a lot. I called and went to see my primary doc this AM and he put me on a 2nd blood pressure medication. He says he suspects it's a combination of the pain and the prednisone making the BP go up and in any event thinks I should be on a 2nd med before I get the epidural which is supposed to get rescheduled for 12/13 (though I'm waiting for a call). Unfortunately my life has come to a standstill until this can all get solved.

     
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    Old 12-14-2012, 02:56 PM   #17
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    Well, long story short, with the 2nd BP med (norvasc which makes me a tiny bit dizzy) and some xanax before the procedure, I got the epidural yesterday about 24 hours ago. My blood pressure is still fine on my lisinopril plus the norvasc (no more xanax)...about 130/70. And, more importantly my back/leg are a whole lot better. Last night they were still bad but today much better; I still have some pain and lots of tingling in my toes but it's like night and day compared to before. I'm hoping things continue to improve and that I can get back off the norvasc.

    Now I have several questions (which the doctors really didn't give me any straight answers to); 1) What types of excercise can I do and when can I do it? (I'm very frustrated about not running or at least doing some sort of aerobic excercise.) 2) Did my running cause this and can/should I run again? (one of the docs said no reason I shouldn't and one said he wasn't sure) 3) (and maybe most important) Assuming it continues to feel better and I feel fine again did the epidural actually cure anything or am I just masking it for a time until it happens again? I don't want to just "hide" the pain and even though I'm not anxious to have surgery, if that's what it takes to "fix" it then maybe I should still have surgery. I would appreciate help on any of these issues. Thanks.

     
    Old 12-14-2012, 03:25 PM   #18
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    [QUOTE=p0506img;5104284]Well, long story short, with the 2nd BP med (norvasc which makes me a tiny bit dizzy) and some xanax before the procedure, I got the epidural yesterday about 24 hours ago. My blood pressure is still fine on my lisinopril plus the norvasc (no more xanax)...about 130/70. And, more importantly my back/leg are a whole lot better. Last night they were still bad but today much better; I still have some pain and lots of tingling in my toes but it's like night and day compared to before. I'm hoping things continue to improve and that I can get back off the norvasc.

    Now I have several questions (which the doctors really didn't give me any straight answers to); 1) What types of excercise can I do and when can I do it? (I'm very frustrated about not running or at least doing some sort of aerobic excercise.) 2) Did my running cause this and can/should I run again? (one of the docs said no reason I shouldn't and one said he wasn't sure) 3) (and maybe most important) Assuming it continues to feel better and I feel fine again did the epidural actually cure anything or am I just masking it for a time until it happens again? I don't want to just "hide" the pain and even though I'm not anxious to have surgery, if that's what it takes to "fix" it then maybe I should still have surgery. I would appreciate help on any of these issues. Thanks.[/QUOTE]




    Dear po506, Im so happy that the horrid pain is gone! To my understanding, the epi inj is steroid & all steroid can mask symptoms but @ the same time it is an inflammatory. I think your drs immediate goal was to get you out of pain. I think the NS will be the one that will ultimately decide, order another mri to compare if the nerve root is still being damaged or not. If so he may recommend surgery and i think that if the problem in the nerve root has significantly reduced the size of the herniation correlated by exam, history & mri and the nerve root is no longer in danger he may ask your PM to do more epi injs. Meanwhile, remember that you havent been released to do running, right? Even though you may feel like it, if it were me i would wait until i got an emphatic yes before proceeding to any level of exercise unless my PT ordered it or the NS said i am free to restart my previous exercise schedule. God bless you & i also wouldnt stop bp med/meds on my own,but would take this step by step. I know its hard, but i would try to do only what the dr said. Thanks, gmak

    Last edited by gmak; 12-14-2012 at 03:31 PM.

     
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    Old 12-14-2012, 05:17 PM   #19
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    Sorry but I lost track of your thread for awhile and missed the posting of your MRI results. My comments don't follow the previous posts very well, but are in response to the results of your MRI.

    I think you will save some time if you make an appointment with a spine specialist at this point. Your issues as indicated by the MRI are sufficiently complex that it makes sense to be evaluated by the specialty that has the most training and education in the workings and diseases of the neck and back. For your issues you might want to consider a fellowship trained orthopedic spine surgeon but a neurosurgeon would also be OK.

    You have some fairly significant stenosis at both L4-L5 and L5-S1 segments as well as arthritic changes in the facet joints. This causes the joints to enlarge which can encroach into the foraminal space, causing nerve irritation or compression. There is also central canal stenosis at both these levels. You will note that at L5-S1 the foraminal stenosis is described as moderate to severe...(this on the following ranking system: minimal, mild, moderate, severe). When foramen are this clogged up, it is unlikely that an epidural steroid injection is going to be of much help. However, if the stenosis is caused by a herniated disc bulging outside the disc space it might be remotely possible!

    At L4-L5 there are degenerative changes to the facets that are causing stenosis in the foramen. There is some spondylolisthesis at this level, slipping toward the anterior side, but the report doesn't indicate how much.
    From what is indicated in the report, it would appear that you have some spinal arthritis which is more than just normal "wear and tear" on the spine. Your report corresponds to what would keep you from being able to stand or walk for more than a few moments. Severe stenosis means you have some severe nerve compression going on. When standing, with the force of gravity pushing down, it compacts the open space even more.

    I'm actually quite surprised that you are feeling some positive effects from the ESI -- with stenosis, there is often little response to an injection of steroids.

    If you can walk, it would be an appropriate exercise. Usually with severe stenosis it is too painful to walk. You try riding an exercise bike or you could swim.

    Obviously a MRI is only one piece of the diagnostic puzzle. The spine specialist will correlate the findings of the MRI with what he/she finds upon physical exam, a basic neurologic exam and from what you have to say about your symptoms and the impact it has on your life...what you can and cannot do any longer, etc.

    My feeling is that you will eventually need surgery to decompress those nerves. Conservative treatments can only do some much.

     
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    Old 12-17-2012, 05:31 PM   #20
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    Its a few days since I last updated and the pain is somewhat better but there are other disturbing things. I still have pain from the hip down the lateral side of my thigh and into my calf if I stand for more than 3-4 minutes. Suprisingly walking is less painful than just standing but after a bit that too becomes painful. The tingling/numbness in my foot (especially big toe) might be a little less but is still there all the time and I can't walk on my left heel (?is this some foot drop). I called to see one of the orthopedic spine specialists (spine fellowship trained) in the large group (with the sports medicine doc and the pain specialist I've already seen) but they can't see me until after January 10th. I'm seeing my primary care doctor in 2 days and will ask his help at getting somewhere earlier. I just don't really know what to do. If I sit all day in my recliner the pain is very mininal but I can't live my life just doing that. I need to get back to running or at least some other exercise or I'll go nuts. When the pain management office called today to see how I was doing I told them a lot of this and they just said "the steroids don't always work until a week after the epidural." It's now 4 1/2 days but I'm not optimistic.

     
    Old 12-17-2012, 07:57 PM   #21
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    [QUOTE=p0506img;5105557]Its a few days since I last updated and the pain is somewhat better but there are other disturbing things. I still have pain from the hip down the lateral side of my thigh and into my calf if I stand for more than 3-4 minutes. Suprisingly walking is less painful than just standing but after a bit that too becomes painful. The tingling/numbness in my foot (especially big toe) might be a little less but is still there all the time and I can't walk on my left heel (?is this some foot drop). I called to see one of the orthopedic spine specialists (spine fellowship trained) in the large group (with the sports medicine doc and the pain specialist I've already seen) but they can't see me until after January 10th. I'm seeing my primary care doctor in 2 days and will ask his help at getting somewhere earlier. I just don't really know what to do. If I sit all day in my recliner the pain is very mininal but I can't live my life just doing that. I need to get back to running or at least some other exercise or I'll go nuts. When the pain management office called today to see how I was doing I told them a lot of this and they just said "the steroids don't always work until a week after the epidural." It's now 4 1/2 days but I'm not optimistic.[/QUOTE]

    Hi p0506, I know how worrisome & boring it can be living with a back injury, I understand! First, I would wonder if I called that ortho spine dr & said "I have... on my MRI, Im on 2 different bp meds for the high blood pressure the pain causes, I am having symptoms related to nerve compression that I fear is causing permanent damage, Im not sure that this is not emergent, Ive seen sport dr in the practice... would it help to be seen sooner. ?!. Also, its important, in my opinion, that the primary understand the correlation between MRI results and all the leg, foot, back,high bp, pain symptoms. Over the years, Ive found many "distraction from the pain & boredom ideas" I can share. But, hopefully you can get "the wheels turning" with the primary dr visit & more relief will come from the ESI. But, I would make a list of all symptoms & questions. I hope you feel better, break out the crossword puzzles in the meantime!lol

    Last edited by gmak; 12-18-2012 at 04:31 AM. Reason: typo, tense

     
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    Old 12-27-2012, 02:23 PM   #22
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    It's 10 days since I last updated. I did see an orthopedic surgeon last week and he basically said he didn't think I needed surgery but maybe another epidural steroid injection. I actually am significantly better than the last time I posted but still a long way from good. I can now stand or walk for about 10-15 minutes before the lateral leg pain gets so intense that I must sit down. The numbness and tingling in my foot seems to vary a lot; yesterday it was almost nonexistent but today it's severe with the whole foot (not just the toes) affected. Yesterday I felt good enough to walk 1 mile on a treadmill but today I couldn't even make .5 miles. The weakness I had previously seemed better for several days but is worse again today. All in all I'm much better than I was at the worst but still can't really do a lot. I saw the pain management specialist yesterday and I'm scheduled for another ESI on 1/7/13 but he wasn't certain it would do me much good. I'm also scheduled to restart physical therapy on 1/3/13. I'm still very frustrated...maybe I'm just too impatient but I'm used to being a very phyicall active person. I've looked into joining a gym where I can swim (I'm even willing to severely cut back my running but I must do something) but at this point I don't think I could do that without a lot of pain. I also forgot to mention that the orthopedist started me on 300 mg of neurontin at bedtime and that does seem to help somewhat; I can now sleep on my back at least part of the night. Sorry to be rambling.

     
    Old 12-27-2012, 06:31 PM   #23
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    Hi p0506, Im really glad to hear you are better, at least. Maybe im misunderstanding you but if the PM doesnt think the esi will work & the spine dr doesnt recommend surgery then what is the game plan, it sounds like you may be "caught in the middle", like the ortho thinks PM will work & PM thinks you need surgery? I hope not. Time? PT? Meds? If so what kind of timeline with conservative treatment? Thank you for the update. Do you have another mri or testing to be done?

    Last edited by gmak; 12-27-2012 at 06:38 PM.

     
    Old 12-27-2012, 07:20 PM   #24
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    I do feel a bit like I'm caught "in between" though I may have stated what the PM said a bit too strongly. He must think it has a chance of working or he wouldn't have scheduled me for another ESI (couldn't just be a paycheck he's after, hopefully). I also think maybe they both think time is the thing and maybe that's right. It's just very hard to accept if we're talking many months or a year or more. I'm thinking if I'm not a whole lot or completely better after the next ESI (which I should mention I'm not that excited about getting since it's certainly not pain free and who knows what all these steroids do long term) then I'll try to pin the ortopedic surgeon (who I see the following week) down to more of a timetable for conservative treatment.

     
    Old 12-27-2012, 09:27 PM   #25
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    If your big toe is numb, chances are the L4 spinal nerve is also irritated or compressed.

    Did you see an orthopedic spine surgeon? I thought I just read through the whole thread but now I can't remember if you've had a recent MRI and some sort of diagnosis. Do you have herniated discs or stenosis or ?

    Until you are properly diagnosed I think it is risky for you to resume a running program. Swimming should be OK unless you have a spondylolisthesis, in which case you should not be doing any strokes on your stomach unless using a snorkel. Any type of position that has the back in extension carries the risk of making a spondylolisthesis slip further.

     
    Old 12-27-2012, 09:28 PM   #26
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    Hi p0506, thanks for sharing that info. In my opinion, time is the smartest approach when it comes to back surgery, if you can wait with no serious complications, of course. I understand how much you want to get back to normal but i think giving your body time & every chance to heal is prudent & i think surgery should be last resort. I hope you do get better from esi, keep us posted please. I was wondering how you were doing & glad to know you're improving!

    Last edited by gmak; 12-28-2012 at 03:58 AM. Reason: wording

     
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    Old 12-28-2012, 05:36 AM   #27
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    [QUOTE=teteri66;5109592]If your big toe is numb, chances are the L4 spinal nerve is also irritated or compressed.

    Did you see an orthopedic spine surgeon? I thought I just read through the whole thread but now I can't remember if you've had a recent MRI and some sort of diagnosis. Do you have herniated discs or stenosis or ?

    Until you are properly diagnosed I think it is risky for you to resume a running program. Swimming should be OK unless you have a spondylolisthesis, in which case you should not be doing any strokes on your stomach unless using a snorkel. Any type of position that has the back in extension carries the risk of making a spondylolisthesis slip further.[/QUOTE]

    Yes I have seen an orthopedic spine surgeon (when I refer to an orthopedic spine surgeon) and he doesn't think I need surgery. And I have previously listed the MRI results but I'll repest them here. The impression: "1)L5-S1 moderate broad based disc bulge asymmetric to the left extending into the left foramen. Moderate bilateral facet arthrosis. Moderate to severe right and severe left neural foramenal narrowing. 2) L4-L5 moderate bilateral facet arthrosis resulting in mild anteriolisthesis of L4 on L5. 3) Sacroiliac degenerative change." Although not listed in the impression, above in the body of the detailed description it also says "L4-L5:Moderate bilateral facet arthrosis with ligamentum flavum redundancy results in mild to severe central canal narrowing."
    Both the orthopedist and the pain management docs say they believe that the main problem is the herniated (bulging disc) at L5-S1 although it all may contribute. I sure hope they're focusing on the right problem.

     
    Old 12-28-2012, 06:04 AM   #28
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    One never wants surgery unless all conservative treatments have been given a fair shot and have failed.

    Have you also had ESIs at L4-L5, or perhaps diagnostic nerve blocks at both L4-L5 and L5-S1?

    Since you have a slight spondylolisthesis at L4-L5 and severe central canal stenosis at this level, too, I'm not sure why the doctors would assume your problems are stemming from just the one segment...particularly if your big toe is numb.

    Having had two fusions because the first one didn't resolve my issues and symptoms, I am particularly aware of the difficulty of locating the pain generators. Even a small amount of spondylolisthesis can cause a nerve to get caught and compressed, and "severe" stenosis in the central canal means the cauda equina is being badly compressed.

    Last edited by teteri66; 12-28-2012 at 06:13 AM.

     
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    Old 01-12-2013, 07:01 AM   #29
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    I'm sorry I haven't updated in a few weeks. But the news is good. I continued to feel a bit better and about a week ago I got my 2nd ESI and now my pain is minimal and localized to a lower back ache with virtually no leg pain. I still do have a numb foot most of the time with a lot of "pins and needle" like feelings in the foot which are a bit bothersome but I'm told they should improve with time. I'm starting to do some light excercise again and that feels really good. I feel like I've been given a new lease on life...I just hope it continues.

     
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    Old 10-04-2013, 09:06 PM   #30
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    Re: L5-S1 vs Sacroiliac Joint Pain and other issues in a Runner

    I have been negligent in continuing to update my story. I received a private message from someone asking how I was doing and that reminded me.

    Well, it's been a long and unpleasant year and while I'm much better than I was at my worst...I've still got issues. To much time has gone by for me to list everything which has gone on so I'll just hit the highlights. After my last post (2nd ESI) I was pretty good for a few months but then in April I got terrible again and had a third ESI which did little. At one point I also got a SI joint injection which I initially thought helped but really didn't after a day. The ESI this 3rd time also did nothing and I went back to the Orthopedic Spine Specialist. Along the way I tried massage therapy (zero help) and acupuncture (good but only short term help). Eventually in mid July I underwent a left far lateral microdiscectomy. I expected the recovery to be easy but it wasn't/isn't. My unbearable pain down the side of my leg is mostly gone but my lower back pain is worse than it was before surgery and I have pain in my foot (burning in addition to the tingling). I just saw the surgeon yesterday because I still had so much pain (11 weeks post op) and he had me restart the gabapentin which I had weaned off and I'm scheduled for PT. I do feel somewhat better after only one day back on the gabapentin.

    Again sorry for the lack of followup and for the brevity of this summary. If anyone has any specific questions/comments I get into more detail.

     
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