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Acute L5-S1 disc extrusion. 8 weeks off PSB

 Poster: A snowHead
Poster: A snowHead
I am looking for advise or fellow Snowheads with past experience with acute Disc extrusion.

I hyper-extented my lower back playing volleyball on my holidays early September (Volleyball is not safe) . Felt a jolt, hoped it was just ligament inflammation and carried on with my daily activities when I got home. Skiing for the first time in a couple of months I went to the Oktobertest and noticed my back was still sore and proceeded to seize up as the evening progressed.

Got myself a MRI. Turns out I popped my L5-S1 disc with moderate neural compression on the right side. I have no neural symptoms and only really notice the pain when I sit/lie down for a extended period of time. My mobility sucks though. I can barely touch my knees straight legged and struggle to put socks on.

My question is, with the PSB only 8 weeks away. Is it a case of being patient and waiting on the good old gp/NHS to look after me. Or do I be proactive? What specialist should I pay for? Chiropractor, osteopath or sports physio?

I am taking antiinflammatories twice daily. Doing stretches throughout the day and a 20minutes session in the evenings. Also plan to carry on my back stretches along with the bike and Nordic Cross trainer at the gym tomorrow.

Is there anything else I can do to speed up the process? So I can comfortably ski come December?

Thanks in advance
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Hi. I wouldn't wait for gp/NHS because it could take a few weeks/months to get seen (speaking from experience). I would get some advice and mobilisation treatment from a good osteopath or sports physio asap.
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@red, I’d definitely go down the physio route. A good physio will have an excellent understanding of spine issues and be able to help.

NSAIDs are a good idea. Keep taking them. If you are pain free then you are more likely to move and use your back.

Some stretches can be very helpful, others will exacerbate the problem. When you said your mobility was limited I wasn’t sure if it’s pain that limits it or just that the back won’t move. Trying to push your back beyond its current limits may just keep prolonging the issue.

Overall, I’d say patience is the best answer. It should heal in time.

Personally, I’d strongly avoid chiropractors and osteopaths for this problem but then I like my medicine to be science based and am not a great fan of alternate ‘medicine’.
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Similar experience to @el Hen... NHS - Each and every step took 3-4 weeks. If you can afford it, go get it sorted on your own initiative.

Or be prepared to jam yourself chock full of hardcore painkillers for the PSB, which has it's benefits I must admit. Worked well for me a couple times.
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@red, osteopathy and chropractic are quackery, so don't touch either of those.
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foxtrotzulu wrote:
@red, I’d definitely go down the physio route. A good physio will have an excellent understanding of spine issues and be able to help.

NSAIDs are a good idea. Keep taking them. If you are pain free then you are more likely to move and use your back.

Some stretches can be very helpful, others will exacerbate the problem. When you said your mobility was limited I wasn’t sure if it’s pain that limits it or just that the back won’t move. Trying to push your back beyond its current limits may just keep prolonging the issue.

Overall, I’d say patience is the best answer. It should heal in time.

Personally, I’d strongly avoid chiropractors and osteopaths for this problem but then I like my medicine to be science based and am not a great fan of alternate ‘medicine’.


I would say it is more of my back tightens when bending down straight legged and at the bottom of the movement the pain starts. Same when I walk I can feel what can be described as a managable straining sensation along my right bum cheek. Otherwise I am pain free until I stay stationary for a while.

I will heed everyone's advice and organise some private sports physio ASAP.
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@red, sometimes back pain and minor disc tears fall into the category of "true, true, and unrelated" - meaning you may have low back pain (which is very common) and you may have a small disc herniation (which is very common) and they are not related to each other. The causal relationship is more plausible if your pain follows a radicular pattern, meaning that you have pain in the parts of the body that correspond to the affected nerve roots. If you also have numbness and / or weakness in the corresponding parts of the body that is the most convincing. From your brief description, it sounds like you may have low back pain without radicular symptoms.

On the other hand, even small disc tears can produce a painful inflammatory reaction that has no relationship to the extent of the herniation. So you could also be experiencing an acute disc injury and an inflammatory reaction that will get better with time.

But the Internet is a terrible place to get medical advice! So please do consult a physician whom you trust and connect with. And in the meantime, I would caution you about using anti-inflammatories and then doing lots of training at the gym. The medication will suppress some of your pain response, and that may allow you to overdo the exercise without even knowing it. If you want the injury to heal faster, you'll have to balance the need to let the injury rest and heal with the need to mobilize and strengthen the back. It's better to take it a bit easy until you can get some guidance.


Last edited by Then you can post your own questions or snow reports... on Sun 13-10-19 17:03; edited 1 time in total
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Also, as an aside - despite how incredibly common low back pain is, there's not a lot of good science about why it happens and how to treat it. So although I agree with the general view in this thread that treatments should be evidence-based, this is one of the many common situations where the evidence is not there, the problem is poorly understood, and physicians have to make a treatment decision anyway. Which I guess doesn't put us a million miles away from what the alternative medicine people are doing!
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under a new name wrote:
@red, osteopathy and chropractic are quackery, so don't touch either of those.
Shocked Wow!
Extensive first hand experience here says otherwise.
Would you also advise not to bother seeing a GP?

It is no exaggeration to say that without the treatment of a talented osteopath snowHeads almost certainly wouldn't exist.
I was losing increasing amounts of time at work through worsening headaches and increasing frequency of debilitating neck/upper back seizure.
Physios would massage to release the seizure but it would re-occur before long.
Between 2 GP's, I managed the sum total of an xray, a MRI and the net result: "You just need to accept that some people suffer head-aches for no apparent reason."
I said, that this was an unacceptable end point as it was preventing me working a full week and the situation was worsening.
"That's what sickness benefit is for."
Seriously, that was the final prognosis rolling eyes

I didn't actually know what an osteopath did but I was referred to one by a friend. He determined what was wrong with the muscles in my upper back and through massage and manipulation gave me, in just 45mins, more movement in my neck than I'd had for 10 years.
Periodic treatment eased the acute issues that prevented basic function, then over time he provided education and advice to ease the chronic issues to prevent re-occurrence.
He literally made the difference between a disabled life on benefits and a fully functioning, healthy, thriving existence.

Since then, I've picked up a few minor injuries which, after recovering to some degree, have become stuck, persistent, chronic.
Almost without exception, a couple of sessions with this osteopath 'un-sticks' the injury so it continues to heal properly.
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admin wrote:
under a new name wrote:
@red, osteopathy and chropractic are quackery, so don't touch either of those.
Shocked Wow!
Extensive first hand experience here says otherwise.
Would you also advise not to bother seeing a GP?

It is no exaggeration to say that without the treatment of a talented osteopath snowHeads almost certainly wouldn't exist.
I was losing increasing amounts of time at work through worsening headaches and increasing frequency of debilitating neck/upper back seizure.
Physios would massage to release the seizure but it would re-occur before long.
Between 2 GP's, I managed the sum total of an xray, a MRI and the net result: "You just need to accept that some people suffer head-aches for no apparent reason."
I said, that this was an unacceptable end point as it was preventing me working a full week and the situation was worsening.
"That's what sickness benefit is for."
Seriously, that was the final prognosis rolling eyes

I didn't actually know what an osteopath did but I was referred to one by a friend. He determined what was wrong with the muscles in my upper back and through massage and manipulation gave me, in just 45mins, more movement in my neck than I'd had for 10 years.
Periodic treatment eased the acute issues that prevented basic function, then over time he provided education and advice to ease the chronic issues to prevent re-occurrence.
He literally made the difference between a disabled life on benefits and a fully functioning, healthy, thriving existence.

Since then, I've picked up a few minor injuries which, after recovering to some degree, have become stuck, persistent, chronic.
Almost without exception, a couple of sessions with this osteopath 'un-sticks' the injury so it continues to heal properly.

I agree.

Most top athletes use either one. Warren Smith also has a Chiropractor as part of his team.

I use an Osteopath - who is highly qualified and is a font of knowledge.

I much prefer the Osteopathic approach, to the Chiropractic one.
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My father-in-law was an osteopath. He qualified in the 1950s and trained for 4 years in London to become one. An osteopathw is registered with the General Osteopatic Council, and an osteopath is a title protected in law (just like a pharmacist). Hubby still can't find anyone to sort his back problems quite like his Dad could. He was not impressed with chiropractors.
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@red, Where abouts in the NW are you? Someone local might have a recommendation for treatment.
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We have a local osteopath who is very good. He is also a registered nurse and has an instinctive "therapeutic" feel - I don't know how much his osteopathic training has contributed, but he is worth his "considerable" fees. I have seen him several times over the years. Each time he has been helpful, treated me, made sensible recommendations and signed me off with good advice (e.g. do lots of uphill cycling in low gear). I am reasonably "body conscious" and would know, I hope, if people were talking rubbish, as I concluded when I saw some massage specialist recommended by local friends who spoke a lot about energy pathways and did some very "soft and meaningful" laying on of hands (or sometimes non-laying on of hands, just kind of hovering) which did nothing for me. But I'm sure there are lots of useless osteopaths out there - you need a reliable recommendation.
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adithorp wrote:
@red, Where abouts in the NW are you? Someone local might have a recommendation for treatment.


I am from St Helens. But I would have no problems driving.
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diaphon wrote:
Also, as an aside - despite how incredibly common low back pain is, there's not a lot of good science about why it happens and how to treat it. So although I agree with the general view in this thread that treatments should be evidence-based, this is one of the many common situations where the evidence is not there, the problem is poorly understood, and physicians have to make a treatment decision anyway. Which I guess doesn't put us a million miles away from what the alternative medicine people are doing!


I understand. I am the worst sufferer when I'm injured. Im not good waiting for something to run its course. And it's is a difficult one, as you say I could aggravate my back even more pushing myself too hard.
I have heard good things from friends and family regarding both Osteopathy and Chiro. Where traditional physio has failed. It's difficult to decide without professional advice.
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I'd recommend Tim at http://www.sport-med.co.uk/ in Stockport
Or Martin Early (ex- TdF stage winner) down near Stone, Staffs for chiro' who's excellent. I'll pm his contact details if you want them.
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If you know any horsey people locally, especially polo or 3 day eventers, see who they use to keep going (horsey people are madder than skiers for sacrificing long term physical health for shorter term thrills, plus they enjoy scooping up the shoite their passion prodigiously produces on a daily basis!)
I've used an osteo/sports physio so recommended a few times in the last 2 years with good results
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@red, While I have no problem with using chiropracters or Osteopaths where appropriate, if you have a damaged disc I would suggest being very careful! I had many years of lower back pain, and suffered a rupture to my L4-L5 disc - this took about 18 months to settle down, all the while with some pain. Two years after that disc went I had much more pain and obvious nerve issues, and the MRI (which I paid for privately to avoid a long wait) showed that my L5-S1 was bulging and crushing my sciatic nerve. I again paid privately for a consultant who operated immediately. This solved the problem, but has left me with permanent nerve damage affecting my right leg and foot.
Your danger is that with the disc extrusion, it may stabilize and not be an issue, but if it is aggravated by exercise or the wrong treatment and gets worse it can be VERY serious (think losing control of bowels/bladder, being unable to walk at all etc!). I would suggest seeing a good back specialist consultant as a matter of urgency before doing else.
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If you go down the osteopath route then I can recommend Martin Murgatroyd in Warrington (near Ikea).

https://warringtonosteopath.co.uk/

Many years ago he helped me get through a damaged disc in my neck and, since then, various other aches and pains.
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@admin, Not suggesting that a talented osteo or chiropractor can't or won't be useful but as the underlying theory has no basis in any sort of real science...

... quackery.
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RobinS wrote:
@red, While I have no problem with using chiropracters or Osteopaths where appropriate, if you have a damaged disc I would suggest being very careful! I had many years of lower back pain, and suffered a rupture to my L4-L5 disc - this took about 18 months to settle down, all the while with some pain. Two years after that disc went I had much more pain and obvious nerve issues, and the MRI (which I paid for privately to avoid a long wait) showed that my L5-S1 was bulging and crushing my sciatic nerve. I again paid privately for a consultant who operated immediately. This solved the problem, but has left me with permanent nerve damage affecting my right leg and foot.
Your danger is that with the disc extrusion, it may stabilize and not be an issue, but if it is aggravated by exercise or the wrong treatment and gets worse it can be VERY serious (think losing control of bowels/bladder, being unable to walk at all etc!). I would suggest seeing a good back specialist consultant as a matter of urgency before doing else.


Thank you for the sound advice and I will take heed. I have a appointment with my Gp next Tuesday. And as @Diaphon says it may be prudent to slow my roll and let the imflammation settle down. Already today I feel better pain wise. I am seeing a Sports Physio on Thursday. They should be able to guide me. On the do's and dont's. Set me on the right path
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FWIW - My back has spasmed several times this year, the last time causing me a lot of sciatic pain/numbness, and the resulting MRI showed an L5/S1 prolapse. Thinking back to the earlier episodes some of those symptoms were already there, but a lot of my back pain was actually caused by the spasms causing my SIJ to get stuck. My physio (and/or your chiro/osteo) have a great manipulation for that - if it works (the physio said it’s generally 50/50), it is miraculous - I literally walked out the office pain-free. My point though is just because your disc looks bad on the MRI, it’s not a given that it’s actually causing your current problems.

But obviously, all this is just chit-chat - getting yourself in front of the experts is the thing to do.
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4 weeks out from the PSB and a update.
The inflammation has pretty much all gone as well as the pain. My mobility/flexibility is getting better although still not where it was pre injury.
I have seen a sports physio for some deep tissue massage and accupuncture twice in the last 4 weeks. I have also continued with yoga designed for disc prolapse treatment daily and my gym workouts. Taking it very easy and concentrating on my core and muscular stamina.

I seen a Spinal Surgeon today. He is happy for me to ski in 4 weeks as long as I feel confident to do so. So I reckon I will keep doing what I'm doing and take a trip to the Chill factore say in two weeks.. See where I am at then. Maybe buy a back protector purely for piece of mind more then anything else.
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@red, any update? I'm in a similar boat, but physio was initially trying to rule out a stress fracture of the pelvis, but nothing on the xray. Back to the GP on Friday to see if I can get an MRI. Pretty sure it's L5/S1 related. Not skiing until end of March, but not been able to do much exercise since it started playing up around 10 weeks ago. I'd been marathon training, and had to pull out a week before the race....
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SHAP wrote:
@red, any update? I'm in a similar boat, but physio was initially trying to rule out a stress fracture of the pelvis, but nothing on the xray. Back to the GP on Friday to see if I can get an MRI. Pretty sure it's L5/S1 related. Not skiing until end of March, but not been able to do much exercise since it started playing up around 10 weeks ago. I'd been marathon training, and had to pull out a week before the race....


Hello SHAP. Yes I made it!! I had a couple of privates Physio session with Accupuncture. Did Physio advised stretching/Yoga everyday. Once the imflamation went Down and got back some suppleness i started doing some light leg work. Single leg Press, Box squats and loads of Bike and Plank work.

I'm on the PSB now and apart from waking up sore. As soon as I start to ski I have now problems. I hope you get yourself sorted. If it's a disc issue the Neuro surgeon said they tend to work themselves out if you keep on the move. Plenty of time before the end of March Smile. Let me know how you get on.
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And love to help out and answer questions and of course, read each other's snow reports.
I've had back problems for over 20 years... Spent a fortune on osteos and chiros - discovered that the good ones are worth their weight in gold-pressed latinum!
However, those good ones only ever helped the spasming to calm down more quickly, and would reduce the sciatica.
I eventually went to my GP, waited for 3 months, was given some physio which was basically a bit rubbish; the physio seemed to be geared toward making sure old folks could get out of their chairs - I wanted to go climbing and mountain biking!
After a couple of months of this the GP eventually got me an appointment for an MRI at Gobowen. Turns out I had herniated discs at L1-2, and L3-4. I had a long chat with the consultant who offered spinal surgery, or some sports physio, or cortisone injections with steadily reducing effect...
He pointed out that the surgery may have the effect of fusing that area of my back so making it worse, then there was the associated problems of major surgery.
He said the best bet was, in the short term, go and see a decent sports physio, get a series of exercises then build core strength to ensure the spine was better supported.
So I saw the physio, he gave me a series of exercises based on Pilates and Yoga as well as low-impact crunchies etc, and said that walking over varied terrain was an excellent way of getting movement back.
I went skiing about 2 months after that, and I've religiously done the stretches every morning, plus a 3 mile dog walk up the hill and through the woods behind our house. I've discovered that mountain biking helps, but road biking most certainly doesn't - presumably being in one semi-stressed position isn't good!
But that was all 10 years ago - and I haven't had an episode since; no spasming, no pins and needles or pain in the legs. I can tell if I've overdone it, but the core strength means that recovery is far quicker.
There's also the other way: read the Dr Sarno book on back pain. A number of friends of mine have tried his method and found it to work, though there's no concrete science behind it; basically he (he was a Professor of Rehabilitation Medicine at New York University School of Medicine) postulated that stress and worry that's allowed to build causes the brain to cut off blood supply to certain areas in a sort of fight-or-flight reaction. This causes nerve pain. So he says keep a journal of your worries - let it all hang out etc. And though it sounds a bit mumbo-jumbo he claimed success rates that are considerably higher than placebo!
Here's a relatively unbiased assessment of Dr. Sarno's approach - it appears he may have had a point!
https://www.vox.com/science-and-health/2017/10/2/16338094/dr-john-sarno-healing-back-pain
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 So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
Walking over varied terrain is great advise. Work your stabilising core muscles.
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 You know it makes sense.
You know it makes sense.
Leonard Smalls wrote:
I've had back problems for over 20 years... Spent a fortune on osteos and chiros - discovered that the good ones are worth their weight in gold-pressed latinum!
However, those good ones only ever helped the spasming to calm down more quickly, and would reduce the sciatica.
I eventually went to my GP, waited for 3 months, was given some physio which was basically a bit rubbish; the physio seemed to be geared toward making sure old folks could get out of their chairs - I wanted to go climbing and mountain biking!
After a couple of months of this the GP eventually got me an appointment for an MRI at Gobowen. Turns out I had herniated discs at L1-2, and L3-4. I had a long chat with the consultant who offered spinal surgery, or some sports physio, or cortisone injections with steadily reducing effect...
He pointed out that the surgery may have the effect of fusing that area of my back so making it worse, then there was the associated problems of major surgery.
He said the best bet was, in the short term, go and see a decent sports physio, get a series of exercises then build core strength to ensure the spine was better supported.
So I saw the physio, he gave me a series of exercises based on Pilates and Yoga as well as low-impact crunchies etc, and said that walking over varied terrain was an excellent way of getting movement back.
I went skiing about 2 months after that, and I've religiously done the stretches every morning, plus a 3 mile dog walk up the hill and through the woods behind our house. I've discovered that mountain biking helps, but road biking most certainly doesn't - presumably being in one semi-stressed position isn't good!
But that was all 10 years ago - and I haven't had an episode since; no spasming, no pins and needles or pain in the legs. I can tell if I've overdone it, but the core strength means that recovery is far quicker.
There's also the other way: read the Dr Sarno book on back pain. A number of friends of mine have tried his method and found it to work, though there's no concrete science behind it; basically he (he was a Professor of Rehabilitation Medicine at New York University School of Medicine) postulated that stress and worry that's allowed to build causes the brain to cut off blood supply to certain areas in a sort of fight-or-flight reaction. This causes nerve pain. So he says keep a journal of your worries - let it all hang out etc. And though it sounds a bit mumbo-jumbo he claimed success rates that are considerably higher than placebo!
Here's a relatively unbiased assessment of Dr. Sarno's approach - it appears he may have had a point!
https://www.vox.com/science-and-health/2017/10/2/16338094/dr-john-sarno-healing-back-pain

You could be me.

I have had a bad back for many years. I managed it for a long time with exercise, stretches and mobility exercises - and trips to an Osteopath.

Eventually, instead of this helping, it did the opposite......and it was at this point I got diagnosed with a herniated Disc L3/L4. I went through all the less invasive options - none of which worked - so I eventually had surgery in 2016.

After a slow, patient and gradual recovery - I found my back was stable enough to go back to the old regime, tailored to my new situation. I was skiing within a year of the operation and would say I am about 80% of optimal for my age - This is a huge improvement from where I was, which was in chronic pain and unable to do anything, like skiing.
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Quote:

Hello SHAP. Yes I made it!! I had a couple of privates Physio session with Accupuncture. Did Physio advised stretching/Yoga everyday. Once the imflamation went Down and got back some suppleness i started doing some light leg work. Single leg Press, Box squats and loads of Bike and Plank work.

I'm on the PSB now and apart from waking up sore. As soon as I start to ski I have now problems. I hope you get yourself sorted. If it's a disc issue the Neuro surgeon said they tend to work themselves out if you keep on the move. Plenty of time before the end of March . Let me know how you get on.


Glad you've made it. I'm fairly sure you wouldn't be the only one on the PSB waking up sore, but maybe for different reasons.

I think massive core work/yoga/pilates is an area I need to get working on.

Enjoy the bash, and stay safe!
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 Poster: A snowHead
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@SHAP, and @red, good to hear your both well on the road to recovery. My better OH has similar although there are slight and very occasional neuro symptoms, she is doing similar work to help support the area and core strength. Consultant felt it should heal within the next 12-18 months but to keep an eye on the symptoms as surgery would then be recommended, he’s not exactly over the moon about us going skiing (this weekend) but also said take it easy and see how you feel. Out of interest who do you use for insurance please?

Incidentally, we all see a chiropractor. He rocks.
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 Obviously A snowHead isn't a real person
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I get the occasional Neuro symptoms. Like shooter pains down the front of my left thigh. Definately felt my lower back tighten up as the week on the PSB has progressed. But as soon as I warm up and skiing I don't have any issues.
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 Well, the person's real but it's just a made up name, see?
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I know this is an old thread but felt I can give some guidance. I had back issue that progressively got worse with the job in agriculture. It got that bad I was down to about 1hr sleep a night feeling rubbish but the dogs loved it as they were getting 3 walks by 6am. Did the Physio and Chiro route via NHS as well as privately but came to no avail. Decided to use my private health cover and researched which consultant to visit, came up with 2, 1 at Cambridge and Mr Rai at Norwich. Had an MRI to show an extrusion on L5 S1. I was disparate but he could not operate straight away but did try injection to the spine to reduce the pain and give some time for the disc to retract. The injection did not touch it, I was taking opiates and codine plus other stuff and this time of my life was a bit fuzzy. I ended up having a op on the area with Mr Rai, who is a micro surgeon, and when I woke up after the op I felt like a miracle had happened. Within 24hours i stopped taking any pain relief which I got told off for because I should have had a "whitey" and put my body into shock.
I was skiing 11 weeks later as the physio said that skiing holds a very good posture for the back and would be a very good exercise for the strengthening of the area as long as I did not do a big crash. Hope it was some help.
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