MRI: L4-5 Disc Herniation

Training
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I ve been having low back pain for around 1 year now. I am 22 years of age. Its not unbearable by any means, just annoying dull and i feel my back stiff and the pain gets worse when i bend over (but sometimes the pain pattern changes and the pain doesnt get worse when i bend over!). There are days though, that tying my shoelaces becomes difficult!

I got an appointment for an MRI. It came back and the diagnosis was that i have a disc herniation in the L4-L5 and the L5 nerve is being pinched. Oh boy, i am too young for this shit…
I have no clinical signs of sciatica (leg pain) or neurological damage et and one would certainly expect that I SHOULD have had!

From the info i ve been skimming through this whole time, there are a lot of false positives with these tests, since 6 out of 10 adults will have some sort of herniation or disc buldge in their MRI’s and could be completely asymptomatic. And vice versa, you could be in excruciating pain and yet have no signs of herniation. So this gets complicated. What is actually causing the lower back pain?

I know the annular disc tissue is avascular so it has no healing properties and that means i am fucked for life. My dad had also had back problems for a lot of years. He was getting regular steroid injections and nsaid’s and stuff. I dont wanna do the same, as they only mask the symptoms, and i want to have a perfectly healthy back, since im an athlete. Doctors know nothing about athletes, and how insane it is to tell them to quit exercise or weight training.

I ve tried physical therapy , the McKenzie stuff. Initially they seemed to offer some sort of relief, but they stopped working soon after.
I ve been going to a Chiropractor who uses the activator method, and however crazy this may seem, my back pain vanishes and diminishes greatly!!. But unforunately this is only temporary. As soon as i get back to training, the low back pain/stiffness comes back.

I ve also been wondering if this back pain/stiffness is somehow linked to my multiple hamstring injuries this year on track… I really believe there is a link.

The good news is that I CAN squat and heavy too. So i am in no exruciating pain or anything, its just a dull chronic annoying thing in my low back (nerve pain) with no sciatic nerve involvement. The pain sure doesn’t get better after squats but it doesnt get much worse! Deadlifts though, are TOUGH. And i get a spasm whenever i try to go even moderately heavy…

I ve tried to take a break 3-4 weeks, and the pain will still get back as soon as i do any sprinting or weights

I know there are lot of back pain sufferers here, so i was hoping for some advice!
And sorry for my bad english, its not my native language:D

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Your herniation appears fairly minor on the sagittal MR images you posted. I had a fairly significant L5/S1 herniation years ago. I simply rested, trained around the pain, dropped heavy deadlifts, ice/heat, nsaids, and worked a lot on my midsection/ab strength. Eventually the disc will recede and/or become desiccated (dried out) and nearly fuse at that level I’d think.

Just so you know all is not lost, I’m 36 and have 4 herniations in my spine and recently competed in a PL comp and can still deadlift, just not very frequently. Just have to be extra careful, no ego lifts and use the deadlift and any other offending movements very sparingly. Good luck.

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For how long had you rested? How can i be sure that i wont make my disc worse and cause sciatica if i keep on squatting and sprinting?
I thought the nucleus pulposus of the disc dried out very late in life in late 50’s…

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I too have L4-L5, L5-S1, problems and after multiple MRI’s, nerve conduction studies, PT, and all the other battery of expensive tests. As a last ditch effort My surgeon suggested an “old school” test: a CT Myleogram. (they used to be the "cadillac’ of tests) and the nerve root on my left side at L4-L5 is compressed (pinched) so badly the contrast die didn’t flow properly. The only way to “fix” the problem is to do a multi-level fusion, and since I can’t be guaranteed to even be any better…
I know there are no guarantees ever in surgeries, but I’m willing to wait until I don’t have any more “good days” and then I’ll consider fusion.
I also have a very modified lifting schedule to keep the constant pain in check, but I still go to the gym anyway.

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An update:

Bushido, man i wanna thank you not for the info you provided, but because you are smart. :smiley:

Anyway, here’s how it went. After the diagnosis was made, i went to an orthopedic surgeon who allgedly had worked with many athletes. HE DIDN’T help me not one bit. The only thing he told me is that as long as i didn’t get sciatica, i shouldn’t worry.

I was advised to go under the knife in the future (microdiscectomy) but i refused of course. ( after all the research i ve read on pubmed, i conclude surgery is definately not a good option esp. in my case).

Anyway, i ve been researching thoroughly back pain and amazingly i have concluded to pretty much the same things you did!! (but more to this later)
The only person that was able to offer some relief was a chiro. He was using the ACTIVATOR METHOD (a spring load tool for spinal adjustments).

Well he told me my sacrum was out, my pelvis was laterally tilted, my shoulder blades were out etc.
Thing is i don’t buy this whole subluxation theory . Its just not supported by science. Hey, i dont mean chiros dont work. ADJUSTMENTS DO WORK, but not for the reason MOST chiros think or say.

So everytime i visited him, i was pain free for the next days as long as i didn’t do anything stupid (hard deads, or squatting) or the pain would come back. He was adjusting mainly my SI joint (and pelvis)and giving some thrust on some vertebraes and the back region and magically no pain, or greatly reduced!

And thats how it probably worked i think…

Concerning manipulation or adjustment of the joint, it is very common to use the side posture adjustment you have described to address SI joint. Technically you are moving the joint with manipulation, but again we are talking about very slight movement.

The key to chiropractic manipulation is not the actual movement of the joint, rather the quick release of pressure within the synovial fluid of the joint…that is what makes the popping sound. It is a release of gasses that happens quicky and escapes the synovial capsule, just like when you open a champagne bottle quickly.

When this happens joint receptors are firing signals to the brain. These are called mechanoreceptors because they respond to movement and mechanical stimuli. There are also proprioceptors which transmit information to the brain about body position and awareness.

Both of these transmitters send information to the spinal cord and brain which will inhibit the pain receptors in the joint which are called nociceptors. It is a neurological and physiological relationship reducing inflammation and pain transmission

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Anyway, so the chiro visits offered great relief but it would come back if i did heavy lower body lifts, or sometimes even if i did a suddent body movent i would get INTENSE pain in my lower back.

I ve researched the stuff, and i believe most of the back pain is related to hypertonicity and or inhibition of certain muscles (your brain cant recruit them properly).

Quadratus Lumborum is one i think (hypertonic)
Spinal Erectors/multifidus another (hypertonic)
Hamstrings (lengthened but pretty weak, notice the PENNATE structure of the hams unlike other muscles!)

In my case core muscles were inhibited (pretty sure for that), and particularly my deep internal/external oblique muscles (pennate structure too i think) didn’t fire all that well. Now, i can FULL SQUAT above 2.3xBW , so how could my core be inhibited with that strength?

Yeah i think IT CAN happen. Ab work in the gym didn’t seem to cut it at all. No amount of crunches, side bends, side planks or any other sophisticated movement.

It’s only when , i started SPRINTING, that my core improved greatly and inhibition in my core greatly reduced (and my anterior pelvic tilt, improved too! My hip flexors were flexible and loose all along , and never had any glute recruitment probs AT ALL).

So my deep oblique muscles got neurally activated somehow through sprinting, my hamstrings got stronger (its harder to effectively train hams through weight training alone, because of their fiber orientation -pennate structure, and high white fiber content).

So that pretty much was, it. I ve been functinoal since i improved my core strength a lot. Lots and lots of core strength! When my core strength (or inhibition sets in), my back pain gets worse every time.

I would trust a chiro more than any traditional orthopedic surgeon ANY DAY!

And yes bushido, when your only tool is a hammer everything starts looking like a nail :slight_smile:
They only seem to offer NSAID’s pill to mask the pain and surgery. Thats it

Bushido, any advice to reduce possible hypertonicity in the QL? (or spinal erectors)
I know QL is a bit hard to pinpoint. somewhere above the iliac crest and below the 12th rib right?

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Bushy, you are brilliant.

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Bushido, thanks!! You the man!! You know your stuff.
that was quite a relieving stretch. :smiley:
Its a rare thing to find someone who has an all around knowledge of musculoskeletal problems in ATHLETES, and not couch potatoes…

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Interested in your thread, I have my own going on about back problems. My question is can a disc bulge or herniation heal itself completely? I find varying opinion on this.

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Bushy,

A while back I asked you about the lower back pain and you gave me some very informative answers.

Thing is, now I’ve realized that the pain isn’t my lower back, but the flat hip bone just above the butt line region.

The only time I can feel pain is when I sit, lean forward, and go into a posterior tilt fashion. My abs seems to get lax and it feels like all the weight is pushing my tail bone or sacrum against something in my hip.

I tried the lying leg lowering test with a posterior tilt and found that my back would come off the floor each time. If I did crunches with a flat back, I would shake a lot. Whenever I bent over in the morning, say to spit out my toothpaste, i would feel a little unstable, and that my back was taking a lot of the work.

Now I think that maybe my spinal erectors, specifically my QLs are doing the bulk of the work, and somehow my core is inhibited. I just realized I got the “spilling of the guts” syndrome, were I can push my stomach out easily, making me look like I have a bigger gut than I actually have. Why do I think this? Because after doing specific ab exercises such as the dead bug, I can not replicate the pain again, after a while tho, the pain comes back. That said I think my Multifidus is inhibited as well.

I would really appreciate your input. Thanks

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Bushy, some other questions

  1. Is glucosamine-chodroitin-msn a legit supplement for athletes with LBP to take? Does it actually do anything?
  2. Do you believe the disc buldge/herniation is the PRIMARY cause of lower back pain?
  3. Do you think the tendency for bulging/herniated disc is genetic? For example some defective gene for collagen production in the outer layers of annulus fibrosis?
  4. Why is core strength so important? Do you have any exercises or stretches we can do at home (besides sprinting that i find to be very effective) to increase core strength, and fix the inhibition in the deep oblique muscles, and lower abs, ?

haha im asking too much!