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BULGING DISCS #3 October 2021

Back Bending for Lumbar Disc Healing: Too Much of A Good Thing
Just about a year ago, I was diagnosed by an upbeat, online physical therapist (PT) as likely having two injured lumbar discs. She didn’t bother defining the extent of injury, bypassing the usual language of bulging, ruptured, and torn that might have required radiological studies. She was a “go get ‘em” gal that wanted me out of the Bright Angel Lodge parking lot under the transmission tower for my appointment with her and back out on the trails. I was all in: ditch the pain and dysfunction and get moving.

The crux of her restorative prescription was doing back bends in the form of yoga cobra push ups. She was right: they gave me immediate relief and I was back to doing 10 mile flat walks right away. Our planned two-day, 46 mile, 11,000’ elevation gain event of hiking between the 2 Grand Canyon rims was off for the season because of my injury, but at least I could hike and bike.

When we arrived in Palm Springs in December, my recovery wasn’t on schedule and I saw a PT in person that I had seen once before for a second opinion. He basically concurred with the diagnosis and treatment plan. With the benefit of his hands-on assessment, he also noted that though my pain was centered on my right side, that a number of my lumbar vertebrae had reduced mobility between them on the left side of my spine. He performed a ballistic, CPR-like bouncing action to loosen them up and prescribed a daily, 20 minute supported back bend to supplement the cobra push-ups, both to be done for the rest of my life.

Once home, I asked my husband to replicate the ballistic motion while I still had a sense of it in my mind-body. He kindly performed the intervention and I did my exercises, but I gradually got worse instead of better. I was down to only being able to walk 2 miles on flat streets without a pack before I had to return to our trailer to treat the pain as best I could with the prescribed exercises.

After a delay from their office being closed due to a covid exposure, I saw the PT again in February and had my husband join me to listen and watch for any tips on how to help me. He quickly saw that he wasn’t using nearly enough force to restore the mobility to my vertebrae. He upped his game, exhausting himself twice a day for two weeks pumping away at my stuck vertebrae.

Scar tissue purportedly can form in a day and we guessed that there was so much inflammation around my vertebrae that every time that he freed them up, the scar tissue got busy stabilizing the area again by gluing everything in place. It seemed like after 2 weeks, he had won the battle and the rate of scarring plummeted. He gradually tapered the frequency of his treatments and by testing it periodically, concluded that my vertebral mobility was ever-so-slowly improving with no backsliding without the extreme intervention.

Darn it anyway, I still had my chronic buttock muscle pain that frequently had me limping off of the trails. I saw my talented and intuitive sports massage guy back home twice in April. He got me sorted out and I felt better, but his fix for my buttock pain didn’t stick.

Moderation In All Things (not my usual stance)
My muscle dysfunction continued to dog me all summer with my performance on the trails flagging. In September, we were back in town for 2 weeks and it was at the second of 2 appointments that the massage guy cracked the code: I was inflicting some of this misery on myself!

I had previously shared my stories with him about the disc diagnoses and treatments but apparently hadn’t mentioned the daily, 20 minute supported backbend that the Palm Springs PT had prescribed. He blanched.

He said that the life time back bending prescription was all wrong for me. He knew me and my body well and he reminded me of what a ‘high complier’ I am. I do sometimes warn new health care professions of my compliance, knowing that some routinely over prescribe because nobody (except me) will follow their instructions.

After a bit of dialogue, we negotiated a new model for me: the intense back bending regime and ballistic mobility interventions were appropriate for the treatment of my acute disc injuries but were inappropriate for me as a maintenance program.

My massage guy wanted me doing the opposite of back bending, which was forwarding bending, like is done with a yoga child’s pose. The intense treatment for my damaged discs had injured or aggravated the facet joints of the lumbar vertebrae and they in turn sent pain signals into the buttock muscles to non-specifically put the brakes on any injurious activity. Apparently the tolerances between the facets is very tight and they are hypersensitive to excessive back bending.

He sent me out the door with a clear diagnosis and a seemingly impossible treatment plan, which was to devise, on my own, the perfect balance between back bending and forward bending every day to maximize the health of both my lumbar discs and facets and maintain my vertebral mobility. It seemed ridiculous, it seemed impossible, and yet we both knew I would figure it out. I wouldn’t see him for 7 or 8 months but we parted with mutual smiles, knowing from our long history that he had given me what I needed to accomplish my “Mission Impossible.”

After a week, I was a bit discouraged but it was about then that my massage pro sent me a rare follow-up tip on a nuance to a hamstring stretch he had recommended. That seemed to be the missing piece and in three days, I dared to undertake the all-or-nothing, 21 mile hike from the S Rim of the Grand Canyon to the N Rim. Even the previous day, I was uncertain about my ability to do it, but once on the trail, I could feel the dramatic improvement in my body, an ease that had gone missing.

Because of the disc injury, we didn’t do even the one way event 2020 but in 2021 on the cusp of recovery, I completed the arduous journey in 12 hours and 35 minutes with my 2019 performance being just under 12 hours. Too bad we were snowed-out of the full, round trip event 10 days later—it would have been fascinating to see my times for it.

Exposing the Accomplices
My chronic buttock pain has been intermittently dragging me down for at least 35 years. I clearly remember the sharp, aching pain, sometimes to the point of severe cramping, in my right buttock during ballroom dancing lessons decades ago. I also distinctly remember my right buttock muscles tucking under me and staying there when I slid into my car’s driver’s seat 25 years ago. I would literally reach under my bottom and pull the right buttock tissue to the right so I could sit more squarely in the car seat. My notes about my body are increasing riddled with right buttock and hamstring pain comments beginning in 2018, without let up.

I doubt that I will ever know the origin of the muscle dysfunction and chronic, sometimes excruciating buttock pain though I know the laundry list of muscles that have joined-in over the years. I know that somewhere along the way that my excessive lumbar curve diminished, resulting in me injuring my discs because of that lost lumbar extension and vertebral mobility. I know that treating my injured discs resulted in me triggering more buttock pain because the back bending treatment injured my vertebral facets. And I know that for at least the last 10 years, the the lateral hamstring, the Biceps femoris, on my right side, has been an active player in the injury pattern. I know a lot, but I only know a small portion of what has gone on. I am very grateful to have been guided out of this discouraging pain and misery.

My Maintenance Program
My current, self-directed treatment plan emphasizes these strategies:
..Presuming that my spine no longer needs the intense daily back bending prescribed by the PTs for repair of my discs, that my somewhat excessive natural curve and mobility has been restored, and so a more balanced treatment approach is appropriate. I’ll monitor my mobility by doing both back bends and forward bends, like yoga cobras and child’s pose. My husband will continue to monitor my recovered vertebral mobility once or twice a month with the ballistic move.
..My right lateral hamstring is in “project mode” and may always need special attention. Currently, that is in the form of a meticulous stretch in which I switch the rotation of my leg at the hip from internal (toe in) to external rotation (toe out) to stretch all of the fibers near their attachment at the tip. I am also reviving a lateral leg release I found online 8 years ago and drifted away from. Rather than being a stretch, it re-patterns the relationship between the lateral hamstring (Biceps femoris) and the glutes.
..I am doggedly pursuing the lumps and bumps in my right buttock with my 5” massage ball and a lacrosse ball, using my tried-and-true myofascial release technics. My massage therapist identified the huge sacro-tuberous ligament as an irritated tissue than needs long, still pressure to release its tension rather than the 20-30 second interventions I normally use.

At the end of October 2021, I did a demanding 7.5 mile descent on the S Kaibab trail in the Grand Canyon in just over 3 hours, a time I believe is a new personal best, with my usual fast time being 3 1/2 hours. I am increasingly hopeful that if I’m not on the cusp of finally fixing my chronic pain and dysfunction issues that originate in my right pelvic area, that I am closing in on a maintenance routine that will keep my athletic ability high and my pain level low. I hope my story will serve others, will reinforce the attitude of never giving up, and encourage those suffering from pain and dysfunction to keep participating in the pursuit of your own cure or remedy.

When embarking on solving a body issue, first note if it is likely a simple situation or a complex one. In the case of something like a sudden infection, it is usually superimposed on a generally healthy body and so it has a linear solution that works quickly and well, like taking antibiotics. Certainly with back problems and often with shoulders, hips, and knees, those dysfunctions are overlayed on other underlying issues, known or not known. Like with me, I had a chronic buttock muscle dysfunction that probably originated with muscle shortening or adhesions deep within my pelvis but I also developed disc and then facet, injury, which was a mess to untangle!

Consider that you may be dealing with several concurrent problems, especially if an expected solution doesn’t seem to be working. And also, as was my case, a cure may be causing a new problem, like the treatment for my lumbar disc injuries injuring the nearby facet joints. The challenge with back issues is that by the time you have a show-stopper issue you need to fix, you likely have several problems, including splinting by other muscles to stabilize the area to literally slow you down to prevent further injury.

An additional challenge can be distracting radiologic “findings”. If you x-ray someone’s back, you’ll likely come up with a laundry list of abnormalities, none of which may be of any consequence. An individual’s x-rays can present an image of a person in great pain with severe mobility issues and, functionally, they can be just fine.

I had an elective back x-ray done in my 40’s when I started an intense yoga practice because I had been warned that the practice would damage my spine, so I had a baseline study done. There were findings, including arthritis. All of these years later, I recently have had the horrible back pain described above but it was all 100% functionally resolved by treating the soft tissue, none of the pain was due to arthritis in any of the joints.

One elective x-ray finding at that time was arthritic changes in my left sacroiliac joint (SIJ) and a little less than 10 years ago, I started having show-stopping SIJ pain. It is highly likely it was a cumulative yoga injury. In 2015, I went into my “project mode” to fix it. It took about 18 months to be confident that it was fixed, not just OK, but functionally fixed. And it is fixed: I’ve been completely free of SIJ pain ever since. I do wonder however if fixing my SIJ shoved the symptoms of some hidden imbalance in my body to the right side, ramping-up my buttock pain there, sort of a musical-chairs situation. I’d been guessing that fundamental imbalances in my body had been the source of my problems for decades and chasing them down one at a time was the only remedy.

My knees are yet another example of a multi-factorial pain situation. In my 30’s, the radiological findings of my knees were roughness under the patella (kneecap) and lateral compression of the patellas, which meant that my knee caps were attached sideways, narrowing the joint space. Both conditions could account for my chronic swelling, both would be improved by permanently bulking up my quad muscles to literally raise my kneecaps a smidge, giving me more clearance at the joints. I did the exercises and they helped, but I still had chronically swollen and painful knees for the next 30 years.

I discovered do-it-yourself myofascial release in 2016, which I performed for about 500 hours that year, largely on my quads, and my knees have been top-notch ever since. The radiological findings offered an explanation for my knee swelling, not THE reason for it, which was over tensioning of my knee joints from densities and scar tissue in my quad muscles and fascia. Restoring the quad muscles and fascia to good health took the pull off of the knee joints and the joints stopped being injured every day. I now describe myself as having wonderful, not bad knees, though I am mindful of how I use them and have a focused maintenance program to sustain their resilience for regular, 20-mile-long hikes.

When problem-solving issues in my life in general and in my body, I rely on:
..using a ‘macro-micro approach’ to keep switching from the overview to the details
..repeatedly casting a broad net to consider all possibilities for causes and solutions to my issues
..being disciplined in pursuing remedies, particularly in devoting the needed time
..recruiting as much help as I can while knowing that a fix will be the result of my efforts
..presuming that simple solutions will save the day
..always expecting to solve my problem
..believing in the power of the body to heal itself if I can figure out how to get out of its way
..relying on non-surgical strategies to solve body issues
..eschewing therapeutic injections of any kind
..Never giving up! My big problems have taken years to fix but I get there every time!