I'm going on almost a year of not be able to run. It started last October training for a Half, noticed some dull back pain. On an 11 mile training run, the second I stopped, my knee felt like it was going to fall off. Rested 2 weeks. THe day of the half, mile 4 the pain started. I broke away from my group, and ran/walked the last 9 miles "peg legged", which caused groin pain (still present). Rested some more and was not able to train without pain, missing last season. Went to ortho, MRI of Knee was negative. DIagnosed with ITBAnd Friction, Sciatica, Plantar fasciatis. Was unable to get to PT and started seeing a chiro. Got orthotics from him, which I since have had him replace since they did not offer any change in calf tightness/heel pain. Within the past few months, I finally got a back MRI and have a herniated disk S5-L1. Chiro advises to "NOt run". NOT WHAT I WANT TO HEAR! Tried to run the other day~ During I felt pretty good, mentally It was great. Day after the back kicked in.
My problems at this time: Chronic tight leg muscles, calves, groin you name it. Can't walk around without shoes due to heel pain, calf tightness. Have been wearing orthotics for 8 months. Had one injection without significant improvement. I am trying a new Chiro (who is a triathlete) with has suggested two times a week Treatment at $35 bucks a pop. His therapies include: adjustment, cold laser, Tensegrity and other things. Not sure if there is anything else I should try i.e. back injections, new orthotics, or resolving to the fact that I shouldn't run. I have read on here about giving up orthotics, night splint etc. I do admit that I don't stretch as prescribed because It just didn't seem to make a difference. Thanks for reading and any suggestions. Nov 1st starts my training group and I want to be there!
Confirm that the MRI of the lumbar spine showed a "herniation" of L5-S1 and not a "bulging" disc. If it is herniated ask does the MRI show that the herniation is encroaching or pressing on the L5-S1 nerve root, and whether the encroachment is central, left, or right? If the lumbar disc is pressing on the nerve orthotics, laser, tensgrity are not likely to relieve it. By the way a herniated disc with nerve root involement at L5-S1 does not explain the groin pain symptom. It is usual for herniated disc with nerve root involement at L-5-S1 to manifest as knee symptoms, the L5-S1 nerve usually manifest in posterior thigh calf, heel, and sole of foot. Not being able to walk around without shoes is not a symptom assocaited with L5-S1 nerve root involvement. You may have multiple unrelated diagnosis. It sounds like you need a better diagnostic work up. You may want to check with a primary care physcian, or follow the recomendation of the Orthopedic Surgeon and see a Physical Therapist to help tease out the diagnosis. Using your zip code you can use the Find a PT. Take a look at the following articleds, Who you going to call choosing a healhcare professional, Contradictory Health Care Advise, and Evidence Based Medicine - Patient Centered Based Medicine.
Damien Howell PT, DPT, OCS - www.damienhowellpt.com
I agree with the gentleman above...
I would suggest seeing an Active Release Tech(ART) in your area.
I know of an AWESOME one in SoCal, if that is near you.
...from my understanding, walking barefoot is best for strengthening and feeling balance.
Do you strictly run? Cross train? Strength train?
The MRI states, "Disc space narrowing, disc desiccation and a 5 MM broad disc protrusion at L5-S1 exerting mild mass affect on the ventral thecal sac. I was informed today by the new Chiro that it does not mean "disc herniation". I believe that my groin tightness is due to running 9 miles literally peg legged. I have already been diagnosed with plantar fasciaitis, which is why walking barefoot irritates my feet/calves. I have quite flat feet. The only time I ran any distance was 3 miles which caused significant back flare up for the next 3 days. I have intentions on cross training, but In my heart, I just want to run! These problems have been nagging me for almost a year now! Thank you for your suggestions folks!
Your MRI results could explain your symptoms in the calfs and heels. The more details you have provided infer that your lumbar problem is aggrevated more by movement of the lumbar spine in the direction of extension. Take another look at One Size Does Not Fit All: Low Back Pain. The activity of walking/running there is relatively more movement of the lumbar spine in the direction of extension. When you cross train consider activities that can be done with the lumbar spine in flexion, sitting (rowing biking). When walking/running conciously shorten step length particularly when going down an incline, and strive to keep lumbar spine relatively flexed. A Physical Therapist could help you sort this out - Find a PT. When walking/running you may find some benefit from an external support such as an abnominal binder, body shaper, lumbar support, girdle or athletic compression shorts with a high waist.
Damien Howell PT, DPT, OCS - www.damienhowellpt.com
I agree with Damien's post, and want to add what I've learned about injuries to the Lumbar spine, pain in the lower back and legs, and the relationships between the two. Bear in mind that 10% of patients diagnosed with a herniated disk have no pain at all, so the x-ray may not be the smoking gun after all, and therapies/interventions related to it may not be necessary.
Regarding chiropractic, if adjustments to the joints in question do not alter your pain, the likelihood of a "subluxation" as a root cause diminishes. In addition, it is not only possible but likely there are muscular causes for both the pain and the bulge as diagnosed and observed. In the second link you will see a discussion of the contrast between disk-related pain and pain of muscular origin, but I am talking about a direct relationship between muscular tension and pressure on the lumbar spine, especially in a runner. In addition, there are misdirections of the perception of pain as a direct result of calf muscle tightness and groin muscle tightness that can be solved without treating the spine itself, even though a diagnosis based on suspicious visuals and location of pain alone can be, and is frequently rendered.
Runners know the importance of rearward thrust to speed and power, but if you observe a runner in competition you will see this rearward movement balanced by the forward thrust of the legs in preparation for the next stride. The hip flexors typically tighten and shorten as a result of this repetitive motion, and continue to "grow" tight in a shortened state while we are seated, and when we assume the fetal position during sleep. In fact, hip flexor tightness is one of the primary reasons we sleep this way, since it reduces the Psoas muscle's pull on the lumbar spine. There is further insult to the lower back when the pelvis tilts to increase disk pressure when seated. The following anatomical video shows how the muscles that flex the hip affect and depend on the integrity of the lumbar spine... http://www.youtube.com/watch?v=AY-4aGKUJeM&feature=related
I could save a lot of time and space and say like the chiro "don't run," but I know that recovery is possible with the proper care. It is true that the problem with your spine becomes less noticeable with rest and inactivity, and that activity can actually make the problem worse, but the proper activity in the proper order can make it better. If you were to attempt to stretch a tightened Psoas with compromised disks, the pressure on those disks would increase during the stretch, and the pain would limit your stretch and its effectiveness. A raw stretch would probably do more harm than good to the spine and the muscle.
On these boards I constantly hear "ice, stretch, exercise," but nothing about release. Without that important step, you run the risk of tearing more muscle tissue. A stretch to a tight muscle without release is what is called in exercise phys an "eccentric contraction," an engraved invitation to injury. When you stretch a contracted muscle you risk further injury and decreased range of motion, limiting your ability to exercise at all. I am a runner too and have limped through entire races, but I have learned when to cut back and how to promote healing. This video shows one approach to releasing the Psoas muscle... http://www.youtube.com/watch?v=_1RARwli_Zs&feature=related Yes it is a sensitive area to work and Psoas release is usually left to professionals, but an informed athlete working on his/her own muscles can perform a release if done with care.
This link is to a short but helpful diagnostic and treatment aid...
A longer more detailed discussion...
A recent post on the same subject with more detail...
I am a physical therapist also and although I am biased I would not see a chiro. As for your disc issues, I agree with the above that your calf and leg symptoms could greatly be associated with your disc bulge. A 5mm bulge can be effectively treated without invasive treatment. I do hope that you have been doing extension based exercises. That is disc treatment 101 in my opinion. Chiros rarely seem to use this effective treatment. To see pictures of the extension exercises visit:
http://www.joint-pain-solutions.com/bulging-disc.html Realize that as long as you are having leg symptoms you are getting nerve compression. The main goal is to eliminate the leg pain, even if it means temporarily having more back pain. This is normal. The initial focus is to get rid of the leg pain. Be consistent with the simple exercises and you will improve.
Hope this helps.
~JTrempe PT, ATC
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