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1. BonusCup
   Member

   Hi Josh,
   I saw your posting on GSF and figured i'd stop in. I'm 36 and I just recently had to get an MRI done because my right leg and right foot would go numb if i was standing or walking around too much. I thought it was Sciatica but my doctor said I have:

   1. Degenerative Disk Disease L4-L5 and L5-S1
   2. Mild degree of Stenosis L4-L5 and L5-S1 due to Spondylosis with disk bulge.
   3. Edema involving the pedicle of L5 on the right likely related to some stress reaction although no fracture or other abnormality is seen. There is no Spondylolisthesis.

   He offered cortizone shots but we both decided PT would be a better option at first. I'm waiting on the PT office to call but is there anything i could start doing on my own?

   Posted 15 years ago #

2. jpassmore
   Member

   Bonus Cup,

   It is good that there is no Spondylolisthesis! Always start with the good news.
   Does the pain decrease upon sitting? If so, how long does that take before symptom relief? Do you get these same types of symptoms when you are lying on your board while paddling out?

   What type of work do you do?

   You want to attempt to get a PT who has an interest in the spine or specialty training. Even better would be a manual therapy certified PT. I don't have mine but I am working towards it.

   What can you do prior to PT?
   The easiest and safest thing to reccomend to you with out going through a full evaluation is to have you assess the flexibility in your legs. Specifically your hamstrings, quads, and hip flexors. If they are tight, I would begin stretching them as long as these stretches don't increase symptoms. To some this may soud like a "blanket" answer, but it can be helpful in most cases.
   Based on your age, hold each stretch for 36 seconds, 3-4 sets per muscle group.

   That is good for starters.
   Get back to me regarding my questions...and I may have more tips...

   Thanks for the question,
   Josh

   Posted 15 years ago #

3. BonusCup
   Member

   Thanks for the reply.

   After I sit, symptons do seem to subside within minutes. When I do feel the 'numbness', it seems that if i kneel down flat footed and stretch out my lower back it does relieve some of the pain briefly but sitting does help more.

   As for work, I work for a TV Ratings company and have to move or spin TV's around daily but it doesn't really seem to bother me that bad.

   Symptoms don't occur when i'm surfing, paddling or sitting on my board. It just seems to happen when I'm standing for a long period of time or walking long distances.

   My doctor is a D.O. and even though he didn't mention it yet, his nurses mentioned something about OMT that he can do, but I can't remember what that stands for.

   Posted 15 years ago #

4. BonusCup
   Member

   Also, I have full mobility in my legs. When I feel the 'numbness', i can grab my right knee and strectch it out to the left and rotate it around in circles trying to stretch it out because it sometimes feels like my hip is hurting also.

   Posted 15 years ago #

5. jpassmore
   Member

   OMT stands for Osteopathic Manipulative Treatment. If he is certified in this he should be quite knowledgable in regards to finding any type of misalignment and aiding to correct it.
   Thanks for the answers...

   Now we assume muscle length to not be an issuse and if we purely go at it like DDD...
   I would lean towards gentle at first and the progressing with some lumbar traction.
   Options: Machines ( I don't favor )
   Manually ( can be very effective if done right )
   Exercises to decompress the disks
   Exercises to strengthen your core. How would you rate your core strength and endurance on a scale of 1-5, 5 being the best like Laird Hamimlton and 0 being like a newborn? Are you familiar with the prone on all fours, quadraped exercise to strengthen the core and multifidi?

   A strong and well controlled core muscle group can aide some relief to stress placed on the spine with daily activity.

   In regards to getting pain when standing for awhile: If I get stiff when standing, I either dom some marching in place movements and some posterior pelvic tilts.

   I do like your choice of the kneeling position for relief. That does aide in some slight disk decompression. A seated QL stretch may also be indicated for both sides?

   I would be really interested in seeing your posture from a lateral perspective and apply my "break" test on your postural stability. This would tell me if you function in your body's most optimal and efficient spinal position to accept the most load possible.

   If I can be of more help, don't hesitate...
   Thanks
   J

   Posted 15 years ago #

6. BonusCup
   Member

   Josh,
   Thanks for your reply again. I am still waiting on the PT office to get back with me. They need to make sure I am coveered under my insurance.

   As for machines, I do not like them either for some reason. I do not have any so I would like to do some sort of exercises I can do in my own home.

   "How would you rate your core strength and endurance on a scale of 1-5, 5 being the best like Laird Hamimlton and 0 being like a newborn? Are you familiar with the prone on all fours, quadraped exercise to strengthen the core and multifidi?"

   I feel like my core is around a 2-3. Do you know of a website or reference to see some of your recommendations on strectching or exercise positions?

   Thanks again. I do not want to take too much of your time. I hope you do well in your endeavors and if you were closer to Pinellas I would definitely look you up.

   Posted 15 years ago #

7. jpassmore
   Member

   The following links are to images only. I do not endorse any information you may find on their websites...

   http://www.coachr.org/corea2.jpg
   Will be the Q-ped exercise. Pay attention to detail. Start in the perfect box position with 90 degree angles at hips, knees, shoulders. Keep you spine in neutral, not rounded up or sagging down. Engage abdomimnals, and lift. Begin with just one arm at a time and alternate. If you can do this 10 reps per side, each for 10 seconds with no problems. The next day try just the legs, same parameters, alternating. If this is still good, try doing the combo, like the picture. Same parameters. If no porblems, keep practicing and get back to me when you feel you have mastered this step and I will make progression suggestions.
   You should keep your core so still when lifting limbs, that you would place your favorite dinner on your back using your mom's favorite "china" and it wouldn't fall!

   NEVER CONTINUE IF YOU EXPERIENCE MORE PAIN!
   IF UNSURE, ASK OR DON'T DO...

   http://www.somatics.com/images/Psoas.jpg
   Look at this image...
   This is why I ask about the QL and Hip flexors, as if they are tight they can compress and not allow needed movements in the spine.
   QL: The quadratus lumborum muscles, together with the illiopsoas (hip flexors), are a common cause of lower back pain. Because most people sit for 90% of the day, their quadratus lumborum muscles are short, tight, and overused. The quadratus lumborum muscles assist in side bending and in back extension.
   I haven't come across a good QL picture for a stretch that I can endorse. So I CAUTION you if you are searching on your own. PAIN IS YOUR GUIDE. A good QL stretch shouldn't increase symptoms!

   Keep in touch,
   J
   (surf is coming mid week!)

   Posted 15 years ago #

8. BonusCup
   Member

   Thanks and I will look into everything with care.

   Posted 15 years ago #

9. BonusCup
   Member

   Hi Josh,
   To get back with this...I've been going to PT and they have me doing alot of different stretching and stuff. Mostly with 'hollowing'. I'll put a ball in between my knees while bent and laying on my back and then arch and 'hollow'. then they'll strap my knees together and i'll push them out and do the hollowing. other stretching while hollowing also.

   they've also just recently been doing traction where I lay down on some device and they strap me in tight on my chest and around my hips and then stretch me out. I've also been doing side steps up and down.

   Some days feel better than others but am stillfeeling the same kind of numbness. Unfortunately, with my job, I drive sometimes hours at a time and i think that is where i get issues from.

   Hopefully all this will help. I get sore from stretching but i think it is working out muscles that haven't really been worked in that manner before.

   Posted 15 years ago #

10. jpassmore
    Member

    Bonus Cup,

    Good to hear from you again!

    I didn't do your eval, but how long have you been in PT? Overall, any improvements? Be honest! I wonder why you are doing some of the things they are having you do? Are you therapist trained with manual therapy skills?

    Which side , if there is a side, do more of your symptoms go to, (which leg) ? I might have a nice stretch for you.

    Are you getting any soft tissue release (massage)?

    Long periods of driving can definitely aggrevate an issue. Do symptoms worsen then or when you get out of the car? If so, what types of symptoms? Usually with stenosis, sitting is best, and a disk bulge is worse with sitting only if increased symptoms are present.
    Be STRICT with your sitting posture in your vehicle!

    Get back to me on my questions...
    Keep in shape for the next swell!

    ~J

    Posted 15 years ago #

11. BonusCup
    Member

    I've been going for a couple of weeks now.
    Improvements??? It seemed like after the fist Traction, my back was fine all next day but it just seems sore now.

    My right leg and right foot is the issue. If i stand or walk long periods, they still go numb or feel like they are going to 'sleep'. Without giving out their name, these are the 'Specialized Services' they have on their website:
    - General Musculoskeletal Rehabilitation
    - Back Programs
    - Orthotics
    - Sport Specific Training
    - Women's Health
    - Vestibular Balance
    - TMJ
    - Biofeedback
    - Massage
    - Functional Electrical
    Stimulation
    - Continence Program

    As for driving, I have no numbing feelings while driving but after a long while, my lower back does start to get sore. Would a lower lumbar type seat padding be useful? I think i've seen them at Target or other stores.

    Thanks for the reply.

    Posted 15 years ago #

12. jpassmore
    Member

    BonusCup

    Where on your R leg and foot? Exactly...

    You can buy a fancy lumbar support thingy from Target, thats cool, but also just don't have such a recline in your seat, try to keep both feet equally placed on the floor to avoid pelvic torsion. If you want a support, first try something inexpensive, like a rolled up towel tightly. I use something that a back store gave me as a promo. It is a lumbar support that I can adjust the inflation in. It self inflates too. But yes, a general lumbar rool should be okay too. Basically, with YOUR back prolonged static positions are not good. Most of the time you may lkke the lumbar support, but their will still be times you will need to remove it. Vary the support amounts for best results in your case.

    No Massage? That's seems wrong at first glimpse... Are they super busy with no time? Do you get ANY hands on work?

    HERE IS YOUR NEW STRETCH:
    To be done throughout the day as often as needed, but a minimum three times a day. Hold for 1-5 minutes, starting at 1 and working to 5. IF MORE PAIN< STOP AND GET BACK TO ME ASAP.
    1. Lay on your LEFT side with legs extended and a rolled up pillow under your lumbar spine against the obliques. What do you notice about your symptoms?
    2. Next, in same position, bend up both knees until you feel symptoms decrease. If having no symptoms to measure by, just bend up your knees a comfortable amount.
    3. Then, in same position with knees bent and sidelying on pillow, turn your right shoulder to the right, towards the surface you are laying on. What do you notice about your symptoms?

    This stretch is specific for stenosis on the R side! The only additional skill you are missing, is the palpation of a PT to not have the stretch be so general and to be specific to the region in your spine where the issue is. This would be based on location of discomfort on leg/foot.

    Do the stretch regulary for 5 days and get back to me with your status.

    Keep in touch in the meantime if you have questions.
    Spread the word if you know someone else who needs guidance.

    Thanks,
    ~J

    Posted 15 years ago #

13. BonusCup
    Member

    Thanks Josh,
    I'll give that a try...
    I say my right foot, but i guess i notice it more in my toes. As for the right leg, it is usually a sharp pain in my right buttock and then sometimes it shoots around to my right groin.

    They did say they will be starting deep tissue massage soon.

    Posted 15 years ago #

14. jpassmore
    Member

    EXACTLY, which toes? Be specific please... This is often lower lumbar area... as indicated by your initial posting.

    The pain in the buttocks that radiates to the groin ca be a few things. SI joint problems, upper lumbar issues, referall pain from muscles, piriformis syndrome. Google some of those and let me know if some of them seem like you. I am leaning to the first and third one, but that is a gut feeling.

    Let me know how you do after the massage...Good to hear your finally getting some.
    You might also benefit from a therapist who uses ETPS. It is direct current at accupuncture points and trigger points. Good for chronic pain! Check them out at http://www.acumedmedical.ca/

    Keep in touch, I'll be curious.

    Posted 15 years ago #

15. treyvollmer
    Member

    Josh,

    What's up, man!

    I really like you're website here, and I'm glad I finally checked it out.

    How can I change my password?

    Take care,

    Trey

    Posted 15 years ago #

16. jpassmore
    Member

    Trey

    Once your logged in, click on your screen name, then click edit and you can change it there. Good to hear from you and I liked your latest video. Dn't know if It ever be better than your 1st fitness center workout video!
    ~J

    Posted 15 years ago #

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