Encouragement Needed

Oh mike…please oh please don't fall into the trap of accepting that an MRI finding has anything to do with your pain. That bulging disc may have been there for years…as a matter of fact, more than 60% of people with NO back pain at all have them.

There are dozens of things in your back that can hurt…a little tweak here, a little pull there…and it can be excruciating. But honestly, and I mean this with all the sincerity I can muster…it will go away, the disc will still be bulging…and your back will be fine.

I would strongly recommend going to a GOOD PT (look at AAOMPT.org for a fellow-trained PT near you…there is some really bad PT out there) to find out why your back is hurting (which very well may have nothing to do with the disc, by the way) and to then fix the biomechanical faults that caused it to hurt in the first place.

Your backpacking days are just fine…..

Good luck, and feel free to email me anytime.

Jenmitol AT gmail DOT com

You'll cope in the end – if determined. PT and exercises will help.

I have a bulging lumbar disc. And several dehydrated discs.

Had hard times for years, – it's manageble between the odd crisis when I overdo things.
And all last year was bad to worse(stiff and painful, sciatica etc) then yet another big crisis – spasms and unable to stand up; easily…. Had chiro/physio regularly (and drugs!) Was on limited work hours for 3 months through winter (am a gardener/tree worker). Still have trouble, but coping.

Finally got an MRI and appointment in April this year (it's free here, but sloooowww). consultant offered me a disc replacement or fusion. (but couldn't explain my symptoms based on the MRI results – hmmm) I said no thanks as I'm managing.

Been backpacking again since february, and recently did a high level TGO challenge in Scotland. 30lb pack when fully provisioned.(yes I suffered, but neck (from pack)not lumbar – except at night on a thin 3/4 mat – sciatica)

Backpacking is what I live for. I just need to get lighter, do regular exercises and change my work.

Here is a fabulous blog post that I give to many of my patients who have a hard time accepting that an Xray or MRI does NOT tell us what hurts:

http://www.bettermovement.org/2012/the-trouble-with-mris-and-my-brother/

I've posted it before, but this is a good opportunity to post it again.

"Anyone else survived this sort of nonsense and have words of encouragement to offer?"

On May 26th I took a shower, then found I could not step out of the tub without excruciating pain. As long as I was vertical I was fine. But I could not in any way lean forward from the hip. If I sat on the couch and slouched back I could not lean forward to get up. I could not turn over in bed. I couldn't get out of bed. I couldn't get in or out of a car. I couldn't do $hit.

It took about 3 days of pi$$ing and moaning before I was semi-functinal, but certainly not happy. By then the pain was a little less intense and I was able to recognize that it was my right quadratus lumborum that was causing all the fuss.

I got checked out by a sports massage therapist (she knows my body), who wasn't able to find any tight spots, or any tender spots, just generalized agony. I started a "relaxation stretching regime" advocated by Peter Egoscue, iced a few times, added a few more QL stretches, and then started with some "side plank dips" just for fun. Three times a day, plus a few "quick ones" when the opportunity presented itself.

It took a week before I could get in and out of a car without audibly complaining.

Yesterday I got back on the bike, rode 50 miles, and felt good for more. Today I'm fine and will do another 50. (My QL is still little tight, but only because it feels good enough for me to ignore stretching….duh.)

+1 on what Jennifer says.

It Might be a disk. But you don't want to go there until Everything else has been tried. With all due respect to Docs, most are trained to find the "obvious problem", and are not aware that other issues could even exist.

Thanks all!

As far as MRI/disk goes…I've actually been through this once before with a cervical disk that got badly out of whack, caused lots of pain, healed, pain went away, before and after imaging shows the difference. This pain has the same quality so at the very least I'm sure it's nerve pain, not muscles/joints (of course moving oddly is exacerbating previous joint issues in the same limb).

So I do plan to get the MRI to see if there's an obvious explanation for the pain. But I won't let that send me down the surgical path until I try everything else. With the cervical disk, it was 6 months of PT plus pain killers…about the last three months of that getting pressured to just let them cut and fix. I looked into spinal surgery outcomes enough to decide I'd rather put up with pain.

What I'm mostly interested in from this MRI is to see whether any other disks in that neck of the woods are showing changes. If not, I'll presume I can just wait this one out. If they are, it'll be time for a bunch more research before making any decisions.

Meanwhile, I am still planning to hike the Tecumseh Trail in September for my 55th birthday. Just gotta figure out a sleep system that'll work.

I have 3 badly deteriorated disks in my lower back, been slowly getting worse for 20 years.
Yes the problem periods are increasing a bit but it comes with the territory.
But, I still run ultras, including 100 milers, and enjoy fastpacking in the Sierra.
For me, sitting at my desk or in a car for extended periods is not good.
Lots of PT, good exercise, yeah probably keep the heavy weight off your back too.

MRI came back as "degenerative disk disease, bulging at L4/S1 level". Next stop, physical therapy.

Listen to Jennifer.

I did, and now, 2 months later, I am pain FREE! (Wallet lighter, too, but hey — it's UL now…) Rock ON, AAOMPT!

Alright Mike….

No worries – you just described the MRIs of >60% of people without back pain. So forget you ever saw the MRI, go to PT (please check out AAOMPT.org for a good one……there is SO much bad sports medicine out there…orthopedics in general….argh it makes me so mad!!!)…and you'll be fine. Degenerative changes and bulging disks are so common, those of us who study pain actually think that's a NORMAL MRI anymore. Neither of those things necessarily means pain.

Good luck!

PS – thanks Valerie!

I herniated a disc a few years back. I was 100% disabled and on narcotics for pain. I decided I didn't want that to be my story, so I began searching for alternate treatments. Chiropractors weren't helpful to me in this instance, so after reading up on it I decided (skeptically) to try acupuncture. Despite my skepticism, acupuncture works for me. Combined with some daily stretching and basic yoga poses, my back has been amazingly stable and I hike, backpack and walk more at 41 than I had since I was in my 20's. I rarely have pain any more. I do have some permanent damage from the herniation, primarily a large numb spot on my right inner thigh, and I think my lower back may have fused on its own because I can't bend it, but it doesn't seem to hamper me much.

Don't give up, and if one type of therapy isn't working, try something else.

Yep, thanks for passing along those stats about MRIs. I'm already firmly in the informed/skeptical patient population (comes from being raised by an RN) so that's just one more piece to go into my thinking.

Choices for PT around here are a bit limited in terms of who my doc will refer to and insurance will cover at the moment. Two big practices, but one of them I had a horrid experience with in the past so I won't go there again. So that leaves me with the other one (http://www.prorehab-pc.com/) where I at least know a few satisfied patients & some staffers. Going to chat with them tomorrow, then will make up my mind whether they make sense or not.

At the moment Tramadol has the pain controlled reasonably well (so long as I can do without sleep ) so I feel like I can take my time and make a good decision. And I'm going to go back to hiking no matter what they say.

Mike, I'm solidly with Jen and the others who think the MRIs can be a real deception. Not that you don't have a bulging disc, (I do too), but that it is meaningful as a cause of your pain.

I went through this several years ago: crippling sciatica and back pain, bulging disc per MRIs, narcotics, shots, etc. None of that really effective for stopping the pain.

What finally turned it around for me was reading Dr. John Sarno's book, "Healing Back Pain" (see link below). I took his advice, acted on it, and my back is fine. When on occasion, it starts to get twingey, I identify the cause and deal with it, and the pain goes away.

Best of luck in your journey.

I too have herniated discs at L4/5 and S1.

Every couple years I have a flare up. Been like this for the past 20 years. First time was from washing my windshield with a squeegee at the gas station. Last time was from lifting weights. It's fricken baaaaad when it does. I have to crawl to the restroom and pee sitting down. Every movement hurts. Chiropractic work does nothing to fix it. It does feel good for the first half hour after a good cracking, though.

I am thinking about having surgery if it happens more than every couple years. Thankfully, I have no problem backpacking. Its actually comfortable on my back. Keeps my posture straight or something.

I would say just wait for the initial pain to subside and you'll be back to normal soon.

Can't speak to your specific condition, but my pelvis got knocked out of place in an accident years ago. Has a permanent cant to it, apparently, but was told that I'm not a candidate for surgery, and that it would do more harm than good. As a result, my back gets out of alignment easily. Sometimes it would look like my top half had been set on my pelvis a couple of inches off center. Back muscles would lock down and spasm, legs would go out from under me if I stepped the wrong way, etc.
I've spent half an hour putting on my socks before.
I'd made up my mind that was just the way things were going to be, and that I should learn to deal with it.
Since, I've gone to a chiropractor, who I visited for years, first several times per week to get the pelvis as straight as possible, and continuing, first regularly and then as needed, to get the spine realigned.

Here's the ironic part. Now, if I have a period of inactivity, I am prone to waking up anywhere from very stiff to unable to stand straight, even walk, but the more active I am, the less problems I have. Like none, aside from the occasional back spasm and some mystery pains in my legs and hips sometimes.
I actually got back into hiking(and mountain biking, rock climbing, kayaking) about 5 years ago, after all that. Guess I realized that I wasn't doing the stuff I wanted, and was in danger of losing the ability to do so. And doing it cured me. Sort of.
Have to cinch my leg around and pop things into place almost daily, but have not needed my chiropractor in over a year, and it's been 2 1/2 years since I had a debilitating episode that lasted more than a day.
When I first saw the xrays with a crooked pelvis and spine all out of whack, I thought I was done, too. As it is, I'm practically forced to get outdoors on a weekly basis.
Here's hoping you find a similar "solution", or can get the care you need to get you back in action, and wishing you the best of luck!

Same thing happened to me nine miles into a 45 mile through-hike. Not a lot of good options there….

Except that I knew about the problem, and had a series of exercises that I do to relieve the pain, They work. And about half an hour later, I was telling my wife that I thought I could continue the hike. Which I did.

Do those exercises. Work on your posture, stay fit, lose weight…

We've backpacked over 100 miles per year for the last eight years or so, all with my back problem.

First PT session went well enough from my point of view – which is to say, more talking than doing, no attempt to rush me into anything, and a therapist who agreed that the MRI was not indicative of much without a "before" to compare to.

Did a short session of dry needling, and got assigned 3 exercises to work on: stretch hip extensors supine, hip abd uni sidelying, lumbar rotation supine. Back next week.

goodluck. I love my PT. She is great and the help I got from her was awesome. I would happily suggest physical therapy to anybody to try first. A trained professional can help you figure out what is wrong and how to fix/alleviate some many issues.

Mike,

Been there done that and returned to backpacking after things healed.

PT and time were the keys. I had a full herniation and I took a summer off from backpacking to heal. Took about a year to get back to where I was before herniation.

My backpack's weight is all supported on my waist belt and the waist belt is below the area of herniation. This helps.

There are times I just don't understand my body.

If I sit down for five minutes, the pain (sacroiliac and upper leg) skyrockets.

Every time I fall asleep I wake up 60-90 minutes later in agony.

And yet…I just hiked 4 miles up and down the trails at Pennyrile Forest State Resort Park with no trouble. Not entirely pain-free, but no more than a 1 or 2 on the 1-10 scale, comparable with normal aches and pains for me.

In other words, things are much *better* for me right now walking (not backpacking; I only had 3 or 4 pounds in a fanny pack for this) than they are sitting still.

I choose to see this as hopeful; it means I can count on getting back to backpacking. There are still some key questions I need answers to (will hammocking still work for me? Do I need to change my pack setup?) but there seems to be no need to plan on cutting back.

Mike,

There are two components to your spine: the posterior elements and the anterior elements. The posterior ones are all the pokey bits that you can feel under your skin – they are comprised of the facet joints, the nerve roots, tons of ligaments and the small stabilizing muscles of your back. the anterior element is the disc, the end plates (that's what attaches the disc to the vertebral body above and below), and the vertebral bodies themselves.

When you stand up or walk (or bend backwards), you are putting (slightly) more weight on those posterior elements and (slightly) unweighting the anterior ones. When you sit down, you tend to load the anterior elements and unload the posterior ones.

So people with more pain at the posterior elements (nerve roots, facet joints, muscles, ligaments) TEND to have pain with standing or walking, and TEND to get relief with sitting.

People with a problem in the anterior elements (disc, vertebral body, end plates) TEND to have more pain when sitting and relief with walking.

If you have more pain when lying flat, that usually indicates poor muscle control (since you are relaxing your voluntary muscles when lying flat, but if you don't have good core muscles deep inside – the ones that are supposed to be on 24/7 – then the bony parts of the spine don't have good support and they hurt.

If you have pain after being in one position for a long time, but then feel better with movement, that TENDS to mean an inflammatory component rather than a mechanical one, whereas if you feel better with rest and worse with movement it's more mechanical.

Take these for what they are, patterns and nothing more. There is a ton of variation here, obviously, and very few of us fit into one of these completely (usually it's a mix of all kinds of stuff – which is why diagnosis is so difficult sometimes)

you hurt your back. It will heal. You will learn good exercises to keep your back healthy, but honestly, there is NO reason why you will need to stop sleeping in a hammock, or running, or sky diving, or cooking with esbit, or anything.

A back injury does NOT mean anything other than – yep, you just hurt your back. It heals just like everything else.

Yeah, it makes more sense when you have a framework to fit the puzzle pieces in. I can see how sitting and walking would load the spinal column in different ways, so that's some pointer to the problematic area. Of course the different loading isn't limited to just the spine, I presume. So put this together with the lack of any "smoking gun" in the MRI, and I wonder if something in the pelvis is getting loaded differently…

The one thing I (think I) know for sure is that there's some insult to one of the major nerves from my right leg somewhere along its length. And for whatever biomechanical reason, it gets more stressed in some positions than others.

Plus of course life ain't simple. I've got some pre-existing arthritis, plus old sacroiliac problems, plus whatever the current proximate cause is, plus knee issues…all coming together. So I won't fault you for not coming up with an "oh, here's what it is" diagnosis over the internet.

That I get better pain relief from Tramadol or Percocet than I do from Ibuprofen or Acetaminophen suggests nerve pain as the major component. I think. But there's clearly some inflammation going on here too.

As far as pain when lying down, I can lie on my back (awake) without major issues. I side sleep with the bad side up, which is relatively pain-free falling asleep but deadly waking up. But this tends to be the only position I can fall asleep in.

By the way, HUGE THANKS for the time you've put into answering me (and others on BPL). I'm keenly aware that you get paid for this stuff in real life, and I appreciate your expertise. It helps.

Very little weight should ride on your back. I have back issues, osteoarthritis, and never bothers me backpacking.

If you want a strong, resilient back you should strength train. Do some heavy deadlifts and squats. I swear by this, I do it myself. I weigh 135lbs and am 49 years old and have worked my way up slowly to 160lb squat and 210lb deadlift. Makes a big difference.