L4-L5 and L5-S1 disc herniations: lessons learned

Fredric Bender | Dec. 4, '13 at 11:29 am | comments: 0

My case history

I herniated my L4-L5 and L5-S1 intertervertebral discs when I was 23 by dominating the boards at an alumni pick-up basketball game at my old high school in 1984. The next morning, I couldn’t get out of bed. I crawled to the bathroom. I crawled to the kitchen. I crawled back to bed. For two weeks.

When the inflammation died down, I got a CT-scan that confirmed the extent of the injury. My board-certified orthopaedic doctor explained that I had herniated the discs by jumping up and down without proper muscular support.

Fortunately, the discs didn't impinge nerves exiting the spinal cord, so I didn’t need surgery, but I was in serious pain, and any awkward movement or pat on the back triggered a muscle spasm.

Over the next two years, I would learn that recovery was not a linear path. I tried physiotherapy, chiropractics, deep-tissue massage, acupuncture with electrical stimulation, and the Alexander technique.

Over time, the pain subsided, but weakness, discomfort and stiffness remained. I discontinued active sports, like tennis, basketball and running, to avoid exposing my discs to further pounding. Instead, I turned to yoga where I dedicated myself to learning practices that relieve stress and compression to the lumbar spine.

Thanks to this, I lead a very active, pain-free life the past 25 years both as a massage therapist who at times has massaged 5 hours a day 5 days a week...

...and as a yoga teacher who, at age 51 now, teaches 14 yoga classes a week, the majority of which are my center's lower back yoga classes.

Lessons learned:

Muscle supports structure

Intervertebral discs serve as shock absorbers of the vertebral column, but properly developed back muscles should assist in this function to reduce as much impact to the discs as possible.

Structural damage is permanent but its effect can be mitigated

When a disc is herniated, the nucleus pulposus of the disc leaks into the spinal canal, and the disc permanently loses its hydraulic ability to swell and serve as a shock absorber. The disc loses height which in turn reduces the foriminal space through which spinal nerves pass, increasing the possibility of nerve impingement.

Even after one heals from the initial injury and becomes asymptomatic, the underlying structure remains damaged, making one susceptible to re-injury years later as a result of stress from an ill-advised movement. Supporting this weakened structure with muscular support will require life-long maintenance to reduce compressive forces on the spine and to mitigate the stress load of improper movements.

Address inflammation immediately

At the moment of injury, inflammation arises as macrophages converge to clear the leakage within the spinal canal. In my experience, the immediate application of ice packs and anti-inflammatory medication are the most effective means against the negative effects of inflammation, followed by later use of ultrasound which, aside from reducing inflammation, helps to break up scar tissue adhesions and to facilitate healing at the cellular level. Cortisone injections may also be an option.

Where inflammation is present, I highly recommend limiting movement within a range that's comfortable to completely avoid further irritation to the area. This may mean being very still if the slightest movement risks provoking irritation and increasing inflammation.

Be pragmatic

Some might think that as a yoga instructor, I might object to allopathic medicine to relax muscles and alleviate pain, but toughing it out for weeks might complicate matters as the body will certainly compensate to avoid pain, and the next thing you know, after weeks of favoring one side, a hip, knee or foot will start to feel the impact of the undo stress placed upon it.

Early intervention with medicine can break the pain cycle and avoid compensations. Taking a muscle relaxant or pain killer may bring the body back into equilibrium before such compensations develop. You should not feel bad about using any or all options available at your disposal suggested by your doctor.

Be responsive to what you feel

I have developed a keen awareness as to when my muscular-skeletal system is slightly out of whack, whether from a micro-tear in a muscle, the beginnings of a tendonitis, or a slightly sore ligament. At the first inkling of something not quite right, I immediately rest the affected area to ensure that the minor irritation does not develop into a full-blown nagging injury.

Whatever movement I make is always within the limited range afforded to me by the irritation regardless of how restrictive it may be. I can't stress enough just how important this is. So often, I have students from my hatha yoga courses coming to me before a class about a slight ache they have been harboring over several weeks. I have to explain that yoga is not magic. Any movement or exercise involving an irritated area is likely to exacerbate inflammation in that area and prolong recovery and, yes, that includes yoga practices.

So often, we want to test our limits, because the injury is so confining, but we tend to test too early, too often, and with each test, we are likely to inflame the area yet again. It takes enormous patience and discipline to sit still (the goal of yoga, by the way) and live within a restricted range without a single test until the inflammation has died down. For me, I treat it like a game.

As soon as the irritation passes and the inflammation is completely gone, one can re-establish normal movement.

Get a diagnosis with the use of proper diagnostic tools

I strongly recommend seeing your doctor immediately and getting a proper diagnosis as to the nature and extent of the injury. Ask your doctor if a CT or MRI scan is in order to have something objective to go by. So many people have come to me without a proper diagnosis, and whether it was for massage or the back class, it makes no sense to get treated without knowing precisely what needs treating and what treatment will be most effective.

Image source: lumbar spine







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