Young 28yr old in desperate need of help - athlete to couch potato

[simondavies]

Hello, this is my first post. But I have been a long term reader. I am at the stage on near desperation. So please hear me out. If you can help I would be the most grateful welshman on this planet!!

I was completing a ski season in Canada from the 16/01/12 till 13/04/12, when two weeks in I felt a strange tight pain in my left buttock, thinking it was due to muscle tightness I stretched it out. This seemed to work, but then it came on the right buttock, deep in my right buttock, like piriformis tightness. Im not the most flexible so thought it might be due to this and my lack of stretching from skiing 5 hours a day. However this side didnt go. This started to get worse and worse. However I just rolled with it. The pain wasnt there when I was skiing, only after and before. The continued to get worse over the next few months.

By this time I was in SE Asia as me and my partner had packed up everything to travel the world and possibly settle in Australia. The pain didnt go away and I had started to rely on my one side alot more, could walk properly, kind of a limp. Lying down I couldnt lift my leg up more than a few inches and bending over was painful. After this went to Australia to start our years visa, working as a ski patroller/ instructor. Again pain free on skis, but limping when off them. Got through the 3 months of skiing and headed to sydney, this is when the pain started to get worse day by day, to the point of not being able to walk for periods over an hour. So I saw a chiropractor, he basically did tests and xrays and come up with sacro-illiac dysfunction. Told me to wear a belt, which actually worked and got me walking a little better. Then the pain got worse, real bad gluteal pain, going down to my calf and outside ankle. Not the back of the leg though. So had a CT done, and then an MRI. Saw a specialist in Brisbane who said I have 2 bulging disc, l3-l4 and l4-l5. L5 showing compression on the nerve root. He said my options would be to either have surgery, have an epidural, or simply ride it out.

I opted for the epidural, did nothing. I am taking panadine forte (30/500) which gives me some relief. But since then I am slowly getting worse. I can cope with about 10 mins standing up, then I am in pain looking for the next seat. It feels pathetic, as I used to be fit. Triathlon, skiing, surfing. Now I cant even kick  football or walk properly. I desperately want to get my life back.

I think it may be due to spinal stenosis?? as it only becomes unbearable when I stand, sitting and lying is pretty much pain free. What I want to know is the best cause of action before thinking of surgery. I have been in constant pain (on my legs) for 15 months.

Firstly I am worried about permanent nerve damage , as it has been there a long time, but then the specialist said I could ride it out??

Would a nerve ablation do the trick?? Given there was no significant trauma, and it slowly came on, what would be the best treatment for this??

Sorry for babbling on, but that was a snippet, I could carry on with details all day. Just wanted to give details of injury in the hope someone can come back with good advice. Im lost.

[mkh9]

Looking back at your post since you had the epidural and it didn't work the area they put the nerve block doesn't have nerve damage or it should have relieved the pain. Pyriformis syndrome is a trapped nerve in the buttock area.  They think the sciatic nerve is pinched by the pyriformis muscle. Streching is good but don't overdo it. For me and what the doctor in the book I mention says for most cases including disk problems and stenosis is to walk it off. Start walking flat areas and do what you can and increase in small amounts per day. Don't over do it. Then once you get to a half hour then do hills. etc. As for a diagnosis I don't at this point. I would get the second opinion. A lot of back surgeries fail. So, I would read the book I mentioned. Also, biofeedback to help the fight or flight response helped me and muscle relaxers (flexeril). I was ok on Flexeril for about 6 months then I got some benign arrhythmia from it. So, I wish you the best.
mkh9

[simondavies]

Thanks for your reply, in particular the advice on the nerve ablation. I have stopped all sports and activity since october 2012, I havnt been able to do anything since the ski season (was going to commence another season next month, but need to sort my back out). So I have been in pain for 15 months all together, 7 months continuous pain after all exercise has halted. I dont feel my muscles are atrophied. But they have shrunk alot in size since last year, but then I did ski 150 days last year so thats is reasonable I feel, my jeans a baggy around my thighs as opposed to looking like they are sprayed on. The specialist I saw was a neurosurgeon and he said it could take up to 5 years to recover naturally. He said the microdisectomy would almost certainly relieve me from my pain. The pain definitely feels deep in my buttock, its the thing I really relay when talking to who ever I meet, deep in my buttock is the worse pain, then outside of my ankle. The fact that it is only when i stand up or walk makes me thing it is my disk. Do you know much about piriformis?? I didnt have any significant accident, it just came on over time and got worse and worse. The one thing I havnt tried and am contemplating is the inversion table?? Have you tried this??

Im sat here after having done 20 mins of stretching and now typing with a TENS machine on my back. Im starting a new routine. See if it works. Bit of focus on the piriformis and glutes too.

Im due to fly back home to the UK in 3 weeks, so I am taking all my scans back with me, and hopefully get a second opinion on what I had out here. Fingers crossed it will go away naturally eventually, then I will definitely look after my back!!

[mkh9]

Sorry you are having all these problems. I know what it is like to be very active and then not to be able to do anything. I was an avid tennis player, hiker, and jogger etc. and got a back injury and now I am at home not working and trying to rehab myself. It does sound like a disc herniation or possibly pyriformis syndrome. Since they did find the disc herniation on the CT and you have pain going down the leg. I would not have surgery for this. Usually it resolves on its own in 4 months with rest and walking etc.The only time I would have surgery for this is if you have lost bowel and bladder control, nerve damage, pain that wont' go away after resting and if the pain won't go away with relative rest. I mean you should walk so as to not get atrophied but not lift weights etc. Follow what the orthopedic surgeon said you can do. You probably have disc degeration and so once you do heal you probably want to do stretches and an inversion table to stretch out the area. I would see a physical therapist that you get a good referral from otherwise have your doctor show you or tell you what to do. I hesitate about physical therapists because I was injured twice by them and I don't trust them any more. I also definitely don't trust or believe In chiropractors. Chiros don't have the experience to work on your back or anything really. I think they get about 2 years experience. Compare that to Med school and internship and specialization etc. Anyway, I bought the book Conquer Back and Neck Pain: Walk it off! by Mark Brown MD, PH.D and he helped me get better. It is a small quick read. It may help you make a decision. As for nerve ablation, if you do have a pinched nerve due to a herniated disk you would have to have the disk fixed then you wouldn't need the ablation in your case. If you did need it for example if you had a pinched facet nerve or somewhere in the pyriformis area it only lasts for about 6 months. My family practice doctor had it done and it isn't a cure it is temporary. I think overall you need to slow down and heal to see if the herniated disks will heal or if those are the problem. Did you actually see an orthopedic surgeon? Did that doctor think you would get better? If it doesn't over the 4 month time then you may have to have surgery for the herniated disks. But you can have herniated disks and not know you have them. The pain could be from a trapped nerve in the pyriformis area. I doubt you have SI joint dysfuntion. They told me I have that too and I don't. Did you have a big fall or accident? If not then you don't have it. You are far to active to have it. The PT's and chiro's love to use that diagnosis. You can get an injection into the SI joint by a pain doc and see if it takes away your pain . If it does perhaps that is the cause but it takes a lot of pressure and a very big accident to dislocate the SI. I have read a lot about this. I hope this helps you think about things. Let me know what you think.
mkh9