# Herniated L5-S1 Disc: What does the comeback trail look like?



## Dajianshan

It appears I have a herniated disc at the L5-S1 and I am going to start a mixed physical therapy regimen tonight. I really don't want to stop with the symptoms, but rather, I need to go to the source of the problem.

What does my comeback trail look like as a cyclist. I hate having physicians that are not athletes. Prescription: Don't ride. 

This is the short version: 

I had a little soreness in my back that would come and go depending upon my fitness. I had had some medial knee pain and a bit of back soreness, so I had a refit with the RETUL system. The knee pain went away after a couple of weeks (good). I thought I might try to stretch my legs and back a bit more to possibly loosen up the tight area in my back. 

I did a standing reach and immediately had a jolt of pain zip down my sciatic nerve into my foot. I was hobbling for a week. The pain ebbed away and I did one more ride, which aggravated the same spot. I took a month off on vacation and used heat to treat the area. The pain mostly went away. I did a couple short rides when I got back, and the pain returned. I saw a doctor, and she described it as a herniated disc. The x-rays were negative for fractures or anything else. 

I suspect this issue may be coming from a muscle imbalance and I am reluctant to change the bike fit as this condition predated the revised fit. 

Now as I do my PT, what are the steps I should be taking to locate the root of the problem and correct it to prevent recurring issues?


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## bq_or_bust

.
the root of the problem is that you have a herniated disc. the herniated disc is pressing on your nerve as it is coming out of the spinal column. i'm unsure if it can be moved back into position, but, developing the muscles around it and working on your posture will help it from recurring.

the l5 - s1 is part of the bending part of your back so it takes a toll when you are in the road riding position. best not to ride your road bike for awhile while you rehab; maybe a very upright hybrid. anything that would cause this area to inflame should not be performed. when i had a lower back issue, my pt described it as a mini fire in that area. at this time do not do anything to disturb it because it can become a bonfire. when this happens, it's a step backwards.

other things you can do when it is aggravated is get acupuncture or tender point injection with lidocaine (western way for acupuncture). lidocaine is just an analgesic. the western tender point was very beneficial to me when my back starts hurting.

if you're getting horrible sciatica, you should consider a cortisone (steroid) injection into the spinal column (aka epidural). this would decrease the inflammation of the nerve. the md said you will know if it worked or not within a short period of time. it worked for me.

i didn't read everything, but, it looks informative.
http://forums.roadbikereview.com/general-cycling-discussion/herniated-disc-need-advice-158397.html


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## robdamanii

I've got the same thing myself, and I'm currently treating several cyclists with the same (or very similar, L4-5 level) injuries.

First off, I can only give recommendations, since you're not a patient. 
Second, everyone is different, so what works for one person doesn't work for another.
Third, get some advanced imaging to understand what you're up against: you don't want to be dealing with a sequestered fragment or something of that nature in a rough and tumble way (potential risks are still low, but they are there.)

What I've done with the cyclists in question:

-I treat each of them for their condition using passive therapy modalities, soft tissue therapy and manipulation as warranted.
-I've had each one of them in to the office on their rollers so that I can view them in a riding position. During which, I've corrected several different muscular or form imbalances on each person (best example is one woman with a left sided disc - her back always rolled or twisted to the left when she activated her hip flexor and pulled over the top of her pedal stroke on the left side, compressing the disc and causing pain with each pedal stroke. Working through some NKT protocols on her and getting her hip flexor, QL, TFL and adductors to fire normally again was a significant help.) She also had some pretty significant compensatory patterns built elsewhere into her body as a result of being hit by a car, with some muscles being facilitated and some inhibited. Clearing those out helped a lot as well.)
-I've tried to stress to each of them that when riding you shouldn't be bending at your lumbar spine or lumbosacral spine: you should maintain a neutral spine and "roll" your pelvis forward in order to achieve the correct position. 
-Myself and our PT have spent a lot of time with each of them building a stability program catered to them specifically. Utilizing things such as chops, lifts, turkish getup, etc in conjunction with a functional movement screen and some NKT work, they can build significant core stability at home which will help to keep their spine supported while on the bike.

One of them has been for epidurals with moderate success. Sometimes that is the key to getting a jumpstart on things, sometimes not.

Since you describe pain in your knee prior and a change in bike fit, I'd suggest looking for a physio, PT or someone else who is NKT (NeuroKinetic Therapy) certified or experienced. The concept behind it is that when injured, some muscles will shut down to protect themselves or the injury. Since each muscle has a specific function, some other muscle needs to work for it in order to keep the system operational. After some period of time, that muscle is overworked and fails, causing more issues. If you suspect muscle imbalance, that's the way to determine exactly what it is and clear it out.

More than anything, pick yourself a good clinician that you trust and that will listen to your wishes, work with you and has an end goal of getting you back on the bike. As I said, PLEASE take the above with a grain of salt: I'm not your doc, nor do I know your health history or the exact nature of your injury, but I know you're a big mileage guy and hopefully it helps in one way or another.


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## bahueh

I had that about 7 years ago. the herniation was so bad that surgery was my only option. surgery sucked...was on my back for a week afterwards. PT started and lasted about 6 weeks. mostly core strength. I'm fine now, ride all the time, pain free. do your exercises, trust the system to work it out...and yes, you'll be off the bike for a few months. your body is broken, don't rush it and let it heal properly.


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## Cervelo S-5

Hi Dajianshan, I do not know if I can help you, but I believe that I may be able to put your mind at ease.

Firstly, let me say that there is no guarantee that you even have a herniated disc, and robdamanii is quite correct that you need further imaging to confirm that diagnosis. It can be diagnosed in a clinical setting, but there are a few much less ominous things that can give you the same symptoms as a disc frank herniation. An annular bulge or a very acutely inflamed facet in the region can do the same thing to you. Even if this is a frankly herniated disc, it is not the end of the world and surgery is not a requirement. As one that sees this type of thing in my practice at least on a weekly basis and has had great success treating these issues take a deep breath and do not panic. 

First off, one cannot tell if a disc is herniated via X-ray period. 

Second, I feel that you may have made some errors in how you have been dealing with this. For example getting back on the bike too early, heating an acutely inflamed area will only serve to add to the inflammation and increase you symptoms; ice is the way to go for this.

Invasive techniques like injection to the area should be considered very carefully as the risk of infection to the area is too high for my liking and infections in this area can be devastating so personally I would avoid this type of thing like the plague. Cortisol injection as an anti inflammatory treatment that is also an invasive technique that need not be considered or even used in this early phase of the game as they are pretty radical treatments. I would stick to a more conservative approach with a clinician that you trust and has some experience in this area (even before advance imaging like CT or MRI) and if you get no results, those other options are still in place.

In my opinion, you comeback trail is fine, just be smart about it and be choosy about the treatments that you endure. 

Hope this puts your mind at ease some.


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## Dajianshan

Thanks guys! This is all very good to know. 
It is very difficult to find any type of sports injury specialist where I am. I did go in to see a doctor who specializes in traditional medicine. He did some acupuncture what relieved the symptoms in about 10 minutes. I was then sent to the muscle manipulation specialist for a bit of alignment work. It worked for a while.

My fitter noticed I had been underusing my hamstrings and relying on the outsides of my legs for my climbing power. I also have a slightly shorter right leg. I probably have tight hip flexors as well. The real trigger came from stretching. On the bike I feel totally fine. 

I will take some time off the bike and work with the specialists we do have here to tame the pain. 

When might it be a good time to start the strengthening work? If that is causing the problem, I would like to start fixing it.


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## Cervelo S-5

My friend................GO TO A CHIROPRACTOR!!!!!!!!!!!!

All you have to lose is your pain!

Best wishes


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## Dajianshan

Most of our traditional medicine guys are chiropractors. I have an appointment with a Western style (not in cowboy boots) chiropractor, but the earliest appointment I can get is in two weeks.


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## bahueh

Dajianshan said:


> Most of our traditional medicine guys are chiropractors. I have an appointment with a Western style (not in cowboy boots) chiropractor, but the earliest appointment I can get is in two weeks.


so, how'd it go? doesn't sounds like a complete herniation. only a CT scan can diagnose that. if it's not, you have plenty of options...and a lot of exercise to do. 
good luck.


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## Dajianshan

It is a herniation on the right side as my spine has been tugged to the left. Comparing X-rays from a set I took two years ago, my lumbar has moved at the L4/L5. Cat Scan revealed mild herniation. I have a whole slew of stretches to do each day. The pain went away in my back, but I still get some mild pain in my right buttock adjacent to the tail bone, usually when I straighten my leg out. I have also developed a mild medial knee pain... where the old knee problem was. The doc says it is just the sciatic nerve talking to me. 

I have back stretches, pelvic stretches, psoas stretches. The doctor also has me doing some core muscle exercises. In about a week or so, I will start doing light leg exercises to more evenly distribute power and workload between the right and the left. 

Things are improving, but I won't get on the bike for a little while.


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## Tachycardic

Would you consider a recumbent bike?


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## VCRC Bike

Here is my experience and what I have done to cope. I don't think I will ever be fully free of discomfort but at least I can ride and live a decent quality of life.

I had a badly herniated L5 disc. I actually herniated it over and over, I lost count after I got past the tenth time. I would feel it herniate, usually when bending over and I'd have to lay on the ground for a week. I can't describe the feeling, just that I'd say "oh crap" and within minutes the sciatica would be horrible. This went on for about 5 years. Then in 2009 it went for good. Was on my back for 2 months, then had surgery. Surgeon said it was 2 separate herniations coming out of the same hole in my L5/S1 disc. One of the worst he had seen.

Surgery went great, I resumed riding again 2 months later. Was able to resume racing cyclocross with time. Fast forward 4 years to 2013 and I re-herniated it. Different this time, not as much pain but still messed up enough I couldn't do much. MRI showed a significant herniation in the L5 again. Ended up having 2 epidural injections.

Have also started "Foundation Training" which really helps strengthen my back. 

But I swear, the best thing I can do for my back now is this. After each and every ride, I do a few strectches (Yoga Cobra and Cat/Cow) and then I lay on a tennis ball. I find the spot that hurts, usually in my bottom along the sciatic nerve and I lay there until it releases. That seems to have helped more than anything. A lot of disc issues that involve sciatica cause the pirifomris muscle to tighten which causes the leg pain. The tennis ball helps with that.

Chiropractic just made my pain worse, although it works for some. Doc says they can do one more disectomy and then the next step would be fusion. So I am trying to avoid that the best I can, by stretching and strengthening my back.

I have also moved my handle bar height up considerably. Bought a Roubaix with the endurance geometry. Seems to have helped me.


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## woodys737

L5S1 and L3/4 ruptured in late 2009 and 3X in 2010 getting back too soon.

The only thing that helped was an extensive PT routine to balance, rebuild and activate muscles that stabilize the spine. I was pretty messed up posterior/anterior, top to bottom, left to right. My posture on and off the bike was something I really didn't think about but was also central to recovery IMO. Stretching is the last part of the routine that I now engage in but never did before. The pain was 24/7 for months after my last insult. I can't adequately explain here how messed up I was but, I was essentially an old crippled man in my 40's. IIRC about 6 months into the routine I started to think I was getting in front of the problem. I spent another 6 months or so off the bike doing PT to give my tissue enough time to heal and ensure the routine was routine. 

Maintenance of this routine is now a part of my life.


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## Tachycardic

Asking for a prognosis for your condition is like someone asking which bike to get; you're going to get a ton of answers because there are so many variables. You're going to have people with mild degenerative disc disease to people with full-blown cauda equina syndrome chime in and it'll make you nuts sifting though other peoples' experiences. It's best to develop a plan with your PCM and physical therapist first. If you are seeing a spine specialist, great, but many won't perform surgery without knowing that you have undergone extensive physical therapy, or some minimally invasive procedures like spinal injections. Depending on the provider, they may not automatically jump to an MRI. With health care costs spiraling out of control, there are many providers who would rather wait a few months and try conservative/non-invasive therapies first. And unless you're having numbness/tingling in both legs that radiate below the knees, or if symptoms are progressing at a rapid rate, there's nothing wrong with that approach.


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## Oxtox

I herniated L4/5 a few years ago. the pain was severe, the first 12 hours were almost unbearable. the following 24 hrs were no picnic either. looked at surgical and non-surgical options...even tho my research showed that patients had the same rate of recovery whether they chose surgery or did nothing, and as much as I do not like invasive procedures, I went with outpatient micro-discectomy and multiple weeks of post-op PT.

I mowed my yard the day after surgery. I rode my bike (2 blocks) two days after surgery. both were fairly stupid ideas, but that's just me being a dumbass. I resumed riding within a month, but could/would not sprint or climb out of the saddle until about 3 months post-op.

I had chronic, low-grade pain at the herniation site for about a year after surgery. a dedicated regimen of yoga helped the pain levels diminish and at 24 months post-op, I ceased to experience any back discomfort. however, 6 years later, I still have some random cramping/numbness of the left quad that is directly related to the herniation event.

if I had it to do over again, I think I'd try chiro / PT instead of getting cut on.


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## NorCal FNG

This book 
The Trigger Point Therapy Workbook Self Treatment Guide for Pain Relief 2nd Ed 1572243759 | eBay
and some core work have cured a life time of back problems. 

I used to suffer almost daily and had weeks when I could not walk but I am about 99% pain free now and ride when I want as much as I want all from getting a few muscles to let go and building up a few others to take get things back in ballance. This book can fix things the doctors will tell you are uncurable without surgery. Give it a try you will not be sorry you did


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## Dajianshan

I got back on the bike January 1. There is lessening discomfort with each ride. Lots of stretching the hip flexors and core exercises. A 35km ride feels like a century, but I am now feeling much better.


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## easyridernyc

my hs basketball coach struggled with a bear, tough guy but that back had him in tears

thing was, he didnt know when to back off. he was a young guy, D1 ahlete, coached three sports, wanted to keep up with the kids and his history. but his back had other ideas. i would imagine nothing is better than relatively vigorous low impact exercise like cycling. unlike contact or collision sports that threaten direct trauma to the affected area, i would think low impact, no load bearing exercise gives you an opportunity to work out just about everything BUT the affected area, improving your overall fitness level, promoting function in the necessary and collateral areas adjacent to the injury, and perhaps more important, contributing to the holistic, emotional sense of self improvement and self esteem that many feel is elemental to the healing and recovery process itself. that's why you're already starting to feel better, your body may actually be going about a comprehensive healing process, exercise is good that way. 

i wouldnt overdo it, though. listen to you body, listen to your back, you only have one. the thing about the disc injury is that once it ruptures, as i understand it, its never going to be the same. so the last thing you want to do is rush the rehab and rupture it again, cause at that point, although we may not necessarily be talking about chronic pain associated with the injury, we do start thinking about permanent tissue damage. which like the original injury itself, has to be addressed in the context of treatment and rehabilitation. dont rush it. and let the doctors, the MEDICAL doctors, know what's going on. your feeling good is likely going to make him feel good enough for him to get on board with the best case scenario prognosis and make it a functional part of his treament plan. which is a good thing, he'll give you benefit of best advice and treatment. 

just dont try to be a effin hero. listen to the pain, ANY pain. if it hurts, slow down. then stop. if it hurts a lot, stop. and dont start again until you have a legitimate understanding of what caused the pain to begin with....


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## Dajianshan

The pain is gone. Doc says it has healed. I still do certain exercises to move the spine a little bit. I have a grand total of 65km of flat spinning over three weeks. Road to recovery.


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## ttimpe

I had Surgery lumbar laminectomy fusion November 14, 2013. L4-L5, L5 -S1 fused together. Just got cleared to ride my bike and start physical therapy February 25, 2014. I got fit march 1st and need to get a different bike cause I need a comfort bike now so I'm going with a Trek Domane 4.3 my hip flexors need some work along with my thighs. But I will get better as time goes on there is hope!!


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## adjtogo

I have degenerated discs in L1-3 and C3-5. The L1-3 discs are the worst, but the C3-5 can go out on me at anytime. I've been on/off steroids, multiple anti-inflammatory meds, been to physical therapy, had accupuncture, been to a massage therapist, a chiropractor, and even a surgeon. I've not only had x-rays, but MRI's as well. The fluid between my discs is very minimal and there's not much more they can do short of surgery. With very little fluid between the discs, they slip out very easily. The best advice I can give you is to seek alternatives than just seeing an MD. Massage does help as well as seeing a chiropractor. The best medicine is rest though. I work on my core muscles a few days a week. I'm supposed to use resistance bands to stretch out my muscles in my legs and back to relieve the pressure, and do some exercises to help stretch and strengthen the core muscles. You might want to do that too.


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## Dajianshan

Is for me, I am building back. I do about 100mi. per week as my plateau for now. I just need to keep stretching my hip flexors and other muscles. The fun is finally coming back. I may be able to get back to racing this year, but I am not going to push it.


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## woodys737

Dajianshan said:


> Is for me, I am building back. I do about 100mi. per week as my plateau for now. I just need to keep stretching my hip flexors and other muscles. The fun is finally coming back. I may be able to get back to racing this year, but I am not going to push it.


That's awesome! Folks that have never had to endure this have no idea. 

Once I figured out soft tissue takes a while to heal I really gave it some time. I think I was overly conservative but, I took about a year off the bike doing PT, etc...

Beyond PT I really spent a bit of energy exploring my fit on the bike and tried to apply what I learned in PT to riding. Nothing new, just worked on pelvic tilt, being more stretched out, proper saddle support, good shoes and insoles/support, etc...which all added up to a much more stable neutral spine while riding. 

Anyways, the point is the combination of strengthening muscles that stabilize the spine and what I think is a much better bike fit have me still going strong today. I'm sure you'll do the same!


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## Nubster

Had a herniated disc at L5/S1. It's now ruptured. Maybe I'm lucky or I just HTFU over time, but it doesn't often bother me and even less on the bike. I find that if my back is arched there's no pain which is nice because on the bike my bike tends to be slightly arched. I have also always slept someone in a fetal position which causes my back to be arched. The jolting of riding mountain bike has never bother me either. Only thing that I hate is I lost about 1/2" of height...lol...I used to be a sold 6'2", now I'm closer to 6'1". I've not had any treatment for my injury but I did find that working out and building muscle and strength in my back went a long way to eliminating pain. I still have the occasional painful day, but that's once or twice a month.


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