Ouch! Slipped disc?

It was all going so well. My VO2 max was up to 42, I was getting a real thrill out of running and ice swimming and then BAM! my back went. I’ve never known anything like it. There is a lovely comfy sofa in our garden room at home, on which I sit with my laptop to attend online meetings and such like, when I’m working from home. I’m beginning to wonder whether my sofa sitting position is ideal…

12th January 2021

I normally have ants in my pants and don’t sit still for hours on end, but on this particular day I am captive on the sofa, assessing a succession of applicants to medical school via live video interviews. It’s a bit of a marathon, 36 candidates spread across the day, with an hour’s break for lunch. After almost 3 hours of sitting, I leap up, don my running/swimming gear and head out the door, determined to use my lunch break to its maximum potential. It’s a gorgeous day and my enthusiasm to jump in the river cannot be curbed. I leg it down to the river bank in record time, strip down to my jog bra and bikini pants, and in I go. So far so good, the water’s 6 oC, the sun is shining and I feel wonderful. I forget that I’m in a bit of a hurry and savour the water and the sunshine. Ooh my muscles feel a bit cold…quads feel a bit weak as I lift myself out of the water. The faff factor starts to kick in once I’ve emerged onto the bank. Hm, have I stayed in a little bit too long? I can’t feel my feet and my fingers are fumbling.

No matter, need to get a wiggle on as interviews restart in 20 minutes! Faff, faff, faff, clothes on over wet skin (I’m so pleased with my new pink towel!), move, move, move. Swish one foot in the water to get it clean and right sock and shoe on. Next bit’s a little more tricky, as it involves balancing on one leg whilst slightly hypothermic. Oops, I overbalance and hop twice on my right leg as I attempt to put my left shoe on. Ouch! Something feels like it’s been compressed in my back. Ooh, not nice, but I’m running late now so need to get a move on. It’ll be fine, these things normally go off once you get moving, don’t they? On the run home something in my back doesn’t feel quite right and my left hip is a bit sore, but I make it back in time.

Back on the sofa, I remark to my colleague that my back is a bit sore. Another hour of sitting ends with a tea break and I pop over to my desk to get something. As I reach across the desk, twisting from left to right, something in my back goes into spasm. The pain is excruciating! I can’t move. I decide it’s just a muscle spasm and attempt to sit back down and resume interviewing. Not too much longer to go now. We’ve got a few no shows which makes it easier. I can’t actually sit. I have to perch on the edge of the sofa, keeping my back rigidly straight. My lumbar spine won’t flex at all. I can feel a solid ridge of muscle to the left of my lumbar spine, from about L1 to L4. It hurts to prod it, but not nearly as much as it does when I try to touch my toes. I take some paracetamol and ibuprofen and hope for the best.

Neuropathic pain

The pain at night is unreal. The first evening I can’t sit still on the sofa to watch TV so I opt to read in bed lying flat on my back. I discover that the least painful position in which to lie is on my right side. Lying on my left is excruciating, and when I lie on my back I get these weird muscle fasciculations all down my left quadriceps which is most disconcerting when you’re trying to fall asleep. I’ve never known pain like it. A deep ache in the gluteal muscles, hip flexors, quadriceps and adductors which doesn’t seem to come from anywhere in particular but is impossible to soothe. I finally do manage to sleep but wake up in a sweat (thank you, menopause!) and can’t decide which is worse, the pain or the cold, clammy cocoon in which I am shivering. I roll out of bed and have a pee, then find I can’t get back in to bed as my back won’t bend. I sort of plonk myself down and struggle to get the covers back over me. Argh!

Understanding low back pain

I’m always on the lookout for learning opportunities, and what should come into my inbox but the doctors.net module on lower back pain? Marvellous! I learned rather a lot actually. The thing which really sticks with me is that the degree of pain and disability has no correlation to MRI findings of mechanical pathology such as a herniated lumbar disc. The other thing is that most cases of lower back pain resolve with conservative treatment within six weeks. After two days I had diagnosed myself with a herniated L3/4 lumbar disc. Now, 5 weeks later I have no idea whether I actually did have a slipped disc or not (my physio thinks not) but my left thigh is still not right. The neuropathic pain was mainly in the L3/4 nerve root myotome and I had parasthesiae over the medial aspect of my left thigh just above the knee. My symptoms required some anatomy revision, and I was delighted to find some beautiful, colour coded illustrations from Gray’s Anatomy, superbly done by Mikael Häggström. Interesting. Most discs herniate centrally, so it would be unusual to experience a lateral herniation. Also, the vast majority happen at L4/5 rather than L3/4, and many of my symptoms are more widespread than to just issue from a single nerve root. A radiculopathy is defined as the presence of actual signs, rather than just symptoms relating to a particular nerve root. I don’t think my sensation is permanently altered, and I would say that the power in my quadriceps is 5/5. Can you run if the power in your quads is less than 5/5? I wonder – my left quad does feel like it might give way when I’m running downhill…

By Mikael Häggström, used with permission. – File:Gray797.png
By Mikael Häggström, used with permission. – File:Gray798.png

Smack on the black ice

The “slipped disc” happened on a Tuesday and on Friday I thought it would be a good idea to gently keep my hips moving by walking to walk (I live half a mile away). My bag, which was slung across my shoulder pulled a little, but I kept shifting it around to balance things out. There’s a marvellous cycle track which runs along the main road down to the hospital. It wasn’t so marvellous that day, as it was patchily glazed with black ice, which looked just like wet tarmac, but was actually lethal. I’d almost reached the hospital when my legs shot out from under me and SPLAT! I landed flat on my back, whacking my occiput as I hit the deck with a sickening thwack. I lay there dazed for a few moments, and was much heartened when two cars pulled over and a couple of ladies came to see if I was ok. I explained that I didn’t feel like getting up off the ground just yet, but that I was fine. You know how sometimes you just have to lie there for a minute or two until the shock wears off and you can assess the damage? The piece de resistance was a few minutes later when an ambulance drew up level with me and rolled down the window. “We couldn’t drive by without stopping to see if you were ok,” said the paramedic. “You sure you don’t want us to check you out?” I groaned that I was fine, no permanent damage, and painfully got to my knees, then my feet. Nothing broken. Oh, my poor head!

For the next few days I could’t tell which pain was worse – the pain from the fall (oh, my neck muscles took about 2 weeks to recover) or from my back. Running was out, as was wild swimming. I could barely dress in the morning, let alone strip down to my underwear on the river bank. The sheer thought of immersing myself in freezing cold water made my muscles want to spasm!

After about a week there was no real improvement. I was still on 4 hourly painkillers though I’d resisted anything stronger than the paracetamol/ibuprofen combination. The first sign of improvement came nearly two weeks later when I managed a brisk walk and a brief dip in the river. It was very brief though, and the pain was worse afterwards so I decided to leave it again for a while.

Mountain walks are replaced by something a bit more leisurely…

Recovery

Fast forward to five weeks later and I continue to improve. I don’t feel as fit as I did as I had an enforced 4 weeks off from running. My first “rehab run”, a week ago was a very slow affair, more of a joggle than a run. Nevertheless, I managed to toddle along with my heart rate just about in the cardiac zone for about 40 minutes, with no ill effects. The following day I went for a jog swim, which also went well. It was a sunny day and although the water was cold (5.3 oC), I limited my time in the water and got changed at a leisurely pace on the bank in the sunshine. It was a totally different rhythm to the fateful run/swim four weeks earlier. I’m managing to do some very helpful yoga exercises for lower back pain and am now only taking painkillers with breakfast. I’m still very stiff when I get up in the morning, but it improves as the day goes on, until my core muscles tire a bit in the evening. I can now put my shoes on without being in agony!

There is definitely still some foreshortening of my left hip flexors, which limits my stride a little. I also have to watch out for sudden muscle spasms in my left hamstring on the inside of my knee, not to mention a pulling feeling in my left groin. You never know, one day all my aches and pains might even up and I might end up with symmetrical legs/pelvis!