L4-L5 Bulging Disc Lumbar epidural Injection

[hotwired]

Although I am rather new to this forum, I need your advice. I have been diagnosed with a bulging disc at L4-L5 which is not responding to physical therapy. An epidural injection is the next option. I am experiencing too much pain to do nothing. I would prefer to avoid switching to a recumbent. My bike is a Specialized Sirrus Ltd. more upright than a road bike with a carbon frame that does a very good job of soaking up the bumps. Has anyone here with a a similar malady recovered to rejoin the cycling world. Thanks Hotwired in Milwaukee

[BSLeVan]

Not completely the same, but may be useful... My wife had two surgeries (12 years apart) to remove tumors from the L5. Both time during recovery she found that upright position and any bumping or jaring up and down was not good. She felt much better with her back stretched out. I also have a friend who rides motorcycles and was prone to the Harley style upright riding. He had L4 & L5 problems when riding in this position. He switched to a morotcycle that had him more stretched out and was able to ride with much less pain.

[Jet Travis]

I can offer you some positive news. I had a similar diagnosis--although maybe not quite as bad as yours--a couple of years ago. I was in so much pain that I could not walk without crutches. The only way I could sleep was lying on the floor with my feet raised up onto the couch. That middle-aged guy you saw driving around in an electric cart in the grocery store--that was me.

It took several months of physical therapy (which was much more challenging than I thought) including a lot of "homework" to finally begin to improve. Although I was scheduled for an epidural, I decided to wait a bit longer, and ultimately didn't need it.

Once I started feeling better, I began to ride again--short and slowly at first--but finally got back to being in pretty good shape. In fact, last year I rode a week-long tour, did a century and some tough mountain climbing events.

One thing that helped--I decided that it was important to deal with my off-the-bike time in a constructive way. I had always wanted to learn Italian, so I spent a lot of time with a self-teaching class on CD, and even ended up with an Italian pen pal. While you are in rehab mode, maybe there is something positive you can focus on to raise your spirits and take your mind away from the pain of being away from the bike.

Good luck--and keep us posted.

[10 Wheels]

I have the same condition as well as another disc up higher on my back.
6 ft 2 in 212 lbs. Started riding @ 223 lbs.
Ride a 83 Nishiki Sport Road Bike 34 + lbs. 1,100 miles this year.
Riding Has helped my back pain.
Lifting or walking hurts me.
Try laying down on the floor twice a day on your back and side for 20 minutes and stretch you entire body. It will hurt when you first lay down, but you need to strectch.
This gets rid of my pain.
This works for me. Pray it works for you.
If I have to lift or walk or stand for long periods I take some Aleve.
Please stay in touch.Doctor like to cut and prescribe drugs.

[BluesDawg]

Four years ago, after years of occasional lower back pain, I started having frequent and increasingly severe pain. This was during a time when my cycling activity had become pretty lax and my weight was way up. I woke up in the middle of the night one night with unbearable pain all the way down my right leg to my toes. I lost feeling in my right foot. After a few dead ends and worthless X-rays, a MRI scan showed that I had a bulging lumbar disk. A few weeks of PT had the pain gone and most of the feeling came back to my foot, but not all (to this day). Neurosurgeon advised to keep up the PT until and unless it stopped working. I still do the stretching and adjusting exercises.

To my Physical Therapist's concern and with my GP's encouragement, I started back to road riding. A little at first, but within a couple of months I was doing centuries again. I learned to be careful of the position of my back and to avoid twisting motions. My back muscles grew stronger and the back pain became much less frequent and less intense. The more I ride on the road, the better my back feels. I did not need to alter my comfortable riding position with my drop bars about 1" below saddle level and a fairly stretched out position.

About 2 years after the episode, I started riding mild XC mountain bike trails without any ill effects. Last year I started racing on a hardtail MTB with a Thudbuster. I had no lasting pain from the offroad riding, but during the races and hard training rides, I did have enough lower back pain to affect my performance. Now I have a new full suspension bike and the difference is amazing. I plan to do only a few races, but many long, hard rides this year. I will continue to do long rides on my road bike.

Every case is different, but I have managed to stay out of surgery and continue to enjoy all kids of cycling. Best of luck with your back. :)

[Bud Bent]

I have had back pain from L4-L5 and L5-S1 discs for 12 years now. I've done therapy, and had two epidural injections. I've had neither for over 5 years though, since I've done some things on my own to help my back. They are:

1. I cut down on lifting at work and at home, and started making sure to lift correctly. I work out with dumbbells, but only reclining and on an incline, so as not to compress my back.

2. I do core muscle exercises. Strengthening your core muscles to better support your back helps a lot. I exercise with the Healthy Abs and Back (http://www.med.umich.edu/pmr/patient/products.htm) video from the University of Michigan Spine Program.

3. I spend 10 minutes on an inversion table after each exercise session. Not enough space between vertabrae is the biggest problem that bad discs creates, and I think an inversion table, which stretches everything, helps.

4. All my bikes are recumbents. I have friends with back issues who ride uprights, and they tell me that as long as they keep their lower back locked, they are able to ride without pain, but riding a recumbent is like therapy for a bad back. The bikes with seats which have the most recline seem to be best.

Most doctors will tell you that being very aerobically fit is the best thing you can do for a bad back, so you do need to find a way to keep riding. Good luck, I know that dealing with bad discs and back pain is not an easy thing.

[bobkat]

I don't want to sound like a salesman again, but I've had terrible back problems the last 10 - 15 years and have tried everything over the years, including 2 surgeries, physiotherapy, a book of back exercises, epidural steroids, NSAIS, accupuncture, chiropractic manipulation, various supplements and I'm sure some other stuff that I've forgotten.
The ONLY thing that works for me is to do at least 10 - 15 miles per day on my LWB recumbent (a Burley, but there are lots of good ones out there) I wish I could ride an uprigt for mt. biking but a 1/2 our on an upright kills me for a wekk.
I wish I had discovered the recumbent years ago. I often wonder if it would have taken the place of all the other stuff I tried. I have no idea how it does it, perhaps stops some spasm back there, or jiggles something around, or whatever. In any case it's been a lifesaver for me.
In my experience, (I'm a retired MD) I've only seen one person who developed sciatica FROM the recumbent, and it went away when he switched back to an upright. Even other case seems to be helped by a bent, and the recumbents have enabled them to continue to ride. So it's trial and error, but I'd sure recommend trying a long wheel base bent and play around with the adjustments of the seat, etc. When I started I preferred the seat being fairly upright, but have now grown to like it in a more laid back position. But everybody is different.
I joke to people with back problems that if I were in charge of approving back surgery for an insurance company or HMO I'd insist on a 6 month trial with 10 miles on a LWB bent per day before they had the surgery. Ha!

[gear]

Thirty years ago I had three back surgeries; problem solved.

Three and a half years ago I flipped over the bars and landed hard on my back. I also had a bulging disc that was pressing on a nerve and causing me lots of pain. After six months I was scheduled for surgery when icing the area began to show an effect. In the past only heat helped my back woes so ice was new to me; apparently it reduced inflammation. Between the ice and figuring out that certain positions (sitting and lying) made the disc press on the nerve.
The pain slowly subsided till it is now gone unless I sleep on the wrong side or sit the wrong way but I'd rather deal with it this way than surgery which is fine if there are no other choices.

So my advice is: try ice and try to figure out if positions that were fine before this problem began are not so fine now.
Good luck!

[hotwired]

To All: You give me hope! I am always pleased with the collective wisdom that the over 50 community shares so willingly. I see my orthopedic surgeon on Wednesday for a review of most recent MRIs. I am inclined to opt for taking the slow and conservative route, continuing with physical therapy and delaying any decision on the epidural for later. A special thanks to Bud Bent for the hyperlink which I have bookmarked. I will certainly be investing the $11. in a copy of the video. To BSLevan, I am thrilled that your wife has been able to endure her surgeries and continues cycling as a hobby. I will keep everyone advised as to my progress. If I have to switch to a recumbent, I won't have to worry about my back. After spending $2k on the Sirrus LTD my wife will kill me if I buy a recumbent. Thanks to everyone. Hotwired in Milwaukee

[bagster]

Been fighting the problem for over 20 years. After spending a week on the floor one time and literally having to literally crawl to the toliet stool, I've been fairly successful at keeping back trouble at bay.
Bike riding, stretching, and overall good physical conditioning are important. However, as informative as the previous posts are, they omit vital piece of information--posture. If you spend any
time at all sloutching down in a soft chair or car seat, your back will quickly let you know your are in deep doo-doo. Use a firm, bench-type seat at home and in your car--most likely, you will have to drive a pickup-truck or SUV--or any amount of exercise and stretching will not help. Also, yoga is an excellent disipline to take up.

[Bud Bent]

If I have to switch to a recumbent, I won't have to worry about my back. After spending $2k on the Sirrus LTD my wife will kill me if I buy a recumbent. Thanks to everyone. Hotwired in Milwaukee

If you do buy a recumbent, don't sell your Sirrus, at least not for a while. Some people stay with the recumbent, and never look back. But, others ride one for a while, then go back to their upright. Again, good luck.

[hotwired]

Been fighting the problem for over 20 years. After spending a week on the floor one time and literally having to literally crawl to the toliet stool, I've been fairly successful at keeping back trouble at bay.
Bike riding, stretching, and overall good physical conditioning are important. However, as informative as the previous posts are, they omit vital piece of information--posture. If you spend any
time at all sloutching down in a soft chair or car seat, your back will quickly let you know your are in deep doo-doo. Use a firm, bench-type seat at home and in your car--most likely, you will have to drive a pickup-truck or SUV--or any amount of exercise and stretching will not help. Also, yoga is an excellent disipline to take up.
I have just recorded eight episodes of Priscella's Yoga on my Tivo. The lady is amazing! I am committed to do what I can to manage my health. Thanks again, Hotwired

[staehpj1]

Although I am rather new to this forum, I need your advice. I have been diagnosed with a bulging disc at L4-L5 which is not responding to physical therapy. An epidural injection is the next option. I am experiencing too much pain to do nothing. I would prefer to avoid switching to a recumbent. My bike is a Specialized Sirrus Ltd. more upright than a road bike with a carbon frame that does a very good job of soaking up the bumps. Has anyone here with a a similar malady recovered to rejoin the cycling world. Thanks Hotwired in Milwaukee
I went that route a few years back. I finally got things under control after an epidural injection. The key was that I finally figured out what stretching exercises worked for me and learned to do them properly and had a chance for them to work after the injection. Another key is staying well hydrated. Doctors never seem to say this but I am a big believer that water, water, and more water is a big part of the answer.

Another thing that I learned is that staying active is absolutely critical especially when there is some pain. At the first hint of pain I do my stretches. I also don't skip exercise when I have a little pain. I would recommend that you at least try to get out and walk even if the pain is bad enough that you can't ride. Laying or sitting around is the worst thing for your back in my experience.

Another thing that I found is that a more upright position is not easier on my back as long as I stay in reasonable riding condition.

I have found that walking, cycling, rowing, and some exercises on an exercise ball using light dumbbells seem to help keep me generally fit and my back happy. Keeping your weight down helps too.

FWIW: After years of bad back pain, I managed to find good back health. I had what sounds like the same type issues as you do at L4 and L5 and my back has been good for a few years now. I even rode coast to coast last year, so there is hope.

[Sixty Fiver]

I was (finally) diagnosed with an L5 nerve impingement (last week) and have been off work for nearly 6 weeks as I am not even cleared for the lightest of duties. I work in a machine shop and have what I would consider to be a very strenuous job. There is a lot of walking, lifting, bending, and getting bounced around on the forklifts in my day.

At the end of 2007 I had logged 16,000 km on my bikes as I live a nearly car free life and was commuting on a nearly daily basis as well as doing a good deal of off road riding and touring... i rode nearly 1000 winter kilometres in January.

I was in some diabolically good shape before things went sideways.

Standing and walking (for any distance or amount of time) is still fairly difficult as for me as that is what causes the most pain and loss of feeling in my legs (mostly my right). Sitting in a good chair is doable.

I also volunteer in our community bike shop and have had to severely limit my activities... I am fortunate that we are a teaching shop and I can direct and instruct instead of having to turn wrenches, lift bikes, etc. I never realized how strenuous working on bikes could be.

This also keeps me sane as if I can't really ride much, I can help other people build bikes and we put two more fixed gears on the road today.

I rode 20 km today (to the shop and back) and spent a few hours at the shop and my back is now telling me I was pushing things a little too much.

It was all good until I got off the bike which actually seems to have a pretty ideal set up...it puts me a little forward so my arms can support me a little and it is very plush. I set it up for doing metrics and centuries as well as being a regular commuter so already had the higher bar position.

http://www.ravingbikefiend.com/bikepics/7500mxb.jpg

[Miguelangel]

I had an erniated L4L5 5 years ago... I feel no back pain whatsoever... never ever.... they wanted to operate and they wanted to do stuff on my back but i did not let anyone do anything..... this is what i did:
1.streching... lying on your back with your legs on a 90 degree position every morning and night for 30 min will do wonders... be careful if you suffer from high blood pressure, then cut it to 20 min....u must be patient as it takes time... you might have to stop straiining your back..if the bike does it to u ..then the bad news is that u shuld be off for a while... There is a great book called YOGA FOR BACK PAIN the exercises there are wonderful and it has lots of info regarding taking care of your back...
2. I started doing tai chi.... yang style... its wonderful and if u have a good teacher you might find yourself loving a new sport..
I hope this hellps you out if you want more info please feel to pm me...
with back injuries you must be extremely patient....

[rae]

I do not know if it can apply to low back, but I can't think why not --my problem has been with a bulging disc in my neck from whiplash injury. A kind of traction therapy at the chiropracter helped a great deal--decpmpression therapy they call it--got things back into alignment & relieved the pressure.

Core strengthening exercises & getting rid of any excess bulge on the stomach as best you can will also help. Good luck.

[flan48]

I had the identical probvlem. Like you I tried PT first, along with taking, per Doc's suggestion, 2 Advils, 3 times per day. This only helped minimally. Finally had the epidural and withing 3 days I was feeling great -no pain down my right leg (the main issue with herniated/bulging discs), and the ability to walk 2 miles with no pain. Additionally, and simultaneously, I gave up my Concept2 rowing machine. Furthermore, I amended my work out routine with weights. Finally, the Doc said that biking is good as long as I am in a upright riding position. So I went out and bought a Raleigh Venture 24 speed comfort bike. I have been riding all winter -no exacerbation of the disc problem.

With all of the above I am doing great and it is 6 months since the epidural. On days, which are very infrequent, where I am experiencing radiculopathic leg pain, I merely take it easy and do extension type of back stretches. These tend to open the vertebral spaces and take any existing pressure off of the nerve.

Best of luck to you

[urban rider]

I have problems with my lower back. I have had four epidurals, PT and now I am taking pain pills as needed. I have lost some of the feelings in my right leg. Walking for a distance is out of the question. I get relief from riding my bike. A friend of mine suggested mustache bars so I am streched out on the bike. I don't feel any pain when I am riding and of course people don't understand why I can not walk far or stand for long period of time but I can ride my bike. It does not help when I get out of the car that has a handicapp sticker. Based upon some of the suggestions from the other entries I will try streching twice a day for more relief.

Gas, .69 cents, the price of a can of beans.

[larry h]

i blew out L-5 in 1993 had it removed after that i quit smoking ,lost wt and took up biking ,i had problems in 2007 and had the shots md friend showed me various exercises that have helped , just had to learn when back hurt get off bike and walk for a few minutes i still do 3500 miles a year wish you good luck

[lubers]

I also have had two epidural injections in that same area, for me it was like heaven an instant relief, and I was back at work the next day. It has been six years since my last shot and while I still have some back pain it is nothing I can't handle. I go 6'1 and 270 pounds and find that riding seems to help. I have done numerous centuries since then and I do at least two support tours a year with no problems.

[MillCreek]

At the clinic for which I am one of the administrators, we have a spinal center with two physicians who do epidural steroid injections. Most of the patients seem to swear by the ESI's.

[stevemtbr]

Check this web site for some outstanding back and spine info. http://www.spineuniverse.com/ Granted I'm only a youngster at 44 but without getting into the long history of my lower back I finally had minimal evasive surgery 4 years to repair a ruptired disc (L4-5). Today I ride 4k yearly on road/off road/cross, can still run 8 minute miles for 6 miles and bench press 235. Everything I do revolves around keeping the back healthy with daily strength training and yoga stretches. Good luck.

[Bud Bent]

At the clinic for which I am one of the administrators, we have a spinal center with two physicians who do epidural steroid injections. Most of the patients seem to swear by the ESI's.

The only down side I've consistently heard about the injections is that the more you have to get, the less they work. On my own series of three, they told me if I was pain free before the third, not to get any more, and I only got two.

I'm still firmly in the camp that says if you can do it without either injections or surgery, that's the way to go.

[Terrierman]

I've had epidurals at the L- 4 L-5 joint and they didn't help me. This was in the days when an epidural was cortisone, I hear they have other options now, but I do not know what they might be. Have had two laminectomies there, one unilateral (left side) when I was a strapping young lad of 30 and another at 44, the second one was bilateral and the surgeon cleaned up bone spurs and scar tissue from the first one. Both times I resisted surgery as long as I could and finally had to give in when I could no longer urinate. Incredible pain both times, and in retrospect I should have given in sooner. Same neuro surgeon both times, he was great. I am fully functional now. The bike really helps both my knees and my back.

[hotwired]

I went that route a few years back. I finally got things under control after an epidural injection. The key was that I finally figured out what stretching exercises worked for me and learned to do them properly and had a chance for them to work after the injection. Another key is staying well hydrated. Doctors never seem to say this but I am a big believer that water, water, and more water is a big part of the answer.

Another thing that I learned is that staying active is absolutely critical especially when there is some pain. At the first hint of pain I do my stretches. I also don't skip exercise when I have a little pain. I would recommend that you at least try to get out and walk even if the pain is bad enough that you can't ride. Laying or sitting around is the worst thing for your back in my experience.

Another thing that I found is that a more upright position is not easier on my back as long as I stay in reasonable riding condition.

I have found that walking, cycling, rowing, and some exercises on an exercise ball using light dumbbells seem to help keep me generally fit and my back happy. Keeping your weight down helps too.

FWIW: After years of bad back pain, I managed to find good back health. I had what sounds like the same type issues as you do at L4 and L5 and my back has been good for a few years now. I even rode coast to coast last year, so there is hope.My physical therapist strongly urged me to increase my water intake. I am doing my exercises religiously. Hopefully, I will be able to avoid the epidural or worse. Hotwired in Milwaukee

[Terrierman]

My physical therapist strongly urged me to increase my water intake. I am doing my exercises religiously. Hopefully, I will be able to avoid the epidural or worse. Hotwired in Milwaukee

What he said about staying active and getting exercise is so right there are not enough plus signs on the internet. Never give an inch, do something ANYTHING as long as you can and you will never be sorry. I was in serious PT before the second laminectomy and there is no way I can say enough about how much it helped to have muscles and muscle tone when it came time to get up out of bed and walk down the hall the first time... and all the rest of the times after. Do your PT, religiously and ride the bike too, they will help.

[BikeArkansas]

Ten years ago I had surgery on L5. A few months later I had two injections. Not much help there. Today, I cannot walk any distance without the siatic nerve rendering my right leg painful, then numb. However, I can ride a mile century on my road bike. When I am forced to miss riding for a period of time, such as very recently due to health, I start having more and more back problems. The exercise helps beyond any expectations.

What I am saying is that the chemicals produced by good exercise helps more than the injection. Of course people are different.

[Ranger63]

Two Thumbs up..WAY UP for the epidurals.
So long as the surgeon doing em numbs the area beforehand:eek:
I have the same problem along with nerve impingement (which can make sitting or walking a teeth clenching experience)
I've been getting the epidurals 2x a year sence 1999.
I kayak (for those of you who don't this places a lot of pressure on the lower arse and back area)and last year did a 7 hour (albeit with breaks about every 90 min.)paddle around Grand Island in the upper Niagara River and had nooo pain or discomfort what so ever.
Without the injections, driving the ranger or sitting thru a movie or walking (forget walking in snow) would be impossible.

[hotwired]

To All: I met with my orthopedic specialist this a.m., and the news is disappointing. The MRIs verify that the disc is herniated. Epidurals may help,but most likely will not resolve the problem. The Good news is that this procedure is so refined that it is now done on an outpatient basis. After rehab, I should be able to both golf and cycle. I may skip the epidurals and go straight to the surgery. Thank you for all of your advise. Hotwired in Milwaukee

[jmel7771]

After a serious back injury over 30 years ago that flares up every so often to where I have to crawl to get anywhere, here is what I have learned. Chiropractic NOT for me. Only made things worse. Best thing for me was exercise and posture. Bought a Total Gym (yea I know Chuck and Christy were hawking them, but it really works) to help strengthen and stretch the body. Keep the weight off and ride as much as I can. I was also very fortunate and had the ability to buy ergonomic furniture (office and home). Keep the stomach and back strong and it may help you too. It is my tonic.

[LastPlace]

I have just recorded eight episodes of Priscella's Yoga on my Tivo. The lady is amazing! I am committed to do what I can to manage my health. Thanks again, Hotwired

Not to get off on a tangent, on a very serious subject, but those were recorded where I work and the lady is amazing, and about 70 years old.

In addition to your doctor's suggestions I heartily second the recommendation of a Yoga class.

Good luck...........

[hotwired]

Yes the Lady is amazing. I note your organ donor connection. My wife is a kidney transplant recipient. Organ donation is truly the gift of life! Thanks Hotwired in Milwaukee

[bikingbuddha]

I have had two episodes of herniation with that disc, approximately two years apart. Both times I had an epidural steroid injection (ESI in medical lingo). The first time the results were miraculous with immediate relief (partly from the anesthetic in the steroid) that lasted until the second episode. The second time I had the injection the relief wasn't quite as immediate but eventually I got to the same point I reached with the first injection two years earlier. Only time will tell how long it lasts. One thing that helped the first time was some physical therapy to strengthen my trunk and stomach muscles to minimize the strain on my back. While the injection procedure isn't exactly pleasant, it's not particularly painful. I would strongly recommend this course of treatment.

[seeker333]

Don't waste your time with quacks.

Go see a neurosurgeon; you probably need a microdiscectomy.

[dorosz]

Although I am rather new to this forum, I need your advice. I have been diagnosed with a bulging disc at L4-L5 which is not responding to physical therapy. An epidural injection is the next option. I am experiencing too much pain to do nothing. I would prefer to avoid switching to a recumbent. My bike is a Specialized Sirrus Ltd. more upright than a road bike with a carbon frame that does a very good job of soaking up the bumps. Has anyone here with a a similar malady recovered to rejoin the cycling world. Thanks Hotwired in Milwaukee

WEdnesday morning I commuted in to work and felt every crack in the pavement in my lumbar...noon I went to yoga for a good stretch..oops differant instructor, :mad: some alternate postures and it was all I could do to walk back to my truck to drive myself to urgent care, muscle spasms about every 4th step.
After a bit of work with heat, massage, and electro-stim I could at least walk enough to go home with a scrip for muscle relaxers. :eek: Went back in today, to see my D.O. we worked it a bit and we decided to do the epidural. Doc said "OK the numbing agent ought to give you 5 hours of relief and then we should see it truly better in a week, its 7 hours later and I still feel human!! :D The ESI isn't always a cure (I had mixed results with it in my C5-6 injury) but when it is its darn near miraculous! Of course this shoots the backpackiing trip in April in the tail feathers but at least I'm agressively pursuing conservative therapy and ought to get it under control without surgery.

I don't care what anybody says this getting old stuff is really is really not for the faint of heart! :)

[Sixty Fiver]

Well...

I have ridden 20km a day every day this week after modifying one bike and building up another so I have a more forward position which alleviates a lot of pain and also stretched out my back muscles. One of the bikes is a folder which is a step through design which works if I don't feel up to swinging a leg over the saddle. Being able to support a little more weight on my arms is also a good thing.

Still waiting to find out what options I am looking at for long term recovery as riding isn't going to fix my back but is an activity I can do to keep myself in the best physical and mental shape possible.