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Back Problems Message Board


Back Problems Board Index


Hi waves!

You are asking some good questions and I'll give you the benefit of my experience and knowledge. If you have only DDD and no herniation, then I believe that doctors would tell you that there is no danger to you continuing to play sports and that you will not do damage to your disc. In fact, I believe they would encourage you to exercise as much as you desire since it only improves your overall health and well-being. It is true, however, that having DDD means your disc is weaker and is more vulnerable to herniation than is a healthy disc. In fact, I've read that healthy discs rarely if ever herniate unless the herniation was caused by a traumatic event (e.g., car accident). Because of this vulnerability, I would make sure that you undergo a rigorous core strengthening program under the guidance of a physical therapist (as opposed to a trainer). Having a super strong core can help you prevent injuries as you know.

When I first started experiencing back pain, I would stop playing tennis for a week or so and the pain would subside. Then I would start again and it would come back. Finally, after a few months, the pain never subsided even after I stopped playing. I suppose there are many possible scenarios as to what happened. Perhaps my annular tear was smaller at first and responded to rest. I may have actually worsened the tear through continuing to stress my back with some aggressive tennis playing (it's hard for me to play any other way). Would the tear have healed if I had stopped playing right away and never played again for months? It's possible but now I think unlikely. My disc is so badly degenerated now that I would imagine that its healing capacity is grossly compromised.

Regarding the waiting it out issue, I did wait it out over a year. When the doctor saw me at 9 months post-injury, he was hopeful that my problem might resolve in a few months. But when he saw no improvement at 1 year and no response to the epidural injections, he said I had only a 1 in 100 chance of improvement with just waiting. I wholeheartedly believe this to be the case. I have a grade V annular tear which are very painful and difficult to heal even in a healthy disc.

I'm sorry to hear that you ended up having what may very well be an unnecessary surgery. I too saw a lot of doctors. Some of them didn't think the IDET would help, but all thought it was worth a chance and that major surgery was my only other option. My hope is not that IDET will provide an instant cure, but that it will allow me to engage in a rigorous physical therapy program to build up my core strength that this will greatly help. I was unable to continue in PT because even very gentle approaches triggered a flare-up. You are correct in that the IDET itself does nothing to strengthen the spine-you need to do that work yourself. It is possible that the procedure contracts the collagen in the disc and stiffens it, but probably the most significant benefit it that it can kill the nerves growing in the outer 1/3 of the annulus. There is a lot of evidence that these are major pain generators.

I assume that you've have some of the major interventions: epidural injections, etc. If not, I would think that these could be both diagnostic and therapeutic. I have to end this note for the moment as am called to dinner. Will add some more thoughts tomorrow.

--tennisnut




[QUOTE=waves2ya]Hi Tnut - first my prayers and best wishes are with you for a good recovery...

I'm an athlete (tennis, surfing, more...) and I've been diagnosed with DDD (no herniations/bulges: MRI). I've done the run around to lots of doc's for ok to poor advice, had pelvic surgery to tighten my stomach muscles and now believe my symptomology more consistent with DDD than with some arcane pelvic malady. So, guru(s), I've got a couple of questions for you...

When you say you "didn't listen to your body..." - what do you mean? Do you think you could have done something that would have forestalled the symptoms that ended up debilitating you?

I'm trying to determine to what degree I should back off my life (eg. not playing singles anymore, and doubles for only 1 1/2 hr per wk) - can do MacKenzie exercises, swim, use an elliptical machine, lift weights (light). But I do have weird, diffuse leg discomfort (no weakness), difficultly getting out of a crouch, some back pain and I get up from my chair religiously each hour. I'm not taking any meds (not that they don't make me feel better, tho'). I know - you can say "... well, ask your doc..." but the doc's don't seem to know much. One guy will say "play tennis. Run. Work through it" - stay active philosophy. I'm doing pilates, watching my posture, strecthing - I've a kitchen sink full of little excercises that I do everyday. Yet - I'm in this for the long haul. If I have to back off my life for 5 yrs (or forever) to end run spinal surgery, well, that's what I want to do. You've all 'been there, done that' - is less more when it comes to DDD?

Tennis: The IDET procedure... Did you undergo, buying time for the "... last bit of hydrated portion of disc (nucleus)..." to leak out? The procedure itself adds no stability or improvement to the spinal structure -correct?

Thank you, in advance, for any guidance. And I'* like to take a moment to thank other board members, as well. Tomorrow, Successstory, Telzy, standingman and the many others - thank you for all the posts I've meticulously picked through...

And to for all those others with soberingly terrible stories of back pain - my humble prayers are with you.


~waves[/QUOTE]
Waves,

It was great hearing more about your story. We really share some things in common and I'll say a bit more about how my thinking has progressed during my personal ordeal. First, I should say that I would not have done anything invasive about my back just to be able to enjoy sports again. It would have been terribly sad to give up what is such a strong part of my identity and enjoyment, but I would have grieved the loss and focused on doing "nonimpact" activites like cycling (recumbent probably), cross-country skiing, etc. Unfortunately, my condition deteriorated to the point that the quality of my life was significantly impaired. I could not sit for longer than 15-20 minutes at a time and for no more than a total of an hour a day. If I wasn't able to work from home while reclining, I would be unemployed. The only exercise I can do that does not trigger a major flare-up is walking. To be sure, this is a much less bleak picture than that of many on this board. I certainly appreciate that and it gives me strength to see how others are coping with even greater adversity. But, for me, I felt that it was worth the risk to try to improve my quality of life. Will I play tennis again? My doctor seems to think so. We'll just have to wait and see. Right now, I'd be so excited to be able to do any type of exercise and work up a sweat. Like you, I've had some sports-related injuries (ACL/meniscus tear & torn elbow cartilage-both due to tennis) and had successful arthroscopic surgeries. I just took my back health for granted, having never had a hint of a problem before. But, as we know, the back is so complex and baffling to even the experts. Right now my plan is to see where I can get in recovery from IDET over the next 2 years. If it hasn't significantly help me, then I will look into artificial disc replacement. Scary as hell, to be sure, but may come to be my best option for a better life. But that's way down the road. I am not at all worried that IDET will permanently change my disc leaving no hope for...what? A natural cure for my grossly compromised and severly painful disc with a full thickness tear? Some new miracle treatment that will repair my disc to normal (yeah, right)? I just don't see it. I did worry about the possibility that I would get worse from the procedure, but the risks seemed rather low. Any intervention is always a calculated risk.

I agree with you that there is no purpose to having a discogram unless you are about to undergo surgery. It certainly does sound worthwhile to get a full work-up from a neuro/pain expert given the weakness and fatigue in your lower exremities. I never had any of these symptoms. Clearly, you've found a top expert to see. At Forest Hills, no less. My back pain started on a vacation to NYC to see the 2002 US Open. Sadly, I was unable to go this year but try to make it a regular trip. Frankly, I wouldn't see a chiro either. Just my particular bias and stories from several people in medical office waiting rooms who were there because a chirco fractured their disc (yikes). When you say "severe DDD", what does that mean in terms of disc height loss and hydration? It certainly seems possible that your back pain may settle down some after you fully recover from your pelvic surgery. For some people, pain from DDD comes and goes. I actually think that my pain is due to the full tickness annular tear rather than my DDD (though of course they are related-I wouldn't have the tear without the DDD). Unfortunately, there is no evidence that IDET can heal a full-thickness tear. Simple as that. So I have to hope that the rest of the benefits will be enough to break the cycle of inflammatory pain.

What is an inversion chair? Could this be making you worse? Please remind me-how long since your pelvic surgery? Is it mainly the pain or the worry that keeps you awake? Ask your neuro/pain mgmt specialist about neurontin. It has deifnitely helped me and they frequently prescribe it for nerve pain. The difficulty with sleeping is so common. I have always been a stomach sleeper though this position seems to make my back worse. It's really hard to change, but I've been trying. I usually have my worse pain at night and have to take painkillers right before bed. At least then I can sleep and wake up relatively refreshed and ready to face the world. You may be anti-medication, but pain killers are a necessity for me. You are probably worrying too much about your leg discomfort. You do need to trust that your doctors have ruled out the causes of this that are life-threatening or potentially catestrophic.

Here's something that I would like to get clarity about regarding DDD. First off, although everybody's discs do degenerate over time, there is a difference in both how a person with DDD has their discs degenerate. It is [B]not[/B] a normal process (physiologically speaking). I have read that usually a disc will lose its hydration and, thus, harden by about age 50. So this is why it is rare for someone older than 50 to suffer a herniation. But the changes to the annulus and endplates that people with DDD have are not part of the normal degenerative process. Now many people with DDD will not have any pain while others may have significant pain. Usually, it is a manageable problem especially at one level. But there are always exceptions. I think in your case it may be difficult to know how much the DDD is affecting your back until you've healed from your other surgery. It is unlikely to be a source of your leg pain/discomfort.

Please continue to keep us updated about how you are doing and what you are learning. I will definitely do the same. :)

--tennisnut


[QUOTE=waves2ya]Tennis - I feel for you in that corset. You've gutted out 4 of 5 sets on a hot sunny day against a baseliner; you'll gut this one out too for what you have to gain.

I am a tennis player as well. Sounds like we'd have a hell of a match as I'm pretty aggressive - so much so that the cutting on my legs lead to an instability in my pelvis/pubis. The medical term is Athletic Pubalgia, avulsion tears in the rectus abdominus off the pubis. Theory was that instability in my pubis and adductors was giving my great pain in my back and stomach (forget about tennis; could play but could not recover. No sleep for days...). Surgery was a bi-lateral reduction of the adductor + pelvic floor repair. Yuck. Anyhow - through this passage I had every test in the book (looking for RA, MS, etc.) and my MRI was unremarkable except for "... severe DDD L5-S1...". Now, at the time, my surgeon said that the films were consistent with an athlete of my caliber and age (43); he said his back was in about the same shape. And after what I know now - his contention is totally plausible. Prior to surgery I couldn't do any rec ab type core strengthening work - burned my stomach/pubis too much. Made me nauseous. Now I'm a core strengthening expert (pilates: mat & reformer). However, my back is comprised...I think you get to a place where you begin to know more than any of your paid consultants (unless you are a Rockefeller). I think between the tears/instability of my pubis, the DDD disk in my back and a sacroiliac instability (not diagnosed but by my gut) - I have ongoing back pain.

My recovery from AP surgery incomplete - no hadn't seen a neuro through this - I've an app'y with Brian Hainline at the USTA in Forest Hills. Chief Med there, he's a neuro/pain mgmt specialist as well and can prolly tell me if I'm ever going to play tennis again. No, no epidural or prolo - no injections of any kind. Not even chiro (more cause I'm too nervous to try 'em). Not going to a discogram, either, because, frankly that procedure is really invasive.

I'm in that lost place we all know so well. I do all my little core exercises, get the workouts in I can - bought an inversion chair and invert 2x's a day - and pray. I can sit. But at night my legs are tired/uncomfortable and I've developed an anxiety around this; once the pain seeps in my mind runs and *boom* I'm up all night. Calf fatigue (but neuro exam is fine) upper thigh muscle burn (very slight)... This missive has been too long but my intro (by the old usenet rules) is overdue, so you all now know my story. No car accident. No trauma. Best of health. And struck down. Don't think I'm some kind of Sally, here, either. Have had my knee rebuilt (RL ACL Recon) and right shoulder. My .sig? Surfer, as well. I've dropped in on waves that would make you pale... (makes me, now that I know something about the vagaries of the spine). This, however, has been a markedly different passage...

In an effort to contribute (and per the subject header) I'd like to leave readers who are trying to work around back pain with some literature ideas (can apply to your recovery, as well).

Rick Jemmett's "Spinal Stabilization"
McGill's "Low Back Disorders"
Ungaro's "Pilates: Bodies In Motion"
"Pilates on the Ball"
McKenzie's Back/Neck bks
Davies "The Trigger Point Therapy Workbook"
Egoscue's "Pain Free: Stopping Chronic Pain"
Brourman's "Walk Yourself Well"
Jacobs "Say Goodnight to Insomnia"

Sarno's book is evil; blaming people in pain for diffuse trauma in their lives is a real pig in a poke.

I often think about this jewel found digging here:



I'm trying, Tel. God must know I'm trying. But, like the header says - I'm open to ideas...


~waves[/QUOTE]





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