Hi BBM team! As the title says I have finally had an MRI on my lumbar spine. Next meet I meet with a surgeon to go over treatment options. I may do a BBM consultation as well but I wanted to check here first if there is anything I should listen for, or ask the doctor next week? For context, i have copy/pasted some notes from the mri that I can see already.
”Impression
1. L5-S1 degenerative disc disease, with large central/right paracentral
extrusion, with impingement upon traversing right S1 nerve root, as
described above in detail.
At L5-S1 1 diffuse disc bulge, with large central/right paracentral
extrusion, which extends posteriorly by approximately 9 mm, with mass
effect and displacement of the traversing right S1 nerve root. Mild to
moderate narrowing of the spinal canal asymmetric to the right. Moderate to
severe right and mild left foraminal narrowing.”
I have been dealing with this for about 4.5 years. It originally began the day after some heavy deadlifts. I tried to manage it with everything I had learned from BBM at the time, with things like starting with very low weight, shortening the range of motion etc but it always led to low back pain and sciatica pain radiating down my leg with numbness in my little toe. I eventually avoided deadlifts, squats, leg press altogether because it always caused painful flair ups that would last a few weeks. In my most recent flair up I think it was brought on from barbell bench pressing. The small arch in my back seemed to cause some pain during the workout that increased day by day until I visited the doctor again and proceed with the mri. This has been very frustrating and eventually led to avoiding a lot of movements out of fear which I really wanted to avoid. I no longer have goals of maxing out my strength potential but I do miss feeling strong.
Any advice or guidance you can give before the meeting is much appreciated!
Thank you,
Phil
Hey Phil,
Sorry to hear about the ongoing back pain. We are a bit limited with what we can do over a forum when discussing a specific medical situation, as that would be best handled via a consultation.
That said, 4.5 years is a long time to navigate these symptoms, and it’s understandable why seeing these results on an MRI might feel like a bit validating. It very may well be related to the symptoms you’re experiencing, though a few bits of context stand out when I think about this.
For one, we know that large extrusions as seen here tend to spontaneous resorb more often than smaller ones. We see people with similar or worse imaging who are asymptomatic/become asymptomatic and return to lifting weights regularly.
Next, your self management was on the right track, but I think there was likely too much sensitivity that wasn’t dealt with, and the progression was likely too quick. I think our pain and rehab team could be helpful here, for sure.
If it were me, I’d be asking the surgeon about the data on 1-2 year patient outcomes with surgery compared to conservative management. What are the risks/benefits of rehab vs surgery? And, aside from pain, what signs would make surgery a necessity?
Just my 0.02.
-Jordan
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Thank you Jordan. I appreciate your advice regarding the questions for my surgeon. You are right as well with the mri results. It did give me some validation as I finally felt like I could point to what is causing the pain but I know it is more Nuanced™ than that.
After the meeting with the doc I will weigh everything up to that point and also seriously consider moving forward with a consultation withe Pain/Rehab team.
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Hi Jordan,
I just wanted to follow up here for you or anyone else who might read this and be interested.
I met with the surgeon today and viewed the MRI. My sciatica type pain is still there but much better than before. He offered the option to get an epidural injection and recommended some physical therapy. I opted to start with physical therapy and if I feel like I am not improving I will consider the injection. He did say I should avoid loading the spine which I was not surprised by but I am not sure that would be the BBM general advice.
I was able to see a PT the same day as well for an initial assessment and I now have a weekly appointment for PT for two more visits. The surgeon will follow up in 3 months to see how I am doing. The PT said I should never deadlift again and if I did do squats that it should never be over 135lbs “because of the disk” he said. After some testing at PT (they tested my hamstring flexibility with a few stretches to get a benchmark i think) I left with a few exercises/stretches to do a few times daily like a supine plank, a piriformis stretch done lying on my back as well a few others.
I no longer have goals of squatting or deadlifting large amounts of weight. Recently, I have actually been much more interested in endurance and putting some effort into running and maybe a half marathon eventually but when I heard “don’t load the spine” and “never deadlift again” I was bummed to hear that. I still want to consider myself strong even if I am not trying to do sets of fahve at RPE 11. I think I will take it easy for a little while hoping for no more flare ups while trying the PT but I definitely think I will be seeking some further guidance from BBM and the Pain and Rehab team in the near future.
Would you recommend following through with PT for the next few weeks and keep doing those exercises or should I try a consultation with BBM right away? Over the next weeks I already did plan to still go to the gym and just do some lifting that doesn’t bother my back. Things like pushups, maybe incline db bench, lat pull downs, cable tricep ext etc. The PT said that type of lifting was fine and to just listen to my body.
Thanks,
Phil
As I mentioned before, I’m a bit limited with what I can do here via the forum. I also think it can be challenging when it comes to weighing-in on other professionals’ recommendations second hand.
That all being said, I have concerns with the PT’s phrasing as relayed by you, which makes me very skeptical about working with them going forward. Yes, I do think you would likely benefit from a consultation with our pain and rehab team. Regardless, I think you should be doing some sort of squat and hinge pattern exercises you can tolerate vs. just upper body stuff.
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Thanks for the reply Jordan. I understand your limited here. I guess I was just hoping for validation about wanting to squat and deadlift again in the future.
I will try to experiment with what I can handle as far as the squat and hinge. I am very limited in what I think I can tolerate though. Not so much as in what I can tolerate intra workout but more so how that pain grows in the days weeks following squat/hinge movement. I will start extremely light.
I will definitely be reaching out for help from the pain and rehab team soon.
To clarify, I think it is very likely you’ll be able to deadlift and squat, though I do think dosing and implementation right now require some special care. I don’t think good healthcare professionals tell people with back pain they won’t be able to deadlift or squat ever again.
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