Trying to understand spine injury mechanics

Posted by thracian @thracian, Feb 5 4:09pm

I'm 57-year old in a pretty good shape but recently it appears that the spine is giving me some trouble. When I do resistance training (it has happened with squats, seated row, and bent over row), sometimes I'd get a glute muscle spasm in the right leg. If I'm lucky, I'll be back online within 2-3 days after the pain subsides with no further issues.

However, if I'm not so lucky (it happens twice in the past year), strong late onset pain (in 2-3 days) will start in right hip and glutes to the point I can't sleep or stay upright (no problem sitting). Eventually, the pain will subside in a week or so, but the tibialis muscle will lose power. The previous time this happened, it would take a few months for the tibialis to recover. Currently, I'm going through another episode. I've noticed that when was in pain, spine extensions, such as cobras, will increase the pain.

After the initial strong pain, I don't have pain but the right leg is somewhat stiff (it doesn't feel quite right) and tibialis is week. There is also some right glute inhibition, for example I can't quite take sharp 90 degree turns while walking. Lumbar MRI shows disc herniations in L5-S1 and L4-L5 but they are left and central protrusions (nothing of interest on the right side). Hip MRI didn't show anything of interest. No sciatica pain or "classic" symptoms.

I've been to orthopedic and neurologist doctors and they appear to be as perplexed as I am. Tomorrow, I'm doing an EMG study. I'm trying to understand what could be going on with the mechanics of such injuries so I know what to avoid. Besides resistance training, I do hiking, tennis, HIIT, and yoga.

I'd appreciate any feedback.

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@thracian I am a cervical spine surgery patient. What you may want to ask, is if you have spondylolisthesis, or slipping of one vertebra past another. When you have a muscle spasm, it may move these vertebrae around if the discs are not doing a good job of holding the vertebrae in alignment. It seems your symptoms come on when you bend at the lumbar spine and that may be changing alignment if one can slip a little bit. X-rays taken in different spinal positions could illustrate a problem like this.

Jennifer

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@jenniferhunter

@thracian I am a cervical spine surgery patient. What you may want to ask, is if you have spondylolisthesis, or slipping of one vertebra past another. When you have a muscle spasm, it may move these vertebrae around if the discs are not doing a good job of holding the vertebrae in alignment. It seems your symptoms come on when you bend at the lumbar spine and that may be changing alignment if one can slip a little bit. X-rays taken in different spinal positions could illustrate a problem like this.

Jennifer

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Jennifer. i was diagnosed with Spondylothesis also. October '23. and they say i have a herniated disc L5. is there a difference?

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No spondylothesis noted in the MRI report.

"The L4-5 disc space level demonstrates desiccation of the disc. There is a broad-based central herniated disc protrusion with annular tear measuring 2 x 15 mm in size across the midline indenting the thecal sac. There is a left foraminal herniated disc protrusion with annular tear measuring 3 x 3 mm in size. The right foramen is normal. There is facet arthropathy without central canal stenosis.

The LS-S1 disc space level demonstrates moderate degenerative spondylosis and narrowing of the disc with Modic changes related to stress response. There is a central and left paracentral herniated disc protrusion with annular tear measuring 2 x 8 mm in size indenting the epidural space and touching the thecal sac. A bone spur mildly narrows the left neural fora men. The right foramen is normal. There is mild facet arthropathy."

Also, the EMG test today confirmed L5 nerve irritation although the exact mechanism remains a mystery.

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@danny5

Jennifer. i was diagnosed with Spondylothesis also. October '23. and they say i have a herniated disc L5. is there a difference?

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@danny5 Good question, Danny. Spondylolisthesis describes vertebrae slipping past each other a bit because the disc between them is not strong enough to prevent this. If they say anterolisthesis that means slipping forward and retrolisthesis is slipping backward.

A herniation in a disc happens when the fibrous outer wall has breached and allowed some of the jelly like stuff inside called the nucleus to escape. That is a disc that is weak and likely would allow vertebrae to slip past each other. Herniated discs loose some of their height. My herniated disc was 50% of what it had been. When the nucleus escapes it causes inflammation and often this causes osteophytes (bone spurs) to grow next to the extruded disc material. When that happens, they refer to it as a disc-osteophyte complex. I had that too. This happened in my cervical spine, and it has been corrected with a single level fusion.

L5 is the lowermost disc in the lumbar spine right above the sacrum, and they refer to that level as L5 S1. The sacrum has a few attached levels, and the tailbone is attached to that at the very end of the spine.

Jennifer

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@jenniferhunter

@danny5 Good question, Danny. Spondylolisthesis describes vertebrae slipping past each other a bit because the disc between them is not strong enough to prevent this. If they say anterolisthesis that means slipping forward and retrolisthesis is slipping backward.

A herniation in a disc happens when the fibrous outer wall has breached and allowed some of the jelly like stuff inside called the nucleus to escape. That is a disc that is weak and likely would allow vertebrae to slip past each other. Herniated discs loose some of their height. My herniated disc was 50% of what it had been. When the nucleus escapes it causes inflammation and often this causes osteophytes (bone spurs) to grow next to the extruded disc material. When that happens, they refer to it as a disc-osteophyte complex. I had that too. This happened in my cervical spine, and it has been corrected with a single level fusion.

L5 is the lowermost disc in the lumbar spine right above the sacrum, and they refer to that level as L5 S1. The sacrum has a few attached levels, and the tailbone is attached to that at the very end of the spine.

Jennifer

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no wonder my back hurts so much. all the way down to my tailbone. right now i have a heating pad in this area as i type this. but it gives so little relief. but a little is better than none. thank you Jennifer.

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@thracian

No spondylothesis noted in the MRI report.

"The L4-5 disc space level demonstrates desiccation of the disc. There is a broad-based central herniated disc protrusion with annular tear measuring 2 x 15 mm in size across the midline indenting the thecal sac. There is a left foraminal herniated disc protrusion with annular tear measuring 3 x 3 mm in size. The right foramen is normal. There is facet arthropathy without central canal stenosis.

The LS-S1 disc space level demonstrates moderate degenerative spondylosis and narrowing of the disc with Modic changes related to stress response. There is a central and left paracentral herniated disc protrusion with annular tear measuring 2 x 8 mm in size indenting the epidural space and touching the thecal sac. A bone spur mildly narrows the left neural fora men. The right foramen is normal. There is mild facet arthropathy."

Also, the EMG test today confirmed L5 nerve irritation although the exact mechanism remains a mystery.

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I’m glad you were able to get an EMG they done one on my arms for my neck. The low back surgery last April was a disaster 3 surgeons say nothing is wrong go get a pain stimulator. I was already fused at L3-L4 now since L5 was loose( explains why I would about fall when I would bend over. I had someone twist me 3 weeks after my surgery thinking it damaged something but docs say no. I have so much nerve damage the sciatic is the worst, along with testicle and anus pair. I’m being treated by a pelvic therapist I found out my tailbone was out of alignment so she’s working on that in between therapies she had me take a foam roller up and down my spine leaning on the wall since I can’t get on the floor, and it immediately triggered more nerves ( 2/1/2 weeks of nothing but aching from the waist down) I’ve got to call my neurologist to see about some more tests or a pain stimulator. I’ve also got narrowing of the spine. Disc bulging in my neck that was causing swallowing problem

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If it were me, I would back off the tennis and any High Impact activities with twisting or bending or weights. And Limit the extreme positions in yoga. At least until you get some definitive answers from your Dr's. I had to give up all those things along with golf and 10speed biking. They all caused more damage to my spine. If you work with a PT, make sure they don't over work you. I had that happen to me. Pushing me to do certain exercises that cause extreme aggravation to my L4 disc. Not all PTs are good, some are too aggressive and think they can cure you. Be careful, don't overdo it. Wishing you and everyone less pain .

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If you are leaning toward a non surgical approach I recommend you find a good PT and exercise physiologist to give you a therapeutic exercise program to help heal your back. But at least you now know why you have the pain.

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I have these condition--Gastroparesis, I've had 9 Colon surgeries, One open Haert surgery to replace my Aortic Valve, the last Colon surgery resulted in an infection into my Spinal Cloumn, I couldn't walk for 2/3 weeks until my wife called an ambulance drove to Miami Beach to Mt. Sanai--_{176 miles}she could not drive that by her self---they kept me up there 12 days, then back to Key West where I was born and raised--and after two weeks at home, my wife sent me by ambulance to Kenndall hospital in S.W Miam--another 12 days, then back to Key West,2 weeks later back to Kenndall for another 12 days--my Spine is horrible, I've 2 treatments of Anti Biotics at home one hour a day for --8-- weeks, then back to Kenndall for another 10 days, back to Key West for another -8 weeks of anti biotics. I won't heal I'm --82--years old and I don't think I will ever heal to the --END. Also for patients out there with this--I'm getting tingling in my fingers, I was also a professional music player here for more than --30--years, when my fingers get tinging I can't play the guitar. It's horrible condition, I'm sorry for any one dealing with this condition,
Bobby Pazo--from Key West,Fl.

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Could be a tendinopathy, which can be excruciating and cause trouble walking or sitting or sleeping, instability, leg weakness, etc.

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