Spinal Stenosis

[Will Morris]

"Spinal stenosis" as used in clinical practice may refer to any congenital or degenerative situation in which the spinal canal is abnormally narrow. A bulging disk can either create a stenotic lesion or exacerbate an existing stenotic situation. It is unclear to me which situation obtains in your case. Is the disk herniation at the same level as the stenosis?

Not that it matters all that much. Rip was right about the MRI. In the absence of neurological symptoms or deficits (sleepy pecker, bowl and bladder dysfunction, paresthesias, weakness, etc) one could make the case that all it did was give you something bad to visualize (that wayward disk) and worry about. I'm unsure how it changes your management or rehab, although obviously I don't know your full history/exam.

I feel your pain. Quite literally. Back injuries suck rabid porcupine balls.

In all seriousness, thank God we have physicians such as Sullydog in this day and age. Sir, I owe you a beer after this post.

[rashid29]

What injury? The OP's? We don't even know what the injury is. The stenosis is an MRI finding, like Will and Sully said.

When I typed my question, I had not refreshed my browser and did not see their responses.

So, since there are no neurological problems, should he worry about the bulging disk once he has regained his strength?

[Mark Rippetoe]

No, he needs to worry about pain and neuro symptoms. Test results by themselves often do not represent an accurate assessment of the situation. There was a large radiography study of a thousand horses several years ago at, I believe, Georgia Tech, where ~500 asymptomatic animals x-rayed positive for navicular disease.

[rashid29]

No, he needs to worry about pain and neuro symptoms. Test results by themselves often do not represent an accurate assessment of the situation. There was a large radiography study of a thousand horses several years ago at, I believe, Georgia Tech, where ~500 asymptomatic animals x-rayed positive for navicular disease.

Interesting. I guess the saying "if it aint broke, dont fix it" would apply.

[Mark Rippetoe]

Especially if the test that tells you it's "broke" is wrong.

[Will Morris]

Interesting. I guess the saying "if it aint broke, dont fix it" would apply.

You could repeat the same study in humans, say for knee osteoarthritis, and the majority of people over the age of 50 would show radiographic evidence of knee OA, but a far lesser number would be symptomatic and have a clinical presentation suggestive of knee OA. Radiographic evidence is one piece of a much larger puzzle and isn't designed to stand alone.

[Roy]

I remember Mike C posting about a concern for a back tear a while ago:
http://startingstrength.com/resource...ad.php?t=29715

Sorry to hear it's still bothering you. Did you ever get any kind of pain/numbness below the waist? Is your pain all still in your back only? Does it hurt better/worse in the morning, with flexion, with extension, sitting or standing, with activity, with rest?

If all the pain is in your back alone, it would probably mean that disc material isn't leaking out of the disc and compressing or making contact with the nerves. Hearing an audible 'pop' in your back during exercise, immediately followed by the pain you described bad enough you went to the ER and eventually pursued an MRI...found out you did indeed have a bulging disc...I'd think your pain is probably from the disc injury which happened during that exercise.

I wouldn't consider doing the epideral shots or anything more invasive until you've given plain old rest and a consistent course of prescription anti-inflammatories (nsaids) some time to prove that won't work. From what I understand the recovery times for disc injuries can be all over the place, because they're just very slow healing and its so easy to undue the repair by little injuries you may have along the way (pushing too hard during exercise, playing with kids, sports etc...while you're trying to heal you certainly don't want to 'tweak' your back doing something silly).

I had l5-s1 herniated with sciatica down the glutes, hamstring, and partially in the calf for months and personally found it ineffective to keep training through it. I tried that for about 6 months, still doing judo, running, weights, and it just got worse. After deciding to just rest and do 'conservative measures' for it, it was better in about a month and a half and pain was gone after 3 months. It took a bit of time to regain range of motion after the rest (like a month or two), but eventually everything was fine and I've moved on to lifting more than before and returned to sports, etc.

I've heard positive and negative experiences from people with supposed disc injuries going to the chiropractor for treatment. If you want to seek that out as treatment I'd suggest finding some recommendations from previous patients who had what you have to find a practitioner. Just a simple way of getting some decompression yourself would be suspending yourself from ab straps and hanging...I'd start doing it on a chair so you can use your legs for assistance until you're sure you won't end up screaming in pain when you try this.

Unfortunately there's no straight path to be known to recover from back injuries so you'll have to use your own judgement on your way...good luck.

[Mike C]

My only symptoms are a constant feeling of needing to have my lower back cracked and in inability to do so, pain when I lean backwards and EXTREMELY uncomfortable soreness after walking for more than 10 minutes or any deadlifting/squatting of more than about 95 lbs. I actually thought it was a muscular (tightness in the psoas or some such shit) and had a scheduled chiropractic massage to deal with it, when these results came in.

[Mike C]

If I have this right, you were completely asymptomatic as far as the bulging disc and spinal stenosis

You have it wrong.

.....if that's indeed the case, why have a procedure to correct something that isn't causing you problems.

No procedure is planned or even considered at this point.

You can find all sorts of horrific issues with MRIs that don't cause any problems at all.

Are you making the claim that spinal stenosis and a bulging disc are common in asymptomatic people (as stated I'm not in this category)? Can anyone in the medical community confirm this?

The imaging is just an extension of the subjective and objective examination, and not necessarily meant for diagnosis in a vacuum.

Yeah, when it comes to spinal issues you'd be a fucking fool not to take precautions to make sure minor issues don't become major ones in a hurry.

[Jonathon Sullivan]

Are you making the claim that spinal stenosis and a bulging disc are common in asymptomatic people (as stated I'm not in this category)? Can anyone in the medical community confirm this?

Yes. Several imaging studies confirm that asymptomatic individuals have a fairly high frequency of disc bulging, protrusion, annular tear, and other abnormalities--in other words, degenerative changes in the spine, including the lumbar spine, are quite common.

Yeah, when it comes to spinal issues you'd be a fucking fool not to take precautions to make sure minor issues don't become major ones in a hurry.

Okay, that's sounds hard to argue with...but what precautions? In the absence of red flags, imaging studies in acute low back pain are extremely low yield, and may lead to unnecessary or harmful interventions. I'm in a clinical situation where every low back pain is considered an emergency until proven otherwise. Differential includes spinal cord compression, cauda equina syndrome, epidural abscess/hematoma/neoplasm, spinal osteomyelitis, spondylolisthesis, vertebral body compression fracture, malignant bony metastasis, ruptured abdominal aortic aneurysm, and any number of other horrors. And yet, we rarely image, because the vast majority of these disasters can be ruled out clinically. Unless you're old, sick, cachectic, febrile, an IV drug abuser, have parts that don't work, or have been shot in the back or hit by a car, your chances of having a life-or-limb-threatening etiology or a serious and surgically correctible underlying lesion accounting for low back pain are very, very small indeed.

The natural history of acute low back pain without red flag findings is: it gets better pretty much no matter what you do. Then it comes back, and gets better no matter what you do. Then it comes back...