Herniated disc

[D S 319]

back mechanic by dr Stuart McGill is a good start. I’d stay away from surgery as long as you can. Learn to take care of your back.

 

[alaska80]

Try to get a PT who is knowledgeable about Dr. Stuart Mcgill's back protocol

What he said.

First off, go to doc and make sure it is not something other than a mechanical injury.

Like others here I have gone through more back injuries and pain than I care to remember. Multiple herniated discs among other things. I spent the better part of my 30s rehabbing, about 8 years. Today my back feels better than at 25, with virtually no pain or stiffness ever. I also pack 1-3 moose a year with no residual pain. I don't want to say my back is bulletproof, but it has become resilient.

Contrary to what I have heard many people say, including doctors, is that discs never heal. That is stupid and goes against any A&P 101 class. It will heal, its just due to the nature of the tissues, it takes a LONG time to heal. The healing process is directly proportional to two things:

1. Eliminate the mechanism of injury. Your back got hurt because you were/are doing something wrong. McGill does a great job in explaining this in Back Mechanic. You have to change the way you sit, lift, walk and run. You also need to make your mid section resilient, e.g. work on stabilization. He goes in depth on this as well.

2. Work on nutrient exchange. Your body's capacity to heal directly correlates to the type of tissue that needs to heal and how much blood flow that tissue receives. Muscles heal quickly, relatively speaking, because of the high blood flow it receives. Discs take a long time to heal because there is very little blood flow to them. That is why walking is so therapeutic for backs as it creates a sort of pumping motion in the discs that facilitates greater nutrient exchange. I also worked heavily on systemic inflammation. I got blood tests and changed the way I ate to create the most optimal environment to heal my body. Alcohol is not your friend when it comes to healing.

Like losing weight, most people do not have the discipline to do what it takes to really heal an injured back. They give it 6-12 weeks, start feeling better and then go back to the same habits that injured it in the first place. After some time they reinjure it and go through the process again and by doing so, think that backs can never heal.

My timeline would have been drastically reduced had I not been an idiot myself and returned to too heavy too often lifting too quickly. I reinjured my back a few times during my journey because of my own stupidity.

Everyone's journey is different, but for me it was about 3 years of nothing but McGill Big Three work and Kettlebells. Nothing has ever seemed to retore my body's movement better than KB work. I then moved on slowly to barbell training.

Now, on the second half of my 5th decade of life, on any given day I could DL 475-525lbs. My cardio is almost as good as it was when I was a young infantry officer and I can carry a lot of heavy loads all over the mountains pain free.

Be patient, do the right things everyday and you will heal.

 

[Elkhuntinfool78]

What he said.

First off, go to doc and make sure it is not something other than a mechanical injury.

Like others here I have gone through more back injuries and pain than I care to remember. Multiple herniated discs among other things. I spent the better part of my 30s rehabbing, about 8 years. Today my back feels better than at 25, with virtually no pain or stiffness ever. I also pack 1-3 moose a year with no residual pain. I don't want to say my back is bulletproof, but it has become resilient.

Contrary to what I have heard many people say, including doctors, is that discs never heal. That is stupid and goes against any A&P 101 class. It will heal, its just due to the nature of the tissues, it takes a LONG time to heal. The healing process is directly proportional to two things:

1. Eliminate the mechanism of injury. Your back got hurt because you were/are doing something wrong. McGill does a great job in explaining this in Back Mechanic. You have to change the way you sit, lift, walk and run. You also need to make your mid section resilient, e.g. work on stabilization. He goes in depth on this as well.

2. Work on nutrient exchange. Your body's capacity to heal directly correlates to the type of tissue that needs to heal and how much blood flow that tissue receives. Muscles heal quickly, relatively speaking, because of the high blood flow it receives. Discs take a long time to heal because there is very little blood flow to them. That is why walking is so therapeutic for backs as it creates a sort of pumping motion in the discs that facilitates greater nutrient exchange. I also worked heavily on systemic inflammation. I got blood tests and changed the way I ate to create the most optimal environment to heal my body. Alcohol is not your friend when it comes to healing.

Like losing weight, most people do not have the discipline to do what it takes to really heal an injured back. They give it 6-12 weeks, start feeling better and then go back to the same habits that injured it in the first place. After some time they reinjure it and go through the process again and by doing so, think that backs can never heal.

My timeline would have been drastically reduced had I not been an idiot myself and returned to too heavy too often lifting too quickly. I reinjured my back a few times during my journey because of my own stupidity.

Everyone's journey is different, but for me it was about 3 years of nothing but McGill Big Three work and Kettlebells. Nothing has ever seemed to retore my body's movement better than KB work. I then moved on slowly to barbell training.

Now, on the second half of my 5th decade of life, on any given day I could DL 475-525lbs. My cardio is almost as good as it was when I was a young infantry officer and I can carry a lot of heavy loads all over the mountains pain free.

Be patient, do the right things everyday and you will heal.

Some good info here. Anyone suffering with this should pay attention to this post

 

[ztc92]

What he said.

First off, go to doc and make sure it is not something other than a mechanical injury.

Like others here I have gone through more back injuries and pain than I care to remember. Multiple herniated discs among other things. I spent the better part of my 30s rehabbing, about 8 years. Today my back feels better than at 25, with virtually no pain or stiffness ever. I also pack 1-3 moose a year with no residual pain. I don't want to say my back is bulletproof, but it has become resilient.

Contrary to what I have heard many people say, including doctors, is that discs never heal. That is stupid and goes against any A&P 101 class. It will heal, its just due to the nature of the tissues, it takes a LONG time to heal. The healing process is directly proportional to two things:

1. Eliminate the mechanism of injury. Your back got hurt because you were/are doing something wrong. McGill does a great job in explaining this in Back Mechanic. You have to change the way you sit, lift, walk and run. You also need to make your mid section resilient, e.g. work on stabilization. He goes in depth on this as well.

2. Work on nutrient exchange. Your body's capacity to heal directly correlates to the type of tissue that needs to heal and how much blood flow that tissue receives. Muscles heal quickly, relatively speaking, because of the high blood flow it receives. Discs take a long time to heal because there is very little blood flow to them. That is why walking is so therapeutic for backs as it creates a sort of pumping motion in the discs that facilitates greater nutrient exchange. I also worked heavily on systemic inflammation. I got blood tests and changed the way I ate to create the most optimal environment to heal my body. Alcohol is not your friend when it comes to healing.

Like losing weight, most people do not have the discipline to do what it takes to really heal an injured back. They give it 6-12 weeks, start feeling better and then go back to the same habits that injured it in the first place. After some time they reinjure it and go through the process again and by doing so, think that backs can never heal.

My timeline would have been drastically reduced had I not been an idiot myself and returned to too heavy too often lifting too quickly. I reinjured my back a few times during my journey because of my own stupidity.

Everyone's journey is different, but for me it was about 3 years of nothing but McGill Big Three work and Kettlebells. Nothing has ever seemed to retore my body's movement better than KB work. I then moved on slowly to barbell training.

Now, on the second half of my 5th decade of life, on any given day I could DL 475-525lbs. My cardio is almost as good as it was when I was a young infantry officer and I can carry a lot of heavy loads all over the mountains pain free.

Be patient, do the right things everyday and you will heal.

This is excellent advice. I’d like to add a few thoughts as a physician doing family medicine and sports/orthopedics.

1) My counsel to all patients with back pain is as follows. If the only complaint is “pain”, then I NEVER recommend surgery. If you read the literature on this, it’s 50/50 if surgery will help vs make things worse for strictly pain. Any good surgeon will steer you away from surgery and towards conservative treatment and PT if the only complaint is pain.

2) When you add symptoms of radiculopathy or muscle weakness surgery starts to make more sense and the literature also supports this. Depending on the cause (which is often determined by MRI) it may still make sense to try conservative treatment such as PT or steroid injections first. Conservative treatment makes sense for things like nerve inflammation, piriformis syndrome or disk herniation as these things will often improve. However is you have bone spurs or narrowing of the spinal cord canal from arthritis, these are unlikely to get better with conservative treatment and surgery may be the only option.

3) Based on 1 and 2 above, for patients with only pain, my reccomendation is usually x-rays if patient wants imaging (not MRI) and PT referral as long as X-rays look okay. Then follow up in 6-8 weeks after above. Similarly, based on 1 and 2 above, if a patient had radiculopathy or muscle weakness, I offer order MRI vs refer to a spine specialist.

4) I agree with others above that a spine specialist will be able to get MRI done much quicker. This is for a few reasons. First, they often own or affiliate with an imaging center and there are “urgent” slots held for this kind of thing. As a PCP I only get access to those appointment slots if I call and beg them or advocate for the patient. Second, insurance rarely allows me to order an MRI without a prior authorization, which means paperwork and often a phone call that has to be scheduled. However, for spine specialists, insurance rarely requires this and will approve it as soon as the order is submitted.

5) If you’d like a primer on back pain and Stuart McGill’s approach, I’d check out this episode of The Drive podcast by Peter Attia.

#287 ‒ Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D. - Peter Attia

“All I did was learn from the best weightlifters in the world, people who know how to move load, learn what the efficiency was and turn it into a hack to change a person's life.” —Stuart McGill

peterattiamd.com

 

[RWT]

Inversion machine. Hang at a 5:00 position for 30 mins morning and night. MRI, stretching the hamstrings with hurdler stretch and finally had nerve ending ablations. Still stretch daily and hang upside down once a week. I avoided the surgery so far.

 

[Jpsmith1]

Could be wrong but I’m not sure how a herniated disc pushing on the nerve causing extreme pain/nerve damage is going to heal itself with PT. At least that’s what the surgeon told me in my case. The big needle shot under the fluoroscope that the insurance company wastes money on lasted about 12hrs…about how long it takes the hit of lidocaine to wear off.

They don't heal. You just manage them by building strength and flexibility.

 

[EdP]

I had a bulged disk at l5-S1 shown on MRI the first week of Sept '24. It was described as "Impinging on and displacing the sciatic nerve." Spinal manipulations by a chiropractor and PT just made it worse (hurt more). If it hurts it is likely going to make it hurt worse in the future. Because the nerve is inflamed, pain begets pain because it makes the nerve more inflamed. What helped me was acupuncture and avoidance of anything that caused pain to the extent possible. A/P treatments are not magic but help increase blood flow to the area so your body can heal. By the first week in Dec a follow-up MRI showed the bulge was gone. That can only happen with healing, so pay no attention to those that say it will never heal. It can heal, but maybe not as strong as it once was, and any underlying structural issue that contributed to the disk herniation may still exist and make re-injury more likely.

I find it frustrating that I can find docs to treat acute problems but none willing to engage in helping to manage a compromised lower back.

 

[CC55]

Good info listed above. I don't contribute much so figure this will be a good chance. This will be a bit of a PSA and will speak in generalities since we haven't met. I work in a similar space in orthopedic PT. No real medical advice here since we haven't met, but a lot of stuff to unpack here depending on how much you want to nerd out.

1. First, I'm sure you already know, but going to someone who sees this daily (and actually gets outcomes) is the way to go. Often you can figure something out in about 30 seconds of talking to someone in person that would have taken a 30 minute debate online. We did the telehealth style of appts during the pandemic and it's tough for both pt and provider. Find a conservative provider (MD/DO or PT) who is qualified (has some extra letters after their name) and have them see what they think. I can't speak for other professions, but I'm sure there are some good ones depending on your region. If they can't figure it out, they will know who to refer you to. It's worth your time and money if you're serious about it.

2. Once sinister stuff is ruled out, a bit of numbness/tingling is worrying but not the beginning of the end. Of the spectrum of neural irritation or referred pain that is seen...numbness is about the lowest bar to hit. Nerd fact, usually the only other sense that gets impacted before numbness is vibration sense when neural tissue is affected. Aside from NT, plenty stuff can cause pain referral as well. Ring finger example you had listed; C8, ulnar nerve along the chain, rib 2-4, infraspinatus, parts of plexus (TOS type). Usually something else is causing the aggravation of said tissue; movement patterns, strength/endurance limitations, neural mobility limitations, segmental control/mobility, etc. Once again, someone can figure this out quickly in person and make an impact on day 1.

3. Upper and lower symptoms should be looked at in isolation and then integration. As a general rule, T8 is the cutoff between upper and lower sx. Usually stuff from T8 and up; refers up. Usually below T8, refers down as a general rule.

4. On LBP and neural issues, I classify stuff on the Bogduk system. This helped my brain organize things better:

https://rwillisdpt.wordpress.com/wp-content/uploads/2014/12/bogduk-2009-on-the-definitions-and-physiology-of-back-pain-referred-pain-and-radicular-pain.pdf

5. Lots of nasty pictures of disc material pulled out of lumbar spines above. Don't get freaked out. Sometimes surgery is indicated. Primarily, it is when worsening weakness in a myotomal pattern (2 or more muscles that are neurally weak/fatiguable with a similar nerve root supply) is present along w/ changes in sensation and/or reflexes...pain is typically not an indication for surgery. Keep this in mind no matter who you talk to.

6. Disc injuries can heal. Extrusions are shown in some instances to heal better then mild disc injury. Before everyone freaks out, not all of them will and I've had people need to move to surgery.

The probability of spontaneous regression of lumbar herniated disc: a systematic review - PubMed

Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc...

pubmed.ncbi.nlm.nih.gov

7. Maybe that posterior disc "extrusion" isn't really what is causing the pain:

‘Typical’ Posterolateral Disc Protrusion and Passive Extension Protocol | Erl Pettman

What is a ‘typical’ posterolateral disc protrusion and how is it so successfully managed by the passive extension protocol innovated by Robin McKenzie? An e ...

erlpettman.com

-TLDR: often the problem is chemical irritation and not mechanical. Work the pump effect in your spine.

The disc also "desiccates" over a lifetime and less water/ material is available to be extruded. The disc turns into something more like beef jerky vs the famed "jelly donut" that freaks people out and makes them feel vulnerable. At 20 years old, there is some water in there to blow out, at 60, not so much. It's pretty hard to blow up jerky. Went to a course that Adrian Lowe (good pain science guy) taught on this, was pretty eye opening.

7. Imaging is a crap shoot. Sometimes helpful, often not:
a. Imaging done on asymptotic lumbar and cervical spines shows some carnage

Systematic literature review of imaging features of spinal degeneration in asymptomatic populations - PubMed

Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient's...

pubmed.ncbi.nlm.nih.gov

Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects - PubMed

2.

pubmed.ncbi.nlm.nih.gov

b. If you don't like your image, you can just get another. Results may vary ha

Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period - PubMed

This study found marked variability in the reported interpretive findings and a high prevalence of interpretive errors in radiologists' reports of an MRI examination of the lumbar spine performed on the same patient at 10 different MRI centers over a short time period. As a result, the authors...

pubmed.ncbi.nlm.nih.gov

8. Don't slow down, just switch lanes. Training is probably the best thing you can do for your body. We could literally fill this page with research demonstrating the positive impact of training and physical activity on your outcome. Find activities/movements that are pissing off the region and remove them, but don't just sit around and wait for the body to heal. Movement is healing, but "nice" movement.

9. Other crap you already know is key: sleep and diet are key. Sleep 8 hours and eat real food. There a lots of zealots in the diet world, but I tell people "if you can't grow or kill it, you shouldn't eat it." There is no pop tart tree in nature. Eating a bunch of inflammatory junk and sleeping 5 hours a night will increase your misery.

Sleep

The association between sleep quality, low back pain and disability: A prospective study in routine practice - PubMed

In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.

pubmed.ncbi.nlm.nih.gov

Sleep disturbances predict future sickness absence among individuals with lower back or neck-shoulder pain: a 5-year prospective study - PubMed

Within all three pain strata, individuals reporting the most sleep problems showed a significantly higher OR for all-cause sickness absence, 5 years later. The group with the most pronounced sleep problems within the concurrent LBP and NSP stratum had a significantly higher OR (OR 2.00; CI...

pubmed.ncbi.nlm.nih.gov

10. To speak on methods to address symptoms and return you to former glory, there are a million ways to approach spine pain, referred pain, movement patterns, loading capacity, etc. This is similar to a toolbox of active and passive methods to hit this: spinal manipulation, progressive loading, directional preference, dry needling, traction, joint mobilization, midline stabilization (McGill), neural mobilization/unloading, desensitization, pain science education...or sometimes a combo of all the above. Sometimes people just have a hammer. Once again, find a provider who is flexible enough to figure out what to do with your case. There is a bit of an art to hitting the right person and the right time with the right tool, I screw it up at times too. I often hear "PT didn't work for me" and come to find out they had crap PT's who tried the same stupid exercises for 6 sessions and didn't get anywhere. The bummer is that they sometimes head to surgery after that "failed" attempt. Even with good providers, insert whatever "it sucked" and it may just have been mistimed, misapplied...or on the "it worked" outcome the provider got lucky! Independently or with a provider, find what your spine likes and hit it!

None of these are absolutes, but just random thoughts this morning. Hope it helps!

 

[cornfedkiller]

Good info listed above. I don't contribute much so figure this will be a good chance. This will be a bit of a PSA and will speak in generalities since we haven't met. I work in a similar space in orthopedic PT. No real medical advice here since we haven't met, but a lot of stuff to unpack here depending on how much you want to nerd out.

1. First, I'm sure you already know, but going to someone who sees this daily (and actually gets outcomes) is the way to go. Often you can figure something out in about 30 seconds of talking to someone in person that would have taken a 30 minute debate online. We did the telehealth style of appts during the pandemic and it's tough for both pt and provider. Find a conservative provider (MD/DO or PT) who is qualified (has some extra letters after their name) and have them see what they think. I can't speak for other professions, but I'm sure there are some good ones depending on your region. If they can't figure it out, they will know who to refer you to. It's worth your time and money if you're serious about it.

2. Once sinister stuff is ruled out, a bit of numbness/tingling is worrying but not the beginning of the end. Of the spectrum of neural irritation or referred pain that is seen...numbness is about the lowest bar to hit. Nerd fact, usually the only other sense that gets impacted before numbness is vibration sense when neural tissue is affected. Aside from NT, plenty stuff can cause pain referral as well. Ring finger example you had listed; C8, ulnar nerve along the chain, rib 2-4, infraspinatus, parts of plexus (TOS type). Usually something else is causing the aggravation of said tissue; movement patterns, strength/endurance limitations, neural mobility limitations, segmental control/mobility, etc. Once again, someone can figure this out quickly in person and make an impact on day 1.

3. Upper and lower symptoms should be looked at in isolation and then integration. As a general rule, T8 is the cutoff between upper and lower sx. Usually stuff from T8 and up; refers up. Usually below T8, refers down as a general rule.

4. On LBP and neural issues, I classify stuff on the Bogduk system. This helped my brain organize things better:

https://rwillisdpt.wordpress.com/wp-content/uploads/2014/12/bogduk-2009-on-the-definitions-and-physiology-of-back-pain-referred-pain-and-radicular-pain.pdf

5. Lots of nasty pictures of disc material pulled out of lumbar spines above. Don't get freaked out. Sometimes surgery is indicated. Primarily, it is when worsening weakness in a myotomal pattern (2 or more muscles that are neurally weak/fatiguable with a similar nerve root supply) is present along w/ changes in sensation and/or reflexes...pain is typically not an indication for surgery. Keep this in mind no matter who you talk to.

6. Disc injuries can heal. Extrusions are shown in some instances to heal better then mild disc injury. Before everyone freaks out, not all of them will and I've had people need to move to surgery.

The probability of spontaneous regression of lumbar herniated disc: a systematic review - PubMed

Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc...

pubmed.ncbi.nlm.nih.gov

7. Maybe that posterior disc "extrusion" isn't really what is causing the pain:

‘Typical’ Posterolateral Disc Protrusion and Passive Extension Protocol | Erl Pettman

What is a ‘typical’ posterolateral disc protrusion and how is it so successfully managed by the passive extension protocol innovated by Robin McKenzie? An e ...

erlpettman.com

-TLDR: often the problem is chemical irritation and not mechanical. Work the pump effect in your spine.

The disc also "desiccates" over a lifetime and less water/ material is available to be extruded. The disc turns into something more like beef jerky vs the famed "jelly donut" that freaks people out and makes them feel vulnerable. At 20 years old, there is some water in there to blow out, at 60, not so much. It's pretty hard to blow up jerky. Went to a course that Adrian Lowe (good pain science guy) taught on this, was pretty eye opening.

7. Imaging is a crap shoot. Sometimes helpful, often not:
a. Imaging done on asymptotic lumbar and cervical spines shows some carnage

Systematic literature review of imaging features of spinal degeneration in asymptomatic populations - PubMed

Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient's...

pubmed.ncbi.nlm.nih.gov

Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects - PubMed

2.

pubmed.ncbi.nlm.nih.gov

b. If you don't like your image, you can just get another. Results may vary ha

Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period - PubMed

This study found marked variability in the reported interpretive findings and a high prevalence of interpretive errors in radiologists' reports of an MRI examination of the lumbar spine performed on the same patient at 10 different MRI centers over a short time period. As a result, the authors...

pubmed.ncbi.nlm.nih.gov

8. Don't slow down, just switch lanes. Training is probably the best thing you can do for your body. We could literally fill this page with research demonstrating the positive impact of training and physical activity on your outcome. Find activities/movements that are pissing off the region and remove them, but don't just sit around and wait for the body to heal. Movement is healing, but "nice" movement.

9. Other crap you already know is key: sleep and diet are key. Sleep 8 hours and eat real food. There a lots of zealots in the diet world, but I tell people "if you can't grow or kill it, you shouldn't eat it." There is no pop tart tree in nature. Eating a bunch of inflammatory junk and sleeping 5 hours a night will increase your misery.

Sleep

The association between sleep quality, low back pain and disability: A prospective study in routine practice - PubMed

In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.

pubmed.ncbi.nlm.nih.gov

Sleep disturbances predict future sickness absence among individuals with lower back or neck-shoulder pain: a 5-year prospective study - PubMed

Within all three pain strata, individuals reporting the most sleep problems showed a significantly higher OR for all-cause sickness absence, 5 years later. The group with the most pronounced sleep problems within the concurrent LBP and NSP stratum had a significantly higher OR (OR 2.00; CI...

pubmed.ncbi.nlm.nih.gov

10. To speak on methods to address symptoms and return you to former glory, there are a million ways to approach spine pain, referred pain, movement patterns, loading capacity, etc. This is similar to a toolbox of active and passive methods to hit this: spinal manipulation, progressive loading, directional preference, dry needling, traction, joint mobilization, midline stabilization (McGill), neural mobilization/unloading, desensitization, pain science education...or sometimes a combo of all the above. Sometimes people just have a hammer. Once again, find a provider who is flexible enough to figure out what to do with your case. There is a bit of an art to hitting the right person and the right time with the right tool, I screw it up at times too. I often hear "PT didn't work for me" and come to find out they had crap PT's who tried the same stupid exercises for 6 sessions and didn't get anywhere. The bummer is that they sometimes head to surgery after that "failed" attempt. Even with good providers, insert whatever "it sucked" and it may just have been mistimed, misapplied...or on the "it worked" outcome the provider got lucky! Independently or with a provider, find what your spine likes and hit it!

None of these are absolutes, but just random thoughts this morning. Hope it helps!

^^ This is all spot-on and great advice.

 

[Coach Chris]

Not sure about you, but seeing an actual doctor without waiting 6+ months is pretty much impossible now. This is all we got...

Asking a question and not making an assumption seemed pretty reasonable when I posted it
Crazy

 

[Will_m]

Good info listed above. I don't contribute much so figure this will be a good chance. This will be a bit of a PSA and will speak in generalities since we haven't met. I work in a similar space in orthopedic PT. No real medical advice here since we haven't met, but a lot of stuff to unpack here depending on how much you want to nerd out.

1. First, I'm sure you already know, but going to someone who sees this daily (and actually gets outcomes) is the way to go. Often you can figure something out in about 30 seconds of talking to someone in person that would have taken a 30 minute debate online. We did the telehealth style of appts during the pandemic and it's tough for both pt and provider. Find a conservative provider (MD/DO or PT) who is qualified (has some extra letters after their name) and have them see what they think. I can't speak for other professions, but I'm sure there are some good ones depending on your region. If they can't figure it out, they will know who to refer you to. It's worth your time and money if you're serious about it.

2. Once sinister stuff is ruled out, a bit of numbness/tingling is worrying but not the beginning of the end. Of the spectrum of neural irritation or referred pain that is seen...numbness is about the lowest bar to hit. Nerd fact, usually the only other sense that gets impacted before numbness is vibration sense when neural tissue is affected. Aside from NT, plenty stuff can cause pain referral as well. Ring finger example you had listed; C8, ulnar nerve along the chain, rib 2-4, infraspinatus, parts of plexus (TOS type). Usually something else is causing the aggravation of said tissue; movement patterns, strength/endurance limitations, neural mobility limitations, segmental control/mobility, etc. Once again, someone can figure this out quickly in person and make an impact on day 1.

3. Upper and lower symptoms should be looked at in isolation and then integration. As a general rule, T8 is the cutoff between upper and lower sx. Usually stuff from T8 and up; refers up. Usually below T8, refers down as a general rule.

4. On LBP and neural issues, I classify stuff on the Bogduk system. This helped my brain organize things better:

https://rwillisdpt.wordpress.com/wp-content/uploads/2014/12/bogduk-2009-on-the-definitions-and-physiology-of-back-pain-referred-pain-and-radicular-pain.pdf

5. Lots of nasty pictures of disc material pulled out of lumbar spines above. Don't get freaked out. Sometimes surgery is indicated. Primarily, it is when worsening weakness in a myotomal pattern (2 or more muscles that are neurally weak/fatiguable with a similar nerve root supply) is present along w/ changes in sensation and/or reflexes...pain is typically not an indication for surgery. Keep this in mind no matter who you talk to.

6. Disc injuries can heal. Extrusions are shown in some instances to heal better then mild disc injury. Before everyone freaks out, not all of them will and I've had people need to move to surgery.

The probability of spontaneous regression of lumbar herniated disc: a systematic review - PubMed

Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc...

pubmed.ncbi.nlm.nih.gov

7. Maybe that posterior disc "extrusion" isn't really what is causing the pain:

‘Typical’ Posterolateral Disc Protrusion and Passive Extension Protocol | Erl Pettman

What is a ‘typical’ posterolateral disc protrusion and how is it so successfully managed by the passive extension protocol innovated by Robin McKenzie? An e ...

erlpettman.com

-TLDR: often the problem is chemical irritation and not mechanical. Work the pump effect in your spine.

The disc also "desiccates" over a lifetime and less water/ material is available to be extruded. The disc turns into something more like beef jerky vs the famed "jelly donut" that freaks people out and makes them feel vulnerable. At 20 years old, there is some water in there to blow out, at 60, not so much. It's pretty hard to blow up jerky. Went to a course that Adrian Lowe (good pain science guy) taught on this, was pretty eye opening.

7. Imaging is a crap shoot. Sometimes helpful, often not:
a. Imaging done on asymptotic lumbar and cervical spines shows some carnage

Systematic literature review of imaging features of spinal degeneration in asymptomatic populations - PubMed

Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient's...

pubmed.ncbi.nlm.nih.gov

Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects - PubMed

2.

pubmed.ncbi.nlm.nih.gov

b. If you don't like your image, you can just get another. Results may vary ha

Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period - PubMed

This study found marked variability in the reported interpretive findings and a high prevalence of interpretive errors in radiologists' reports of an MRI examination of the lumbar spine performed on the same patient at 10 different MRI centers over a short time period. As a result, the authors...

pubmed.ncbi.nlm.nih.gov

8. Don't slow down, just switch lanes. Training is probably the best thing you can do for your body. We could literally fill this page with research demonstrating the positive impact of training and physical activity on your outcome. Find activities/movements that are pissing off the region and remove them, but don't just sit around and wait for the body to heal. Movement is healing, but "nice" movement.

9. Other crap you already know is key: sleep and diet are key. Sleep 8 hours and eat real food. There a lots of zealots in the diet world, but I tell people "if you can't grow or kill it, you shouldn't eat it." There is no pop tart tree in nature. Eating a bunch of inflammatory junk and sleeping 5 hours a night will increase your misery.

Sleep

The association between sleep quality, low back pain and disability: A prospective study in routine practice - PubMed

In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.

pubmed.ncbi.nlm.nih.gov

Sleep disturbances predict future sickness absence among individuals with lower back or neck-shoulder pain: a 5-year prospective study - PubMed

Within all three pain strata, individuals reporting the most sleep problems showed a significantly higher OR for all-cause sickness absence, 5 years later. The group with the most pronounced sleep problems within the concurrent LBP and NSP stratum had a significantly higher OR (OR 2.00; CI...

pubmed.ncbi.nlm.nih.gov

10. To speak on methods to address symptoms and return you to former glory, there are a million ways to approach spine pain, referred pain, movement patterns, loading capacity, etc. This is similar to a toolbox of active and passive methods to hit this: spinal manipulation, progressive loading, directional preference, dry needling, traction, joint mobilization, midline stabilization (McGill), neural mobilization/unloading, desensitization, pain science education...or sometimes a combo of all the above. Sometimes people just have a hammer. Once again, find a provider who is flexible enough to figure out what to do with your case. There is a bit of an art to hitting the right person and the right time with the right tool, I screw it up at times too. I often hear "PT didn't work for me" and come to find out they had crap PT's who tried the same stupid exercises for 6 sessions and didn't get anywhere. The bummer is that they sometimes head to surgery after that "failed" attempt. Even with good providers, insert whatever "it sucked" and it may just have been mistimed, misapplied...or on the "it worked" outcome the provider got lucky! Independently or with a provider, find what your spine likes and hit it!

None of these are absolutes, but just random thoughts this morning. Hope it helps!

Huge help and thanks for taking the time to put all this in writing!

Edited just to reiterate what a great contribution this post was. Only thing missing was a meme.

 

[gbflyer]

For me the knife was the way. I can’t **** around and be out of commission for months dragging myself around on the floor like a broken down dog. I’m one of those lucky folks who cannot tolerate anything for real pain other than morphine which is no bueno. The PT is an airplane ride, $400 r/t. I have to work, construction, and sometimes it’s physical. I am fit, not overweight, walk a couple miles a day on the treadmill when I’m not packing a chain saw or a shovel.

I’d do it again tomorrow if that was the option.

 

[Fowl Play]

I'm not a doctor, so listen to the ones who posted above, but I will give you my experience for piriformis syndrome/sciatic pain which may or may not be what you are experiencing.

I went to a sports medicine physician who did an MRI and said my discs were bulging, but that it was likely musculature since I worked a desk job 60-70 hours a week. I thought I was staying decently fit and didn't like hearing that a muscular imbalance in my core could be the issue, so I dealt with the pain for a year because I didn't want to do the "sissy" Clam exercises he recommended. Only did stretches, crunches, side planks, all the "manly" exercises to strengthen my core (which did help, highly recommend pigeon pose, etc.). But I literally "cured" myself after two weeks of doing clam exercises every morning. Now I keep them in my rotation and my sciatic pain is GONE. I had something called piriformis syndrome.... you may not.... so do whatever your doctor tells you.

I do the modified ones he describes at 5:45. Can't hurt to try it.

 

[mb6355]

Once it heals enough, strengthen it. Work on mine about 3 days a week.

 

[Bubblehide]

From a guy with a collapsed disk with herniations and calcification, norowwing of ccx the nerve channel... in his low back and neck, it does not sound like a herniated disk to me, but I suppose it's possible. It could be a lot of things, from weight to cysts , get some imaging so you know exactly what the cause is. Some great suggestions gave been made, so to repeat, stretching/yoga, an inversion table, and building core strength and stamina. Lastly, from what you're describing, at this point, it sounds like surgery would not be an option. Considering how bad mine is, I manage it very well with the above suggestions and epidurals from time to time.

Okay one last addition as an edit. If you need some releif, you could always go to your medical providers urgent care and request an injection. I'd be asking for torodol (it's a strong short term antiinflamitory), possibly a steroid also, and a very mild muscle relaxer, something taken at night that wears off by morning. In my case, because I have the medical documentation in my records, the urgent care doctors typically want to give me narcotics, which I refuse, for a variety of reasons, but the nain reason is because what I suggested in this paragraph above, is soooooo much more effective and it leaves you fully functional, unlike narcotics.

 

[rogerdoger]

I had lower back pain with some numbness in my foot, would always get lower back pain when sitting or standing. Had a PT do some dry needling in lower back until numbness was gone in foot. Do a lot of hip stretches, lower back pain is pretty much gone.