Lower back slipped disc

[NathanSummers]

Slipped a disc in my lower back doing leg presses, ive messed up this disc before doing squats, i can literally feel it move out of place.

Any advice on how to speed up the healing process besides ice and rest?

[Kratos]

Slipped disc is a strange term...how do you know you injured the disc before? Leg press is a bad one for the low back. I do squats with a belt and find it to be pretty low back friendly as long as form is good.

When you say you can feel it move...that could be bad but it could still be muscle related and the disc might be ok. If you had true instability with subluxation or a spondy, you'd be feelin some real pain.

If the pain is from the disc you can see a doc and be put on prendisone. If it's a slip and it's moving around (probably not) eventually you would need fusion. If it's muscle and that's more likely ibuprofen should help quite a bit.

[NathanSummers]

I've had it looked at before when i messed it up last time and was told by my doctor it was a slipped disc.

When i first did it, i couldn't walk let alone move for about 5 min, and if i bend down or turn wrong, it puts me in terrible pain.

i've been icing the crap out of it and im taking the week off of lifting.

[Kratos]

I've had it looked at before when i messed it up last time and was told by my doctor it was a slipped disc.

When i first did it, i couldn't walk let alone move for about 5 min, and if i bend down or turn wrong, it puts me in terrible pain.

i've been icing the crap out of it and im taking the week off of lifting.

I'm not sure how he came to that conclusion without imaging, but depending on what's going on in there. Sounds like it could be disc related, so I'm suprized he didn't give you some powerful anti-inflams...it may or may not get better on it's own. Most general practice docs don't know a whole lot when it comes to spine.

If it doesn't get better in a couple weeks icing and poping ibuprofen see a real spine doc. If you've got a herniation or a instability (true slip), you might be in pain for the foreseeable future.

[RockyX]

discs don't slip...that's such a funny term...if you are feeling someting moving then you likely have lumbar instability and you need to have some films taken, it is likely you have a bulge...there are things called McKenzie exercises basically extension exercises, assuming this is a disc problem you can lay flat on your stomache and push up with your hands curving your back (keeping your pelvis on the floor) given that 90 percents of disc herniations are posterolateral, this should give you some relief, hold it for 10 seconds per rep and repeat 10 times.

[Kratos]

discs don't slip...that's such a funny term...if you are feeling someting moving then you likely have lumbar instability and you need to have some films taken, it is likely you have a bulge....

Yeah that's kinda what I was saying...it's a broad term that's overly used...any doctor that knows spine well doesn't use it, it's more of a layman's term. So, I wouldn't trust that doc's opinion too much.

Disc's do slip I guess you could say, and you can even see it on plain x-ray...instability usually leads to herniations, loss of disc height, and sometimes (see below)... this isn't uncommon for me to see on an x-ray for someone who needs surgery.

See how S-1 no longer lines up with L-5...they kinda overlap and the nerve root foramen is tighter because of it. Usually the disc will not be in good condtion on MRI and fusion is common for this problem. Sometimes there is instability to the point it is aligned or misaligned depending on if the person is bending forward or back. You can see on the film how much height has been lost compared to the level above...they should be pretty equal in height.

[Kratos]

Anyway, hope you are feeling a bit better by now and that it was only muscle trauma.

[lovbyts]

Yeah that's kinda what I was saying...it's a broad term that's overly used...any doctor that knows spine well doesn't use it, it's more of a layman's term. So, I wouldn't trust that doc's opinion too much.

Disc's do slip I guess you could say, and you can even see it on plain x-ray...instability usually leads to herniations, loss of disc height, and sometimes (see below)... this isn't uncommon for me to see on an x-ray for someone who needs surgery.

See how S-1 no longer lines up with L-5...they kinda overlap and the nerve root foramen is tighter because of it. Usually the disc will not be in good condtion on MRI and fusion is common for this problem. Sometimes there is instability to the point it is aligned or misaligned depending on if the person is bending forward or back. You can see on the film how much height has been lost compared to the level above...they should be pretty equal in height.

Well that all sounds and looks to familiar. My doc is saying I need a fusion. I wish my MRI looked as good as yours. LOL

[RockyX]

Kratos, You don't really NEED surgery for that do you? You would just recommend it? It looks to me like a Spondylolytic Spondylolisthesis...Very managagable unless extremely unstable correct? I mean its gonna have bad days but better than having a knife around your nerve roots rights? Are you a radiologist? Just interested because you said that is not uncommon in someone who NEEDS surgery...I'm not a spinal surgeon or anything, just a chiropractic student in my final year (thank god) but I don't think I would necessarily refer someone out for surgery with an old spondy...

[RockyX]

Well that all sounds and looks to familiar. My doc is saying I need a fusion. I wish my MRI looked as good as yours. LOL

Yah that's a pretty ugly MRI bro...have you looked into other means of care?...you have virtually no curve in your lumbars and it seems to me unless you get some care going to correct that you are gonna have continuous problems with discs, Degenerative Joint Disease, ETC..

[Kratos]

Kratos, You don't really NEED surgery for that do you? You would just recommend it? It looks to me like a Spondylolytic Spondylolisthesis...Very managagable unless extremely unstable correct? I mean its gonna have bad days but better than having a knife around your nerve roots rights? Are you a radiologist? Just interested because you said that is not uncommon in someone who NEEDS surgery...I'm not a spinal surgeon or anything, just a chiropractic student in my final year (thank god) but I don't think I would necessarily refer someone out for surgery with an old spondy...

I work for a major ortho company in R&D and spend a great deal of time in surgery but none seeing patients.
Managability depends on symptoms though...you can't treat x-rays.
People with spondy's actually do better with fusion then people with DDD.
Depends on their desire to have surgery vs live with what pain they have.
Just don't be one of the sleezy chiro's that keeps people coming back for more when you know they aren't getting better.

[Kratos]

Yah that's a pretty ugly MRI bro...have you looked into other means of care?...you have virtually no curve in your lumbars and it seems to me unless you get some care going to correct that you are gonna have continuous problems with discs, Degenerative Joint Disease, ETC..

he needs a 2 level fusion (or depending on surgeon opinion on the issue as it's a controversial subject, total disc replacement) if your assesment is by MRI only (not a complete way to look at surgical needs). Anterior colomn support will help resore lordosis.

[RockyX]

Just don't be one of the sleezy chiro's that keeps people coming back for more when you know they aren't getting better.

Lol..I have no intent on doing that lol...there are chiros that do true...there are also surgeons that perform unneccessary surgeries..over 48,000 people a year die from surgeries that a board of surgeons determined were not warranted and were unneccesary. theres sleeze balls in every profession. realigning bones or restoring biomechanics is a lot like getting braces...it takes a while to realign things the way they should be...in chiropractic its a lot less long term of course..if your not seeing results into your 3rd week on complicated problems..its probably time to look at other options.

[jfalco]

Well that all sounds and looks to familiar. My doc is saying I need a fusion. I wish my MRI looked as good as yours. LOL

OMG that hurts just looking at it.

[Kratos]

OMG that hurts just looking at it.

pft, I've seen much worse

the ones that make me cringe are always the trauma cases

the cervical spine traumas where the person will be forever a quad are just depressing

[Kratos]

one time this drug dealer got it in his head he could fly...well, turned out he was wrong as he jumped out the 4th story. After they got him stable enough to actually work on his spine...turned out everything from t-10 to l-5 had just bursted to peices...I think he will even have a hope of walking again but I'm sure with crutches or something.

I see stuff like that once in awhile...a lot of construction workers fall off buildings, more then you would imagine

[Kratos]

didn't even notice the thread starter was banned...that's kinda fun

[Kratos]

Lol..I have no intent on doing that lol...there are chiros that do true...there are also surgeons that perform unneccessary surgeries..over 48,000 people a year die from surgeries that a board of surgeons determined were not warranted and were unneccesary. theres sleeze balls in every profession. .

I personally know a guy well who cuts on everyone who comes in his office. I know many others who are overly anxious to operate.

[RockyX]

damn bro haha do you have these films? lol I know your not really supposed to share them if they have personal info on them but id find it interesting to see some of the crazy stuff...the xrays I look at are normally like AS, DJD, spondys, sometimes something like pagets or bone tumors...though I learned all the trauma stuff and can identify them, you don't see a whole lot of trauma films in my line of work hehe

[yannick35]

Kratos i do leg press but i manage to do it with 315 pounds sorry and i really dont want to hijack the treat but that really scared me there, my back is well supported.

Can this be dangerous for my spine and lower back, i have been injured in the past MRI showed 2 discopathy but no loss in disk space, i am doing a lot of prolotherapy treatments and everything is going good.

Just dont want to reinjure myself scared

[Kratos]

all the x-rays and mri's I see in surgery only live on in my mind and the people's medical records...I don't get a copy, but in some cases I wouldn't mind having one.

[Kratos]

Kratos i do leg press but i manage to do it with 315 pounds sorry and i really dont want to hijack the treat but that really scared me there, my back is well supported.

Can this be dangerous for my spine and lower back, i have been injured in the past MRI showed 2 discopathy but no loss in disk space, i am doing a lot of prolotherapy treatments and everything is going good.

Just dont want to reinjure myself scared

good question, actually leg press is a bad one for you. stop doing it.

When you bring the knees into the chest on the lowering phase, this, in turn, rounds the lumbar spine and because of the heavy weights typically used the pressure acting on the spinal discs increases greatly. The high compression forces on a bad disc =

in addition you have some shear going on (the pelvis tends to rotate backwards) with this machine, especially at end range of motion.

[Kratos]

If you must use the leg press, go single leg with the non-working leg stabilized on the floor. This helps maintain neutral spine positions.

better still would be bodyweight lunges for time under tension and single leg glute bridges

[yannick35]

If you must use the leg press, go single leg with the non-working leg stabilized on the floor. This helps maintain neutral spine positions.

better still would be bodyweight lunges for time under tension and single leg glute bridges

Thanks me and my girlfriend just bough a leg press hack squat machine, grrrr 1500$, its in the basement and took 3 hours to put togheter.

I dont feel it in the lower back when i leg press, i do it very slow and i dont get my knees to my chest. My lower back and pelvic never lift up, i am always very well supported, i also use a weight lifting belt that is really tight keeps the lower back in place.

Kratos i forgot to mention that i do inversion table daily has well at least 5 minutes a day after training. I dont have pains in the lower back a part the ligaments that pull but even that is a lot better since prolotherapy.

I have been cleaning up my diet and taking glucosamine complex daily along with collagen, i did see some studies of a person that was able to rehydrate is disc doing this but it took 2 years.

I do not have the money right now to get another MRI, i just lost my job and since insurance covers 450$ on the 650$ that the MRI cost i cant really afford to pay that 650$.

But has soon has i find another job i will get an MRI and see if my disc have rehydrated, from what you said last time it was not that bad

ongoing back pain Doc sust if you are still around

This is a link to my MRI pictures taken last year.

Once again Kratos i must thank you for your time and help.

[beatango2008]

I've had a herniated disc about 7 months ago. It pushed out so far it caused conpression against my sciatic nerv, It caused a numbing and pulsating pain throughout my left leg, by far the greatest pain i've ever been in.
The doctor wouldnt give me anything but IB for the pain, and some cheap anti inflamatory crap. They just gave me the run around sending me to 4 diffrent doctors.
So I decided to let it heal on its own, but its been 7 months about since then, and I can still feel it in my back if I do strenous work. My advice would be to, lay totally off the lifting till it heals.

[yannick35]

I've had a herniated disc about 7 months ago. It pushed out so far it caused conpression against my sciatic nerv, It caused a numbing and pulsating pain throughout my left leg, by far the greatest pain i've ever been in.
The doctor wouldnt give me anything but IB for the pain, and some cheap anti inflamatory crap. They just gave me the run around sending me to 4 diffrent doctors.
So I decided to let it heal on its own, but its been 7 months about since then, and I can still feel it in my back if I do strenous work. My advice would be to, lay totally off the lifting till it heals.

The good news in there is that a hernia does heal. I had read some studies saying it can take up to 6 months to heal.

Lets see if i can find them and i will post the links here.

There is a great website that i got too a lot called rebuildyourback.com lots and lots of great info on there.

There is a study that is very intersting in there about people and MRI, this was done on a lot of people who did not have back pain at all.

80% of them had some disc degeneration and hernia but felt no pain at all, in there day to day activity.

[beatango2008]

The good news in there is that a hernia does heal. I had read some studies saying it can take up to 6 months to heal.

Lets see if i can find them and i will post the links here.

There is a great website that i got too a lot called rebuildyourback.com lots and lots of great info on there.

There is a study that is very intersting in there about people and MRI, this was done on a lot of people who did not have back pain at all.

80% of them had some disc degeneration and hernia but felt no pain at all, in there day to day activity.

Good post, I'll have to check out that website,
thankfully my pain is not anywhere close to it was when I first got it.
I dont think it will ever heal 100% and if it does you will always be proned to re-injure it.

[yannick35]

Good post, I'll have to check out that website,
thankfully my pain is not anywhere close to it was when I first got it.
I dont think it will ever heal 100% and if it does you will always be proned to re-injure it.

This is where core strenght training comes into play, i do not have a hernia but be sure that i dont life heavy anymore, today i did leg press 2 plates on each side, i shoot for reps 12-15 reps slow motion.

Also i have dropped 15 pounds in the last 3 weeks, i been layed off that will do this to someone, good news is that my blood pressure is 120/80, when i was heavier it was 140/90 not good.

I rather be small and still lift weights then be bigger and injured all the time.

squats, deadlifts, standing press, front squats, shrugs heavy are not in my training regiment anymore, do i miss them hell no LOL

[Kratos]

It kinda goes by the rule of third's when it comes to HNP.
1/3 get better
1/3 stay the same
1/3 get worse

You can't really say disc herniations heal. Eventually you may have to do something about it, should it not get better on it's own.

[RockyX]

It is true that somewhere around 80% of people have some sore of disc bulge and do not know it..but that doesn't mean they should be taken lightly, there are different variations of herniations...it can cause a lot of pain when it is rubbing against a nerve like in Beatango's situation. It doesn't take much irritation at all to cause a lot of pain, and in fact the weight of a dime on a nerve can render the nerve completely useless and cause paralysis of the muscles and such that it innervates. Beatangos..there are many people who deal with disc herniations without surgery, I can give you some pointers if you like, just drop me a PM

[lovbyts]

1/3 get worse
That was me, mine was bad for 20+ years and just kept slowly getting worse until I could not walk more than 10 minutes at a time. (L3 & L4)
I opted for surgery. It was great in my case and I felt MUCH better the day of surgery and after for the next 2 years unfortunately once you have had surgery you have about a 50% better chance of herniating the disk above or below the fixed one. I did L5

When mine ruptured it was immediate. I lose all feeling from my lower back down to my feet. I mean EVERYTHING except the pain. It was almost impossible for me to walk more than 30 sec. I mostly crawled/dragged myself for the next 10 days and had NEVER been in so much pain.
3 750 mg vicodine, 1 Valium and 1 morphine got me to where I could relax and sleep after not moving for 20+ minutes on the floor.
18 months after 2nd surgery I still have pain (bearable) and numbness in my feet and my a$$ a little. Nothing a vicodine once in a while doesn't help.

Yeah I may do the fusion one of these days but I'm working on the core for as long as I can and gona try some Deca along with my HRT to see if that helps any???

[batlin]

Just came across this thread, I herniated my L5- S1 disc back in Oct.. I did physical therapy for 4 months till I had to see a pain management dr. I got 2 ESI (Epidural Steroid Injections) over a course of a month and it made a WORLD of difference. My disc (looking at MRI) was severely herniated into the Siatice nerve and caused pain down to my foot.. After the ESI I was in the most pain of my life from the added pressure of the Steroid in my epidural space, I went on Toradol for a few days which HELPED immensity and I was 100% without pain since April. I was given full clearance to go back to the gym and all I was not aloud to do was leg press. It has just started to flare up again but nothing like it was and it is only because the steroid has worn off. but I am back to the gym doing low weights (was out of gym since Oct.) They say I will be 100% by end of year..

[lovbyts]

Just came across this thread, I herniated my L5- S1 disc back in Oct.. I did physical therapy for 4 months till I had to see a pain management dr. I got 2 ESI (Epidural Steroid Injections) over a course of a month and it made a WORLD of difference. My disc (looking at MRI) was severely herniated into the Siatice nerve and caused pain down to my foot.. After the ESI I was in the most pain of my life from the added pressure of the Steroid in my epidural space, I went on Toradol for a few days which HELPED immensity and I was 100% without pain since April. I was given full clearance to go back to the gym and all I was not aloud to do was leg press. It has just started to flare up again but nothing like it was and it is only because the steroid has worn off. but I am back to the gym doing low weights (was out of gym since Oct.) They say I will be 100% by end of year..

That's good to hear.

I have done the epidural 3 different time. NEVER did anything for me, nothing. Only think that helped AFTER the surgery when I really irritated it and got the sciatic never going was a regiment of prednisone (hate the stuff, water weight) and ICE for several days.

[Kratos]

1/3 get worse
That was me, mine was bad for 20+ years and just kept slowly getting worse until I could not walk more than 10 minutes at a time. (L3 & L4)
I opted for surgery. It was great in my case and I felt MUCH better the day of surgery and after for the next 2 years unfortunately once you have had surgery you have about a 50% better chance of herniating the disk above or below the fixed one. I did L5
???

we don't know why that is though. It could be the instability from the surgery. It could be that people who have surgery have discs prone to failure.

With fusion the thinking is, once you fuse a segment, the segments around have to take on additional motion and stress.

You might want to look into disc replacement surgery when the time comes. Keeps the disc moving so the additional stresses don't translate to the next level (in theory).

[lovbyts]

we don't know why that is though. It could be the instability from the surgery. It could be that people who have surgery have discs prone to failure.

With fusion the thinking is, once you fuse a segment, the segments around have to take on additional motion and stress.

You might want to look into disc replacement surgery when the time comes. Keeps the disc moving so the additional stresses don't translate to the next level (in theory).

Yeah I just need to find a GOOD doc in my area who does it. I know mine is good but he seems to like fusion over replacement but that's probably just more his specialty.

From the vids I have watched and research online it's still 50/50 on what one is better. Thats why I'm trying to hold out as long as I can before doing it but I have living on vicodine almost daily. Only one a day, sometime none for 1 or 2 days but never more than a week.

I'm leaning toward doing a Deca syscle (I'm on HRT) to see if this aleviates any of the discomfort long enough to help build things up more also. YES I wont lift heavy or hurt myself just because it doesnt hurt. It's just even doing situps or any type of bending still hurts a lot but I do what I can.

What hurts the worst though is any type of lifting that puts pressure on my back, even lifting dumbbells to do curls or bench so I tend to lean towards the machines more

[Kratos]

CHARITE artificial disc v. Lumbar Fusion: Five-year follow-up, SpineJ 2008 Sep 18

--------------------------------------------------------------------------------

Spine J. 2008 Sep 18. [Epub ahead of print]
PMID: 18805066

Prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the
CHARITE artificial disc versus Lumbar Fusion: Five-year follow-up.

Guyer RD, McAfee PC, Banco RJ, Bitan FD, Cappuccino A, Geisler FH, Hochschuler SH, Holt RT, Jenis LG, Majd ME, Regan JJ, Tromanhauser SG, Wong DC, Blumenthal SL.


BACKGROUND CONTEXT:
The CHARITE artificial disc, a lumbar spinal arthroplasty device, was approved by the United States Food and Drug Administration in 2004 based on two-year safety and effectiveness data from a multicenter, prospective, randomized investigational device exemption (IDE) study. No long-term, randomized, prospective study on the CHARITE disc or any other artificial disc has been published to date.

PURPOSE:
The purpose of this study was to compare the safety and effectiveness at the five-year follow-up time point of lumbar total disc replacement using the CHARITE artificial disc (DePuy Spine, Raynham, MA) with that of anterior lumbar interbody fusion (ALIF) with BAK cages and iliac crest autograft, for the treatment of single-level degenerative disc disease from L4 to S1, unresponsive to nonoperative treatment.

STUDY DESIGN/SETTING:
Randomized controlled trial-five-year follow-up.

PATIENT SAMPLE:
Ninety CHARITE patients and 43 BAK patients. OUTCOME MEASURES: Self-reported measures: visual analog scale (VAS); validated Oswestry disability index (ODI version 1.0); Short-Form 36 Questionnaire, and patient satisfaction. Physiologic measures: radiographic range of motion, disc height, and segmental translation. Functional measures: work status.

METHODS:
Of the 375 subjects enrolled in the CHARITE IDE trial, 277 were eligible for the five-year study and 160 patients thereof completed the five-year follow-up. The completers included 133 randomized patients. Overall success was defined as improvement>/=15pts in ODI vs. baseline, no device failure, absence of major complications, and maintenance or improvement of neurological status. Additional clinical outcomes included an ODI questionnaire as well as VAS, SF-36, and patient satisfaction surveys. Work status was tracked for all patients. Safety assessments included occurrence and severity of adverse events and device failures. Radiographic analyses such as index- and adjacent-level range of motion, segmental translation, disc height, and longitudinal ossification were also carried out.

RESULTS:
Overall success was 57.8% in the CHARITE group vs. 51.2% in the BAK group (Blackwelder's test: p=0.0359, Delta=0.10). In addition, mean changes from baseline for ODI (CHARITE: -24.0pts vs. BAK: -27.5pts), VAS pain scores (CHARITE: -38.7 vs. BAK: -40.0), and SF-36 questionnaires (SF-36 Physical Component Scores [PCS]: CHARITE: 12.6pts vs. BAK: 12.3pts) were similar across groups. In patient satisfaction surveys, 78% of CHARITE patients were satisfied vs. 72% of BAK patients. A total of 65.6% patients in the CHARITE group vs. 46.5% patients in the BAK group were employed full-time. This difference was statistically significant (p=0.0403). Long-term disability was recorded for 8.0% of CHARITE patients and 20.9% of BAK patients, a difference that was also statistically significant (p=0.0441). Additional index-level surgery was performed in 7.7% of CHARITE patients and 16.3% of BAK patients. Radiographic findings included operative and adjacent-level range of motion (ROM), intervertebral disc height and segmental translation. At the five-year follow-up, the mean ROM at the index level was 6.0 degrees for CHARITE patients and 1.0 degrees for BAK patients. Changes in disc height were also similar for both CHARITE and BAK patients (0.7mm for both groups, p=0.9827). Segmental translation was 0.4 and 0.8mm in patients implanted with CHARITE at L4-L5 vs. L5-S1, respectively, and 0.1mm in BAK patients.

CONCLUSIONS:
The results of this five-year, prospective, randomized multicenter study are consistent with the two-year reports of noninferiority of CHARITE artificial disc vs. ALIF with BAK and iliac crest autograft.

No statistical differences were found in clinical outcomes between groups.

In addition, CHARITE patients reached a statistically greater rate of part- and full-time employment and a statistically lower rate of long-term disability, compared with BAK patients.
Radiographically, the ROMs at index- and adjacent levels were not statistically different from those observed at two-years postsurgery.



If it were me, I'd be looking at a total disc rather then fusion.
The only really bad things that can happen different from fusion is surgeon error related.
The return to activity is quicker because you don't have to wait for a fusion and you aren't putting stress on screws. You avoid the posterior surgery, and that's the part that f's you up. They can always leave the disc replacement in as a spacer and throw screws in the back later and the result is the same as a anterior posterior fusion.

[Kratos]

You'll have surgeons bag on the charite vs bak study because stand alone cages are a bit of a joke these days. The truth is, when they did the study, that's what was being done. They wanted to avoid surgical approach related differences also.

But, a bak patient that does well does better then a 360 patient at recovery time, and does very well overall. A small percentage of them sink into the vertebal bodies and cause major revision nightmares, and that's why surgeons don't like them. For study numbers though, it's a very good control.