Herniated disc :-( whinging

My second disk herniation was just where yours is. I blew it out in June of 2014 (being stupid at Boy Scout camp) and 14 months later I'm finally at the point where the pain doesn't come to my attention all the time. Initially I couldn't sit at all, and I still stand most of the time. Walking, fortunately, has been good for me all along. I still can't use a pack that puts any substantial weight on my shoulders. For me that means a couple of Aarn packs are the best, and I pay the weight penalty, but honestly I think anything with excellent weight transfer to the hip belt would work. Having found something that works for me, I'm done experimenting for now. Someone who knows more than I do will be along presently to give you PT advice, I'm sure. I don't expect to ever be at 100% again (age, meh), but I'm happy to have recovered well enough to get out to the woods on a regular basis. It took time but it did happen.

If you haven't already consulted with a chiropractor, I would recommend it. A good chiropractor will give you an evaluation and should be able to determine if you would benefit from chiropractic treatment. A good chiropractor is worth his/her weight in gold and I trust mine with my kids who are all runners in high school and college. Some insurance does not cover chiropractic treatment (mine does) but my doc also works with patients directly if their insurance doesn't cover it so you may have some luck finding someone reasonable.

Thanks for the advice and personal stories, guys – it's particularly good to hear that there is (backpacking) life after herniation.

So you go to start your car in the morning, but it won't start. You call your mechanic up in a frenzy – MIKE! My car won't start!!!! Help!! Go take a photo of it, says Mike, and send it to me. You do. Holy crap, Mike says. Look at that massive dent in your front quarter panel! Just as you would never think that Mike could figure out why your car won't start by looking at a photo…we CANNOT diagnose pain from a photo (MRI, X-ray, etc). Just because tissue is not "normal" does not in any way mean that it hurts. You have wrinkles, you have grey hair…those don't hurt, do they? Pain is an experience that is formed in your brain…NOT necessarily tissue damage. More than 80% of people who have never had a single episode of back pain have massive herniated disks. Just because your back hurts, and just because you have a herniated disk does not at all mean that the disk is what hurts…HONEST. We all have them and we cannot be sure that they actually hurt. Yes, people "hurt" their back, but there are literally dozens and dozens of possible pain generators in there, and back pain is SOOOO much more than any single tissue. You need to STOP thinking about back pain as any type of tissue damage. Pain is your body's warning signal – a system to get you to stop what you are doing and pay attention to something. What pain is NOT is a picture of a herniated disk on an MRI. What THAT is is a surgeon's or anesthesiologist's car payment (ala surgery or injection).

And I've stopped trying to be politically correct when it comes to chiropractic. It is a sham, plain and simple. That chiropractic gun – the Activator – SERIOUSLY?? how can they be serious about that crap? Cracking your body feels good – and the relaxing effect on your nervous system lasts all of 30-60 minutes and no more (which is why you have to come back all the time). I would never, ever allow a child whose growth plates are not closed to be "adjusted" by a chiropractor. Ever. And I say this as someone who cracks people all the time for a living. But I do it sparingly, and on very specific people, and based on sound scientific theories and practices (evidence-based)…and I cannot tell you how many patients I see who come to me after being hurt quite badly by a seemingly good chiropractor. If you even try to get a good explanation about what they are doing – adjusting subluxations – you will see that it is exactly the same explanation they offered when Parmer cracked his first person in the 1880s. Yes, you read correctly – NOTHING has changed in the chiropractic world since the 1880s. There is no such thing as a subluxation. Check out this eye-opening speech from a researcher about how chiropractic came to be (watch all three segments if you have the time): https://www.youtube.com/watch?v=ZxvwJl53ywY By the way – did you ever wonder why there is not a single chiropractic school associated with an accredited university? Or that you only need a high school diploma to get into chiro school? or that more than half the curriculum is devoted to business education? OK – off my soap box now.

Yeah, what she said. I'll take a good massage therapist over a chiropractor any day. Subluxations? STFU! I've been known to throw my back out on occasion, or get a wicked pinched nerve under my shoulder blade. Every time it's a reminder that I have to exercise and stretch more. If I just do even a modest amount of conditioning I'm good. Lift properly and listen to your body. Let your doctor know you want to pursue physical therapy and massage as your primary mode of recovery. See what they say. And good luck!

Good name for a doppelbock.

Well, PT is the approach my doctors are taking, thankfully. I did try a massage a few weeks after the injury, with a really good massage therapist who's helped me with other problems, but the things he wanted to do did not feel like they were the right thing for me at that point, so I have not been back yet. Maybe when I've improved to where things feel more stable again. PT is working on extending range of motion, gentle stretching, and just started mild core/stabilization exercises. It is helping, but I'm just impatient to be out and about again (but not impatient enough to do anything stupid and risk hurting myself by getting out there too soon).

I also have a herniated disc in the same place. It first happened to me when I was in my young 20's from washing my car windows at the gas station. Every 5 or so years I have a flare up and am floor bound for a couple days, then can walk with pain for 7-20 days, and then can participate in physical activity as normal but still have tightness/ pain for the next couple months. Then after that, I'm back to normal. I'm 40 now and have had this happen maybe 4 times total. I have tried EVERYTHING but surgery and the steroid shot. Did PT, Chiro, heat, ice, inversion table. Nothing really works but resting it till the inflammation goes down. The doc said his only options were surgery but doesn't recommend it since it is not a yearly occurrence and it gets better between occurrences. I have heard about the laser surgeries so that may be something to look into. Actually, swimming and hot tubs are soothing and offer relief while in the water. Gravity is your worst enemy at this time. Funny story…..on day 1 or 2 of one of the flareups I was unable to walk. I was lying on the floor. I had to drop my morning deuce after having cup of coffee. However, I was struggling to get off the floor and get to the can. I was on my hands and knees crawling and sweating. Going slow like a turtle, I had plenty of time to think (imagine life flashing before your eyes at death?) and was soo scared that I was going to crap my pants. I had been living with my fiance for a couple months so the last thing I would want to do is ask her to help clean me up. I wouldn't of been able to do so at that moment. Luckily I made it and slithered up on the pot. Phew. Wiping was a 'hole' nuther story, but, in writhing pain, I managed to take care of that too. You'll be back in no time. It does SUCK though. Hurts like a mofo for the first couple days. Hurts worse than the two times I broke my arm skateboarding, time I broke my hip snowboarding, and the time I cut off my pinky in woodshop. Yes, I have 9.5 fingers.

And some good stories. I have a series of exercises that I do—and when I do them, my back seems to be fine. But let me spend a couple of weeks without them, and all sorts of bad things start to happen. And I loved the advice I got from my orthopedist: The next step might be surgery–we'll have to see. But if so, before you sign up for any surgery, you are going to come back and talk to me about it. Because every surgeon will tell you that's he sure he can fix the problem, and only 75% of surgeries are successful….

Interesting stories indeed, thanks! I guess I can be thankful that I didn't get this until I was 60 (well, two days away from it, anyway). The only other back injury I've had before was in my mid 20s, when I tried to lift a rototiller into my trunk to get it back to the rental place – that's my entertaining story. Much more monumental stupidity than just bending improperly…

Brownies…

LOL. Funny you should mention that…I just had two, probably as you were writing, Ken. But if I keep up eating without being able to exercise it off, I won't be able to hike again because I won't be able to get my bloated body off the chair! Trouble is that eating is one of the few things I can do really well right now that give me pleasure. I'm sure I've gained weight in the past 8 weeks. But I must say this is my most favorite advice so far.

"And I say this as someone who cracks people all the time for a living. But I do it sparingly, and on very specific people, and based on sound scientific theories and practices (evidence-based)…" How does your cracking, and I'm guessing you mean manipulation of the spine here, differ from what a chiropractor does? I ask because I use a chiropractor occasionally for quick, effective relief from a kind of back pain that will immobilize me if left untreated. The treatments have usually been effective for at least a month or so of strenuous mountain activity, and formerly running, often many months more. So, I am a qualified advocate of chiropractic for certain situations, with the caveat that most of them are quacks, IMO, exactly as you state. However, to paraphrase a poster, above, I have found the occasional good one to be worth their weight in gold. The problem is finding one of the few, IME.

Well said Tom. I agree totaly, just like anything else you need to find a good one and I finaly did.

Loose weight. BMI is not perfect but a good guide. Get to about 20 and many back and other joint issues go away. Trouble is that cancer has a better prognosis than people attaining ideal weight in our culture. Personally, my MRI looks terrible, many herniated disks, but I am pain free. I do eat brownies. Maybe that is the common denominator. Art

Another +1 to having to find a good one, which can be difficult.

A "sham" saved me from a horrible life of back pain in less than a year, after I was rear ended by a drunk driver. X rays showed plainly how my back had strayed from normal. A good chiropractor is hard to find, and not everything is helped by spinal manipulation, but. I went from persistent excruciating headaches every day to normal functioning and a stable healthy back. I am hiking and backpacking every week. I was a skeptic, now I am not. Physical therapy and massage would have done nothing to realign vertebrae.

Well Lori, not to chaff up this discussion, but your spine was never un-aligned. Our spines are very mobile – they are supposed to be. When you have a very significant muscle spasm, which you will have in the presence of some sort of back injury, then an X-ray will make it seem like you are crooked. You may actually even BE crooked. But nothing is out of place, nothing is subluxed, nothing is out of alignment. So I heartily disagree that PT or massage would not have "realigned" your spine because even tho the image looked funny to you, it was perfectly normal (despite what the guy taking your money tells you). See the post a few posts up…guy has lots of herniated discs and no pain; ANY findings on X-ray are NO indicator of pain or dysfunction. NOT ONE BIT. There is NO correlation between what can be visualized on X-rays and CT scans and MRIs etc that has any consistent relation to pain. OK, you break your femur – yes, that probably hurts. More than 80% of people WITHOUT back pain have nasty findings on imaging, and plenty of people in tons of pain have perfectly fine images. What manipulation does (adjustment, cracking, whatever) is to reset the muscle spindle receptors in the belly of the muscle, causing it to temporarily relax (thus making it look like the chiro "realigned" your spine, and feeling great, then getting you to come back over and over since nothing actually was fixed). A good chiro knows this and uses it to this end – yes, if you can find one, great. But the entire foundation of chiropractic is a sham, plain and simply. There is a reason universities won't touch the profession with a 10-foot pole, but they have enough cash to make sure their licenses stay intact and insurance companies will pay for them. But not for long I predict….. Nothing makes me shake my head more than the patient who says "i love my chiropractor! i've been going to him for 20 years!" Holy crap, why aren't you better then????!!!!!!

Jen says" ANY findings on X-ray are NO indicator of pain or dysfunction. NOT ONE BIT. There is NO correlation between what can be visualized on X-rays and CT scans and MRIs etc that has any consistent relation to pain." If this is true, then then all the spinal surgeons (neurosurgeons and orthos who do spine work) are a sham too. And all the university medical schools are taking in the neurosurgeons and spinal orthos. I have read the studies on the questionable efficacy of spinal surgeries too, and have a fair amount of skepticism as well. But surely you've seen discectomies and fusions that have been successful

This is my key modifier here…consistent. Of course, if you break your arm – there is a fracture on X-ray, there is pain – i get it. The problem is that pain is an experience, not a thing. It CANNOT be imaged…just as your anger, or happiness, or depression cannot be imaged. The most commonly cited number is more than 90% of back pain has absolutely no identifiable cause. From the Lancet (Feb 2009): "Lumbar imaging for low-back pain without indications of serious underlying conditions does not improve clinical outcomes. Therefore, clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute low-back pain and without features suggesting a serious underlying condition." FYI – "serious underlying condition" means tumor, infection, or progressive neurological decline. There is literally a whole body of research and writing and conference lectures about this very topic, by the way. Sure, I've seen discectomies that have been successful, but each of those cases has been because of neurological deficits, NOT back/buttock pain. I've never seen a fusion that actually relieved anyone's pain. Stopped progression of a neurological disaster? yes – but to actually relieve someone's pain, no. And there's a reason even the American Academy of Orthopaedic Surgeons has come out against performing meniscal debridements on degenerative meniscal tears (knees), and spinal fusions in absence of any neurological deficits. I would completely agree that there is a fair bit of spinal surgery that is an absolute total waste – bordering on criminal – and I will actually lump many of my PT colleagues in there, too. At least when a PT is bilking you out of your money it doesn't permanently change your anatomy and cause constant, lifetime pain. Here is a blog post I've referenced before, but it's just about perfect: http://www.bettermovement.org/2012/the-trouble-with-mris-and-my-brother/

Jen, I don't completely disagree with you. But if findings on films don't correlate to pain-generating injury for chiropractors, the same should be true for the doctors, especially those who are cutting on the spine, plucking out parts of discs or fusing vertebrae. If there is no correlation, then we have a whole successful specialty of physicians who are university approved. Seems to me that at least the chiros are providing more conservative care than the surgeons, and that they are less likely to be doing harm based on films that don't correlate to pain-generating injury.

Well Ben, I hate to tell you, but you are exactly correct that for surgeons the problem is exactly the same. There is a huge controversy in the orthopedic world about spinal fusions and the amazing explosion in how many are done – and their utter lack of any better outcomes (see http://www.forbes.com/sites/robertlangreth/2011/01/10/why-you-should-never-get-fusion-surgery-for-plain-back-pain/ for a good layman's overview) Perhaps you saw all the write ups recently about how many meniscal debridements are done in arthritic knees – "but I have a cartilage tear! That's why my knee hurts and I need surgery!" – and the outcomes were exactly the same as those who had a sham surgery. We can't even properly grade osteoarthritis anymore using X-rays because the level of pain and dysfunction are not at all correlated to how much joint damage we see. Check out this article: http://www.hindawi.com/journals/arthritis/2012/984060/ "Our results demonstrated that age and disease duration were found to be positively associated with Kellgren-Lawrence grading scale. Also disability scores were significantly associated with pain and stiffness scores as measured by WOMAC. However, we could not establish an association between Kellgren-Lawrence grading scale and WOMAC subscores." Of note, Kellgren-Lawrence grading is the grade of change on X-ray, and the WOMAC is a measure of pain and disability. I can't tell you how many patients undergo KNEE REPLACEMENTS who did not have any pain or difficulty, or only minimal pain – but they were "bone on bone" and their doc said they needed a replacement. So yes, it's a problem.

It's certainly an interesting issue in orthopedics right now. And a lot of money is at stake. I will admit I had a meniscus tear trimmed with VERY good results. I know, anecdotal.