A cautionary tale of back injury and recovery

In technical terms, referring to the position of the spinal segments, I had an L5-S1 herniation. In other words, this was the vanilla ice cream of back injuries.

The engineering of that joint “makes it most susceptible to herniated disks,” Peponis said. “It’s the fulcrum that transports the weight of the upper body to the lower body.”

Dr. Scott Otis, a Columbus-area specialist in back pain, laid out my options: rest and possibly some physical therapy; a round of injections with steroids; surgery.

It turns out that surgery for back injuries like mine is a hot topic. What’s called a diskectomy — or trimming the offending bulge to ease pressure on the nerves — is the most common surgery in the United States for people with back and leg pain.

Disk herniation causes back, leg pain Injury: Herniated disk, also known as a lumbar disk herniation. Anatomy: The disk is part of the series of connected bones called vertebrae that make up the spine. The disk, a cushion between vertebrae, is made of a tough outer layer called the annulus fibrosus and a soft center called the nucleus pulposus. Occurrence: For a variety of reasons, including a combination of aging and wear and tear, the soft center pushes through the outer layer (a herniation) or escapes through a crack (a rupture.) The resulting bulge can press on nerves running through the spine causing pain, numbness or tingling in the leg known as radiculopathy or more commonly as sciatica. Location: Most herniated disks occur in the lower part of the spine near or just below the waist. Frequency: Herniated disks are among the most common lower back injuries diagnosed when people complain of back pain or sciatica. In addition, MRIs regularly turn up undiagnosed disk herniations when people are being treated for unrelated injuries. Treatment: Options usually begin with conservative care including bed rest, physical therapy, over-the-counter anti-inflammatory and pain-relieving drugs to ease the pain. More aggressive treatments can include oral doses of steroids, spinal injections of steroids or surgery. Surgery: The most common surgeries for a disk herniation are a diskectomy or partial diskectomy in which part of the herniated disk is removed to relieve pressure on the leg nerves. Prognosis: Many people with disk herniations will get better without surgery, but the healing process can take several weeks or months. Sources: North American Spine Society, AP research

Yet two big government-funded studies published in the Journal of the American Medical Association last fall found that patients with herniated disks saw substantial improvement over two years whether or not they had surgery.

I opted for a conservative but aggressive approach: no surgery but two cortisone shots about two weeks apart. Steroids are injected directly into the area of herniation to reduce the swelling and ease pressure on the nerves.

On a particularly bad day, I tried walking up the street with my wife and the help of a cane. I made it just past our house before I had to turn around.

The pain didn’t go away.

Off work for several weeks, I stayed in bed, watched TV, read, and generally felt sorry for myself.

“The teaching in the 1970s was bed rest for two weeks,” said Dr. Anthony Delitto, chairman of the physical therapy department at the University of Pittsburgh.

“We’ve come so far away from that — you really want a minimal amount of rest and you want to activate a person as soon as possible.”

Mapping out a recovery plan
The turning point for me came that December in a large pool of warm water as I moved my legs slowly while periodically stretching my hamstrings. The combination of warm water and loosening exercises gave me flexibility in my leg I hadn’t felt for months.

“It’s problem solving, basically,” said my physical therapist, Brenda Shoup. “It’s identifying, ’What are this person’s limitations, what are their goals, what do they want to get out of therapy?’ and then how can I help them get there the fastest?”

As the pain eased, I methodically plotted a recovery. For months, I walked around the park, resisting the urge to run.

Eventually, a hundred yards at a time, I jogged, a bare shuffle, then returned to walking. Always, at the end, I did five to 10 minutes of stretching and back exercises.

I changed the way I did even the smallest physical task. No more bending over without a hand on a chair or table top. Kneeling replaced leaning. I perfected the golf bend, the movement that imitates a golfer picking up a ball by stretching a leg out to relieve pressure on the back.

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