Degenerative Disc

[Michael Wolf]

Used the search function, didn't find this directly addressed.

Background: After hurting my back while warming up the Deadlift at April's Seminar, recovery was going well. About 8 weeks out, re-tweaked it while Squatting light (175lbs). Realized it was time to stop being stupid and stubborn, and get an MRI. Doc and I figured herniated disc. Turns out had 1 negligible and 1 minor herniation, both asymptomatic. The problem seems to be a degenerative/narrowed disc at L1/L2. It's not completely flat yet, but considering I'm only 29, there's not much thickness or nucleus pulposis left for another (hopefully) 60ish years of life.

My doctor actually lifts (I've coached him some in the lifts, and watched him squat 285x5x3 and pull 335x5 today), and respects it, but his initial feeling is that if I continue to lift as I do, especially those lifts with heavy compressive forces, it will probably hasten the decline of the disc.

The thought of not squatting, pressing, or deadlifting anymore is pretty depressing. Especially at only 29, and otherwise very healthy (and was chasing a 600 deadlift before all this happened). What are your thoughts on this? Am I stupid if I keep loading the bar?

[Mark Rippetoe]

About 15 years ago, my T12/L1 - L1/L2 intervertebral spaces were about 3 and 4mm respectively. It is the only part of my back I have never had trouble with. We have discussed this many times here: if you MRI 1000 healthy asymptomatic people you will diagnose at least 500 of them with spinal pathology. Everybody that walks upright with a spine will eventually have back pain, since your spinal column has only been bearing a compressive load for the past 5 million of the 400 million years of its existence. Look through the pasts on this board about back trouble. Calm down. BTFU. Train through it. You'll be fine.

[Steve Hill]

Seems to me that you're in a race between how fast the disc is declining and how fast you can make all those nice little supportive muscles in your back stronger. Here's a tip: you're going to end up with back problems. How strong your back is when you do is up to you.

[Jonathon Sullivan]

All true, yes. But...what about all those poor spinal surgeons? C'mon, guys. They have Lexus payments to make.

[Thomas Jones]

Tagging on to what Rip said: If you take 100 MRIs of healthy individuals and compare them to 100 MRIs of those with back pain, you won't find significant differences between the populations. There are people with bulging disks with back pain and those with bulging disks without back pain. At the same time, there are people without bulging disks who suffer from back pain. With that said, if you are suffering sciatica, then you need to seek treatment options and be careful. If you are not suffering from sciatica, then do everything you can tolerate (and, maybe, a bit more) and your back will get stronger and your symptoms will improve.

[Shion]

Last time I got checked I had a one inch herniation in my L5/S1. I am completely functional and I lift.

[Jonathon Sullivan]

Here's the skinny on musculoskeletal back pain. It gets better . And eventually it comes back. And then it gets better again. Repeat until death occurs from unrelated causes. That is the natural history of most back pain. As has been said here, many times I would guess, it's better to have recurrent back pain and a strong back than recurrent back pain and a weak back. But recurrent back pain is the human condition. There are red flags that indicate a more aggressive evalutation: high energy impulsive trauma, signs of a space-occupying lesion (focal weakness, numbness, tingling, a flaccid Johnson, bowel and bladder incontinence, etc), and systemic symptoms (fever, cachexia, syncope, etc.) But absent any red flags, the correlation of back pain with an identifiable radiologic lesion is tenuous at best, and it really doesn't matter what you do over the long run. Musculoskeletal back pain gets better.

Rheumatology (Oxford). 2010 Dec;49(12):2346-56. Epub 2010 Aug 16.
Low back pain symptoms show a similar pattern of improvement following a wide range of primary care treatments: a systematic review of randomized clinical trials.
Artus M, van der Windt DA, Jordan KP, Hay EM.
Abstract
OBJECTIVES:
To assess overall responses to treatments among non-specific low back pain (NSLBP) patients in clinical trials to examine the pattern following a wide range of treatments.

METHODS:
We conducted a systematic review of published trials on NSLBP and meta-analysis of within-group responses to treatments calculated as the standardized mean difference (SMD). We included randomized controlled trials that investigated the effectiveness of primary care treatments in NSLBP patients aged≥18 years. Outcome measures included the visual analogue scale for pain severity, Roland Morris Disability Questionnaire and Oswestry Disability Index for physical functioning.

RESULTS:
One hundred and eighteen trials investigating a wide range of primary care treatment for NSLBP were included. Plots of response to treatments showed that there was a similar pattern of initial improvement at 6 weeks followed by smaller improvement for both pain and functional disability at long-term follow-up. This was also shown by the pooled SMD for pain which was 0.86 (95% CI 0.65, 1.07) at 6 weeks, 1.07 (95% CI 0.87, 1.27) at 13 weeks, 1.03 (95% CI 0.82, 1.25) at 27 weeks and 0.88 (95% CI 0.60, 1.1) at 52 weeks. There was a wide heterogeneity in the size of improvement. This heterogeneity, however, was not explained by differences in the type of treatment classified as active, placebo, usual care or waiting list controls or as pharmacological or non-pharmacological treatment.

CONCLUSIONS:
NSLBP symptoms seem to improve in a similar pattern in clinical trials following a wide variety of active as well as inactive treatments. It is important to explore factors other than the treatment, that might influence symptom improvement.

This is a typical finding, as anybody who has read the literature on back pain will attest. Except for spinal surgeons.

[Briks42]

Tagging on to what Rip said: If you take 100 MRIs of healthy individuals and compare them to 100 MRIs of those with back pain, you won't find significant differences between the populations. There are people with bulging disks with back pain and those with bulging disks without back pain. At the same time, there are people without bulging disks who suffer from back pain. With that said, if you are suffering sciatica, then you need to seek treatment options and be careful. If you are not suffering from sciatica, then do everything you can tolerate (and, maybe, a bit more) and your back will get stronger and your symptoms will improve.

In the past week or so, for the first time in my life, I have started suffering symptoms of sciataca. I have had some back pain in the past, but never anything too bad. However, this feeling shooting down my right leg now is extremely painful. I am not even sure how I hurt my back this time. Walking, standing, bending over, and getting in and out of chairs or my car are all extremely painful. I have an appointment set up on Tuesday to have it examined by an Ortho. Is that the correct first step to be taking or should I just set up an MRI on my own without seeing an Ortho? Also, what do you think this means for my recovery? Does this go away after a while? Is light deadlifting and squatting going to be the key to my rehab?

[Mark Rippetoe]

It is seldom wise to ask a man who operates surgically on spines what he thinks needs to happen with your spine, especially if you haven't spoken with anyone else first. You can't get an MRI without a prescription, for some weird reason I don't fully appreciate. If I were you I'd decompress by hanging in the rack, while you think about what may have happened to cause this.

[ChuckBell]

It is seldom wise to ask a man who operates surgically on spines what he thinks needs to happen with your spine, especially if you haven't spoken with anyone else first.

Yes. Never ask a barber if you need a haircut. I often have some pain from sciatica. Comes, I think, from sitting so much. The best remedy for me has been squats. It always goes away after I do squats.