In 2012, I had back surgery to repair a herniated disc. I started seeing doctors in September of 2012 and finally had the surgery in December. At that point my neuro thought surgery was the best option since I was in such great pain. The surgery went great and I was back playing sports again in a couple months. Since that time, I have always dealt with mild nerve pain down my left leg. However, when I first ran a linear progression a couple summers ago, the pain all but went away.
Fast forward to 2019: I have run another LP (I had taken a long time off), two rounds of the Bridge 1.0, Strength 1, and am currently in week 4 of Strength 1 again. About six weeks ago, I started having the same very mild back pain after doing some deficit pulls. I kept training and things seemed to be fine. However, three weeks ago I tweaked my back squatting and the nerve pain increased a bit. Then last week it started to exhibit a burning sensation in my left buttocks and down to my knee. It stopped me from being able to bend over with straight legs but I was still able to execute all of my lifts. Finally, yesterday, during my last back off set of squats, I got a little too forward on my toes at the bottom and got a sharp pain down my leg. I was able to complete the set, but the rest of the day I could not do anything besides walk, stand, and lay on my back. Sitting in chairs and driving cause me a lot of pain. I saw a physician today who ordered an MRI to confirm if it is a herniation.
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Currently, I am unable to squat beyond about three inches down. I cannot even put on my own shoes. Pressing motions seem to not cause any distress.
My questions are:
I have been taking ibuprofen, which at least allows me to walk with only a little pain, but that is about the extent of my physical ability at this time. So do I need to start air squatting and work on getting lower as time progresses? Or maybe some weighted lunges?
How do I talk to my parents about this? I have talked extensively to them about how lifting has helped me in the past (I want them to start lifting), but this injury pretty well confirms their fear that lifting can be dangerous for health.
Should I seek PT if my doctor recommends it? The Friday before the injury, I pulled 440x1@8, so I feel like back weakness is not my problem.
Sorry to hear about this issue. I know it can be quite frustrating. Fortunately, the prognosis for this sort of back pain (whether or not it is related to a disk issue) is good overall, particularly with continued activity.
Additionally, I would recommend listening to our Low Back Pain podcast and other content on injury management.
I think continuing physical activity and exercise as you can tolerate would be wise, although we cannot give you specific/individualized advice outside of a consult (which is available via our website).
I have been reading as much of the sciatica posts as I can find. I understand that the general prognosis is that the body does tend to take care of these things well. My concern is that none of the studies that have been cited so far in my search have mentioned if the prognosis changes for a herniation in the same disc as has been herniated previously. Can you just herniate the same disc ad infinitum? My surgeon from the previous surgery noted that the nucleus pulposus does not regenerate, thus a re-herniation would most likely result in a fusion should surgical action be required. They have an MRI scheduled for me (although I do not think this will change my management at all; I believe it is more for insurance or PT), but I DO NOT want to have surgery, much less a fusion.
To answer your questions:
I plan on just doing exercises I can tolerate. Hopefully I will be able to at least squat with a bar soon enough. I guess my initial question was if air squats with increasing depth were not worth the time or if they are a viable option until I can tolerate weight and a better ROM?
I am 23. My first herniation/surgery was at 16 years old. I have been trying to get my parents to trust strength training so that they can stay out of the retirement home as they age. Of course no amount of research papers will convince them, but hey a guy can try!
Are you saying PT would be a reasonable option, or rehabbing this thing myself being potentially more worth my while? Or both?
BONUS QUESTION: If I rehab myself, or with a PT, when can I expect to be back to full capacity? Specifically, if my pain subsides with time and my weights are increasing, can I expect that I run a lower risk of squishing more fluid out? Once again, I do not intend on that coming off as me catastrophizing so much as just trying to not run too far ahead.
Sorry for the novels. I am just frustrated that every time my training is progressing, I hit a big roadblock. Thanks again for your input!
How would you even know if the same disk re-herniated? Did you have a repeat MRI after the prior episode showing complete resolution?
Yes, range of motion is worth the time and is more important in the short term than absolute loading in the short term.
Ah, I see. Yes, this can be a challenging conversation especially coming from a son.
I think this sort of thing can often be self-managed, but I don’t know enough about you, OR what they may put you through at PT, to have a strong opinion/recommendation here.
Finally, I can’t give you a specific timeline for this, as it is an individual process for everyone with ups and downs along the way. I would encourage you to read this: Recovering From an Injury: Embrace the Process | Barbell Medicine . Furthermore, I would not concern yourself with “squishing fluid out”. If you need specific / individualized guidance, our rehab team is happy to help via consult as well.
If a post-op MRI had been taken showing an incomplete resolution despite being asymptomatic, would that change the general management guidelines that doctors would generally prescribe? If it would not change management, then does it really ever matter at all if a disc is herniated aside from symptoms like radiculopathy/neuropathy? Furthermore, if the disc never healed completely in the first place, for example, and the current radiculopathy that I am experiencing is a direct result of the same pathology as before, then why would there not be concern for “squishing out more fluid?” It makes sense that an otherwise non-compromised disc has the capacity to resist prolapse the same way a tire without a hole can hold its pressure, however, a tire with a hole can tolerate very little load without losing its pressure.
As far as the rehab team, I have applied and will most likely work along side them depending on what my spine specialist prescribes. I believe my limited stores of cash would be much better served working with the rehab team than doing “glute bridges” and TENS units at my local PT, but obviously I have to take my specialist’s advice as paramount and go from there. Just don’t want to fall victim to any more “wow you are young and have a bad back so I guess just lay in bed all day and give up anything that loads your back.”
Arguably, not really, especially given the high prevalence of asymptomatic herniated disks that we can find on imaging. This makes it hard to tell if/when such a thing “matters”, versus whether it’s something that just happens with aging and has become excessively pathologized.
These mechanical analogies, while superficially seeming to “make sense”, are unhelpful and inaccurate. This view of things is a very common problem that we discuss at length in our content on pain.
We can’t necessarily vouch for the spine specialist’s recommendations without hearing what they are, but we are glad to hear that last sentence.