Oh My Aching Back!

More than 80% of the US population will experience an episode of low back pain in their lives, and 95% of those with low back pain will recover within a few months of onset. Some will not recover after the first three months and develop chronic low back pain. I was recently part of the latter group. Almost 2 years of left leg pain which eventually ended with surgery, a left L5-S1 discectomy.

Onset:

Like most people I had my occasional backaches and pains. I exercise 5 days per week, so I’m no stranger to the Delayed Onset of Muscle Soreness (DOMS). Many years ago I had an x-ray which revealed arthritis in my lower back, and a congenital condition of a fusion of my lower vertebrae on the right to my sacrum. Not much you can do to fix that. The best thing to do would be to stay strong in the core, flexible and avoid excessive strain on the back.

Two years ago I was sitting on plane to go on vacation. When I got off of the plane I noticed a different type of pain. It was a dull toothache-like pain in my left buttock. Sitting was my most uncomfortable position.

Treatment:

I went to the doctor and had an MRI that revealed a left L5-S1 disc herniation. Initial treatment was conservative: Medrol dosepak, Anti-inflammatories, PT and exercise. I had also purchased an inversion table that provides self-traction and alleviates pressure on the disc. This course of treatment temporarily relieved symptoms.

Several months later the pain began to travel toward the middle of my hamstring, which was more of a deep and aching sensation. Sitting was more of a challenge, and I had a lot of difficulty bending forward and squatting. Additionally, if I extended my left leg from a seated position I would get tingling into my foot. This time I went to a Pain Management Specialist for an epidural steroid injection to L5/S1 on the left side of my back to alleviate inflammation of the nerve root. This helped with pain temporarily but did not change the nerve tension in my leg (extending my leg from a seated position and bending forward continued to reproduce the tingling). This is commonly referred to as “sciatica”.

So for about a year I lived with limitations. I was in the chronic low back pain category. I had to limit my sitting. I continued to exercise with restrictions (no squatting, no dead lifting, more core work) I was also taking a lot of ibuprofen to get through the workday. Not ideal because of the effects of NSAIDS on the stomach. Plus since I had this for so long, I knew that I was just buying time. it wasn’t going to get better, it was going to get worse.

And indeed it did. The outer part of my left foot began to go numb, which is the L5-S1 disc distribution. Tingling in the leg began much quicker in the seated position and longer time to alleviate. Driving longer than 30 minutes became unbearable.

I made an appointment with a neurosurgeon. The office could get me on the schedule in 2 months! Well that’s what I get for waiting so long.

Pain worsened and became burning in my leg.  I was in 10/10 pain. Now sitting and driving became impossible. I could barely put on my pants and shoes. So off to the ER I went with MRI in hand. The surgeon reviewed my MRI, my symptoms and history and had agreed to admit me to get into surgery right away to perform an L5-S1 microdiscectomy.

Immediately after surgery the burning in my leg and pain in my hamstring was gone!  I had some post-operative stiffness/pain at the surgery site which was nothing compared to what I had endured.

Following the surgery, the surgeon had informed me that within the first 6 weeks of recovery from this type of surgery that the chance of re-herniation is 20%. Therefore I was to be out of work for 6 weeks. No bending, lifting or twisting. My only form of exercise allowed was walking.

I am happy to say that at 7 weeks post op I’m back to work, driving and being able to sit at my desk to do my notes. I’ve also returned to the gym, not to full capacity but at least to a point where I can get a decent workout. I continue to have numbness on the outer part of my left foot. This may or may not be permanent. Its still too early to tell.

Summary

Conservative measures first. Not everyone who has a herniated disc requires surgery. A large percentage of people will benefit from conservative measures that I had mentioned (NSAIDS, PT, activity modification, spinal injections). Back surgery is all too often viewed as a “quick fix”. We are in a hurry to get back to our normal lives. I went through all conservative measures before I underwent surgery.

Be aware of any bowel or bladder changes with low back or sciatic pain. The disc could be pressing on your cauda equina which is a cluster of nerves responsible for bowel/bladder function. This is a serious condition that requires immediate attention from your doctor.

Be aware that if your pain is not alleviated by rest there could be something more serious going on. Additionally if pain does not resolve within a few weeks consult your physician.