[BackPain88]

#27973

Hi Doctor,

First off, I just want to say thank you for creating this forum and helping out the back pain community with your knowledge :)

So a little background about me:
I’m 30 years old and a professional MMA fighter with a record of 8-1, and over 10 years of boxing, kickboxing, wrestling experience. I’m the #1 ranked fighter in Virginia in my weight division. I also work as a Martial Arts instructor to children/adults. As you can tell by now, it’s a large part of who I am.

Now some background to my injury.

The first injury happened on December 8th 2016. I had started a new lifting program a few weeks before, which consisted of squats and deadlifts every week (5×5 strength program). I had been doing alot of squats and lifting more weight than I have before. The day after one session, my back just felt sore, no problems during the actual lift. Rather than resting, I decided to do wrestling training that same morning. It became more sore. That same night I went to my second wrestling session. We were doing live 1 on 1 wrestling, and while taking my partner down, I felt a “ripping” sensation in my back (lower left side).

It was unlike any injury I’ve had before, where I could just power through. For this one, I had to sit out. I didn’t train again for about 6 weeks. After 6 weeks, my back had shown some improvement. I came back to training for a few days. One morning after a wrestling session, it felt very sore with sharp pains (still lower left).
I decided to take more time off. A good friend of mine who is a certified PT told me that he believed it was my QL (Quadratus Lumborum) that had tore, but not really sure. I also saw a chiropractor who assured me that I didn’t need x-rays because he believed there were no spinal issues.

I finally came back to full training around the beginning of March. At this point my back was feeling great. I had gotten back into lifting again also with no complications. I had a fight scheduled for June 17. One day, 3 weeks before the fight, I was playing an intense game of basketball where I was jumping alot, during the game my back started to feel very tight and stiff. I gave it rest until my fight. This seemed like a red flag to me, because it seemed like my back was good as new.

I competed in my fight and won, with no issues. Back felt great. Now this is where all the problems begin. My first day back in the gym after my fight; June 20th, I began working with a new lifting coach. He had me warm up with deadlifts, and had me hold with a grip different than I usually do. During the lift, he was trying to instruct me on what to change about my stance. I was deadlifting 200 pounds, I tried adjusting during the lift, bent too far forward, and boom. I felt a “zapping” electric sensation run across my back. It was very bad and probably worse than the first injury. I had slight sciatica I believe, pain in my glutes mainly on the right side. The sciatica symptoms wore off in a few days. The pain in my lower back stayed, at this point there was pain on both sides, left and right.

I had another important fight lined up, so I only gave it about 3 weeks and came back to training. There was pain, more than before, but I continued to push through. The mornings were the worse. I couldn’t even put my socks on in the morning. I dragged myself to training every morning, after warming up, I felt ok. During this time, I was seeing my chiropractor 2 times a week, but it was only temporary relief after each visit. He still assured me that an MRI wasn’t required, and since I don’t have insurance, I would be saving money. My back had improved but very slowly, I would say I was at 75%. The pain is only on the lower left side now.

I trained for a few more weeks, then took 2 months off. During this time, there wasn’t much improvement. I came back to training after the 2 month break, still about a 75%. Since the last injury in June, I have trained for a combined 7 months.

Now the weird thing about this injury, after I warm up for a long long time, my back is good to go for any training with no issues. Usually, what irritates and causes flare ups the most is Wrestling. Anything that involves pushing weight upwards or squatting. I can do kickboxing with no problems. I can push, rotate, kick in any which way that I want. Some days, when my back started to feel ok after a good warm up, I would wrestle. And some mornings after I paid for it, and some other mornings no pain.

I finally decided to get an MRI on February 15th. The results came in, and diagnosis is a slight bulge in L4-L5, along with some other things. I have the MRI text report that I will include in this text also.

Since finding out the actual problem, I have been able to focus more on the rehab and exercises to help fix the issue. After watching your videos, I purchased an Inversion table, and I feel that it’s been helping slightly. My father and I also built a “Reverse Hyper” Machine with weights. I’ve been using that also, and it brings great relief, albeit only temporarily.

I saw a Neurologist last week and we looked over my MRIs. He seemed just as clueless as me to the fact that I had a bulge but really no sciatica symtoms. Although he did a few tests with the “rubber hammer” and believes I have a reflex change in my left leg. He wants to do an EMG and Steroid injection.

I have been completely devastated and my world has been flipped upside down since this injury. I’m the #1 ranked fighter in the state of Virginia, I feel that I have so much potential and i’m only a few fights away from making it to the UFC. I cry every single day because I feel like this is the end of the road, and that my dreams are gone. I’ve been very depressed since I found out I have a buling disc.

******************************* MRI REPORT:

At L4—5 the signal intensity of this disc is decreasedv The disc height is
fairly well preserved. Diffuse disc bulge is noted at the L4—5. The
bulging disc does not appear to compromise significantly the spinal canal.
The bulging however is asymmetric favoring the left side and compromises the
left neural foramen. A focal hyperintensity is identified in the bulging
part of the disc at this level. This is due to an annular tear which is
best shown on series 3 image 10 and on series 7 image 14.

At the LS—Sl the signal intensity of this disc is decreased. The disc
height is well preserved. A small and broad—based disc protrusion is noted
at this level. The protruding disc is centrally located compromising the
ventral epidural space and abutting but not compressing the thecal sac‘
This is best shown on series 5 image 6, on series 3 image 6 and on series 7
image 19 — to and.

The bulging of the discs at the L2-L3 and at L4-L5 is asymmetric
favoring the left side. The above abnormalities compromise the left neural
foramina at these 2 levels. An associated Small and subannular diSc
herniation at the L4-L5 cannot be entirely ruled out. The focal
hyperintensity described in the bulging part of the disc at the Lé-LS is due
to an annular tear.

3. A small and broad-based disc protrusion is identified at the LS-Sl.

This is centrally located compromising the ventral epidural space. The
above abnormality also favors the right side. It compromises somewhat more
prominently the right lateral recess of the spinal canal. The focal
hyperintensity described in the protruding part of the disc at this level is
due to an annular tear.

**************

Thank you so much for reading this, Doctor

[Donald Corenman, MD, DC]

#28004

Congrats on your MMA success.

Your initial injury mechanism is typical for a back injury:”I had started a new lifting program a few weeks before, which consisted of squats and deadlifts every week (5×5 strength program). I had been doing a lot of squats and lifting more weight than I have before”.

The injury is classic for an annular tear. This occurs when the actions of BLT (bend/load/twist) occur at the same time. Deadlifting and squats are the perfect mechanisms for these tears. The disc is similar to a car tire. The inside (the nucleus) is filled with jelly instead of air and the outside is composed of about 30 rings of collagen arranged just like the plies of a radial tire. That is, the fibers angled about 30 degrees from horizontal in a ring around the disc with each ring angled the opposite of the ones next to it in an alternating fashion.

When you bend forward, you stretch the posterior fibers (in the back of the disc). You then twist which tightens half of the rings but loosens the other half. This twist literally reduces the strength of the back of the disc by 50%. When you then load the disc by lifting weights, this completes the abnormal load on these fibers and commonly, some of the fibers will tear. See https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/

What you did next is to continue the tear of the annular fibers with the next lift: “I began working with a new lifting coach. He had me warm up with deadlifts, and had me hold with a grip different than I usually do. During the lift, he was trying to instruct me on what to change about my stance. I was deadlifting 200 pounds, I tried adjusting during the lift, bent too far forward, and boom. I felt a “zapping” electric sensation run across my back”. These symptoms are classic for a new annular tear.

Your symptoms match an annular tear; “Now the weird thing about this injury, after I warm up for a long long time, my back is good to go for any training with no issues. Usually, what irritates and causes flare ups the most is Wrestling. Anything that involves pushing weight upwards or squatting. I can do kickboxing with no problems. I can push, rotate, kick in any which way that I want. Some days, when my back started to feel ok after a good warm up, I would wrestle. And some mornings after I paid for it, and some other mornings no pain”. Wrestling involves twisting and loading motion with compression. This places great strain on the annulus. Kick Boxing involves quick non-loaded moves without the degree of force on the spine that wrestling involves.

You do not need an EMG but an epidural steroid can be helpful. I would advise Pilates exercises as strengthening the small core muscles can be helpful, even though your core is probably already very strong. I have had NFL players scoff at the thought of Pilates but 10 minutes into it, they look like a deer in the headlights as they thought they were very strong and were proved wrong.

I would stay away from deads and squats for now as the sheer forces are not appropriate for you now. These annular tears will heal with some scar but will always be permanent. You should be able to overcome them over time.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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