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Bulging Discs 2020

A Prescription for Successful Self-Treatment
The Palm Springs physical therapist (PT) that I saw for chronic buttock muscle pain on December 1 promptly diagnosed me with a bulging and/or damaged disc at the L4 (lumbar) vertebrae. He must see disc damage like mine all the time since he had a nice hand-out for self-treating my back. Here are his recommendations, which I found very helpful:
1. Avoid bending forward. (The fewer forward bends in your day, the faster you will recover).
2. Always sit with a lumbar roll at your waist. He gave me a roll with a convenient waist strap.
3. Do 10 backbends, yoga cobra poses on the floor, every 2 hours, with your waist remaining on the floor when you lift to straight arms. Once you’ve recovered, continue doing them twice a day forever. Standing back bends are better than nothing; 10 reps also.
4. Lie on your stomach with your chest propped up with pillows, like cobra pose, for 20 minutes a day. Ten minutes is worth doing, 20 is better. Both Bill and I find this compellingly therapeutic feeling and it is quickly becoming a welcome habit. Recommended as a life-long practice. We time-slice it with screen time to improve compliance.

Why Back Bending Is Curative
Our spinal columns are designed with a forward curve at our waists and that curve flattens when bending forward or slouching. The squishy discs between the boney vertebrae can weaken over time from this motion. The lumbar, or lower back, discs are the most vulnerable in the spine. Flattening the curve with extra weight, like when lifting, increases the strain on the discs. A sudden or accumulated strain on a disc can cause the disc to hit its breaking point, causing some gel to leak out of the disc or the disc to shift backwards and to either side, into the nerves coming off of the spinal cord.

Either the mechanical pressure of the disc moving into the nerve fibers or a tear in the disc that releases a bit of gel from it, can irritate the nerves it contacts. Irritated nerves register the irritation as pain and the pain signal is transmitted into the lower body to wherever that nerve goes, like into muscles. The alerts from the nerves can cause the muscles to go into spasm, causing additional pain in them.

Given this vulnerability of the lumbar discs to damage, we’re lucky that the antidote to their injury is as simple as changing our mechanics, to back bend instead of forward bend. The simple remedy is taxing however because bad postural habits are likely what created or contributed to the disc injury and part of why habits are habits is because they are hard to change.

The goal in treating a disc injury is to let the body heal itself, with your cooperation. Back bending physically pushes the disc forward, away from the nerves.

Shifting backwards towards the spinal cord when you forward bend has become a well-worn path for the injured disc, so you must change that pattern with counteracting backward bends. That accomplishes 2 things: the subtle repositioning of the disc forward and, when in its normal position and no longer under stress, scar tissue can be laid down on the disc’s weak spot to patch it.

In my case, relief from disc pain can come in minutes with back bending. I was able to comfortably do a flat, 10 mile walk with a light pack the day after my first damaged disc diagnosis and early in my self-treatment at the Grand Canyon. Feeling like I was solidly on the road to recovery came at about 3 days. The 7-10 day point can mark a substantial improvement in comfort and function. I’ve read that 4-6 weeks of good habits is generally required for more complete healing of a disc problem. I’m in that window now with a second injury and doing much better but am not at all tempted to be reckless with my back. I’m still following all of the treatment guidelines, including minimizing forward bending to the necessities, like washing my feet and putting on shoes. Long term care of my discs will require persistent vigilance.

Mobilization Is A Bonus
The Palm Springs PT with whom I consulted in December used a hands-on technic to loosen my stuck lumbar vertebrae. I was dumbfounded that I had a disc issue and equally stunned that my vertebrae had become immobile. For decades, I’d had excess curve in my low back and had been admonished to diminish it and now, I had too little curve and 3 stuck vertebrae. Thinking back, I wondered if limiting bending and twisting for about 18 months 5 years ago to treat my too-mobile sacroiliac joint had set the stage for this problem. I’ll never know the answer, but it was compelling to accept that my beliefs about my back were totally outdated.

The evening of that appointment, I asked Bill to replicate the hands-on treatment I received from the Palm Springs PT. OK, that was overly ambitious for Bill since he wasn’t at the appointment and I couldn’t see what was being done, but Bill read a little online and succeeded. For almost 2 weeks, Bill loosened my lower lumbar vertebrae each night by pressing firmly down on them and attempting to restore a bit of springiness to the joints. Each night he would coax some mobility back into my lower spine and then the muscles surrounding the vertebrae would cinch it down again by the next evening. But instead of just relying on me doing cobras every 2 hours, having him jostle the vertebrae around each evening improved the pace of my recovery substantially. I doubt that I could have restored their mobility on my own with the only the prescribed exercises and might have needed a return visit to the PT for this work I couldn’t do myself. Clearly, improved mobility was the important part of my cure.
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Doing a 10 minute, supported cobra on the trail at the turn-around to protect my vulnerable discs.

After about 2 weeks, Bill reduced his manipulations of my lower spine to every other night and a little after 3 weeks, I went it alone. I could sense when doing the cobra pose reps that the restored mobility was finally holding from day to day. Some of my old pains returned in my buttocks but I assumed that they were from a purely muscular issue, perhaps the deep belly muscle, the psoas, that attaches on both the spine and the pelvis. I would proceed on my own, searching for any muscular confounders like the psoas, while I continued my maintenance work for my disc repair and vertebrae mobility indefinitely. I could always return to the PT, though given the 3rd surge of the coronavirus was upon us in California with a new variant on the loose, I preferred to stay out of indoors spaces.

I saw 2 PTs in 6 weeks in late 2020 for buttock and leg pain and, much to my surprise, they both diagnosed me with a bulging or torn lumbar disc. The first identified the disc at L5 as the injured one, the second PT diagnosed the damage up a vertebra higher, at L4. I believe both were true. The first diagnosis was made by a PT during a telemedicine appointment while I was under a WiFi tower in a parking lot at the Grand Canyon in October. I found her online, booked, and paid for the 15 minute appointment, and 2 hours later she had me doing a series of moves after getting a verbal history from me. I flopped on the lowered tailgate of our truck while Bill held my phone so she could see the execution of my prescribed exercise, the yoga cobra pose. She was right—the pose did allow me to heal.

The second PT appointment was in person in Palm Springs. He had the luxury of being able to manipulate my body himself and came to the same general conclusion with the same antidote though with more detail. After my appointment, Bill looked up the innervation in the pelvis from the spinal cord at the L4 vertebra and it was an almost perfect match with the muscles we had identified over the months that were in spasm. The list included a back muscle, 4 in the buttock, the TFL or tensor fascia lata at the front of the pelvis, and 2 leg muscles. Pressure from the disc or chemicals from the released disc gel on the spinal nerves irritates them and they pass their complaints on to the muscles they innervate, causing pain and spasm.

We were both stunned that we and others had missed the diagnosis for years, if not decades. One guess is that my pain was more intermittent and more mild than is typical and that mine generally presented as chronic pain, not a sudden onset event. The other confounding piece was that we presumed that pain from disc damage presented primarily as back pain, not as lower body pain. I had been directly treating the painful, lumpy muscles with stretching, massage, and myofascial release for years but those traumatized muscles were secondary to the disc injury; they were the effect, not the cause.

I missed my one and only clue that I had a disc issue the night before I made the virtual PT appointment after the onset of a particularly painful episode. Both Bill and I had used our 2 new massage guns purchased for treating this buttock pain problem and we had worked out the lumps and bumps in the muscles. I blurted out “How can I still be in pain when the muscles aren’t in spasm?” The next day, I had my answer: the pain was caused by the injured disc pressing on the nerves in the spine, which irritated the associated muscles. This was the important next clue to the source of my problems and fortunately were told the secret by the PT instead of having to discover it ourselves after days or weeks of more sleuthing.

Hopefully, never again will we miss the diagnosis of a disc injury when presented with buttock or leg pain. Fortunately, using the repetitions of the cobra pose and/or the 20 minute supported cobra pose, provide almost immediate relief from disc pain, so we will both be able to use them as diagnostic tools and for treatment in the future. If we are lucky, our routine use of these interventions for disc injury will prevent a recurrence in either of us.

Discs degenerate with age and poor body mechanics and bad posture accentuates the effects of degeneration. Both activity and inactivity can contribute to disc injury. In answer to the questions of “Why me” or “Why me now,” the best I can say is “Why not?”.

What a shock, a week to the day after being diagnosed by the virtual PT with a ruptured disc on October 13th of 2020, to experience bliss! Bliss isn’t even a part of my active vocabulary. “Tranquility”, “peaceful”, and “contented” are usually as far as I go on that continuum and yet this was bliss.

I wondered how similar my euphoria was to that delivered by opiates, with which I have no experience. In the shower when it hit, my best guess was that my experience of bliss reflected the sudden absence of pain, of an occult, persistent, pervasive pain that I hadn’t fully recognized until it was gone. I had suspected that I was suffering from chronic pain but it was curious how difficult it had been to pinpoint.
The chronic pain may have been dragging a part of my being down for months, if not years.

Who Knew?
Teasing apart the symptoms to make the diagnosis of a torn disc in the presence of spasm in multiple buttock muscles wasn’t obvious to us. I likely have suffered from damaged disc symptoms off and on for years and I and others have attributed it to isolated muscle issues.

The typical symptoms of a damaged disc include: numbness, weakness, tingling, and sharp shooting pain. These are the expected, nerve-related symptoms. Sciatica, that can be caused by a damaged lumbar disc, usually triggers sharp, burning pain. These were not my symptoms except for one time, the day before I scheduled my appointment with the virtual PT, and which is why I made the appointment. Then, I experienced a shooting pain down my outer thigh with a single step. I’m guessing that the vulnerability for nerve irritation at L4 had gone on for years but was at a low ebb when I abruptly injured the disc at L5 while hiking up a steep hill.

Lumbar disc damage, like I have at S1/L5, does cause buttock muscle pain which can radiate down the leg. It can cause aching, like muscle cramps, but it’s not the usual presentation. Bill frequently wondered if I was having a nerve issue but neither of us could imagine that the predominant symptom of a torn disc could be muscle pain.

Once again, my body has taken me on a journey of discovery, with me learning more anatomy and more about its needs along the way. Listening to one’s body is a powerful tool in managing one’s wellness but I’m still learning to speak its language. Hopefully, my journeys will assist you with yours in some way.