Bulged Disk with extruded cartilage

5 weeks ago in my local strongman gym I was doing some deadlifting, I hit a single at 180kg which is 30kg off my PB and felt a pop like a knuckle cracked so I instantly hit the floor and layed still for a few minutes to see how my body reacted, felt ok until I went to move and the pain was that bad I pretty well crawled to my car, drove to work and lied in a ball of pain until the doctors opened up and gave me some drugs, with oxycotin panadol and nurifin the pain was pretty good while standing and moving around but sitting and going from sitting to standing or sitting down was absolutely horrible, I told the dr to book me in for a MRI, came back with a L1/S5 bulge and extruded cartilage, then got referred to surgeon who said extruded cartilage will dissolve on its own and to never go to the gym again, I talked to a few physios but couldnt find one I was happy with, had a few good emails with one about 2 hrs away who gave me some good tips and a guideline to work with, which I have been doing, 5 weeks later and the pain is about 2 out of 10, if I didnt know the extent of my injury i would be back under a heavy barbell which would prob not end well, lately ive been working on strict pullups/dips and handstand pushups, over the last week ive done some weighted lunged and Bulgarian squats, and yesterday I did some light hang cleans and pushpress, ive felt no pain in any of these movements and physio said to work stuff that doesnt aggravate it,
has anyone else been through similar and got them selfs back to deadlfting and squating? if so how long did it take

Taurus is your man.

It's good to read your are back on the mend, luckily I've never experienced what you had, but I know many who have and going under the knife (fusing discs) is not always the best course of action.

Out of interest is your job manual standing repetitive work?
Work related question; could you honestly say that is so far as lifting in general is concerned you have been poor (twisting,bending)?
I ask because from my experience it's not necessarily the lifting in the gym that is cause.

aren't you a cross-fitter?

[MENTION=11621]taurus[/MENTION];

Best of luck and sorry to hear 69er!

ride29er said:

I told the dr to book me in for a MRI, came back with a L1/S5 bulge and extruded cartilage, then got referred to surgeon..........if I didnt know the extent of my injury.......

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Just FYI:

This may be an example of why doctors should not arrange MRI without clinical signs of nerve compromise - firstly, there is no way of telling whether the L5/S1 bulge is new or old (and if it's old then it's completely unrelated), and secondly no competent surgeon would perform surgery for pain alone.

Even if you had good going pain in an L5/S1 distribution (which might suggest it's acute), without objective signs on examination the MRI, and then the surgeon visit, may have been unnecessary.

Of course, maybe your GP found signs when they examined you and everything done was completely appropriate, but it's increasingly common for patients to demand MRI scans when often many doctors don't understand how to interpret the results. This inevitably leads on to referrals to either surgeons or people like me (Neurology).

It's a big expense on our health system, so even if this doesn't apply to you I hope it helps someone else be investigated rationally.

At the end of the day, the natural history of acute disc prolapses is variable - some will recover really well (with follow up scans showing disc almost completely back where it should be), and some do worse or somewhere in between.

I think following the advice of your physio sounds sensible, and just avoid activities that exacerbate it.

Hope some of this helps.

Helped me and my back is fine. ?

DocSpachemmen said:

Just FYI:

This may be an example of why doctors should not arrange MRI without clinical signs of nerve compromise - firstly, there is no way of telling whether the L5/S1 bulge is new or old (and if it's old then it's completely unrelated), and secondly no competent surgeon would perform surgery for pain alone.

Even if you had good going pain in an L5/S1 distribution (which might suggest it's acute), without objective signs on examination the MRI, and then the surgeon visit, may have been unnecessary.

Of course, maybe your GP found signs when they examined you and everything done was completely appropriate, but it's increasingly common for patients to demand MRI scans when often many doctors don't understand how to interpret the results. This inevitably leads on to referrals to either surgeons or people like me (Neurology).

It's a big expense on our health system, so even if this doesn't apply to you I hope it helps someone else be investigated rationally.

At the end of the day, the natural history of acute disc prolapses is variable - some will recover really well (with follow up scans showing disc almost completely back where it should be), and some do worse or somewhere in between.

I think following the advice of your physio sounds sensible, and just avoid activities that exacerbate it.

Hope some of this helps.

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Like.

I hurt my back bad once bending over to pick up a footy. Second time deadlifting and felt a squishy pop in my back. Like squeezing a grape between your fingers. Took me half an hour to slither on my guts to the couch 5 meters away.

Pain killers didn't work great, was in constant pain. I found high rep back raises seemed to relive the pain and get a nice lower back pump. purchased one for my gym and did heaps of them. Seemed to fix my back up and develop a pretty strong lower back.

I notice now when I stop lifting my back gets very painful again.

My other advise is don't go to a chiropractor. ever.

Welcome to years of walking like a duck and periodic agony. Save yourself heaps of heartache and just get it fixed. Physio wont fix this. Would you go to a physio if you had a compound fracture? No youd go to a doctor.

This isn't just a sore back all these joker s have no understanding of the incredible discomfort you are in.

Wait patiently for physio to claim he knows better than doctor despite only having 1/3 of the education and charging 3 times what the thais do better with a tug thrown in.

Brick said:

Welcome to years of walking like a duck and periodic agony. Save yourself heaps of heartache and just get it fixed. Physio wont fix this. Would you go to a physio if you had a compound fracture? No youd go to a doctor.

This isn't just a sore back all these joker s have no understanding of the incredible discomfort you are in.

Wait patiently for physio to claim he knows better than doctor despite only having 1/3 of the education and charging 3 times what the thais do better with a tug thrown in.

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I assume you didn't read my post above, where I explain there are only a very few specific circumstances where surgery is a useful thing.

In fact, MRI scans are NEVER useful in assessing for levels of pain, and the fact there is a bulging disc at L5/S1 does not mean his pain is any worse or any better than anyone else's.

It's just selection bias - people with severe back pain tend to get MRI scans because non-specialist doctors are worried. It is uncommon NOT to find a bulging disc over the age of 40 years; hence, almost every MRI for acute back pain will find a bulging disc but that is not the same thing as have an acute disc prolapse with neural injury that requires surgical repair.

The most important factor in heading towards seeing a surgeon is if there is evidence on trained examination of nerve injury at the appropriate level, which does not get better with a trial of conservative management +/- steroids (systemic, rather than locally injected, usually). There are always rare exceptions but my point is that most people with acute back pain don't even need an X-ray, let alone an MRI, because if the examination is normal it literally doesn't matter if you see a few small bulging discs or not, the treatment is the same.

As one of the people with (more than) 3 times the education of a physio, I'm hoping to help add a bit of perspective to this thread because even many GPs don't appreciate the nuance (that's not a criticism - it's impossible to know everything; that's why specialists exist).

DocSpachemmen said:

I assume you didn't read my post above, where I explain there are only a very few specific circumstances where surgery is a useful thing.

In fact, MRI scans are NEVER useful in assessing for levels of pain, and the fact there is a bulging disc at L5/S1 does not mean his pain is any worse or any better than anyone else's.

It's just selection bias - people with severe back pain tend to get MRI scans because non-specialist doctors are worried. It is uncommon NOT to find a bulging disc over the age of 40 years; hence, almost every MRI for acute back pain will find a bulging disc but that is not the same thing as have an acute disc prolapse with neural injury that requires surgical repair.

The most important factor in heading towards seeing a surgeon is if there is evidence on trained examination of nerve injury at the appropriate level, which does not get better with a trial of conservative management +/- steroids (systemic, rather than locally injected, usually). There are always rare exceptions but my point is that most people with acute back pain don't even need an X-ray, let alone an MRI, because if the examination is normal it literally doesn't matter if you see a few small bulging discs or not, the treatment is the same.

As one of the people with (more than) 3 times the education of a physio, I'm hoping to help add a bit of perspective to this thread because even many GPs don't appreciate the nuance (that's not a criticism - it's impossible to know everything; that's why specialists exist).

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Oh yay a person claiming to be a doctor online. Well instead of clubbing you in the head with my 14" penis that only exists n online dick pulling competitions perhaps your expensive education could teach b that the protrusion is v exacerbate by the force of gravity which is vastly decreased when a patient is v flat on their back in an MRI machine. And before you knock surgery for chronic pain perhaps give v us some info on the success rates of the surgical options.....

Helli disectomy... I'm no doctor but removing a hunk of already weakened structure, yeah that sounds like ba great idea..... Fusion hello 1950 called they want their procedure back..disc replacement bingo we have a winner......

Also I am Friday arvo tradesman drunk typing on a phone not retarded sorry about my grammar.

Sting is removed from my insults when I can't type a sentence correctly but you get the gist

Brick said:

Also I am Friday arvo tradesman drunk typing on a phone not retarded sorry about my grammar.

Sting is removed from my insults when I can't type a sentence correctly but you get the gist

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You back lifting at the moment.

Contact Andrew Lock

only guy who ever diagnosed my torn cartilage correctly, besides myself from reading, including an AFL surgeon who was convinced it was something else.

He is pretty respected with powerlifting relevant injuries.

Brick said:

Also I am Friday arvo tradesman drunk typing on a phone not retarded sorry about my grammar.

Sting is removed from my insults when I can't type a sentence correctly but you get the gist

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Haha mate not a worry, I'm pretty sleep-deprived at the moment so we'll see if I can't do the same.

Totally agree re: gravity and the MRI scan making things even more difficult than they already were. Perhaps another reason why the MRI doesn't correlate well with pain or other non-specific symptoms.

I'm not sure which parts of my post you don't agree with. My point is pretty simple - for isolated back pain, without symptoms that can be attributed to a nervous system structure, surgery is of little use.

Of all the surgical options you mention, I agree they all have their drawbacks. In terms of their individual effectiveness, I have to caution you that I am not a surgeon - merely one of the few who help decide who should have surgery.

However, fortunately for you, the Cochrane Collaboration have a fairly extensive review on the disc replacement procedure you mentioned:
http://www.cochrane.org/CD008326/BACK_total-disc-replacement-for-chronic-low-back-pain

Summary: There is little evidence that it does any better than rehabilitation.

As mentioned previously, I am referring specifically to the group of people who have back pain only, without evidence of nerve involvement.

Acute disc prolapse with acute nerve involvement is a completely different beast, and it is common to treat these mostly conservatively, with those that fail conservative treatment sometimes being selected to see a surgeon to consider intervention. There is no doubt that of those group who are appropriately sent to a surgeon, there is often a significant benefit to surgery.

As with most conditions, the natural history of a condition is important: the fact that most acute back pain, whether accompanied by disc prolapse or not, gets better, means that if you spend a few weeks in agony before going to see a surgeon, there is a high chance your pain will be better post-operatively because it was going to be better by then anyway. And only a select few really need an operation.

The whole point of all of this is just cautious scepticism for people being sent for an MRI willy-nilly by their GP and then referred to a surgeon just because a bulging disc is seen. It really means nothing on its own, and the points above and in my other posts are really critical in deciding whether someone will actually benefit from surgery or they'll be better without it.

Do you agree tgen that a damaged disk is far likely to continue to bulge in the future further weakening surround disc with every instance (marked by nerve pain). That it will only rarely not become more debilitating with time.

I concede the impact can be lessened with time but you will never repair that bulge although us suppose you may get scar tissue(ii dint know all that much about what that tissue that hold the membrane fluid whatever it is dies post injury.

Theoretically if it is nice tight scsr tissue isn't surround disc tgen undr more load.

Strengthen surround muscle helps the disc maintain integrity but the damage is there itll come back and bite you right? Whether that's a year or at 90 it's done it's dash as a healthy little rubbery shock absorber we take for granted?

Bazza20 said:

You back lifting at the moment.

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Nah into fitness or rather rooting. I'm trying for the fuckabkle look not the don't fuck me cause I pull 5 wheels ea side and have a grotesquely oversize arse and trunk coupled with shortness of breath and ttaps that touch my ears

So lifting but like homo lifting for more hetero action. Just realised thatd pretty ironic.

Getting a hernia didn't help things either. Now it's shoulder, back, kne e, hernia and elbow

What about you mate?

Brick said:

Nah into fitness or rather rooting. I'm trying for the fuckabkle look not the don't fuck me cause I pull 5 wheels ea side and have a grotesquely oversize arse and trunk coupled with shortness of breath and ttaps that touch my ears

So lifting but like homo lifting for more hetero action. Just realised thatd pretty ironic.

Getting a hernia didn't help things either. Now it's shoulder, back, kne e, hernia and elbow

What about you mate?

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Getting back into it after training on and off mostly off for 12 months.

You are right. The fit skinny look gets the roots.

Brick said:

Do you agree tgen that a damaged disk is far likely to continue to bulge in the future further weakening surround disc with every instance (marked by nerve pain). That it will only rarely not become more debilitating with time.

I concede the impact can be lessened with time but you will never repair that bulge although us suppose you may get scar tissue(ii dint know all that much about what that tissue that hold the membrane fluid whatever it is dies post injury.

Theoretically if it is nice tight scsr tissue isn't surround disc tgen undr more load.

Strengthen surround muscle helps the disc maintain integrity but the damage is there itll come back and bite you right? Whether that's a year or at 90 it's done it's dash as a healthy little rubbery shock absorber we take for granted?

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Well actually that's the counter-intuitive part of all of this, and something I didn't learn at medical school but only after actually entering this area:

It's actually much more common for a bulging disc to repair itself and then go essentially back to normal. It doesn't always result in an area of weakness that will continue to cause problems down the track.

The reasons are not entirely clear to me why some people recover really well and others go on to have chronic pain and trouble, but nonetheless that is what happens.

Keep in mind that people who have terrible trouble and ongoing pain are much more likely to get an initial scan and then follow up imaging, so maybe that warps the view that the bulge will never get better? There are published studies on people who have recovered clinically and their follow up scans return to baseline.

And spinal surgery is far from a risk-free thing and can cause chronic pain in itself - I would never advocate surgery just on the "what if" that the bulge may return and cause pain again - each episode has to be assessed on its merits before a fairly serious procedure is undertaken.

Never underestimate the body's capability for self-healing. And never underestimate the medical profession's ability to worsen things by intervening (despite good intentions). The evidence in backs is clear - there is only a small minority of people who need intervention, and the whole point of this whole line of chat is that most people can avoid even the MRI scan if there's no clinical features of nerve compromise. It's a terrible thing to over-investigate, find a disc bulge that was never going to cause problems, and then perform a risky inappropriate procedure to 'fix' it.

Great reply.

That was a terrific reply Doc