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leg pain
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leg pain

I have a herniated disc at L1-L2, L3-L4, L4-L5, L5-S1.  The L4-L5 also has an annular tear.  I am an RN for 21 years, with a long hx of lifting, pushing, pulling etc, in PACU.   I have had 3 L1-L2 esi's, along with facet injections x2.  My leg pain is quickly approaching unbearable.  I must physically lift my legs to get in the car, dressed, etc.  I cannot stand for any length of time.  The pain is now bringing tears to my eyes.  The pain is worse in my left leg than right, but now I am having a hard time walking on bothlegs.  I would appreciate any advice.
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Avatar_m_tn
just some food for thought. MRI findings, as bad as they may read to us laypeople, are usually NOT the cause of back pain. Most people over 30 have herniations, stenosis, spondylosis bulges etc--usually these "findings are symptomatic and were probably present before your pain started for years. Most leg pain Lower back pain, hip pain, shoulder pain, neck pain has muscular causes that almost always lead back to posture and muscle balance--- head posture and pelvic posture. I'd suggest you do some trigger point wok on your hip flexors (clair Davies has a great T point manual) and also stretch them-- see a website by jolie bookspan (t saved my life-- i was in pain 24/7 for 2 1/2 yrs). also look into the Escogue method. and a book on posture by Paul d'arezzo.. you should be able to find great hip flexor exercises and stretches-- or get the recent Men;'s Health Magazine with Matt Leinart on the cover-- inside in the middle somewhere are some great pelvic stretches....a whole page. I'd certainly consider this before even thinking of surgery. The fact that your problem is in both legs helps support the notion that an out of balance pelvis is the problem. just my 2 cents having been through this nastiness --pain free now. played tennis this morning,.
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Avatar_m_tn
3rd line i meant to say "asymptomatic"
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Avatar_n_tn
Hi,

Sorry to hear all the trouble you are having. Contrary to what Mike says above - there are plenty of other problems BESIDES muscle/posture, etc. etc. that cause pain, change our productivity and also change our functioning levels in life.
I will say this though...even though your MRI shows all those herniations, that does NOT mean your should necessarily have a ton of pain. I will agree with Mikey about how most people have herniations who are not even aware of them. But, in your case, because you have so many, there is bound to be at least one that is causing your pain.
It only takes one disc rubbing you in the wrong way - pressing on a nerve, etc, that can take down even the strongest of men (or women, in your case) I am assuming you are a woman. Also, that disc does not need to be a complete rupture, all it takes it a tiny bit out of place that can cause immense pain.
Yes, there are a lot of things that can be corrected with proper posture, stretching and exercising on a  REGULAR basis. There are plenty of things we can do to take care of our bodies that we tend to let go as we age. There are also things that cause a great deal of pain and no matter how much we have PT, exercise, etc. It will not go away without surgical intervention. But, be sure that everything has been tried BEFORE considering surgery because obviously, it can not be undone once performed.
How much physical therapy have you had? What sort of PT was it? What sort of exercise are you able to do in your condition? Are you overweight?
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Avatar_m_tn
But, in your case, because you have so many, there is bound to be at least one that is causing your pain.
i disagree. you cant assume it is a disc problem simply becasue there "are so many" .---the herniations happen in the first place from wear/tear/ excessive weight, sports etc and also due to weak back musculature----the muscles cant support the spine well enough (especially considering that we are constantly flexed in our society) so the spine suffers. herniations dont cause pain unless they press on a specific nerve root--and then the symptoms generally correlate to a specific level of nerve compression.. this is usually diagnosable with the appropriate nerve studies. pelvic imbalance is usually the cause of the type of bilateral problems described--especially in women. I certainly would try to correct this imbalance with the appropriate hip flexor stretches and myofascial work, and have nerve studies as an adjunct your MRI findings, and to see if there can be a correlation of symptoms to a specific nerve root.

I do agree with giveitback in that all options should be explored before surgery, which in essence removes a joint (at least) and makes you less flexible.

I jsut dont believe in blaming a disc for pain until it can be reasonably proven w nerve studies, diagnostic injections etc---- but remember diagnositc injections are invasive in themselves....
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Avatar_n_tn
I am not assuming anything, I am just saying that it is very possible her pain is disc related. She should not rule out the fact that it can be. Even if she only had one disc that was diagnosed as being "herniated" - I would have responded the same way.

I am assuming that she had physical therapy because obviously you need to have tried all possible conservative treatment before doing anything invasive, ie, the epidural injections that she already had. We don't even know if the MRI shows nerve compression and we also don't know whether or not she had any nerve conduction tests performed, ie, EMG. Even if her MRI does not show nerve compression does not mean it does not exist.

p.s. I totally agree with the fact that in order to prove the disc is the culprit, ALL possible tests (including EMG) should definitely be done and that she should not jump to the conclusion that it is her discs just as you should not jump to the conclusion that it is muscular, postural, or whatever else you keep saying. : )

Your advice is good, but it is not helpful in all situations, it can, in fact, be harmful in some patients.


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Avatar_m_tn
i dont know how improving posture and stretching tight muscles can ever ever be harmful. dont get that.
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Avatar_f_tn
Because if there is something not in it's proper place and exercises and stretching are not done correctly there could be more harm done. I feel these things should be done with the help of a doctor or physical therapist to ensure that that the correct form is being used. The improving of posture can be beneficial but the stretching should be supervised. I was told one thing from a WC doctor and when I went to P.T. I was told not to do certain things because they would in fact be harmful to my condition. I believe that is the point being made. Not everyone's condition is the same.
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Avatar_f_tn
I also developed problems with my L4-5 because of my job. I was caring for a child in our school district who has C.P. I never had problems with my back and neck until I started to care for her. The strain of picking her up and moving her around all day to her different apparatus and changing her diaper caused my injury. I was in my early forties and I felt very strong before all this happened. I have since then lost my job because of the time I missed from not being able to walk or move my neck. I actually felt my neck pop one day and then I could move it for days. I have herniated and bulging discs in my neck also. I have had an emg done that shows nerve damage to my right leg. Have you had an EMG done yet to determine if there is a pinched nerve anywhere? I can feel your pain as far as your legs go. I now have good days because I am not working anymore but my activities are definetly limited. I tried to start walking again, very slowly at first and I really concentrated on my posture as I did this but I do not think I can do this anymore as I started to get pain again. I wish you the best of luck and let us know if you have had an EMG and what the results were. I also can not stand or sit for long perods of time. Shopping can be horrible but you have to do certain things. Not being able to work is the worse for me right now because I have always had some kind of job. I am just trying to get through 2 small classes at college to get my degree and sometimes just sitting there brings on pain. We know how you feel. Check with your doc or P.T. before you start any physical routine. Sometimes they give you handouts that are specific to your condition. I was told by one doc that swimming was OK and then I was told not to swim at all with my neck. It would put too much pressure on my neck. Just be careful. Take care.
Chadry
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Avatar_m_tn
Because if there is something not in it's proper place and exercises and stretching are not done correctly there could be more harm done. I feel these things should be done with the help of a doctor or physical therapist to ensure that that the correct form is being used.

i totally agree-- doing these things wrong can hurt and they should be supervised... but posture is at the root of most muscle pain syndromes. --and bad posture doesnt show up on tests. It should be addressed first as the cause of muscle pain if it is out of whack visually.

Also-- Nerves can get entrapped in tight muscles.. just becasue there is EMG evidence of nerve compression does not mean it is happing in the actiual spine. Pljus, if your posture is corrcted and your mid back muscles are strengthened, and your pelvis is in balance and not tilted forward, if your nerve root is being pinched there is a good chance it will be relieved. YOUR symptoms of low back pain/neck pain form "straining" (this word in itself implies muscles as the cause of pain) reeks of muscle imblance pain and compensatory spasm. the finding of a herniation may have just been coincidental. Like I always say--just about everyone over the age of 30 has at least a few of em. Your first sentence tells me yu firmly beileve your problem is a disc. If uyyou haven't yet, just visit Jolie Bookspan's site and do everything she says and see how you feel after a few weeks or maybe even days.
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