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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Medical
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Experience:  14 years experience in the field of Family Practice
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Herniated disc

Customer Question

Hello I am 22, suffered from a basketball injury and I have 2 herniated discs (bulging disc) L4-L5, L5-S1 since 1. November 2012. The MRI report also indicated Spondyl Arithritis. The pain in the back/sciatic area is virtually gone except for some positions/activities. However my back still has limited movement range and feels very fragile. The main issue is the weakness in my knees. I don't know how to explain it other than that in the center of the knees i get this feeling that they can't carry any weight. It is constantly there but much worse in the morning. My perscribed physio-therapy is over. 2 questions: 1. How do I carry on from here? What is the best exercise to help heal my discs? 2. Could you please recommend a sleeping position/mattress that helps? I mean I've gotten contradicting tips. Is softer better? Harder ? Memory foam? - I also got contradicting opinions about swimming, does it help or hurt? Thank you

Submitted: 1 year ago.
Category: Medical
Expert:  Anthony Bray, MD replied 1 year ago.

Hello!

 

I would recommend the memory foam as a good option with regard to your back.

 

Sleep positions usually helpful ( these reduce tension of the nerves between the legs and back) would include lying on back with knees bent and 1 to 2 pillows under the knees. ( lying completely flat on your back would tend to exaggerate the arch of the back and may cause some pain and discomfort) Lying on your side with a pillow between the knees tends to help. This helps because without a pillow between your knees you would naturally be uncomfortable to knock your knees together >> we tend then to scissor apart the knees and this will place the pelvis and lower back into a twist position... this is not as good for the back as being in alignment.. the pillow between the knees helps to you to keep this position alignment more comfortably...

 

I think it fine for you to swim. (Avoid diving of course!!!) Any exercise that causes an increase in pain I would advise caution and to back down from... listen to your body... walking on a flat surface tends to help strengthen the posture muscles of the back.. so walking on level surface tends to help.

 

I advise the donkey kick as a helpful exercise usually for the back>> this one you assume a stance on hands and knees and raise one leg backwards >> steadily and as far as you can comfortably>> repeat several reps ( 10 and then repeat times for total of 3 sets if your back is essentially well)

 

I would think that this and/or other exercises would have been a part of your physio program. It is generally the plan to have you continue a home program of the same exercises once you return home or to normal routine... So I would advise that you resume the exercises that were done with your PT as being most helpful to you.

 

I hope that this information helps! Let me know if you have further questions or concerns and I will be happy to get back with you!! If my answer has been helpful and to your satisfaction then please remember to leave positive feedback. That would be very much appreciated! Thank you and Best Regards,

 

Anthony Bray MD

 

Anthony Bray, MD, Doctor
Category: Medical
Satisfied Customers: 6802
Experience: 14 years experience in the field of Family Practice
Anthony Bray, MD and 10 other Medical Specialists are ready to help you
Customer: replied 1 year ago.

Thank you for your answer,

so what I gather:

1. continue doing "therapy" at home

2. contact sport are a no, running/cycling/swimming are ok?

How long should I give the knees ? another 6 months?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Yes I think that you are on the right track!! Yes most definitely continue the home exercise program to mimic the exercises that were part of your physical therapy!

Avoid lifting free weights and contact sports to reduce your risk of re-injury. I think cycling and swimming would be safe if you are well into your recovery. You should be able to exercise without sharp pain during exercise or feeling much pain in back the next day. I would be more comfortable with walking first and running if you are very firm and confident into your recovery. The high exertion and impact with running would make this exercise a but higher risk and so toward the end of recovery rather than beginning. I would advise confidence in other exercise regimens without problem before doing much running. I'm not saying that running for you is forbidden but just be careful!!

With your sensation of weakness of your knees ---this is likely an abnormal sensation associated with your back injury ---- I suspect. Hopefully this sensation will also improve in time. Have you any weakness of your legs? Have you had particular difficulty with climbing stairs or standing from a squatting position? Do you have any abnormal sensation that radiates to one or both leg? Does pain radiate down one or both legs??

I think that the details of your MRI of back and of any neurological symptoms related to your back condition would help in estimating what you might expect with regard to this sense of weakness in the knees.

Let me know of these details and any further questions and I will be happy to get back with you !!

Take care,

Anthony Bray MD
Customer: replied 1 year ago.

thank you for the prompt reply

Yea from November to March I had electric shocks going from my sciatic area to my knee until the ankles in both legs. This is almost gone now, except for this knee sensation.

Yea on bad days going up the stairs is difficult; this is the issue I mean by my knees. If i could describe it, imagine a sneeze that aborted and the feeling you get around your nose. That similar feeling is inside the knees.

The MRI report says: 2 herniated discs in the form of a bulging disc L4-L5 and L5-S1 with moderate compression of the nerve root. Spondyl arthritis evident (translated from German).

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Of your results the ruptured discs with the nerve compression would be the most relevant to your symptoms. The nerve root compressions would be the cause of your weakness and abnormal sensations. The majority of cases of this type injury will improve after the injury. Tissue healing and resolution of area inflammation usually occurs. The degree if nerve root compression usually lessens with this healing process. ( there is the remaining ten percent of cases in which this healing does not alleviate the nerve compression enough and these cases would be the group for which surgery would be needed) Hopefully you will not be in the subset that needs surgery...

Nerve injury may show gradual improvement over a six month period. This sounds very consistent with your reported history going back to November...

It seems to me that your sense of weakness is probably due to two factors. One factor would be nerve injury and the second would be probable reduction in muscle strength related to the rest required for your back injury to heal. So I think that you would be expected to see improvement in your sense of strength in your legs as you are able to recondition your muscles with your gradually improved ability to exercise.... The recovery would continue I think BUT this may fall short of you returning to feeling 100% as you felt prior to any injury.

If you continue to experience difficulty as the next few months pass then I would advise further follow up evaluation by your treating physician...

I would advise strengthening exercises of your quadriceps and hamstring muscles of the thighs. I think that this conditioning will continue to build your sense of strength and comfort.

I hope this is helpful for you! Let me know if you have further questions! Best regards!

Anthony Bray MD

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