21y/o with Chronic LBP and Sciatica from Training Injury 21y/o with Chronic LBP and Sciatica from Training Injury

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Thread: 21y/o with Chronic LBP and Sciatica from Training Injury

  1. #1
    Join Date
    Jan 2021
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    1

    Default 21y/o with Chronic LBP and Sciatica from Training Injury

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    (M21, 6í0, 190lbs, training consistently for 2 years, dealing with the injury for just over 1 year)
    -
    I have been dealing with constant left-sided low back pain w/ off and on sciatica along the L5 nerve pathway down my left leg (not from Piriformis Syndrome), though pain is mainly in my low back. MRI results are as follows:
    ->slight rotoscoliosis
    ->mild disc space narrowing greatest at L4-5 and L5-S1
    ->no compression fracture IDENTIFIED
    ->slight anterior wedging of T12 appears physiologic
    ->no significant bone marrow edema within the visualized sacrum
    ->there is mild sacroiliac joint osteoarthritis

    L4-L5:
    ->small left-sided foraminal protrusion measuring 14x6mm
    ->mild facet hypertrophy
    ->moderate stenosis left neural foramen AND mild stenosis right neural foramen (no central canal stenosis)

    L5-S1:
    ->small left-sided foraminal disc osteophyte complex
    ->mild facet hypertrophy
    ->moderate stenosis left neural foramen no central canal stenosis

    Impression:
    ->mild lumbar spondylosis greatest at L4-L5 and L5-S1

    ->L4-L5 left-sided foraminal protrusion results in moderate stenosis left neural foramen + mild stenosis in right neural foramen

    ->L5-S1 small disc osteophyte complex extending to the left neural foramen also resulting in moderate stenosis + mild stenosis in right neural foramen
    ---------------------------------------------------------

    -The Injury occurred during set 4 of 5x8 @225- felt a pop on the concentric part of a back squat (have since determined why the injury occurred and have corrected form). Iíve tried physical therapy at multiple clinics, epidural injections, NSAIDs with limited successÖso far, stretching, myofascial release, and strengthening of low back/core have improved my symptoms the best.

    -Iím not looking for short term solutions/treating the pain- most of the time it is fairly manageable (low back pain is, on average 5/10, though it can get up to a 7 or 8; sciatica normally is around 2-3/10) though I feel as if it is taking up too much of my time to both manage my injury and continue to progress in the gym (with compound low body movements; takes up a good 4-5 hours each day between training session and strengthening/stretching/releasing muscles in morning, before/after workouts, and in the evening.

    Here are my biggest questions!

    1) How should I proceed with my treatment? -As I said, I am looking for a more permanent solution, I donít think that a minimally invasive surgery (to fix foraminal spinal stenosis) is out of the question but would like to avoid it at all costs. I donít feel comfortable doing any sort of more invasive/permanent surgery to try and treat pain. Any ideas on whether or not I should consider surgery or alternative treatments I have not yet considered?

    2) Going off of that, is it ok to continue training with squats and deadlifts at a reduced weight? -It feels good during training but will moderately increase pain symptoms post-workout for the rest of the day. (I know what my doctors would say, but I am looking to continue training at my full capacity, long term, as long as it wonít make my injuries fundamentally worse or cause additional damage).

    My current goals/timeline is to continue with my current treatment (largely consisting of stretching, strengthening low back/core, continue barbell training, and using medications as needed) through the end of February to improve pain, and consulting with my orthopedic surgeon to explore options if I donít see a significant reduction in pain.

    I appreciate any and all advice, Thanks!

    -Noah

  2. #2
    Join Date
    Aug 2010
    Location
    Olympia, WA
    Posts
    2,153

    Default

    Quote Originally Posted by byersnoah View Post
    (M21, 6’0, 190lbs, training consistently for 2 years, dealing with the injury for just over 1 year)This is not a coincidental report. Nor should this be overlooked.
    -
    I have been dealing with constant left-sided low back pain w/ off and on sciatica along the L5 nerve pathway down my left leg (not from Piriformis Syndrome), though pain is mainly in my low back. MRI results are as follows:
    ->slight rotoscoliosis
    ->mild disc space narrowing greatest at L4-5 and L5-S1
    ->no compression fracture IDENTIFIED
    ->slight anterior wedging of T12 appears physiologic
    ->no significant bone marrow edema within the visualized sacrum
    ->there is mild sacroiliac joint osteoarthritis All relatively benign findings.

    L4-L5:
    ->small left-sided foraminal protrusion measuring 14x6mm
    ->mild facet hypertrophy
    ->moderate stenosis left neural foramen AND mild stenosis right neural foramen (no central canal stenosis)

    L5-S1:
    ->small left-sided foraminal disc osteophyte complex
    ->mild facet hypertrophy
    ->moderate stenosis left neural foramen no central canal stenosis

    Impression:
    ->mild lumbar spondylosis greatest at L4-L5 and L5-S1

    ->L4-L5 left-sided foraminal protrusion results in moderate stenosis left neural foramen + mild stenosis in right neural foramen

    ->L5-S1 small disc osteophyte complex extending to the left neural foramen also resulting in moderate stenosis + mild stenosis in right neural foramen
    ---------------------------------------------------------

    -The Injury occurred during set 4 of 5x8 @225- felt a pop on the concentric part of a back squat (have since determined why the injury occurred and have corrected form). I’ve tried physical therapy at multiple clinics, epidural injections, NSAIDs with limited successThis, too, is not a coincidental report, and this is a pretty telling of the overall prognosis.…so far, stretching, myofascial release, and strengthening of low back/core have improved my symptoms the best.stretching and myofascial release will have no positive impact on the low level pathology seen on the MRI. Thus, it is likely these treatments offer a benefit to you that is outside of the actual pathophysiology leading to the MRI findings.

    -I’m not looking for short term solutions/treating the pain- most of the time it is fairly manageable (low back pain is, on average 5/10, though it can get up to a 7 or 8; sciatica normally is around 2-3/10) though I feel as if it is taking up too much of my time to both manage my injury and continue to progress in the gym (with compound low body movements; takes up a good 4-5 hours each day between training session and strengthening/stretching/releasing muscles in morning, before/after workouts, and in the evening.

    Here are my biggest questions!

    1) How should I proceed with my treatment? -As I said, I am looking for a more permanent solution, I don’t think that a minimally invasive surgery (to fix foraminal spinal stenosis) is out of the question but would like to avoid it at all costs. I don’t feel comfortable doing any sort of more invasive/permanent surgery to try and treat pain. Any ideas on whether or not I should consider surgery or alternative treatments I have not yet considered? I would think long and hard about ofting for a microdiscectomy or some other surgical procedure to be your attempt to "fix" low back pain. If you have an EMG that shows significant nerve root involvement, I'd certainly consider it....but, surgery has a terrible reputation for "fixing" low back pain.

    2) Going off of that, is it ok to continue training with squats and deadlifts at a reduced weight? -It feels good during training but will moderately increase pain symptoms post-workout for the rest of the day. (I know what my doctors would say, but I am looking to continue training at my full capacity, long term, as long as it won’t make my injuries fundamentally worse or cause additional damage).The question to answer is from you: do you believe that squats and / or deadlifts, even at moderate to maximal weights, are potentially dangerous for your condition? Consider this as you earlier stated that you have "corrected" your form. Then, the follow-on question is this: is a particular form necessarily dangerous?

    My current goals/timeline is to continue with my current treatment (largely consisting of stretching, strengthening low back/core, continue barbell training, and using medications as needed) through the end of February to improve pain, and consulting with my orthopedic surgeon to explore options if I don’t see a significant reduction in pain.Seems to me that you have already made up your mind. But, again, I'd refer you to the literature to research, for yourself, how efficacious spine surgery is for a chief complaint of chronic low back pain.

    I appreciate any and all advice, Thanks!

    -Noah
    As above in bold type.

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