[Closed] Massively Prolapsed L5 Disc - is there hope?

I the very same thing around 20 months ago. I had bad sciatica in both legs and pain in ankles also. I did however find that, after a few weeks, riding my bike steadily helped manage the pain, and I now ride the mountain bike freely as before.

Timeline for me was -

- Floored instantly, never known pain like it.

-Absolute agony unable to get off floor for 2 weeks, sleeping?! on the living room floor as I couldn't get up the stairs.

- Absolute agony with small movements available after that, managed with a **** ton of pain killers for several weeks.

- Return to work, very steadily after 8 weeks, still in pain.

- Back pain reduced steadily, but sciatica remained for 6-8 months.

- One day, woke up and legs felt a lot better and sciatica had gone. it's a miracle!!

I still manage it with exercise day to day and I'm VERY careful lifting things these days, often bowing out early of what I'd previously have dead lifted without question. I had no surgery.

Does prolapsed = bulged or worse them that?

I biked a couple right at the bottom of my lower back - mixture of a deadlift that tweaked something - followed by a vigorous sport massage which I think messed it up further.

I went a few months just on pain killers / anti-inflammatories / no weights /
Cut down cycling etc. Eventually got a referral from the doctor for mri when bulged discs identified. Had physio to try and correct posture / strengthen my core etc - then I had a cortisone injection under local anaesetic / ultrasound guidance.

That calmed the area down / got rid of some pain. Eventually the tingling foot and lack of power in my right calf eased and I got back to sport.

That was at least 4 or 5 years ago or more - I still have to manage it from time to time - and stretching properly before any kind of sport is really key.

Prolapsed = herniated, i.e. the disc has burst and the inner gel has leaked into the spinal cavity. Bulging is usually associated with a disc protruding into he spinal cavity, but not yet leaked.

Been there, done that. Had about a 50p sized bulge at the disc between L4 and L5. Lots of super wrong diagnoses and 3 years of abysmal pain. Through one thing and another ended up going for surgery that was a temporary success. About 9 months before I could go back on a bike and then about 2 years before it prolapsed again. 9 years on, managing my back with specific exercises, back support and trying to not stress it too badly with super long or super intense climbs. I live with a lot of pain.

My recommendation is to not do the surgery as you will always have a weak spot there. Have a look at "Treat Your Own Back" by Robin McKenzie. I use a number of stretches that are similar to the regime in there and I've recommended the book to quite a few back sufferers who have found it very useful.

Yeah, herniated same disc back in August 2019.

Sciatica down to the calf which got progressively worse to the point where I couldn't drive and could only 'shuffle' instead of walking, etc etc.

Ended up on strongest dose of Gabapentin, Tramadol and Oramorph liquid morphine which made it sort of manageable, was still able to work from home.

Elected for surgery as three months of no real improvement was taking its toll, wife was exhausted doing all the childcare and I couldn't give work any firm timescale for returning to office. I was also worried about causing long term scarring or thickening of nerve. At the end of the day I wanted to make the most of what remained of my thirties rather than waiting months for something to MAYBE heal of its own accord.

Got access to surgery via my work healthcare so didn't have too long a wait. Was in and out of hospital within 24hrs. Was a little despondent when doctor told me just how much disc he had removed, and just how long it would be until the surrounding muscle damage would heal, felt he hadn't been as explicit about this PRE-op!

The comedown off my painkillers was terrible, I lost a box of the Gabapentin so couldn't taper off perfectly, a bit of a bad trip for a week or so!

Recovery took time and there was still some residual sciatica which was never unmanageable, but could get me down as it still felt like there was something 'wrong' when in reality the nerve was just taking time to return to full 'health'. The surrounding muscles were still quite sensitive and had a couple of minor spasms in the months sfter surgery, possibly because I was just over-doing the strengthening work jn the gym. Lots of sessions with my physio got me back on the right track and in the right head-space.

The good news is within 9 months of the surgery I was able to do a 500km gravel tour in the Cairngorms and feel like I'm approaching the fittest I've ever been, it's just taken a more careful approach to riding and training (little and often!).

Could offer lots more advice, ask away! (or P.M. if you prefer).

I'd this about January i think last year.
Maybe mine was worse as i didnt do the right things so maybe made it all worse. Took the bike to the top of the road for coffee and i could hardly stand . The dumbest thing ive done yet.
God knows how i made it back.
Actualy no, this was the dumbest thing as effectively then lay on the floor for 4 days, 2 days, minute by minute with just the ticking of the clock. No painkillers and by day 3 the whole areas in spasm.
Ambulance to hospital then acute ward for 10 days.

They should raise a statue to whomever created oramorph.

Prior the back was okish. Would get sore when i try to lift things bigger timbers when i worked in the joiners. I think I lost a lot of those core muscles when I stopped heavy working. A lifetime to build, hard to put rebuild.

Now its a lot worse and can go out quite easily, but by 'out' i dont mean prolapse again, i think its the muscles around the area that arent as strong. But very sore tryign to stand up, i think its more stiffening that damage.
Physio suggested a core machine, similar to those ones on the shopping channel, just something with variable resistance to work and strengthen the muscles around the area. Apparently if it comes out once, its more prone to do so again.

Say 4 days at home from the off, then 10 in hospital, then a total of 60 days before i could move about freely for longer than a couple of hours.

PS
I was told surgery is a bit hit/miss, and can actually make it worse. Currently I'm not opting for a surgical fix, as Im still thinking its more down to being stronger in that area 😕

Yup me too. No clue as to when it will create hell with my life so just try and keep up with stretches and be careful about lifting (very very careful)

I also use massage to help keep everything loose.

It's not nice and you'll never get used to it, but I've just had a solid summer mountainbiking so it likely won't be the end of your world.
Hopefully the spells of occurrence are well spaced out and not often.

I've had sharp pain and been unable to get off the floor for a few hours (not as bad as Blazin-saddles), and I've had it sneak up on me getting gradually worse until I couldn't walk more than 50m or lift anything more a about 2kg, with sciatica. I went to a sports physio and have never had MRI so don't know exactly which disc, and have never had surgery. He said the fluid from disk irritates the nerves and said I should take as much ibuprofen as necessary to enable me to keep moving, and keep moving (but not lift things). It gradually gets better. Last time I went to the GP and got some Naproxen. I could do stuff where my back was moving but not under compression, like paddling a kayak (and I think that helped it), but had to ask my friends to lift anything. On one occasion, it was skiing that fixed it. Pilates, once it was back to normal-ish, has been very good for keeping it away (except Covid has shut down the Pilates class and it's a bit technical to do on your own unless you're really into it). The other thing I've learned is that taking NSAIDs like ibuprofen and naproxen helps my back but I think it was responsible for stomach bleeds that I knew nothing about until I found I was anaemic - so I now have a stock of omeprozole to take with the NSAIDs.

I would not rush to have surgery.

I would not rush to have surgery

Hmm... I completely understand and respect everyone has their own experience, but you haven't exactly made a great case for avoiding surgery!

I was in and out within a day. Whilst I acknowledge I am now missing half a disc, I am also approaching full fitness again, gradually increasing the weight I can squat, throwing my three year old son around to his great delight and able to put in successive 9hr days on a gravel bike in terrain that many would only take an MTB into. I have barely even touched an over-the-counter painkiller in that time.

If the above sounds like boasting then don't take it as such, it's just an example of the gamble I took, surgery feels like the easy way out, but in terms of quality of life I absolutely believe it was the right decision. I also believe that it gave me a clean slate to 'rebuild' and relearn how to look after my back. I'm reading stuff up above about spasms etc. which makes me wince as that was me before I went in for surgery and 'rebuilt' from that point.

All the best OP, give conservative management a chance but don't bevtoo proud to ask for the surgery, you only live once, you don't want to spend your time nursing your back and living on painkillers...

Most prolapsed discs will get better eventually just depends whether you can live it until it does

Glad I searched of this. I’ve just gone and ordered “Treat Your Own Back” by Robin McKenzie”. Thanks for recommendation.

I did mine back around 9-10 weeks ago. I’ve had MRI couple weeks ago, which was actually for my hip as that’s been painful for ever! but I asked them to check my back too as I had a hunch I’d herniated a disc.

Results for MRI came back. I have laberal tear and cam lesion (iow. hip impingement), I've currenlty decided against surgical treatment for that, will see if I can improve things with physio and strengh work.

But also “at L5S1 level degenerative disc bulge and central disc protrusion contacts the dural sleeves of both traversing S1 roots, but with no overt impingement”.

Pain was initially very high, that turned into lower back stiffness and pain over the whole area, which has eased off a bit over the weeks. But still get dull ache and stabbing pain if I move the wrong way.

I had in my mind I had it that it would eventually resolve.

The thing is, last night I had initial physio appointment to start addressing it. He was of the opinion that we can build the strength around the area, as expected, but not to expect it to get better than it is now! He said it’s just a case on managing it, and strengthening to stop it worsening.

Mrs. S has had five microdiscectomies bless her along with a nerve sheath repair (gluing!).

So surgery is worth considering.

How bad was it? Did you have surgery?
L5/S1 bad enough to receive surgery. Struggled to stand up from sitting, lots of regular pain.

Did you fully recovery? How long did it take?
Yes post surgery, at least 6 months before doing anything strenuous. Then lots of physio type work which i had to figure out what appropriate. Took me about a year post surgery before i was happy to ride frequently.

Did you change anything about your posture, do exercises etc?
I do a lot of core exercises and some yoga for flexibility. Good to keep the back healthy and good for biking too. Still have bad posture but am constantly working on it.

Can you ride an MTB again? (I.e ride pretty hard, Dyfi slab track and the like etc)
Yup, BPW, Afan, road rides, cross racing etc.

But in lockdown I've been doing morning yoga sessions -45 min of fairly intense work - overdid some of the new to me stretches and really hurt something in my mid back (thoracic) area - back totally locked out and in lots of pain. This was just last week. Anyway a couple of days of cocodamol and voltarol cream seems to have cleared it up. Just taking it easy on the yoga now.

But also “at L5S1 level degenerative disc bulge and central disc protrusion contacts the dural sleeves of both traversing S1 roots, but with no overt impingement”.

I was told by numerous people that most healthy adults will show some degree of disc bulging and impingment, but can still be totally pain free, so don't make any decisions based just on an MRI!

Pain was initially very high, that turned into lower back stiffness and pain over the whole area, which has eased off a bit over the weeks. But still get dull ache and stabbing pain if I move the wrong way.

Could this just be related to your hip impingement though? If you have a 'malfunction' in your hips, I'd bet any money that there's lots of muscles working overtime to try and address it/balance it out, so all your aches and pains could just be tired or overwork muscles sending out little warning signals (that's all spasms are, I've learned, is just tired muscles effectively going into lockdown in order to stop you doing whatever is upsetting them!)

The thing is, last night I had initial physio appointment to start addressing it. He was of the opinion that we can build the strength around the area, as expected, but not to expect it to get better than it is now! He said it’s just a case on managing it, and strengthening to stop it worsening.

I don't know about the hip impingment, but my surgeon showed me before and after pictures of someone who DIDN'T elect for surgery, showing discs recovering by themselves. I think he said that within 2 years the outcomes for surgical vs. non-surgical treatment were much the same. I would still continue with the strength and flexibility stuff though, just on general principles!

This video was the best thing I have watched for my back health, it condensed my whole issue into one, simple prognosis. I've been stretching quads and hip flexors ever since and strengthening my TVA using the McGill 'Big 3' exercises and have made big improvements, even just in the last few weeks.

I was told by numerous people that most healthy adults will show some degree of disc bulging and impingment, but can still be totally pain free, so don’t make any decisions based just on an MRI!

Yep, more common as you get older eg

Evaluating MRI Scan Results

First, the difficulty with the results of an MRI scan, as with many other diagnostic studies, is that the "abnormality" that shows up on the MRI scan may not actually be the cause of back pain. Numerous clinical studies have shown that approximately 30% of individuals in their thirties and forties have a lumbar disc herniation on their MRI scan, although they do not have any back pain.

https://www.spine-health.com/treatment/diagnostic-tests/important-considerations-mri-scan

studies also show that herniated discs often sort themselves out in 6 months eg

The good news is that in most cases — 90% of the time — pain caused by a herniated disc will go away on its own within six months. Initially, your doctor will likely recommend that you take an over-the-counter pain reliever and limit activities that cause pain or discomfort. But in some cases, if you've been using these strategies and haven't noticed an improvement, your doctor may recommend further evaluation and possibly an additional treatment strategy, such as physical therapy. Surgery is typically not recommended unless the problem does not respond to therapy, if you are having an increasingly hard time moving, or if your doctor believes the spinal cord is being compressed.

https://www.health.harvard.edu/pain/will-my-herniated-disc-heal-on-its-own

I had surgery on 28 October and it's been brilliant.

I've had niggling lower back pain on and off for a couple of years, diagnosed as facet joint irritation. In June I must have done something as it got really bad. Therefore it was assumed it was a worsening of my original problem.
I managed to get an MRI scan on 18th October as it was really debilitating, really bad pain, couldn't walk more than a few metres, couldn't stand upright. These scans take a little while to get through the system though.
On 27th October I got a call from a spinal surgeon at Stoke hospital. He called me on his mobile as he was looking at the scan. "How soon can you get here? Come straight to Major Trauma Ward, the surgical team will be waiting".
They operated next morning - he apologised for the wait - a spinal injury had come in that he needed to deal with. That evening I was up walking about. I haven't needed a painkiller since.
It was a disc bulge at L4/L5 causing severe stenosis. Apparently I was one good sneeze away from being in nappies and impotent for the rest of my life. They removed a bit of vertebra at both sides to allow the nerves a bit more room then pushed the spinal cord forward (OK its not the spinal cord at that point it's the Cauda Equina) so they could cut off the bulging disc.

The next day I was able to walk out of the hospital unaided, carrying my rucksack to the waiting car. I took it easy (for me) the next few days but I'm back on making wardrobes and the following weekend did a 5 and 10 mile ride on Cannock Chase. Last weekend a 10 then 15 mile ride. Managed a couple of PBs too. One of them down BigJohn's trail, fittingly. Ripped the legs off my younger riding mate (who was on his Levo SL).

Yes I'm aware this is the sort of operation that 10 years ago nobody would have chosen unless they were absolutely suffering but I've had no side effects, everything works a treat and for a fat 67 year old, not a bad result.

Oh, and I'll be fine to go windsurfing again in another 4 weeks!

I know I'm not representative of everybody but feel free to ask me any questions you want. Like where are you thinking of windsurfing in December!

OK, I haven't read the above replies, so I might be repeating stuff.

But I had exactly the same thing a couple of years ago. There is definitely hope: I'm now riding ~100 miles a week.

In case any of this helps, this was my experience and what I did/what happened.

TL;DR: long-term, the answer for me was Pilates. I still do it conscientiously, and I am sure it's what keeps me flexible and strong enough to keep going.

• Yep - bad pain, barely able to walk
• NHS GP was useless. Wouldn't refer me to get a scan, prescribed codeine which had no effect.
• My physio (who I saw privately) recommended I get a scan immediately which I did privately and cost me £200.
• When this showed a large bulge, my doctor referred me to a specialist.
• The physio, meanwhile, had taken one look at my attempt to walk from waiting room to her practice room, and told me that she wasn't even going to touch me until things settled down a bit.
• Physio and specialist both told me to use Ibuprofen. The specialist told me that it was OK to keep taking the max dose for as long as I needed to. So that was basically what I did for several weeks, along with total rest.
• I stopped driving on advice of physio - the driving position is bad for backs.
• Gradually I was able to taper the Ibu intake, and begin gentle Pilates movements.
• From there I was able to gradually build up miles on the bike again.

I think that all took about 8/9 months maybe?

• I bought a back brace off Amazon that was a great help in the early days.

For me, it was the total rest + Ibuprofen that got me through the initial crisis, and then great advice from physio and Pilates instructor (especially the latter) when I was able to start moving again.

Like you, I could hardly walk in the early days, and I was pretty scared that it might be permanent/need surgery. I was shocked at how little use my GP surgery was.

I still give thanks I didn't need surgery, but do wonder what would have happened had I not been given the advice I had in the early days. Would it have improved to the same extent? Will never know. Everyone is different.

Wishing you the best of luck and a speedy and full recovery.

I never had a scan so don't know if I had a herniation or just a bulge (the latter probably) but physio and drugs sorted me out. In particular high strength diclofenac. I went from crawling around the house in agonising pain to trotting up and down the stairs in 72 hours. After that it was 6 months of 1-2 hours per day of physio-instructed core strength work and stretching before I could do what I could before. Residual stiffness and random episodes of pain lasted a year or two after that but now 6 years later I rarely feel anything. Try not to get too panicked. I thought my active life was over back then and was very depresseed about it, since then I've ridden thousands of miles and numerous endurance races.

Years ago I used to play rugby in the front row to make a long story short I was involved in a scrum collapse which lead to 3 prolapsed discs.
First operation went well and recovery was good however a second op was required when further damage revealed itself about 2 years later.
Following second surgery I was walking 2 to 3 miles after 8 weeks and have no restrictions at all obviously no rugby after first op.
Other than no movement of big toe on right foot I have no issues mtbing running boxing and hill walking even done 7 day trek in Alps carrying all my kit with me.
Core stability core stability core stability do the work a d you will recover

1990 - Aged 18 working in butchers carrying quarters of beef all day, every day. Slipped three discs and totally crushed two. Had an operation by an Orthopedic Surgeon in 1991 which was a disaster three weeks of agony in a local hospital.

1995 - Admitted to Hallamshire Hospital Sheffield where a Neurosurgeon cleared the mess up and I recovered fine worked, rode The Lakes, Wales, Peaks regular for years.

2015 - Trapped a nerve in some old scar, never felt pain like it, treble to the operations above, went private through work and had an injection to free the nerve and all's been well since though i'm living with slight sciatica.

I sold my Soul (Cotic) just after and haven't rode an MTB since, though I do ride a road bike and off road on a gravel bike but nothing too heavy. Only advice from me is never give up and let it get the better of you, keep moving whenever possible and try not to get dependant on painkillers. My old dad used to say "what doesn't kill you makes you stronger" which I sort of live by!

In the late 90's I damaged my L4/L5 disc by hyperextension. Eventually I had a foraminal nerve block injection (2007-ish) which allowed me to exercise my core without experiencing pain. (Lots of climbing but unable to bridge any corners while leading). Touch wood, I have been free of further problems with it.

Some on here will know that I'm in the middle of a mental breakdown while stuck in temporary accommodation following a catastrophically ill-advised move and house build.

Our possessions are arriving from storage on the 18th and there's going to be a lot of lifting of weights and pushing and shoving. I've been completely sedentary for the last 6 months and have lost 8 kilos, over 10 percent of body weight in muscle bulk. I've never suffered from serious back trouble apart from occasional sciatica which cycling strength kept at bay.

How worried should I be about causing myself a serious back injury while lifting something heavy and awkward like a mattress ?

First time poster - long time lurker but this touched a nerve (sorry).

Around a year ago I'd just returned from a weeks riding in Livigno (an awesome weeks riding) and was about to finish off the last few rounds of the SXC start the SCX season again. Felt my back go (again) difficulty rotating standing to sitting, movement was ok once I'd started but changing position was horrendous. This developed into sciatica down my left leg which had me off work etc. Roll on a few weeks of different painkillers, unable to sleep, no riding, no running and the pain lifted but then I suffered 'drop foot' kept catching my foot on steps etc and noticed I'd developed a shuffle. GP was great and arranged an MRI scan I was booked in for surgery to remove part of disc that had bulged and was squashing nerves giving me the lack of movement. Short story is that I elected to not have the surgery (the disc position was such that Facet joint removal and pins were discussed) and decided to see what other options were. I'm sure I havent remembered this correctly but the pain had gone because the pressure (if thats the word) had killed off the pain pathways in the nerve, as I had no pain I thought I'd see how I'd get on.

Rather than surgery I have, with a very good instructor, started pilates to strengthen the core, started swimming, stopped running, (surgeon mentioned degenerative disc disease which we'll all have in some form but not everyone gets an MRI to see the extent), stretch more often, had a complete re-think of the use of core musles all the time.

I can't ride the road bike due to discomfort after the ride, I can't confidently unclip my left foot so ride flats all the time now, but do walk the dog multiple times a day, MTB most days in some form, planning a return to Livigno with the kids but the key thing is that everyday I think about what I'm doing and how it could impact on my back so taking care of how I lift and move and continue with the Pilates exercises.

Back pain is horrendous and when it threatens to take away the ability to participate in an activity I've loved for over 25 years I was struggling. But getting as much advice as possible and forming your own decision is key. Pilates, once I got over the fact I was the only male in the class and the youngest at 41, was/is a godsend. The exercises sound so simple but I'm using muscles I didn't know existed in an effort to strength and support my back.

Hope this helps

I'm the same. L5/S1, twice. Never had surgery. Second time around the sciatica was worse. Was booked in for surgery and one day I woke up and most of the pain was gone. Went to see the surgeon and he told me that he wouldn't proceed with surgery at that point. It all started in 2017 for me, so it's taken me just over 3 years to return to almost normal with regards sciatic pain. Some days it will flare up but not last for long. Still have lower back stiffness, but that's more down to me not doing enough stretching and strengthening.

Good luck.

Phew
Some nerve wracking stories there.
And now I’m in the same boat.

I went through a year of left side sciatica 2012 and, after a year of various physio treatments and weekly pilates, eventually had an MRI to rule out something that might paralyse me in a minor crash. (Well that was my thinking).
Diagnosis = L4/5 bilateral disc bulge, specialist said he very much doubted that nerve root impingement at L4/5 could cause my type of sciatica. That would more normally be an L5/S1 job
It gradually cleared up. Upledger Cranio Sacral Therapy helped A LOT. Plus the pidgeon pose. I eventually put the whole thing down to piriformis effect.

Fast forward to the days of COVID.

Meanwhile I was doing weekly small class Pilates up until them closing on the first lockdown.
2 years in the gym on the Doug McGuff Body By Science Big 5 up til maybe 2018 when I lot my gym rat partner. (Doubled my leg press in 10 sessions of 90 seconds activity each!!!)
I know. I should have stuck with it. Hindsight is amazing

6 weeks ago I had to do some fiddly electical work under the loft floor so spent a day lifting the floor and messing about with a transformer. Bit of a sore back and looming sciatica next day.
Gradually faded until I was up for a ride 2 weeks later.
So, month ago went out on the good old geometron for an hour, 100% standing in the Sussex clay.
My leg hurt a bit, but keeping mobile seemed a good idea. Cut the ride short as it was a bit too painful. Felt Ok washing the bike etc but had pretty bad sciatica next day. It faded.
20 days ago, feeling much better I went for a walk on the gravelly beach.
Felt a bit of sciatica but ibuprofen made it bearable.
Next day.
OMG
Really very very intense sciatica with any movement.
Gasping on movement.
Taking ibuprofen and paracetamol max dose for maybe 10 days and it wasn’t really touching it so called the doc.
(Phone appointments only just now) immediately put on Tramadol. 4 days later another call, it’s not enough.
Added Amitriptyline.
Still not enough, so another call, this time I got my own GP. “Get round here now however you can but ASAP” (despite the face to face only rule)
Cut a long story short (but not missing out the bit where she tickled my knackers with cotton wool) I was admitted to hospital - next day MRI.
Ruled out Caude Equina-
diagnosis - protrusion at L4/5.
Also a T11 spinal compression fracture.
Same L4/5 issue as 2013, but I guess it could have worsened.
But it’s still L4/5 which apparently does not cause glute, outer edge of leg and foot sciatica. My left calf muscle is also almost entirely unresponsive.
No surgery offered.
Discharged with Gabapentin, which I’d started in there 5 days ago.
Oramorph as needed, and I’ve needed it.

So I’m back at home pretty much bed and sofa bound.
Gradually increasing the Gabapentin as instructed and I’m now on
300mg x 3 am,
x2 noon,
x2 10pm.
It’s way short of enough to wipe out the pain - maybe giving a 50% reduction, so I can still nit stand up straight and only manage 5 mins in my feet, can make the stairs and walk 20 yards, but it requires full on abs contraction and it still hurts. A lot.

I’m having a very bad time whilst laying around thinking of having to sell my bike if I can’t even get out of the house.

The Gabapentin is making me feel a bit detached / dreamy.
There are some bad side effect reports online. Someone’s permanently numb hand being one! Plus someone else’s permanent (partial) memory loss. (But that’s the Internet for you)

I have 3 really simple exercises from the NHS physio and a phone appointment in a week or so.
Sciatic nerve glide,
combined quad and psoas stretch and seated figure of 4 piriformis stretch.

Also I tried the exercises in the free phase 1 from “Back in Shape” one of which which seemed to significantly increase the pain afterwards perhaps because it prescribed laying flat which isn't really on for me.

I’d appreciate knowing about folks Gabapentin experiences.
Should I worry. I certainly can’t manage without them.
Do they take 6 weeks to kick in as package info says?
If so it seems crackers to be increasing the dose so soon.
Perhaps I am just testing my max bearable dose before side effects kick in? Rather than what’s enough to kill the pain?
Max dose is 300mg x 12 a day.

And am I right to avoid ANY movement that irritates the nerve?
That’s a tough one.

Will I ride again.
I bloody hope so but I am feeling rather sorry for myself.
Pathetic I know especially as my mate just died of cancer.
I should feel lucky but I have the occasional thoughts of how much oromorph would I need to finish me off.
Not in a great great place overall.

Advice on early treatment and Gabapentin experiences would be appreciated.

No haters please. I’m a bit fragile

Neil

Hi Neil - that's a big post so will give a condensed answer.

I was on max dose of Gabapentin, Tramadol, Ibuprofen and a dash of Oramorph.

I was mostly fine once I'd got the tramadol related nausea under control.

I forget how long I was taking the full dose, but by that stage it was clear I was heading for surgery.

Once I got used to the drugs I was fairly functional, in fact at times I think I was even a bit high off them, what I imagine a cocaine high might be like. Was certainly able to be quite productive while working lying face down on the floor!

Came off tramadol first while keeping full gaba dose, no problems. Tried to taper off gaba but me or my doctor got our maths wrong and I basically crashed off from 3x2 300mg a day. That was brutal, very emotional/paranoid/depressive. Take it seriously and come off it as gently as you can!

Can't help with exercises I'm afraid but don't take the McKenzie/'Treat your Own Back' stuff as gospel, I still avoud cobra type pises to this day! I think if you can do glute stuff without straining low back (difficult) or work on hip flexor and quad stretches.

Good luck, your active life is definitely not over, I came back from surgery and got fitter, stronger and more back-aware than previous, so it's all good.

Thanks monk. That’s reassuring.
Neil

The docs tell me I should be fully functional (walking)once the drugs are right. So strange that the packet says Gabapentin takes up to 6 weeks to start working.
Know what you mean about McKenzie. I couldn’t do a cobra to save my life. That’s one move I just can’t stand. A backwards bend.
For sure it works for some.
N

I can't offer much advice except to say that I had surgery for much the same thing at the end of October (see my contribution above). I'm now moving and doing things just like I was 10 years ago. Since my op the only pain relief I've needed totals about 12 paracetamol!
A cheap Tens machine gave me considerable pain relief before the op.

Lot of long posts/war-stories on here so I'll not go into detail. Other than to say a lot of pain and frustration over the years, culminating with me collapsing on a train and being off the bike for 3 months at the end of 2019. MRI showed up some bad stuff L5/S1. Managed to get an appointment with a top sports medicine consultant who told me I'd likely not ride MTB as hard as I'd like again and running would be a complete no no. Surgery wasn't worth the effort and told the pain would go in a few years as the vertebrae would fuse naturally.

Enter depression stage left...

However, I've never been one to take only one opinion. My physio had put me onto a guy in the states that does a lot of back related stuff over the internet. I was super sceptical but ended up contacting him and going on his program for 6 months. 6 months after the end of the program all I can say is it has changed my life. I've not felt this mobile and painfree for a long time - and I can feel my 47 year old body getting stronger every week. I can't recommend him enough. He isn't cheap but for what he has given me it's more than worth it. https://www.therehabfix.com/low-back-program or https://www.instagram.com/rehabfix/

Also been there. Had a fall and all seemed fine til i turned sharply and felt something go. Next morning it was extreme pain. I couldnt stand up for more than 10 seconds.

Unfortunately i discovered I'd run out of coffee, so got on the bike and roade the 500m to the shops. Christ knows how I got there, and worse after tying up the steed I'd nothing to support myself. Loads of people looking at me staggering along grimacing horribly.
Return journey was probably worse.
Then made it home an lay down on the floor and remained there for 4 days. Didnt sleep during those 4 days beyond maybe 20 minutes, but I did manage to get a clock down next to me so I could count each second of those 4 days.
I think the sciatic pain from hip to toe didnt help or promote me trying to move
Family phoned, then came round, ambulance called, morphine administered, into hospital acute ward, more morphine daily for a further 7 days. Scans etc.
Then physio.
The physio girls are nuts, its agony to stand and they MAKE you get up and walk a couple of steps, with each step them saying "Thats Excellent" 😆 sure doesnt feel excellent 😆 but I see the importance of it.
Further 3 days of that.
Felt I could get about and walk about 10m one way then t'other.From bed/corridor/back to bed so signed myself out(others in need)

It took about 60 days of movement using the same, walk a little rest, then walk some more and rest. Big painkillers and force yourself into the routine of walk, rest walk rest and it slowly loosens up the muscles and that seems to help the disc resettle into place.
About a year down the line it was still sore to sit on any firm surface like the floor, and its been about another year since then.

The reason mine got as bad was , going cycling to the shops the first day after, then lying on the floor a further 4, i think it was probably that that sent it into spasm locking everything up tight, and caused the amount of pain i was in, but it was the movement forced by those very nice girls in physio that loosened it up and that movement was the key to getting it back to about normal
Two years now, to the month in fact and i still cant sit on a hard surface without the back getting sore. But it is considerably better than last year, though I worry about doing the same thing again, though at the same time understand the importance of taking big painkillers and forcing myself to move.

PS
A recliner is helpful. I found/find it a bit sore sitting up for any length of time and being a relined state a bit more comfortable.

Never been as bad as the op but my thoughts are

Tens machines are great to keep you moving

There's an exercise where you put your arms above your head and squat, concentration on keeping the arms as vertical as possible. Once you are more recovered it's worth a try as it's had a dramatic effect for me.

Thanks everyone.
7 days on latest regime
Gradually upped the Gabapentin
Now
Gabapentin 900mg 3x day
Oromorph as needed (4-5am)
21 days in since it got bad

Still can’t stand upright or walk without significant pain.

Testing isn’t it.
N

Still can’t stand upright or walk without significant pain.

Testing isn’t it.

It is indeed, but remember you still need to move, to get it to settle by working the muscles surrounding the damage(As long as it's been recommended you move)
Very easy to take the edge off with the morphine and not move.

Motion is lotion - rest is rust!!! Keep on moving!

I feel your pain (literally) Had back issues for a few years, most of it related to my job.
2018 was the worst point saw a (useless physio) and ended up paying for my own scan.
Disc bulge in L5 -S1 which was causing bad sciatica. As mentioned here pain relief etc.
Pilates really helped me, and my job were brilliant.
Through work I managed to get physio and treatment.
The MRI also picked up an endplate fracture (I used to do a lot of JuJitsu)

Thx all.
I am trying to move but at the same time to avoid stuff that makes the pain searing.
I understand that it’s a nerve being pressured by the disc bulge.
I’m feeling that mechanically it’s like you have a cable rubbing on the bike when the suspension compressed. So how is that going to stop?
The disc pressure is always there. So how can the inflammation be reduced. I’m confused.
N

Mudfish - I've learnt there is a big difference between hurt and harm with regards to pain. This time last year I didn't trust my back at all - now I push it loads and always bounce back even if I have a little pain. To be fair I ride and if I do like 5 hours my back yelps at me but now I wake up the next morning with no pain. That ability to differentiate between something that is going to harm my back rather than just hurt it is important.

In my opinion surgery fixes a problem but until you learn to move and build your back correctly you'll end up going down the same road again. I'm coming up fast on 50 and I've realised that there is a way to keep your back in good condition - we all start to wear out but this accelerates if we don't look after ourselves. The back is no different - if we don't encourage mobility, flexibility and strength it'll start to cause issues - surgery will fix the effects, but the root cause is not keeping your back in great shape. A bit like never washing / lubing your bike and replacing parts when they seize up - for some this might be OK.

The pain will stop when your body is freed up to move how it should.

Sounds cryptic I know, but having been there and now being where I am "I can see the light!!"

Mine was nowhere near as bad as some above but quite a few years have elapsed so there might be something of value in my experience. Christmas Eve 2010 I was on a trip round New Zealand and went into spasm for the first time. Went to a back specialist physio and after sitting on me he gave up, gave me a large whisky and about 2 days worth of diclophenac in one tablet. Got codeine and valium from somewhere else and spent Christmas talking gibberish but immobile on the floor. Couldn't move for a couple of days. Spasms are horrific as described by others. The shape they contort your body into is frightening to look at. In my case though, a few days later I could achieve some movement and as soon as I could I did and it worked wonders. Result was that once I could walk I could walk a couple of miles and 3 days after that I was good for a proper hike. Relief of symptoms was oddly quick.

6 months (almost to the day) later I had a repeat, about to start team lap 2 at Mountain Mayhem, track standing in a crowd, back spasmed, hit the deck, ambulance car, injected anti inflammatories. Similar recovery to before except only took the anti inflammatories. On the floor til Tuesday when I managed to go for a dump for the first time; to say that was a relief is an understatement. Thursday walked a couple of miles. A year later I did the Megavalanche, LEJOG and normal riding. I had recurrences about every 6 months which got less severe and I learned to feel them coming. Physio, Pilates, walking and riding helped. Any massage from not a proper physio i run a mile from.

Nowadays I get back stiffness sometimes but it's not that frequent. Had it the last 4 days. Got myself to ride yesterday, but walking up the hills. That worked nicely. Today I went for a normal MTB ride except walking and stretching on the steeper climbs. I find mountain biking about the best thing for it. Move around on the bike, exercise, stretch as I go, but no great force through the back. Even the rough stuff seems to shake sense into my back if symptoms are only mild.

So for me, exercise is both prevention and cure. Even when it's bad, moving it is good.

A family member who's a professor of biomechanics in the USA gave me the analogy when I was lying on the floor that time, aged 34, that your discs are like a sack of gel and a prolapse is a break in the sack and a leak in the gel, but then as you age they change consistency until at around 40 they're more like cheddar cheese. Cheddar doesn't prolapse. So there's a benefit to middle age!

Thx Bushwacked,
For sure there is damaging pain and strengthening pain. I am over 60 but no stranger to the 180 kilo leg press.
With full spine support of course.

Luket, thanks.
Seems like yours is a sometimes severe spasm. Mine is disc prolapse. (I’m over 60) I never sit. I’m a full time no sitting rider. Prostate reasons.

My current issue is severe, unfortunately
24 days in and the pain seems to be worsening, its catching up with the meds as they are upped.
300mg x3, 3x day of Gabapentin seemed enough for a couple of days. Now the pain is becoming too much for it so I’m needing to add Morphine in the evening and at night. Even fully loaded with meds the pain when moving is never gone, it just becomes more bearable.

I suppose the next step might be to add back Tramadol. The hospital took me off that. There was a poster above who mentioned taking both Gabapentin and Tramadol (and morphine as needed) for an extended period to manage L4/5 pain.

I’ll ask the doc. A friend sent a Wikipedia page about Gabapentin which said it doesn’t work for everyone and sometimes opiates have to be added.

I am struggling with the exercises. For sure I want to keep moving but anything that irritates the nerve seems to set me back.

How will I heal? Does the nerve move away from the disc? Maybe it’s swollen and will shrink back with time, but surely not if I keep irritating it - every stabbing pain is an irritation of the nerve, right?

A chat with the NHS physio later today will clear some of this up I hope.

Thanks guys. Good to know I’m not alone in this and that many of you have healed without surgery.

Neil

So then, on Saturday afternoon I appear to have involuntarily joined this club! 🙁

Unpacked my XC race bike & took it out for the first time in 6 months following a solid Winter of road riding mileage. Had a nice local 2.5 xc ride, very tame lanes & gravel trails just to check the xc bike over.

Suffered unusually high pressure on my wrists in final 30mins of the ride & slight left knee tightness but put this down to change in position from road to XC bike. Anyway, finish the ride at home and then when it comes to getting off the bike I barely can, and when I do get off am absolutely gob smacked that I can no longer stand up straight without total nerve agony in my lower most back!

Crawl in the house & have then spent the past 48hrs lay out flat on the bedroom floor on a very slim, super hard mattress we had stored away, regular is no good and doesn't ease the pain. Saturday night pain like I've never experienced before.

I'm still flat on the makeshift bed today but have been standing every 90mins or so and then returning back to the floor just to try to get some movement. Any half quick movements lead to fairly monumental lower back spasm / jolts of pain. I can not stand for more than 4-5 mins before there's a build up of pressure in my lower back and the associated back spasms commence.

Also worrying me is that my torso is no longer straight if viewed head on from the front. My hips have visibly shifted a decent few cms to the right and my upper body is sitting off Centre from my lower half??!! I presume the 48hrs of back spasms have overly tightened my lower back and caused a shift, hope its temporary! :-O

Currently awaiting GP appointment phone call back and health insurance physio call back.

I had prolapsed/burst discs in my lower back in 1987. A couple of weeks on traction then after a scan (new tech in those days), I was told I needed an operation and would have 25% chance of walking again. On my feet next morning, six months later back as an operational firefighter. Completed 32years and now completed 10 years as a bicycle mechanic. The operation was NOT keyhole and I think that can be the difference in success sometimes, there’s a lot of nerves in that area. Hope this helps, any inspiration needed pm me.

Herniated L5-S1 when I was just 23 from a waterskiing accident. Really bloody painful. It took me about 6 months before I could walk properly again, and another 6 months to get my confidence back to lift things/run/mountain bike.

Saw an expensive chiropractor and made very slow progress (only later realised what pseudo-scientific nonsense that is) before switching to a proper physio and rapidly improved.

I sympathise completely with your pain - know that with patience you can make great progress and recover fully. Wishing you a smooth recovery!

I had an op on a L4-5 about 12 years ago. Pain had become too much and too constant despite pain killers, injections etc. A few weeks after I was fine. Fast forward to last summer, sleeping on a very soft bed on holiday and a familiar bad sensation when I woke up. That was 6 months ago and I think it’s starting to mend.

Amyway, what I wanted to say was my pain management specialist said that 95% heal by themselves as the herniated disk is remodelled by your body. I had not heard that before so I wonder if it squares with what you’ve been told?

Bennyboy call 111
Have you googled Caude Equina?
Ideally treated within 48 hours.

Robertgray05, wheelsonfire (Julie Driscoll, eh?),
good feedback thanks
Dr J
Yes I’ve been told to think of the prolapsed disc as similar to a cut on your skin. Healing involves swelling (inflammation) which gradually subsides. It’s the swelling that’s pressing the nerve.
Some say that 2 years after an injury those who had an op and those who didn't are largely in the same place.
It can recur.
Looks like I MAY be a candidate for the a spinal injection to kill pain and allow my disc to heal naturally
(that X-Ray guided injection would apparently cost 3K in the USA, lucky us to have the NHS)
Blimey.

12 years ago I had a prolapsed disc, L5 S1, like others here. It was at 3am while taking a piss! I had to stagger out of the loo holding on to the kitchen counter tops for support. I’ve never felt anything like it.

Looking back I had been suffering a sore back for years and gave up playing competitive squash because of it. Rode XC on the bike more but always ached afterwards. An office job and lots of driving thrown in did it no good either and I had sciatica for months before the night it went.

I had 4 weeks off work in bed and almost went for surgery but the surgeon opted not to as the pain was receding. Naproxen, Tramadol and Codeine Sulphate fried my brain for months but kept the pain at bay. Physio, careful pain management, occasional ibuprofen and years of Pilates has helped massively.

I still get the occasional twinge if I do something stupid, but it recovers in a day or two. I’m super careful about what and how I lift anything now.

I know it was a while ago now, but my physio did say that many disc ruptures do repair themselves naturally, they just need time and careful physio. He was glad I didn’t have the surgery.

So six weeks in today.
Saw the specialist last week - he talked to the epidural injection guys who refused to put me on their waiting list because my unresponsive calf is unexplained by my L4/5 prolapse.
He couldn’t see anything of significance at L5/S1.
I’m taking Gabapentin (4,4,4) Amitriptyline (3, evening)
ibuprofen and paracetamol plus Oramorph 30ml/day.
That lot are making me feel pretty “calm”.
I’ve been told THC drops will help so I am trying to get some.
Yesterday, after a better sleep, I found I can stand up straight and also sit with my leg straight. Both were firsts since the injury flared up.
Good sleep last night but more pain this am, so I guess it’s going to be a cyclical recovery.
I can feel the corner approaching but perhaps have not turned it yet.

I’d love to know why my left calf is 60% dead (unresponsive). They have me on the list for a nerve conductivity test. Might take a while they said.
Thanks for all the feedback. Disc issues are pretty common I guess as time passes and a lifetime of injuries catch us up.

Neil

Bennyboy1
Yeah the shift is typical.
I have / had that too.
6 weeks rest - avoiding any painful movement allowing the nerve to calm down - to some sort of recovery seems typical.
You’ll need the right painkillers to get on top of it and get some sleep. Gabapentin and Amitriptyline seem to be a fairly standard approach.
Their effect increases with time - both can take up to 6 weeks to work fully.
An MRI is of limited use, because a very large proportion of people have some kind of prolapse and the majority of them never noticed any issues.
So, your issue can be connected to something revealed by the MRI, but may not be.
Backinshape seems a good resource.
They have some free stage 1 stuff to get you started out.
Hip hinge and straight back seems to be the way to live / ride. Keep the spine straight and stable. No “get aero” if that means curving the spine.
A GOOD Pilates class is a great way to teach the subconscious to look after the “core” I’d call it “core awareness” rather than core strength.
Have a look at Dr Eric Goodman’s “Foundation” training. There’s a great 12 min video on UTube
I messed mine up whilst doing underfloor electrical work and I blame bad posture due to 12 months off from my weekly Pilates since the studio closed 1st lockdown.
In the absence of Pilates, regular Foundation Training would have saved me perhaps but, hey, hindsight is always 20/20.

Good luck
Keep us posted.
Neil

I can feel the corner approaching but perhaps have not turned it yet

Good luck, sounds like you're going down a different path than I did, but I still took the best part of 6 months to get back o a bike and start rebuilding BUT remember that rebuilding is possible, I've put in some of the best riding of my life since getting most of my L5/S1 chopped out 🙄

Hip hinge and straight back seems to be the way to live / ride. Keep the spine straight and stable. No “get aero” if that means curving the spine.

This is good advice, my return to cycling happened to co-incide with experimenting with cut-out/short nose saddles which allowed me to rotate pelvis a lot more and keep a flat back, even on road bike. I didn't realise how useful this effect was until I started messing about with conventional saddles which gradually forced me into more of a flexed lower back position. Amazing how quickly all the old pains returned!

Thanks 13FM
I do feel I may be at the corner. (Time to let go of the brakes)
I’ve now had about 4 decent nights sleep - after 40+ agonising nights.
I had an Upledger CST session yesterday from a master practitioner and I feel far better for the feeling of contact with my inner workings it’s given me. I’m definitely feeling taller.
So it’s either that the Gabapentin has started to work properly (that can take 6 weeks) or I am healing.
I’m hoping it’s the healing and that I am one of the 85%.
The specialist told me 85% of patients suffering from what used to be called a slipped disc recover in about 6 weeks. I’m certainly not recovered as the unmedicated first thing in the morning pain is quite bad. But at last I can now stand straight and move about without supporting myself on the furniture.
Good luck to anyone suffering this as I did.
I’ve never felt pain like it.
Insist on proper medication. The Oramorph is what got me through the periods between taking the Gabapentin and Amitriptyline.
They say morphine doesn’t help with nerve pain but that’s definitely not true for me.

Bit of free gold dust here imo.
https://m.youtube.com/watch?v=4BOTvaRaDjI
I just bought his book and once I can use it I’ll report back.
N

The tone of my previously almost disconnected calm muscle is slowly returning. That was the symptom most worrying the specialist I saw.

I’ve rigged up a way of measuring calf strength progress at home using kettlebells on the kitchen table and the bathroom scale.
It’s lifting 20k now. Long way to go to about 100k (weighted single left calf raise, bodyweight plus a decent kettlebell) but it’s a step.

I wrote to the Foundation Training team (book I mentioned previously) and they wanted me to avoid exercising whilst on painkillers. Playing by it safe I think, as the NHS physio wants me doing anything I can manage. Apparently the nerve is inflamed by being trapped and lack of movement makes it worse. Keeping moving helps healing.

Double edged sword that, as irritating the nerve with movement makes it bloody painful a few hours later.

Surgery has been discussed now, but as progress is being made I have a reassessment in 2 weeks.

At last I am sleeping through after 40+ nights of agony.

It's almost 6 months since I was called in out of the blue for my operation by the surgeon who was looking at my MRI and saw I was one sneeze away from Cauda Equina syndrome and a life in nappies.
Mine is a wholly good story, so I won't run your noses in it (but it's great to be windsurfing again and getting PBs on Follow the Dog and Monkey).
But some of the numbness in my toes has only recently gone away. I think nerve damage and bruising can take months to recover.

My story continues. I’m now 7 weeks in from the onset of serious pain (and almost 4 months in from the event that seems to be what caused the actual prolapse).
Saw the Brighton spinal triage specialist yesterday and, in the light of reduced pain and of my calf muscle starting to awaken (showing a bit of tone and able to support 30kg) he now feels surgery is not indicated. There’s still a nerve impingement but what nerve remains that’s still partially activating my calf should gradually activate mire and more over time.
I am feeling heartened.
The spine surgery info he referred me to was bloody scary.
There’s still the occasional, position dependent, acute pain which can last a few minutes, but that I can deal with.
There’s an element of fear early on that subsides as you get used to it and believe it’s not permanent.

I’ve managed to cut down on the oral morphine but conversely am now taking Zomorph - it’s a background morphine, slow release 2x10mg a day. WAY less than the self administered 72mg I had to take (in liquid form) one really bad day early on.
I’ve been sleeping through for a couple of weeks now. After 49+ nights of agonising wakefulness that’s a real blessing.
Anyone reading this who has recently been diagnosed. It’s potentially a long long road and I am nowhere near in sight of the end, but do persevere. Take the drugs. Try keep moving and don’t let depression take you over.
The Gabapentin and Amitriptyline will certainly help with that.
Onwards and upwards
I hope.

15 weeks in
Walking is still awkward due to limping (inactive left calf muscle) it has, however, picked up strength. Last report 2 months back it could support 30 K, now it’s 50.
I did have the nerve conductivity study, a pretty straightforward test which gave ok results. The consultant said that and my recovery process show that my remaining nerves are branching out to recruit the “disconnected” muscle parts.
Im titrating off the Gabapentin.
4 at 8am, 4 at 2 pm, 4 at 9pm has become
3,4,3
Amitriptyline down to 2 evenings from three.
All positive steps. Once I can walk more smoothly things will speed up I believe. Walking is a great back exercise.

Hi guys,

Just thought I would resurrect this thread to see how everyone is getting on?

I've recently joined the Sciatica club for the second time.

First was about 10 years ago, L4/5 on the right side with Laminectomy surgery to cure the sciatica pain, I was living in London at the time and wasn't doing much exercise.
I've been riding properly for any 6 years now and really been focusing on fitness in the past few years.

Unfortunately since March my back has been slowly deteriorating with pain starting across the top of my right butt cheek. I started seeing an osteopath who had given some relief, and the local NHS physio unit but unfortunately the sciatic pain carried on getting worse getting down into my foot.

I carried on with my stretching/fitness exercises and riding as these always eased the pain. I did something I don't know what and it suddenly got worse and I'm now at a stage where I can't stand up straight, walk more than 50m, can't sit normally, and lying down in most positions causes pain.
I was referred for an MRI which showed bulging L5/S1 disc and I've now got an appointment with a consultant at the start of November. I'm on Etoricoxib for anti-inflammatory, Gabapentin for nerve pain, Dihydrocodeine, diazepam, paracetamol but to be honest they just scratch the surface and just make me have naps in inappropriate places.
I've also moved from the NHS physio as they did FA apart from 3 exercises which actually made things worse, apparently Physios don't do any hands on anymore, and I'm now seeing the Osteopath.

Basically I'm just here to hear from people with similar conditions that things will get better. I've ordered the book linked earlier.
If anyone has any good exercises that they can suggest to help ease the pain or strengthen the area that would be great. And any recommendations of decent Physios/Osteopath in Horsham area I'll be happy to give them a try.

Thanks very much

Bump to see if any of the Sciatic Team are about.

I'm still pretty immobile but my consultant appointment is just over a week away so that is a date to hopefully get some progress.

The local MSK unit moved me over to the NHS Osteopath and they were better at relieving my upper back pain which has been caused by the way I have to move around however they said to just move around as little as possible and do no stretches or exercises.

I got a TENS machine which I thought would be snake oil but with the pads placed either side of where I get pain it gives some relief.

How is everyone else getting on?

I think I said on this thread or one of the others that physiotherapy didn't help me, but the pilates (that my physiotherapist recommended) did, so I'll recommend pilates again.

I had about 6 sessions of 1-1 which gave me enough to use on my own regularly or when it feels like it might be playing up.