Sciatica

[Shaft109]

I recently (4-weeks ago) suffered from a herniated or slipped disc in my back, L4 I believe. Although I am back at work and can drive no problem it is irritating the piriformis muscle in my backside and am at the physio now.

Would like to know what sort of outcomes I can expect and any other experiences as it is not too painful, but really beginning to p!ss me off now!

e.g. did it go away, get worse, operations etc?

Cheers

[Loose rivets]

Your age will make all the difference to outcome.

If the disc is really herniated, stop the physio until you know what' s going on!! No ifs or buts, just stop. I cannot say enough about some so-called physios that start wrenching away at backs that have a disc with an annular tear. Well, I can, but I would get banned.

This should be taken very seriously. See a neuro/spinal surgeon, and have an MRI.

I have written a fair amount about backs/discs/spines in the last few years. I don't think my opinion has changed much except that I wouldn't use the same traction forces that I launched into while I was learning.

Rest has a lot to do with this problem, and remember, sitting gives the highest core pressures. This is exactly what you want to avoid.

However...there's always a however. If the 'physio' is very highly trained, and has worked alongside surgeons who are monitoring the results of certain manipulations, then there is a chance that they will do you a lot of good. I know when I meet a good one. He asked a lot of questions, and does very little pulling about at the early stages.

[Shaft109]

Cheers for that, the physio I go to actively wants me to go to a specialist in the area and get a scan / x ray or whatever to make sure there's nothing untoward happening in there. He also advises me not to sit for too long.

As I said the back isn't to bad now (TBH I've had quite a few bad backs but nothing with referred pain down the leg) but I certainly don't want it to happen again.


I'm 27 so hopefully this can be sorted out.

[Loose rivets]

At 27 it's vital to take the right path. No surgeon will operate unnecessarily, well, not in the UK anyway. I doubt it's still offered, but DON'T have the heat treatment in the core. It can stop pain, and indeed stabilize the disc, but only for a while. What it does do is stop the disc ever being a live and functioning part again.

You do need to know if any of the disc's soft core has protruded into critical areas. This can not be done with X-rays of the old type. (with Tomography it might, I don't know. ) However, MRI shows it quite well.

Lots of rest...Horizontal. Gentle traction if advised. Every effort to avoid inflammation. That's the big enemy. Inflammation will cause all sorts of spurious data to be sent back to the ganglia / brain. This in turn will put out corrective muscle control that is quite simply wrong.


Keep us advised.

[TheFlyingPhysio]

Actually, current advice these days for patients with bad backs is to keep active, obviously within moderation.

Loose rivets is correct in stating that disc pressures are greatest when seated but remember also that it is reduced in standing and even less when lying down. However, "Lots of rest....horizontal" is a prelude to rigor mortis ! From what you have reported (4 weeks, back at work, able to drive etc) then keep moving if you can. Avoid postures / activities / tasks that aggravate the symptoms. Anything that eases the symptoms should be encouraged.

Most physios (certainly Australia, New Zealand and Uk) are highly trained and some only specialise in musculoskeletal conditions. Furthermore, the days of traction as the only treatment or as described by Loose rivets are long gone.

It sounds as though your physio is on the right track. A MRI can give peace of mind in terms of what may be going on. However, if you want to get it sorted you need to think positively about looking after your back. A good book to read is "Treat your own back" by Robin McKenzie, a great New Zealand physio and a pilot (PPL) if my memory serves me correctly. Take on board whats in this book and add to it some core stability training because current research shows that recurrence rates are reduced.

Move well and stay well.

[Shaft109]

Got one of those core stability balls and slowly getting into it. No need for the cocodamol tablets now but sometimes a paracetamol when it feels a bit niggly.

It's slowly coming round but now I know the symptoms then I can nip it in the bud in advance as to be fair it did give me warning but I just ignored it.

Weirdly I was talking to a delivery driver today and he mentioned that he had L5 disc taken out as the pain had put him on his arse. So it isn't that uncommon I believe.

Thanks so far!

p.s. I have my JAA class one renewal coming up in Jan. Could this affect it? Bear in mind I am not actually flying at the moment but just keeping the medical unbroken while doing the ATPL exams.

[gingernut]

Cheers for that, the physio I go to actively wants me to go to a specialist in the area and get a scan / x ray or whatever to make sure there's nothing untoward happening in there.

He/she obviously knows your case better than we do, but resolving acute back pain in a chap of your age, with nothing worrying in the story of your symptoms, probably wouldn't warrant further investigations at this present time.

Lumbar x-rays tell us little, use a high dose of radiation, and usually do not affect the management of the patient.

MRI/CT scan is the investigation of choice, although at this stage, probably not warranted.

The long term outcomes are a little unpredictable, but the odds are, in a young chap such as yourself, you will go on to make a complete recovery.
You need to be thinking of caring for your back in the long term, physio's tend to have the expertise in this area.

Keep in shape, work on the tummy muscles, avoid abusing your back, (we all do it!), have a look at your firms "lifting and handling" policy- not very exciting I'm afraid, but essential reading for you now.

Management of chronic (>6weeks) back pain is slightly different.

[Loose rivets]

What I was trying to get at was the importance of finding out just what you are dealing with.

Perhaps what I should have said was, to take as many rest periods -- that you normally take -- in a horizontal position where possible. I didn't mean to imply that you should spend many extra hours resting, though some extra might be good.

However, all of this is academic if there is no tear/rupture. Find this out first.

Some experts claim to draw the leaked substance back into the tear with traction. That has been described as, and I quote. "Bollox" by a senior spinal surgeon. Basic hydraulics and the makers of $100,000 traction machines seem to think this happens. Right now I'm not sure, but gentle traction is unlikely to do any harm and quite a lot of good.

I have a friend that was employed by IBM. He was very fit. He turned to get a manual out of a low draw and was suddenly disabled with back pain. He got the best medical treatment possible...flown home in a brace, and then in traction on his bed. The thing is that they were treating a very specific fault. He got back to playing squash, and running his 7 miles a day in a short time. BTW, for a while, he was 1 3/4 inches taller.

What I do know is that his treatment was successful and mine was not. I carried on flying for a couple of years and worked out in the gym as much as possible. It just got worse and worse until it was an inflamed mess. I have often wished that I had taken the other route.

What is so misleading is that when high traction loads are applied and the facet joints move allowing the disc to 'increase' in size, it feels so good that you can not believe that it is doing harm. But it is. Gentle traction -- cycling the load -- might just cause the disc to regain some fluid. Remember, it has no other supplies...yet.

If the body recognizes the damage, and starts to effect a repair, then this is where long term pain might start. A neuro-vascular web will be formed to do the job, but this has the unfortunate side affect of transmitting pain back down these new nerves.

That's why the heat treatment inside the disc seemed so good...it destroys that new 'cloud' of vessels and nerves and stops the pain. But they grow again in no time, leaving the patient with the burned disc and a new lot of pain.

I could argue for hours about the minute detail and typical faults in the lower spine, and I have acquired some of the best reference material published, but non of it helps until you know just what is wrong. X-rays and even cheap MRIs will not tell you that.

[Shaft109]

For what it's worth, I no longer sit for more than 10-15 mins unless driving and that seems to be the major factor that I was ignoring in the run up to this latest episode.

It is certainly on the mend as 3 weeks ago I couldn't walk at all, but won't be jogging again until at least the new year.

As for the traction it's quite gentle and cycled maybe 15mins at the most. I accept that it's now a weak spot and always will be so just have to exercise caution.

[scanscanscan]

I bet if you go jogging again the problem will return.
I was advisd to cycle and have had no further problems.

[hippocrates]

http://www.spinesurgeons.ac.uk/
You may find this link usefull.
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