Degenerative Disc Disease

[PorkPieHat]

I was just diagnosed with degenerative disc disease, along with 2 herniated discs (between L4-L5 and L5-S1).

The MRI report says this for L4-L5: "loss of signal in the intervertebral disk. Constenting bulging of the disk with annular tear and posterior central herniation indenting the ventral thecal sac. Also facet joint arthropathy and ligamentum flavum hypertrophy. Mild to moderate narrowing of the central canal. There is Schmorl's node deformity.

It says the same for L5-S1, along with, "the herniated disk is in position affecting the descending right S1 nerve root."

There are also spondylotic changes involving the lumbar spine.

In short, I had what was originally diagnosed as a pulled hamstring about 3 months ago. After it did not get better I saw an ortho who recommended therapy. Therapist says, "Dude, you almost definitely do NOT have a pulled ham, you have what looks just like a disc problem." Went back to doc, he prescribes MRI, and here we are. Constant pain in right leg (sciatica) and an inabilityt to sit, sleep, [censored], and [censored]. Life is not really good right now.

Has anyone else had this? If so, what did you do to fix it (if anything)? Do I even bother trying alternatives like acupuncture, massage, chiro, etc? I have seen a chiro in the past for back pain but never had it like this.

FWIW, I am not fat, but I am tall and old (41).

[kyleb]

Back pain is really bad and tough to deal with. Multiple surgeries are almost always necessary, but people report improvement with decompression therapy. You can start by supplementing glucosamine in your diet to help, but chances are good you'll always have a bad back even if you have surgery and go through physical therapy. Sorry, man.

[cbloom]

You need to find a good doctor and go right away. This needs to be treated early or it will get worse.

That said (I am not a doctor, just a guy with a back injury) -

L4-L5-S1 herniations are the most common back injury, usually just called "sciatica" in common language.

surgery - risky, definitely reduces your mobility and sports function, hopefully will eliminate pain but will cause discomfort your whole life.

management - this is just minimizing the pain and improving the function, and it is a life-long commitment. You will think about your back every day for the rest of your life, and should do some therapy for it every day.

You want to stick with management if the injury is mild. All the therapies you mention can help but by far the best thing you can do is to strengthen the muscles of your back and be very careful with how you hold your posture and how you use your back under load.

If the pain just started recently and isn't that bad, you can probably get it back to a livable level without surgery. You need to get rid of the impingement of the nerves, which means reducing inflammation and postural pressure.

Your doctor should give you antinflammatories and pain killers. Your physical therapist should help you with posture and eventually exercises. You have to learn and teach your body to hold your lower spine in a neutral position all the time. You can get the big daddies of all pain killers for this if you want to, but I don't think that's actually a good idea because the pain will become a guide for you to know you are holding your body well.

Acupuncture, massage and chiropractic care all have very little evidence supporting them as being beneficial at all. Anecdotally I think they can be beneficial, mainly at the beginning to help you get your body into a different configuration. This should be done after you get on pain killers and antinflammatories so that you can be adjusted without resistance. Finding a legitimate chiropractor is very difficult and bad ones can make you worse.

[PorkPieHat]

I do have pain killers (vicodin) but they don't do much. I can get maybe 4 hours of sleep if I take 2 before crashing.

Everyone I know that has had surgery still has issues, but as one physical therapist told me, "a lot of what causes the problems in the first place are still in place after the surgery, and guys don't stick to the regiment of stretching and exercise afterward like they should, so taht's why it recurrs." Makes sense to me, but still scary.

I have had some form of back pain pretty much my whole adult life. I worked on cars for many years and spent 5+ hours a day bent over; probably not good. Runs in the family too, which is probably even worse.

At this point my sports function is limited to coaching pop warner and little league, so that effect would be minor in the overall scheme.

[cbloom]

[ QUOTE ]
I do have pain killers (vicodin) but they don't do much. I can get maybe 4 hours of sleep if I take 2 before crashing.


[/ QUOTE ]

You should talk to your doc; you can get epidural injections for pain; you should also perhaps get a steroid injection.

[ QUOTE ]

Everyone I know that has had surgery still has issues, but as one physical therapist told me, "a lot of what causes the problems in the first place are still in place after the surgery, and guys don't stick to the regiment of stretching and exercise afterward like they should, so taht's why it recurrs." Makes sense to me, but still scary.

[/ QUOTE ]

No matter what you do, the #1 thing will be the rehab. It will literally be like 30-60 minutes a day every day. If you do it, you can get better. Depending on your state right now you may or may not want to get surgery before rehab but in any case the rehab is what will determine if you really get better or not.

If you feel like you aren't getting enough good advice from your doc, find another one. University teaching hospitals tend to be the best. It's worth paying a little more.

[kyleb]

[ QUOTE ]
Finding a legitimate chiropractor is very difficult and bad ones can make you worse.

[/ QUOTE ]

cbloom raises a good point and I cannot stress how important this is. Be sure to find a chiropractor who approaches pain management and therapy from a medicinal point of view rather than someone who thinks subluxations of the spine cause all sorts of diseases. Do your due research and find a good therapist who will work with you.

Losing weight will undoubtably help, but I know how hard that can be with back problems. I have been lucky enough to have only muscle strains in my back, but even with that pain (barely compares to yours, I am sure) it is hard for me to want to go to the gym and run, much less lift weights and play baseball.

[kyleb]

[ QUOTE ]
You should talk to your doc; you can get epidural injections for pain; you should also perhaps get a steroid injection.

[/ QUOTE ]

Also, this is good advice. See if you can get corticosteroid site injections (better known as cortisone shots) to help manage the pain, reduce inflammation, and possibly increase your chances of healing. These helped the pain in my shoulder before and after surgery significantly.

[PorkPieHat]

I am 6'3" and 205, not sure how much I'll be able to lose. I have been able to do some core work (crunches and such) but more would help I'm sure. My cardio fitness is terrible due to all this, however.

I was reading that sometimes they can inject glucosamine instead of cortisone, has anyone tried this? I don't care which one I have to get, as long as it works. People I know have both good and bad to say about cortisone wrt back pain. Most say it does not last too long, but at this point I'll take a week and be happy.

The chiro that I know is not a nutjob 'subluxations caused the death of Princess Diana' kind of guy. He has a sports medicine background as well (might have been a PT or something before, I forget). He wants to see the MRI as well, so if nothing else it will be one more opinion to weigh.

Right now my main goal is get the pain to stop, but then get this all 'fixed' and be back in shape by little league next year. My son will be 12 and it might be his last year, I'd really hate to miss out on yelling at him to stay down on grounders and stop throwing freakin curve balls, lol.

[kyleb]

Oh, hm, you're not overweight. I see.

Glucosamine and joint fluid supplements take well through the GI tract; I'm not sure injections are necessary or worthwhile. Less needles = better.

Keep us updated.

[cbloom]

[ QUOTE ]
People I know have both good and bad to say about cortisone wrt back pain. Most say it does not last too long, but at this point I'll take a week and be happy.


[/ QUOTE ]

The problem most people have is they expect the wrong thing from the cortisone. (there are also other steroid injections you can get which may be better depending on your exact problems). They just get the shot, feel better for a while, don't do their therapy, and then the pain comes back the same as before.

The steroid provides some pain killing, but mainly reduces inflammation. This stops all the swollen tissues from putting pressure on the nerve and makes some more space where things can move around. It's just a temporary effect, though, and if you don't do anything else, the vertebrae don't move on their own and the problem will come right back. Basically the steroid gives you a month or so of "breathing room" where you can use exercise/chiro/PT/etc. to adjust your spine into a position where you aren't putting so much pressure on your nerves. If the steroid wears off and you've got your spine in a better position, the inflammation won't come back.