Warning: This is a long blog entry. My goal is to help you learn how to listen to your body and navigate the medical system to your benefit for your unique challenges. Some of what is below is graphic (both text and images).
As I navigated the medical system and my options for treatment, I found that first-person accounts of similar accounts gave me hope in finding solutions that were appropriate for me. My desire is that you will use this information like-wise and that you will consider what approaches are most helpful for your unique healing process.
According to a quick google search, over 3 million people in the United States suffer from disc disease annually. Stated simply, degenerative disc disease can range from issues between the vertebral discs of the neck, mid and low back. It's a literal pain in the neck or back, and it is to some degree a natural part of aging. And it can occur quicker with repeated injury/trauma. But it doesn't have to end your life as you know it. Below, I will highlight and detail my own recent challenges with confirmed degenerative disc disease and provide evidence that surgery and other drastic measures are not always the way to go in gaining relief and your life back from this challenging problem.
MRI: Herniated Disc Confirmed
For those needing guidance on this image above, there is a clear and significant protruding disc between vertebrae 4 and 5 of my lumbar spine. The block looking shapes are vertebral discs and the balloon-like structure poking out between two of the vertebrae is the bulging/ herniated disc. Fortunately my disc is in tact meaning that the liquid still resides within the jelly donut. Diagnostics are helpful in determining a treatment plan. If this protrusion had displayed as ruptured instead of in tact, my treatment options may have been different. But, here's how we got to this image:
A Pain in My Hip
Vacation. Soft Sand. The Beach. Who doesn't love that scenario? Someone with an undiagnosed disc protrusion...
Bicycles along the beach, bent forward over handlebars, unstable footing for walking... Those are an absolute nightmare to someone with disc issues. I landed myself quickly in a chiropractor's office July of 2020, shortly after my vacation. The six hour ride back in a cramped and noisy vehicle from Florida to Georgia certainly did not help matters. Everything was literally getting on my nerves, but I didn't know that quite yet. I looked at the first medical professional I could get in front of (everyone was on limited schedules due to Covid) and said: "I have a history of blunt force trauma (falls on concrete in flip flips (Age 16), falls down stairs (Ages 9 and 24), a few equestrian-related spills (various ages)), I have pain around my tail bone and down my left leg. Please send me for diagnostic work." Well, practitioner to practitioner helped as I left with an MRI for my left hip. Fortunately, I didn't go.
Insurance wouldn't cover an MRI ordered by a chiropractor instead of a MD. I decided the ache in my leg wasn't worth $500 out of pocket. So, I spent seven months with two different chiropractors (insurance covered it) within the same office receiving spinal manipulation that sometimes made me feel dizzy post adjustment. I also tried a few rounds of treatment with two MFR specialists. All brought some degree of relief (although I often felt braced and nervous in the chiropractor's office, especially with adjustments to my hips and low back). And all didn't keep me from the pill box (mostly Ibuprofen and Naproxen).
As time went on, my symptoms really didn't get much better. In fact, I developed nerve pain. Cue tingling and numbness down the left leg and SIGNIFICANT pelvic inflammation (not to mention minor rectal bleeding) to which my primary care physician suggested I might have pelvic inflammatory disease. What does PID come from, you ask? Typically, that's from an STI or STD. Well, those were ruled out...
Finally, as the holidays approached I was tired of struggling without gaining much relief. I was crying daily. So, I landed in an orthopedic's office and begged for an MRI. Two rounds of x-rays, one from the chiropractor in July and one in office with the orthopedic showed nothing clinical, although manual resistance testing in-office indicated a problem. "Have your tried physical therapy?" Yes. I had tried physical therapy. She finally sent me for the MRI.
MRI Follow-Up
So, what did the orthopedic suggest following the MRI reading? Epidural steroid injections and possible referral out for laminectomy surgery.
WHOA! ... is what I was thinking.
Let's unpack epidural steroid injections, then surgery as options for DDD/protruding/ herniated discs.
First, steroid injections are mostly anecdotally helpful (to those who have benefited from them, I am super happy that they helped you). Some studies have shown that "People who have local anesthetic injected do just as well as those who have the steroid" according to Mayo Clinic Provider Dr. Bradford Currier. See his Youtube interview here on spinal stenosis (narrowing of the spinal canal- can present with similar symptoms to DDD) and treatment options.
Fortunately, a physical therapist I sought for an umpteenth opinion suggested that the Orthopedic would likely prescribe oral muscle relaxers and an oral steroid pack.
Check please! ... I said and left with a scheduled round of injections and an prescription for muscle relaxers.
And so relief began...
At first, the orthopedic refused to offer oral steroids due to the injection RX (that's shorthand for prescription). Fortunately, my first injection was scheduled over a month out, so I was able to try them before committing to the injections.
At $400 per injection due to a change in insurance coverage from December 2020 to January 2021, I am thankful that the oral medication began my healing process enough for me to start my own program of self treatment. No, I never received the injections.
Why are Diagnostics So Important? Aren't you still living with this issue in your back?
I brought my MRI images to my chiropractor for review. He IMMEDIATELY decided to stop adjusting my lumbar spine. Stated frankly, he wouldn't touch it given the images. I wonder now if he would've ever adjusted my low back if I started with an MRI, which I requested at my initial appointment in July...
Diagnostics help medical professionals give advice. Those of us who practice MFR can often feel into the body's restrictions. Many chiropractors, physical therapists and licensed massage therapists etc. are trained in orthopedic testing to help rule out issues or help you obtain diagnostic proper imaging. We, however, do not have x-ray or even MRI vision. I would not have known to stop chiropractic and repetitive exercises (pelvic tilts and forceful stretching) without an MRI showing the bulge/ disc herniation.
Is the protrusion still there? Maybe. But my symptoms have dissipated to maybe 5% of the time and I have a progression of poses and exercises that I can enact when I have flare ups. I am back to riding horses regularly, lifting heavy items and just overall enjoying a physically active life.
Changes in Lifestyle
Passive treatments and exercises: one of the most commonly suggested PT exercises for low back pain is the pelvic tilt for core/ abdominal strengthening. Oh, and stretching for piriformis issues was also suggested to me.
I found out the hard way, these exercises and stretches made me WORSE (at first, that is)!
Think about it this way: if you imagine the spinal canal as a rubber band attached from the head to the pelvis, every time I stretched or did a pelvic tilt, it pulled the rubber band taught and the protruding disc rubbed the nerves in that section of the rubber band producing more irritation. Cue more inflammation and pain and discomfort and weakness! My body was screaming at me to stabilize and rest and get the irritation off of the nerves, not cause more irritation.
What worked well: my spine needed decompression therapy, rest, and lots of it. There are plenty of options from inversion tables (suggested in February 2021 by my primary care physician who has managed to avoid surgery for four disc herniations), decompression tables (suggested by the last chiropractor I may ever see) and the plain and simple McKenzie Method on the free floor, to name a few. I chose the later, and I'm so glad I did. I bought the Treat Your Own Back book and read it cover to cover (don't skip around... seriously, this book teaches you to read your body and treat yourself according to the progression or regression of your symptoms). What excited me as I read the book was how familiar I already was with the process. Each pose is required to be held a minimum of five minutes. As a John Barnes MFR Practitioner, know that it takes fascia's collagenous component (think connective tissue and the dural tube/spinal ligaments) a minimum of three-five minutes to begin to release. So, I held the poses longer and let whatever associated emotional connections to flow out of my body as well... Sometimes there were tears. Sometimes I need to scream. No one got hurt. No one died. Expression is critical to healing.
Combining McKenzie Method poses/exercises with the expression and time elements of Myofascial Release was critical to my recovery.
I spent at least two hours each day on the floor/ on my massage table laying flat on my tummy and pushing up into extension. I also began to use the floor or table as first aid when I felt a flare up.
Yes. I spent a lot of time on recovery. And sometimes I would get off my table or the floor and not quite feel 100%, but with each passing day I could more quickly eliminate inflammation if it arose and I grew stronger with each decompression session.
Things I still do to this day: I am laying on my massage table writing this blog. I lay down or stand more often than I sit. Sitting, especially on soft chairs and couches is absolutely detrimental to the low back. When I do sit at a table, I sit erect, with the best posture possible including driving my heels into the ground and using that force to engage my abdominals so that my lower spine and all of my upper body is supported.
I plank a minimum of 2 minutes per day, sometimes incoporating pelvic tilts as well (now that my nerves aren't irritated, I can incorporate more movement based strengthening). The plank without movement/pelvic tilts is how I began to strengthen my core without aggravating the nerves around the disc. I didn't add the pelvic tilts until I could confirm they would not lead to more irritation. After planking, I will often fold into child's pose to give my lower back a release in the flexed position. I also use a couple of ramps (tennis shoes can be used) to passively correct an anterior pelvic rotation and a four inch squishy treatment ball to release restrictions in my abdominals that are pulling on my spine.
Nutritional Considerations: Prior to feeling icky, my diet starting incorporating more red meats and alcohol on sometimes a weekly to twice weekly basis (no, I'm not proud of that). Widespread knowledge now suggests that both of these items negatively affect health when not consumed in moderation. I have largely scaled my consumption of both back since December and have incorporated more leaner meats (chicken, turkey, fish) and elected to consume non-alcoholic beverages (preferably water) more often.
New Tools: new bed (prior to a change in sleeping surface, I was sleeping on a very cushy mattress. The plank is the firmest foam, comes in a box mattress I could find), car seat cushion (this opened my hip angle while driving), lumbar roll while sitting/driving (decreases pressure on the lower spine) I normally just roll up a jacket or blanket of some sort so that I can adjust the width as needed, but a link to the recommended tool is above.
Please note: I do not receive any kick backs from the highlighted products in this section. I simply wanted to share the specific tools and living changes that have helped me achieve physical wellness despite dis-ease. Healing is often requires a multi-faceted approach. One must closely examine the process by which one becomes sick (if not only attributable to a specific instant injury), eliminate or augment contributing factors, and maintain those changes.
Acknowledgements
Few of us can truly thrive on our own. Navigating and healing from any disease, disorder or the like requires individual determination but also an incredible support group. I am simply indebted to my clients for their understanding as I took time away from serving many of them to heal my own body. Further, I am supremely grateful to my endearing partner Jason Lawya and long-time best friend Cecili Reid for their continued check-ins and support of my seemingly at times excruciatingly slow process of decompression and regaining of strength. Additionally, I am thankful to several other friends who happen to be in the therapy business for sharing their expertise and guidance: Tess Donnelly PT (retired), Greg Zimel PT and anyone who has offered their thoughts and shared their stories who I have not mentioned.