[Kingy]

Hi, I wondered if any medical wads out there (GCW? Sausage?) had any advice on a back problem I have. I have just had an MRI scan and the only problem is that my L5 disc is herniated and has lost height leading to 'degenerative changes' in the region. The left S1 nerve root is being compressed by leaked disc fluid and the right S1 nerve is being touched also. The problem started 6 months ago and got a lot worse 6 weeks ago. I had severe pain in my left leg (at base of upper thigh) and could hardly walk for a week, although I have never had any pain in the back itself. The pain went away pretty quickly but then I was left with a weakness in my left calf muscle (I could not lift my left heel off the floor for over 2 weeks), numbness in my heel and the loss of the 'angle jerk reflex', which has still not returned. Thankfully, my calf muscle has come back and is now at about 75% of its power and my heel numbness has got a lot better. I understand that this is not a particularly unusual problem and can get completely better given time but am still worried.

In terms of climbing, I was forced to take 3 weeks off as I couldn't use my left leg properly. I then returned gradually leading routes at the wall and toproping outside. My weak left foot has held me back a bit but not too much in the last 2 weeks. I have only very recently attempted to return to jumping down off selected low boulder problems as my calf muscle didn't agree with it.

I would be very interested to hear of the experiences of people with similar lower back problems and how they approached their climbing rehab. Specifically:

- Did you wait until the weak leg returned to full power before returning to roped climbing or bouldering?
- Am I likely to damage the s1 nerve by climbing when my calf muscle has not yet returned to full strength? (My physio said I should not go back to climbing until it had but he reluctantly allowed me to do very easy stuff a month ago).
- Will roped climbing or jumping off in bouldering (even onto mats) aggravate the disc problem and prolong/impair the healing phase?
- What is the long term prognosis in terms of climbing? Have ppl with similar problems been able to continue to climb, in particular to boulder? I really want to continue bouldering as I do a lot of it and without it I don't think I will have the motivation to do endless fingerboarding to get strong.

I have been able to redpoint 7b+'s and onsight 7a+'s in the last 2 weeks but now the grit season is upon us, I want to get back into bouldering ASAP. Thanks for your help in advance!

[Dr T]

Not a medic but have had this problem

sounds like you are about where I was mine never got better whereas it sounds like yours is.
Mine was up and down for a while before it nose dived and I had to have the micro discectomy
sounds bad and I was out for about 6 months (had issues with sticking scar tissue) but now I'm back far better than I was so there is light at the end of the tunnel

so my advice for what it's worth, give it every chance to get better and if it doesn't don't look at the op' as being the end of your climbing...

[Kingy]

Thanks a lot Dr T, great to hear of your experience. Good to know that there is the option of an op as a backstop although I suppose that is not without risk...

[GCW]

So you've got a degenerate L5/S1 disc with herniation.  Sounds like it's compressing the S1 nerve root (exiting), and it's pretty typical to get leg pain without back pain.

Things to consider:
You've got an abnormal disc.
Things usually resolve themselves.
If not, (micro)discectomy may be an option.
Things like lifting by bending will not help your problem.

As far as returning to bouldering is concerned, there's no proper Science.  many spinal guys say it doesn't matter, and symptoms are your guide- ie if you can do something and cope with symptoms, do it.  Others will say avoid if possible.
I suspect jumping down may aggravate your problem if you land awkwardly/ bend.
In general, by climbing etc you aren't going to make things worse other than your symptoms may recur.  This may give you gip long term.

Physio is often very useful in this circumstance.
A friendly physio will no doubt offer their opinion..... Joe?

[Kingy]

Nice one GCW. I will have to go super careful and not do any stupid highballs. I am in the hands of a decent physio at the minute so hopefully they have the bases covered. Cheers!

[GCW]

Generally, if surgery is not an option, your physio knows more than your Orthopod  

[Kingy]

your physio knows more than your Orthopod  

Why what's the deal here? My GP said I was better off seeing a neurosurgeon than an orthopaedic surgeon. Am I missing something??

[GCW]

See a Back Specialist (ortho) or a neurosurgeon (provision varies depending where you live). 
These guys are very good at managing the cases that need surgery.  Those that aren't surgery amenable tend to be discharged, to physio or pain clinic etc.  So the physios have far better experience of their treatment.  That's all.

[Dr T]

my ortho was very good
not knife happy at first but once he saw no improvement it was quick under the knife
Recovery should be quicker than the time I had off from what I hear, unfortunately I have a tendency to over produce scar tissue apparently...

[Kingy]

Thanks guys, I have been referred to a neurosurgeon at Salford to see if an op is necessary but the NHS waiting list to see them is a month so will have to sit tight.

[GCW]

Who is it, out of Nosiness?

[Kingy]

I don't know yet as there are no available appointments yet. I am in the system though. its Salford Royal. I'll let you know when I find out, maybe you could pull a few strings!!

[Kingy]

I would just like to post some interesting thoughts on this matter following a conversation I have had with a GP mate of mine who specialises in this area for the benefit of ppl with disc problems now or in the future.

- Basically, these things commonly clear up left to their own devices whether in 6 weeks or 6 months.
- An MRI scan is not really required as it is not difficult to diagnose a slipped disc (eg. via the 'slump test'), any GP worth his/her salt can do this for you.
- All an MRI scan will do is panic the patient as the report might say 'degeneration in the lower back' which is enough to to put the wind up anybody.
- If you did a scan of the back of a random section of the population, most ppl would probably have some form of disc abnormality or latent back problem so all a scan does is create worry.
- A scan may not even reveal a trapped nerve root near a disc as nerve compression is not the only way these problems can start. Apparently, chemicals can leach out of a disc and affect the nerve also which will not show up on a scan.
- An MRI scan is ammunition for neurosurgeons to advocate unnecessary surgery. Apparently these guys might bully you into an op that you don't need and fuck your life up.
- Seeing a neurosurgeon is therefore a bit of a waste of time unless your symptoms are really not getting better.

My mate says that I can do any physical exercise I like as long as I am operating within the 'pain threshold'. He says jumping down off boulder problems onto a mat will not have any effect on my dodgy disc or compressed leg nerve. The problem is getting a lot better on its own and as jumping down is not causing me any pain, he says knock yourself out, this will not impair healing in any way. Which is great news, I can boulder as much as I want .

I hope this is of some use to those suffering from a dodgy back!!

[webbo]

i had a problem a few years ago with one of the discs in my neck pressing on the nerve.i had a scan and saw a neurosurgeon who advised doing nothing and to do my activity within the pain threshold.so they all don't start rubbing their scalpels together when you walk through the door.

[Kingy]

i had a problem a few years ago with one of the discs in my neck pressing on the nerve.i had a scan and saw a neurosurgeon who advised doing nothing and to do my activity within the pain threshold.so they all don't start rubbing their scalpels together when you walk through the door.

Cheers that's reassuring to hear! I think my mate has some kind of grudge against neurosurgeons     I will keep an open mind!

[webbo]

i've just remember i saw another one last year who again was open and honest enough to say he didn't know what was wrong with me.
in order to get seen sooner you could try and speak to the consultant secretary and say you are willing to except a cancellation.

[Kingy]

in order to get seen sooner you could try and speak to the consultant secretary and say you are willing to except a cancellation.

Yes I can see how that might work! Being cynical for a moment, I think these guys have all got yachts to pay for and so the more ops the better! Obviously this would not be the case for the NHS guys, only the private ones.

[Tim Broughtonshaw]

My mate says that I can do any physical exercise I like as long as I am operating within the 'pain threshold'. He says jumping down off boulder problems onto a mat will not have any effect on my dodgy disc or compressed leg nerve. The problem is getting a lot better on its own and as jumping down is not causing me any pain, he says knock yourself out, this will not impair healing in any way. Which is great news, I can boulder as much as I want .

I would definately add the caveat to cease the activity if it is causing additonal compression of the nerve. Which in my case meant i ended up resting from all exercise for 12 weeks. I did try on several occasions starting some cardio and found after a minute or 2 i would start to get tingling sensations running down the arm fo the trapped nerve. Which is a definate indication to cease the activity.


Also an interesting fact is that it takes 1 month per centimetre of nerve to repair (if it can repair). And this happens from the spinal cord outwards direction. My surgeon is a top bloke and really gave me loads of info on the subject.

Cheers
Tim

[Kingy]

Great info there Tim, cheers for that. Definitely one to 'tread with care'!!

[duncan]

I would just like to post some interesting thoughts on this matter following a conversation I have had with a GP mate of mine who specialises in this area for the benefit of ppl with disc problems now or in the future.

- Basically, these things commonly clear up left to their own devices whether in 6 weeks or 6 months.
- An MRI scan is not really required as it is not difficult to diagnose a slipped disc (eg. via the 'slump test'), any GP worth his/her salt can do this for you.
- All an MRI scan will do is panic the patient as the report might say 'degeneration in the lower back' which is enough to to put the wind up anybody.
- If you did a scan of the back of a random section of the population, most ppl would probably have some form of disc abnormality or latent back problem so all a scan does is create worry.
- A scan may not even reveal a trapped nerve root near a disc as nerve compression is not the only way these problems can start. Apparently, chemicals can leach out of a disc and affect the nerve also which will not show up on a scan.
- An MRI scan is ammunition for neurosurgeons to advocate unnecessary surgery. Apparently these guys might bully you into an op that you don't need and fuck your life up.
- Seeing a neurosurgeon is therefore a bit of a waste of time unless your symptoms are really not getting better.

My mate says that I can do any physical exercise I like as long as I am operating within the 'pain threshold'. He says jumping down off boulder problems onto a mat will not have any effect on my dodgy disc or compressed leg nerve. The problem is getting a lot better on its own and as jumping down is not causing me any pain, he says knock yourself out, this will not impair healing in any way. Which is great news, I can boulder as much as I want .

I hope this is of some use to those suffering from a dodgy back!!

All excellent advice. Anyone would have thought he had read this.      

I've plugged this article before, it's mostly aimed at GPs and to help them help people who are at risk of doing too little (rather than climbers who are more likely at risk of doing too much).

I'd just be a little careful about jumping off from heights for a few months.  I've no science to support this, it just makes me slightly nervous.

[Kingy]

Anyone would have thought he had read this.      

I've plugged this article before, it's mostly aimed at GPs and to help them help people who are at risk of doing too little (rather than climbers who are more likely at risk of doing too much).

Nice one Duncan!! Looks like an excellent article, I will read it at my leisure this weekend. Cheers for the advice too. I am on a lowball bouldering mission at the moment trying to tick low traversey stuff I would not otherwise do so am steering clear of the crazy highballs. Thanks again!

[Sonya]

Hi,

I had problems with my L5/S1, with compression of SI nerve root, a couple of years back which resulted in a Discectomy and Laminectomy.

Firstly, only a VERY small amount of disc issues will result in surgery, something like 5% I think.

It's hard when things cause pain, but I was told that pain wasn't an issue and some with nerve issues get no pain whatsoever whereas others can be in excruciating agony and that the amount of damage/pressure on nerve doesn't dictate pain levels.  But I was told that things which caused the pain/nerve symptoms such as burning/tingling/numbness/altered sensation, to travel downwards in a radiating fashion were to be avoided.  So, if something makes the pain worse but doesn't make it move downwards towards the toes, then it isn't necessarily bad.

I climbed when I could throughout my back issues but fraid there was no way I could have jumped off boulder problems and I don't care what any proffessional says, if the nerve is badly compressed, then anything that causes more compression can't be good! 

When I climbed the trick was to climb slowly and to make small movements.  Anything that had me in a crunched up position was bad, high stepping was bad and you could forget about lunging/dynoing type movements!  Anything that involved too much twisting was also bad.

Also, when the disc/nerve root is involved there is usually inflammation and sometimes if you do an activity it won't cause worsening of activities straight away.  If I did something to irritate my nerve root more, I often wouldn't feel the symptoms until 3 days later when the inflammation had built to it's peak.

Most important is your posture.  Do you spend alot of time sitting?  Get up and stretch if you do and walk, do lots and lots of walking!  Your back loves it when you walk.  But avoid walking down steep and uneven ground which seems to cause more compression of the spine.  If your driving, use some lumbar support and don't drive for longer than an hour without stopping to get out and stretch.

Re stretching, you will know/your physio will guide you as to what is suitable for your circumstances.

[Kingy]

Thanks for the reply Sonya, I have only just noticed it! Good to hear somebody with the same problem. I think mine is possibly not as bad as yours was as I am able to climb and boulder fine now and I have a full range of movement in my left calf doing a heel raise, its still a bit sluggish compared to the right one but I am hopping around on it fine so it can't be too bad. Jumping down onto pads seems to be OK for me as well so I guess I am lucky! I am still very careful but I think being active is defo the way to go.

Yes I do spend a lot of my time sitting - I have got one of those inflatable cushions that forces you to sit upright for work, it is impossible to slump whilst sitting on it which is excellent for posture. Luckily I have no pain anywhere so I've just got to keep doing what I'm doing and hopefully it will go away completely. I'm going to see the neurosurgeon but I reckon its not necessary now but I will go anyway to see what they say. Yeah, I'll take ur advice on the walking front, funny now I can walk fine but all summer I had this horrible painful neural tension going down the back of the left leg which was only relieved by sitting down but this seems to have stopped now...weird!

i hope your symptoms are/ have got better on the other thread, time seems to be a great healer! Thanks again for your advice.

[Sonya]

Yup, being active as possible is def the way forward.

Thanks re my injury! I'm giving the wall a miss at the moment as it just seems to irritate my arm but I've been doing these Brachioradialis stretches pretty religiously, doing some shoulder stuff with a theraband and I'm sure my forearm has settled a little.  I've still got weird arm and leg nerve stuff going on, but I managed to do 3 winter routes over the weekend and using an axe doesn't seem to overly bother it so I'm happy.