aging – Hillfamily dot net

I want to shout this from the rooftops.

I am writing this while sitting at my desk, something I haven’t been able to do in the past 14 months.

My daily life until recently involved an hour-long routine of stretching, lying on my back, hanging upside down on an inversion table, taking a bunch of pills, alternating hot and cold compresses, and swearing under my breath.

Last month I took a van service to the airport for an international flight. The van driver noticed the back cushion I brought as well as how much I shifted in the seat to try to get comfortable. I told him I had sciatica and I hoped it would get better soon. “In my experience,” he said, “the way you feel right now is the best you are going to feel for the rest of your life.” That hurt his tip.

[amazon template=iframe image right&asin=0446557684]But it inspired in me a fresh batch of research into back pain. I’d already read a dozen-plus books on the subject, but I checked Amazon’s current bestsellers in the chronic pain category and checked Healing Back Pain: The Mind-Body Connection by Dr. John Sarno out from the library. I started reading it on New Year’s Eve and by January 6 I had less pain than I’ve had in over a year.

To emphasize how big a deal this is, let me quickly review what I’ve experienced so far.

I’m not sure why the pain started in the first place. It was getting bad in December 2015, so I thought back and blamed it on Turkey Bowl football Thanksgiving morning (my team won but my muscles ached for days) and then helping a neighbor move a week later. I was lifting a big couch at the end of the move and felt a bolt of pain in my back. Sciatic pain started up a couple of weeks later.

I’d experienced sciatica a couple of years earlier but it wasn’t too bad and it went away after some physical therapy that included leg exercises and stretching. This time around it got worse and worse. For a few weeks I had a cane next to my bed to help me get up in the morning. The pain was constant and consumed my thoughts.

I started with a family doctor who specialized in sports medicine. He gave me an oral steroid that completely relieved the pain. . . for one day.

He referred me to a physical therapist. Physical therapy left me in so much pain I could barely walk back to the car in the parking lot. I quit after 5 or 6 visits.

I got x-rays. Inconclusive.

I was referred to another specialist who prescribed an MRI.

I got an MRI. Herniated disc, spinal stenosis.

He referred me to a back surgeon.

The back surgeon referred me to a pain specialist, a physiatrist, who gave me a steroid injection.

This sounds fast as I write it out, but each step in this process took at least two weeks. We’re into March 2016 now and I’m sleeping on and off all day, exhausted from the constant pain. I’ve tried TENS therapy, As-Seen-On-TV Magic Back lumbar stretcher, acupressure mat, ice packs, hot packs, yoga, stretches, ibuprofen, aspirin, acetaminophen, muscle relaxants, turmeric, hydrocodone, Jamaica dogwood extract, meditation, and crying.

Almost every day some new back gimmick was arriving from Amazon.

I would give up for a few weeks and then try something new. A new book, a new doctor. Two chiropractors, acupuncture, so many YouTube videos and forums on back pain, an inversion table, ointments, creams, deep-tissue massage, the Miracle Ball Method, McKenzie exercises, Egoscue exercises, the exercises of some random dude on YouTube. I investigated a clinic that offered laser therapy and the DRX9000 spinal decompression system but balked at the price ($10K) and the 20+ required sessions in a machine that claims to stretch my spine (and whose effectiveness is much disputed).

I switched to a standing desk at work. I avoided sitting down, as much as possible. While my family sat on the couch to watch tv, I knelt on the floor and propped my arms up on a stool. Piggyback rides and wrestling matches with the kids were a distant memory. I couldn’t pick up my 3-year-old and I imagined my kids describing their dad to their kids as the guy who had a bad back and couldn’t do much. I bought all slip-on shoes because I couldn’t bend over to tie anything.

The steroid injection is the one thing that actually worked, for a while. It cut the pain down to a manageable level from March until about October when I got a second one (which either didn’t work or took several weeks to kick in). I still couldn’t sit very long and had to take back support cushions to meetings. And I had incessant hip pain, a pinch in the back of my right knee, an aching right ankle, and sometimes just numbness or pins and needles all the way down the right leg.

On that international flight I mentioned, I took a seat cushion, a back cushion, and an old-fashioned ice pack that I had flight attendants refill 6 times on the way there and 6 times on the way back. (They were very nice about it, by the way.) I walk around a lot on flights and do stretches wherever I can find a little space. I usually end up talking with someone else who has back pain and/or sciatica. Most of them are about as hopeful as that van driver.

Ok, I think we’re caught up to New Year’s Eve 2016. I checked out the book and started reading. A week later (January 6, 2017), I was almost pain-free for two days. I could sit for an hour. I played basketball two nights ago for the first time in a year. I could stand up and sit down at will!

After a couple of blissful days, some of the pain came back. I’ve been a serious student of Dr. Sarno’s other books and I found an amazing website, tmswiki.org, with all sorts of free information. It’s now March 13, 2017, and I hardly even notice the pain any more. In fact, I only notice it when I realize it has been gone all morning.

I’m hesitant to go too much into the book because I’m at the stage right now where it seems like magic. And I’m not sure if discovering it the way it’s presented in the book is part of the magic. But here’s a brief overview:

My pain is real but it’s not necessary. It’s not fulfilling its usual purpose of warning or keeping me from doing something dangerous. There’s nothing wrong with my back. The herniated disc was there all along and has nothing to do with my pain.

But there’s something in my subconscious that my brain thinks it needs to protect me from. And a great way to do that is to distract me with physical pain. It doesn’t have to be something big — it could just be everyday stresses or anger.

The trick is to shine some light on that. Convince your brain that you can handle the repressed emotion and it doesn’t need to distract you. Just reading the book provides most of this education. Reviewing a few daily reminders keeps you on track. And giving up on all your other attempts seems to be part of the trick — no more stretches, exercises, magic balls, physical therapy, etc. Just get back to work — sit and sleep normally, go for a run, play some ball. And your brain does the rest.

That’s it. For reals. I can barely believe it myself. It’s almost infuriating when I think of all the time, money, and suffering I’ve been through. And all it took was reading a book and thinking about it for a few weeks.

I have no idea if it will work for you. But, holy cow, you should try.

[Update May 24, 2017] When I wrote the above, I still had some minor daily pain (especially evenings) and occasional “relapses”. Another couple of months and it’s all gone. I catch myself slouching in a chair – something I couldn’t do without sharp pain and pins and needles a month ago. So, for me, the full recovery took about 5 1/2 months. This is in line with several others I’ve met in online forums. Interestingly, those who meet directly with Dr. Sarno tend to have a much quicker recovery – perhaps something about the authority of a doctor makes it all click into place more rapidly.

Ignore this whole thing. Read this March 2017 update instead.

For the past four months I’ve had pain pretty much all day, every day. I think I’m finally at the end of it. I saw a lot of doctors, watched a lot of YouTube videos, and read a lot of articles, forums, and books. It’s difficult to get good information:

Product reviews seem to say “I TOOK ONE DROP OF THIS AND MY SCIATICA IS GONE FOREVER AND MY HAIR GREW BACK!”
Many books and articles promise quick solutions
YouTube videos imply that this one stretch will fix all your woes and bring the spice back in your love life
Surgeons say chiropractors can’t be trusted
Chiropractors say the same about surgeons
Group forums say nothing will ever work and you’d best get used to a life of misery.

So, at the risk of further muddying the waters with yet another individual experience that may not match yours, I decided I’d go ahead and document my process a bit in the hope it will help someone else get relief quicker than I did.

(I don’t know if I’m required to explain that I’m not a doctor and this shouldn’t be taken as medical advice, but if I am then I’m not and you shouldn’t.)

I’m 42 years old, by the way. And I had one other short stint of sciatica about 5 years ago, after a long (19 hours in the air, each way!) flight to/from India. It went away in a few weeks with a little physical therapy. Since then I’ve been medium consistent with daily stretching and exercise. And I’m the guy you see walking up and down the aisles during the flight, stretching his legs in whatever little space he can find between food carts and lines for the bathroom.

This time around the pain started with a sore back after a Turkey Bowl football game on Thanksgiving morning. Then I helped someone move and felt a quick bolt of pain in my lower back as I lifted a couch. Within a few days sharp pain entered my hip and then gradually worked its way down my right leg. For a couple of months it was constantly in the back of the knee and felt like repeated tetanus shots, every few seconds all day and all night. It was miserable.

Mornings were worst. After a night of tossing and turning for a comfortable position, I dragged my leg like Igor to the shower. My hip muscles ached because they were working overtime to accommodate a new way of walking. Sitting was painful, so I assembled a laptop stand to work standing up. If I iced my back and never sat down I could halfway enjoy the afternoon. Then it was time for bed and everything would start over.

A few things provided temporary relief during this period:

Ice therapy – This was the most reliable source of short- and medium-term relief. I used a Bed Buddy Back Wrap, which didn’t get cold enough by itself (it’s apparently much better as a heat wrap), but it was great if I wrapped it around my waist and slipped a regular lunchbox ice pack between it and my lower back. I would do this for 30+ minutes every morning and again during the day if pain sharpened.
Heat therapy – this seemed to help sore muscles more than the nerve pain, but sleeping with a heating pad seemed to give me some relief.
Walking – I didn’t feel like walking, but 10 minutes into it I always felt better. Walking slightly downhill felt best. Aerobic exercise is extremely important in the healing of your back – keep it up!
Hot chocolate – I’m pretty sure chocolate has no ingredients that actually heal a degenerated disc, but I swear it brings me more relief than ibuprofen. For you it may be something else, but find something that brightens your mood and relaxes you. It’s your brain that’s deciding how to react to pain, so give it something it likes and it might get distracted for a bit. My current favorite is the Starbucks double chocolate packets, especially that last spoonful of melted chocolate at the bottom.
Yoga/stretches – I found a few exercises in the book Treat Your Own Back by Robin A McKenzie that helped somewhat. They didn’t give the long-term relief the book promised, but maybe they’ll work better for you. You basically just lie on your stomach for 3 minutes (trying to relax your legs and hips), then lift yourself up on your elbows for 3 minutes (still relaxing your hips and legs on the floor), then do some “cobra” pushups with your hips still on the floor.
TENS therapy. This is the electrical stimulation you may have had at a chiropractor or physical therapist. I used the Icy Hot Smart Relief system because it was the first one I saw. It worked pretty well at interrupting the pain and was very portable since it was battery-powered. I could actually wear it to long meetings without being noticed. I’d sometimes wear it all night and turn it back on every time I woke up. But the battery power also meant I had to replace them often. It’s just cheap watch batteries, but it’s still a little bothersome.

I alternated between ibuprofen, aspirin, and acetaminophen – none of them seemed to help much and started to upset my stomach. My doctor prescribed a narcotic, Norco (Acetaminophen / Hydrocodone), which didn’t seem to relieve the pain but made me care less about it. I only took a total of 4 or 5 of them when the pain was at its worst since they made me babble like an extrovert (how do they live like that?) and feel loopy.

I count at least eight doctors that saw me, including x-ray and MRI techs. It took about 2 weeks between each visit, which I think (and at least one doctor confirmed) they do intentionally to see if it will go away on its own. I started with a sports doctor, specializing in orthopedics. He put me on an oral steroid, which made me think I was cured for about 1 1/2 days before wearing off. He also referred me to a physical therapist who was a super nice guy but only made things worse in the 2 1/2 weeks he worked on me (3x per week). By the end of each physical therapy session I could barely walk to my car. My right foot would go completely numb (which never happened on its own) and I wanted to kick puppies and punch cars. My doctor said I could quit physical therapy and referred me to get an MRI.

The MRI showed that I had an unhealthy and bulging disc at L5-S1. This means the disc where the lowest lumbar (L) vertebra meets the upper sacral (S) vertebra, right below the belt (depending on how low you wear your pants).

Here’s what it looks like.

Healthy discs show up with whiteness in them – unhealthy ones are dark. And that poky part I circled is not good. That’s where the disc is bulging out and pressing on my sciatic nerve (the white band cutting through the middle of the picture, top to bottom). There’s another slight bulge three discs up. I also apparently have “congenitally short lumbar pedicles resulting in a predisposition for spinal canal stenosis”. Thanks, ancestors! What this means is there’s less room than usual for the nerves to hang out in the spinal canal, so when the disc bulges it can’t help but aggravate the nerve. Others might have the same disc bulge as me but never know it because they have more wiggle room.

After reviewing the MRI results, the doctor referred me to an orthopedic surgeon. Two weeks later, he reviewed everything and said the next step was a steroid injection. That happened yesterday and I currently feel better than I have in 4 months.

Here’s a picture I took of the x-ray showing a needle (bottom right) in my spine, filling it up with juicy goodness.

The puncture didn’t hurt much, but it did all manner of weirdness to my leg, especially down by my right ankle. I also found out that I have six lumbar vertebrae instead of the usual five. He counted twice via x-ray and then said, “You, sir, are an anomaly!” Apparently, about 10% of the population has this abnormality, which doesn’t usually cause any problems by itself.

The steroid is supposed to shrink and calm down the nerve long enough for the body to heal the disc and get things back to normal. Sometimes another round or two is required. And if it doesn’t help for long, the next step is surgery: a microdiscectomy, which is a minimally invasive slice in the back to slice off the bulging part of the disc. Since that destroys the annulus, or the crust that’s holding the gel in place (that’s the way I think of it and may not be anatomically accurate), scar tissue develops to hold things in place again. My surgeon says the surgery itself is very straightforward and safe, but recovery is about three months.

I also looked into several other solutions:

Deep tissue massage – this gave me some temporary relief, but not much.
Acupuncture – I didn’t try this, but I’ve heard from others that it can buy them a few days of relief at a time.
Acupressure – I bought a mat from Amazon and would lie on it for 20 minutes most nights. It’s like a bed of nails. It’s supposed to encourage blood flow and do magical things. Maybe it helped a little.
Magic Back Lumbar Support Stretcher – the jury is still out on this one, but it does seem to help.
Inversion table – also seems to help. Hard to say in the short term.
Spinal decompression treatments (the Axiom DRX 9000!), laser therapy, etc., from a chiropractor. I read this very well-done ad in a mailer and was almost convinced to throw down the $10,000 (some covered by insurance) for 20 treatments. I was ultimately convinced by Internet forums (I found spine-health.com to be very helpful and relatively unbiased) that DRX 9000 claims are dubious at best and the main benefit comes from the exercise part of the plan, which you can get without throwing down so much cash. I was also warned by two doctors and one physical therapist to not get any chiropractic adjustments in my current state. I don’t have anything against chiropractors and have been helped by them in the past, but I decided this wasn’t for me right now.

Pretty much every day something new arrived from Amazon and my wife would smile in that one way you’re all familiar with and say, “Hey, another back thing!” If Amazon sold hot tubs I’d probably be cured by now.

In my case, nothing could control the pain until the steroid injection. From what I gather from my doctors, there’s a sequence they go through from conservative solutions to invasive ones:

Physical therapy
Oral steroid (Prednisone)
Steroid injection (possibly multiple)
Surgery

I’m glad no one tried to rush me to surgery. I wish the path to what eventually worked would have been shorter, but at least I can be sure the more conservative steps didn’t work.

[Update a week later: I still have some pain, but it’s much lighter and less-sustained than before. My Igor gait is gone. Sitting for something I enjoy (a basketball game or a concert) is bearable but sitting for something I’m required to attend is still painful. I’m hopeful that things will continue to improve now that the nerve is less irritated. I walk at least 40 minutes a day and do McKenzie exercises and a few others.]

Here’s what I’d do differently next time:

Go to a doctor sooner. I spent almost 2 months thinking this was piriformis syndrome (where the piriformis muscle in the hip pinches the sciatic nerve) and I just needed to do some stretches on my own. By the time I went to the doctor I was in serious pain and it was having a big impact on my daily activities.
Start with a physiatrist instead of spending (wasting) time on a series of referrals. According to a large Back Pain Survey performed by Dava Sobel and Arthur C. Klein, the authors of Backache: What Exercises Work, the premier back doctor is a physiatrist. “These practitioners rarely prescribe drugs and do not perform surgery. They prefer instead to use individually prescribed exercise regimens and physical therapy to treat back pain.” This was the last specialist I was referred to, the one who did my steroid injection. He works closely with a surgeon and can refer me in that direction if that looks to be the best route.
Don’t help people move.

Hopefully some of that is helpful to someone out there. May you find rapid relief. I’m currently working out my daily exercise routine and might post it later.