RAParticipantSeptember 4, 2020 at 8:58 pmPost count: 6
Dear Dr. Corenman,
First of all, thanks very much for your kindness. I have already learnt so much about my condition from your website and hope to keep doing so in future. Really appreciate any advice you have for me.
I am a 36y old male. I have had a minor discomfort in lower back for 4-5 years. Otherwise I was generally active and try to remain fit. With two severe episodes of pain in the back and shooting down the left leg 2 months apart this year (Feb and May) I underwent a L5-S1 microdiscectomy in early May. The MRI showed two herniations. One at L5-S1 (left side of spine) which was operated on and a 3cm protrusion extracted (it had become quite bad by then). Other one at L4-L5 which was not so bad, not yet touching on the nerve and doctor chose not to touch.
The surgery went well. I felt amazing after. Started recovery with walking at first, then brisk walking and starting physio, core exercises and Pilates along the way (2-3m). Had a good recovery path, was running at my pre-surgery speed by 3 1/2 months post surgery. Felt ok afterwards. Was feeling pretty normal except for some minor stiffness in the morning which went away 10-15min later. Was exercising and swimming almost every day (maybe that was too much in hindsight?). Also started doing some deadlifts and that also felt ok.
Now it’s 4 months since surgery and after a busy and unfortunate weekend, pain came back. Could be because of any of these things or a combination – continuous & long office chair sitting (9-10 hrs) on Friday just before the w/e, or intense flexion during Pilates combined with playing some football (with a kid) in eve on Sunday, or could be 3-4 hrs of sitting on hard floor playing a board game on Sat night.
I started feeling discomfort and pain (3-4) in the hip (deep and along the outside and going down but sometimes on the inside) and lower back along the waistline on Monday afternoon (more on the right side), and got worse on Tuesday. One specific motion that causes it is when I push my pelvis back – like further backward extension of the hip in a pelvic tilt. Accordingly i also feel the pain if I sit too long and stand up without doing pelvic tilts. I also feel a solid dull strain kind of pain (3-4) near backbone on right side (around L3 height) – comes and goes. The surgery was done on the left side. Leg raises also cause a pain but only in the hip (again not too severe, 3-4). The pain started around 55 degrees. Pain is manageable for now and only in the waist / hip area, but feels similar to how this whole issue started in the first place. I ignored it in the beginning thinking it was weak or tight muscles and will go away with time which I regretted later.
Visited my physio and she said it does not look serious. I have most likely strained my back by overloading during those 2-3 days. Should take it easy for a week and give some time to heal. She thinks it’s referred pain from the back to the hip, not necessarily a nerve issue. Asked me to keep doing extension exercises (pelvic titls standing and lying down, and cobra pose) and also avoid too much flexion movements in future, mix them up with extension (like swimming). This does help and extension exercises make the pain / discomfort go away. Swimming feels great.
I am obviously worried if it could be reherniation or herniation of L4-L5 (which was not operated on). If not then is it some inflammation, or is it mechanical compression as you suggested in another post? What exactly is causing this? Also if this does heal in a week, I also wonder what I can do and what to avoid in future. Can I please ask if you are able to say what this might be based on the symptoms? And if you have any advice for me.
Many thanks for your kindness helping so many people through this forum.
Warm regardsDonald Corenman, MD, DCModeratorSeptember 5, 2020 at 10:10 amPost count: 8465
This worries me; “Also started doing some deadlifts”. Deadlifts create significant sheer forces along the disk and I don’t recommend these or squats after a disc herniation.
“4 months since surgery….I started feeling discomfort and pain (3-4) in the hip (deep and along the outside and going down but sometimes on the inside) and lower back along the waistline”. Where do you note where this pain is? Think of a pair or Levi jeans. Would you think of the the pain as in the front pocket, the back pocket or where a 6 gun holster would sit (on the side of the hip)?
The differential here is most likely either from the spine or from the hip joint. Do you have pain getting in/out of a car seat, going up or down stairs, crossing your knees when sitting or getting on/off a bicycle (hip questions)?
Dr. CorenmanRAParticipantSeptember 5, 2020 at 7:05 pmPost count: 6
Thank you very much Dr Corenman for your time and advice.
The pain is surely in the back pocket area. No pain around front pocket or holster area.
Climbing stairs or getting on / off a bike doesn’t cause any noticeable pain.
Sitting in a car seat feels uncomfortable as it does on a comfy recliner (because they all sink in and cause some flexion I think). While getting out of a car seat, I feel some pain in the back pocket area (more upper part) and more generally along the back waist line. Then I will need to walk squeezing in the butt and tummy to avoid it for a bit. Gets better in 5-10 mins. The longer I sit the longer this will last.
SLR on right leg causes this pain also on the back pocket (more on the lower outside corner). Earlier it was the left leg but now it’s only right. It’s close to where the side holster would be but not exactly there.
Thanks very much for taking the time to understand my condition better!RAParticipantSeptember 5, 2020 at 9:05 pmPost count: 6
Just to add, no pain at all in crossing my knees while sitting. Thank you very much Dr Corenman.Donald Corenman, MD, DCModeratorSeptember 6, 2020 at 9:53 amPost count: 8465
“Back pocket” pain is generally nerve generated pain with a small subset of hip and sacroiliac joint origin. Hip flexion also causes nerve root stretch and referral pain into the buttocks so this seems like spine generated pain.
Dr. CorenmanRAParticipantSeptember 6, 2020 at 4:52 pmPost count: 6
Thank you very much Doctor. That is very helpful and rules out any new issues in the hip. I have two follow up questions if I may ask please.
1. Are you able to say what condition in the spine might be causing this more specifically? Maybe not Herniation as the pain is not going down the leg. Could this be a strain? Would you agree with my physio who called this “angry discs”. She massaged my back in the right side and it felt better already. It has also healed quite a lot in a week’s time as she had suggested. While she was right, I could not fully understand from her description what causes this exactly? I would like to understand what are the mechanics of such pains?
2. If the diagnosis above is correct, second question is what to do about this. I really enjoy running – would you recommend I try again and pick back up slowly? Deadlifts I realize you don’t think is a good idea given the shear force.
Many thanks for your kindness and time!
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