I’m going to say it started seven or eight years ago, but the more I think about it the more I suspect that the issues with my lower back began quite a bit longer ago than that. But that’s when it hit the place where I couldn’t ignore it anymore, so let’s roll with it. And by “couldn’t ignore” I mean crippling pain. It hurt to walk on uneven surfaces, I couldn’t run, sitting or standing for long periods of time was very difficult, and certain types of chairs was completely off the table.
I went to a few different specialists. Got scanned for bladder cancer, testicular cancer, and more prostrate checks than I care to recollect. Told I had chronic pelvic pain syndrome, piriformis syndrome, lazy glutes, hyper/hypo mobile SI joints, it was all in my head; which, I guess, could all be true. Branching off briefly on a tangent; there are a lot of medical doctor types that rail against alternative medicine as quackery. While I get what they’re saying, and they aren’t wrong about a great deal of it; I also prefer an evidence driven approach. But, I understand why these alternative approaches exist. These medical doctor types didn’t really offer me much besides pharmaceutical products and a shrug once they ran out of tests to run. Going to a [sane] chiropractor/massage therapist/etc, provided a measure of symptomatic relief that I wasn’t able to get from the MD community. But to be clear, I’m also not trying to say that there isn’t value in traditional evidence driven medical science. Crossing my fingers, that is path I’ve chosen, but we’ll get to that in a bit.
Part of the problem was that my symptoms were inconsistent, and the intensity would come and go. There were always a few commonalities: it was always lower back down, almost always involved some level of sciatic pain, lower back and/or SI area pain, and weirdness with the muscles in my glutes especially the piriformis. Oddly though, of all the scans I went through, no one suggested doing a lumbar MRI. Even though, as I now know, the issues I experienced can be explained by a herniated disc. Which is what I have, or actually two, one at L4/L5 and another at L5/S1.
In my bio, I mentioned that I traded my soccer cleats for a bike a few years ago. Well, this was the underlying condition that made it impossible for me to keep playing. I was caught in an endless cycle of recover-play-blow up. All the while doing physical therapy (PT), or the exercises that I got from PT (mostly core and hip stabilization). But it wasn’t until I stopped trying to rush back to soccer ASAP, that I was able to manage it adequately. Which is how, a little over four years ago, while trying to figure out how to keep some fitness without running, I casually picked up the bike the 182lb Climber talked me into buying the year before. Then later that summer he kicked my ass on what was probably a recovery ride for him, and things started clicking. Haven’t played soccer since.
Staying on the PT exercises, and trading soccer for the bike, made a intolerable chronic condition into a managed chronic one. It never totally went away, but I figured out stretches and exercises that brought the baseline down to a place where most of the time I could ignore it. After all, a big part of endurance athletics is telling your body to stop complaining, and working through the discomfort.
I’m not exactly sure what happened to make that managed state, less manageable. Late summer/early fall I started having increased sciatic issues, weirdness with my right knee, and extra weirdness on the right side of my back where the pelvis meets the spine. My assumption, at the time, was that it was an artifact of my lack of focus on weight training and core after breaking my collarbone in the spring. So I got back to it, and ended up being a little overenthusiastic with the weights, and sprained my back (left L2/L3 area) at the end of November.
Rehab was going well for that, so I started scaffolding up my activity level. Was totally fine on the bike, and with core/body weight work, still not lifting, but then I added a couple recovery paced runs to the mix around Christmas. After the second one, I started having excruciating pain in my right glute, my leg went numb down the back, and I lost feeling on the bottom of my foot. It was hard to walk up stairs, get out of chairs, and touching my toes was next level uncomfortable.
When I sprained my back, they did an X-Ray. While everything looked fine, they also provided an open order for an MRI that I could take advantage of if things didn’t heal up. So a few days after my glute started complaining, I scheduled the MRI.
As I understand it, there are really only two options for dealing with a herniated disc. PT or surgery; although I guess there is also the pure pharmaceutical approach, but let’s leave that off the table. There’s kind of a third option; which is PT + a steroid shot (which doesn’t fix anything), but should make the discomfort tolerable so you can do PT long enough, fingers crossed, to get symptomatic relief. When I pressed the MD I spoke with around at timeline for this approach, he wasn’t able to provide any solid numbers. Maybe six months, maybe a year, maybe never.
Remember how I said I had two herniated discs? Well, as of yesterday morning, I’m back down to one. And since that one doesn’t appear to be touching any nerves, anymore, it’s a keeper. At least for now.
I’m not qualified to provide medical advice, so take the next part in that context. This is the part where I explain the thought process behind choosing surgery over more PT.
Unfortunately, solid guidance is hard to come by here both from the medical literature or non-surgical MD types. I had to do my own research, talk to folks who’ve gone through it, and of course consult with the 182lb Pure Climber to come to a decision. It’s my understanding that the outcomes for PT and surgery are fairly similar long term, except in some edge cases. Surgery fixes it sooner, is fairly low risk, and in those cases where PT doesn’t totally resolve the problem, is necessary to achieve a permanent solution. As I see it, there are two ways to think about my situation. As a seven or eight year dive into PT and behavior modification with fairly successful results, then a triggering event that made surgery necessary. Or an isolated acute injury with two months of accelerated PT, and a rush to surgery.
I didn’t want to do the surgery. It’s expensive and will require significant time off to recuperate, but I’m not confident that PT had anything more to offer me. I was already doing 70-80% of the exercises they gave me when I started herniated disc specific PT, and 100% of what I was doing was easy. I saw almost no progress that I can attribute to the exercises, in the time I did it. That’s not to say I didn’t see some limited progress, when I stopped doing child’s pose and deep hamstring stretches by touching my toes, the OMG I’VE TOUCHED A LIVE WIRE feeling went away. Interestingly enough, no one mentioned that maybe I shouldn’t be doing those things with a herniated disc…
Just so it’s said out loud; I do think that PT can have incredible value for many people. Especially, if their issues are caused, or exacerbated, by weakness in the areas that matter (i.e. core and pelvis for this problem). In many ways, the four-ish years I managed the issue by doing core, body-weight, and targeted lifting is a testament to that. It’s also very possible that if I had known the root cause of my symptoms, I could have avoided the surgery altogether; child’s pose, BAD / putting your hands under your feet, BAD / heavy dead-lifting without a belt, WTF ARE YOU STUPID (yes, yes I am).
Obviously still to early to call surgery a complete success, but I can feel the bottom of my right foot again, and the sciatic issues have dialed way back. I was told that it might take a couple weeks for those to go completely away, as the inflammation from them messing around in my back dials down. Will be interesting to see how it plays out. Mostly trying to stay on top of the ice and drugs, because when I don’t it feels like someone carved a hole in my back :).