Herniated Disc, Now what?

[floppyammy]

A week ago I was diagnosed with an L-5/S-1 hernia, which I gather is fairly common. In fact, I suspect I have had it for at least 4 years. However, I recently managed to make it very, very angry and ended up in the ER in serious pain. They did a great job, patched me up and sent me on my way and I have been pain free for about a week. I do have residual numbness in my left calf and foot, which I read can take up to 6 months to fully resolve.

My question is, how quickly is it reasonable to get back in the saddle?

[S1969]

Do you have an idea of a cause? I would be mainly worried about reaggravating it, even though you are pain free at the moment. Are you in PT to rehab/strengthen around it?

[floppyammy]

While I don’t know the cause of the original injury 4 or more years ago, most recently I do know that I (re-aggravated? re-injured?) it by picking up my 55 lb. dog. He was having trouble getting up the stairs and I bent over to pick him up. I felt the strain in my back.

I usually can just alternate tylenol and advil and get by. I continued to ride, move around poles and cavalettis at the barn, etc. I had a lesson and I couldn’t sit the canter. I drove home and after sitting for 20 minutes in the car, my back went into spasm. That’s when I ended up in the ER, about a week or more after the picking-up-the-dog injury.

[S1969]

I would see if you can get a referral to PT and/or a specialist to look closely and help you avoid future issues. I assume what I did some years ago was herniate a disk, and wish I had gotten to PT sooner. The numbness in my leg took about 4 months to fully dissipate. But I would never want that pain again.

Most of the time disk issues are indirectly caused by a lack of strength or balance; usually core strength. The few times I’ve tweaked mine is always related to reaching forward and picking something up that is too heavy - just as you describe. So, usually bulky and heavy.

[Kyrabee]

I herniated that disc on the right side years and years ago. It took me 4 months before I felt good enough to get back in the saddle. After a round of physical therapy I found what worked the best was 2x/week deep muscle massage to resolve the spasms and sciatica. I found a therapist that would do concentrated work on that area for 30 minutes/session 2x/week. Same cost as a longer 1hr massage. It probably took nearly a year for the right foot weakness and numbness to resolve.

Susan

[FitToBeTied]

I’ve had herniated disks in my back since I was in my late twenties. It’s been the last twenty years they really become problematic as they have degenerated. It’s good the ER helped you out but you should really get with a specialist and get a good diagnosis with imagery. The imagery is good to have as you can see how things are progressing over time. Also a pain management specialist who does injections. One thing a back specialist told me is that the further away from the spine you can feel the pain, the worse you have herniated the disk.

As someone noted above, strength and flexibility are key but nothing will totally prevent re-injury or further degradation. I work out 5-6 days a week on strength and flexibility and yet the disk will cause problems over seemingly non-events. Like just the other day. I had foxhunted the day before with no problems. I worked out in the morning including all of my stretching and PT. I was cleaning tack and bent over to pick up one of my boots when I felt it go. I no longer have minor outages so my first call was to the pain management doc. Hopefully they can get me in on Tuesday. In the mean time, it is several rounds per day of loosening up on the treadmill/elliptical followed by stretching, followed by ice and TENS. I find the key when you have an incident is to attack it right away.

Tomorrow’s weather is supposed to be warm so I am hoping to get back on the horses just to walk around. Walking on the horse seems to be helpful.

[floppyammy]

Thank you @FitToBeTied. That is super helpful info to have. That does help shape my path forward. I do have a lot of numbness in my left foot and the bottom front of my left calf.

I contacted my primary care doctor after my ER visit and she said that if the numbness did not go away in a week, that she would order a consultation with orthopedics and an MRI.

Now that I’m out of pain, I had been planning to ignore the numbness and hope it resolved with time, but your thoughtful post makes me think that I should pursue further diagnostics and treatment instead. I hadn’t considered further degeneration and what my back might be like in another 20 years. I should probably do all I can now to make sure that I preserve function for the future.

I’m fortunate that I’m in one of the areas in the country with the top medical communities in the world and I have access to the best of the best. Perhaps it would be foolish to ignore that.

[S1969]

I agree that nothing can totally prevent another injury, but PT is really critical to strengthen your core to protect your back. But also - a good PT should go through safe lifting techniques for your injury and especially the type of movement that is likely to cause the injury – usually, as described - bending over to pick something up. We all do it, but I try to remember safe lifting for things that might be risky - using legs, engaging core, not leaning forward past a certain angle. I also think that PT for my back was pretty minimal as far as core strength goes; I definitely do way more than that now and use a personal trainer to keep me accountable.

[Rothesay]

I had a disc herniation which caused quite a few issues. I ignored it longer than I should have, hoping it would just go away and ended up with foot drop (was unable to lift my foot) and unbearable pain. Next step was a cortisone injection which was of no help. Eventually I had to have surgery on the disc which was effective in resolving the foot drop and most of the sciatic pain, but comes with a long recovery period. Nerve damage takes a long, long time to resolve. Agree with the comments about physical fitness and lifting awareness. Hope yours does not continue to trouble you.

[Cabaret_SK]

Agree with the advice to see a specialist. I’ve been dealing with a herniation (and accompanying sciatica pain) since August, with limited relief. I understand that physical therapy seems to work for most people with this injury, but unfortunately I wasn’t one of them.

I had epidural cortisone injections into the area a few weeks ago which helped a bit, but has not ultimately fixed the pain.

[RAyers]

I work in Ortho spine. I absolutely say get a better consultation with either ortho spine or neuro spine. Neurogenic claudication and radicular numbness are things to no better ignored. As others have noted, these things can come back and become debilitating as we get older.

ER docs are NOT trained in spine other than the most simple things. ER radiology is the same. Their job is to stabilize the patient sufficiently to allow the patient to seen by specialists, not to provide comprehensive diagnosis or treatment.

When I blew out a lumbar disk (bad sciatica) I found the only time I WASN’T in pain was riding. I couldn’t walk 100ft without stopping but I could ride dressage and jump an hour straight and feel great. My best guess is that the position decompressed the nerve root.

That said, full disclosure, all I ever see are train wrecks (we see patients from all over the US) so I avoid ever seeing a spine doctor other than for imaging and stimulating discussion and arguments.

[FitToBeTied]

@floppyammy

Now that I’m out of pain, I had been planning to ignore the numbness and hope it resolved with time, but your thoughtful post makes me think that I should pursue further diagnostics and treatment instead. I hadn’t considered further degeneration and what my back might be like in another 20 years. I should probably do all I can now to make sure that I preserve function for the future.

So what ultimately happened?

[floppyammy]

Our beloved dog got diagnosed with cancer three days after my last post. I spent the last four weeks utterly devoted to his care. We had to let him go last night.

My focus hasn’t been much on my own well-being. Thank you for the timely reminder that I should probably re-focus on my own health.

I still do have some residual numbness and weakness in my left leg. It has continued to improve; enough that I kind of ignored/forgot about it while I was focused on our dog.

[rubygirl1968]

I’m so sorry for your loss.

[floppyammy]

I came back to provide an update. I did finally get around to having a consult with an Ortho-Spine doc. I still have numbness and tingling in the front of my left calf and foot, so I figured it was worth checking out. I was surprised at the level of concern the doc showed at the weakness and lack of strength in my left foot. He mentioned something about “drop foot” and ordered an MRI.

The results are in, still waiting on a follow up appointment to review and discuss next steps.

[RAyers]

Injections should be the first thought. They can be both therapeutic and diagnostic. You have typical spondylosis.

Ironically, I blew out L2-L3 a few weeks ago (L3-L4 was my last blow out). Basically my L1-S1 disks and facet joints are old, arthritic, and there is not much to do. So, we do injections and try to get a couple more decades out of my spine before surgery.

As I noted prior, drop foot is a significant indicator of serious cord compression. It verifies there is an issue in the L4-S1 region. The MRI will actually tell the doctor what is really happening.

[floppyammy]

@RAyers

Injections should be the first thought. They can be both therapeutic and diagnostic. You have typical spondylosis.

Ironically, I blew out L2-L3 a few weeks ago (L3-L4 was my last blow out). Basically my L1-S1 disks and facet joints are old, arthritic, and there is not much to do. So, we do injections and try to get a couple more decades out of my spine before surgery.

As I noted prior, drop foot is a significant indicator of serious cord compression. It verifies there is an issue in the L4-S1 region. The MRI will actually tell the doctor what is really happening.

The initial appointment prior to the MRI, the doctor was hoping the MRI would show that the disc had reabsorbed. From my rudimentary reading of the MRI report, that’s clearly not the case. He had mentioned something about “going in there and clearing it up” if it hadn’t reabsorbed. Of course, he specializes in minimally invasive and microendoscopic spine surgery, so that is probably why he would jump to the surgery option. But I had hugely successful and beneficial results with injections when I herniated a disc in my C-spine, so I will definitely raise that with him in my follow up visit (whenever that is).

Your comment also may explain why he was so very concerned about my foot weakness. I was legit thinking “well it’s still attached and mostly works, so… good enough”. I was genuinely surprised at his level of concern.

[Kyrabee]

I have had two herniated disks. The first one (L5-S1 right side) that I did have some significant foot drop, I was able to heal up without surgery. It took a good 4-5 months but I haven’t been bothered by it since and my foot returned to function. I did PT then found a good massage therapist that teased out the spasming muscles.

The second (L4-L5 left side) I tried a lot. 6 months of chiro PT, pool therapy and massage with no relief from the relentless sciatica (some foot numbness but no drop). I gave up and had a microdisectomy. That was in 2018 and so far…that was a win.

So I guess it just depends. Not much downtime with the microdisectomy (for me).

Susan

[signmypapyrus]

I would seek a specialist to find out what is going on. I have ankylosing spondylitis and have ruptured discs from L3-S1 and a bulging disc a bit higher up, but I also have disc height loss, spinal stenosis, disc desiccation, and arthritis in my spine. I was out riding my young horse today.
For treatment, I had an epidural almost a year ago and then I’m on Humira and prescription NSAIDs. I also periodically do PT.

[signmypapyrus]

I don’t want to create a new thread, but does anyone have experience with riding with disc issues? Care to share any tips or tricks with dealing with pain? I do see PT.