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Back Treatment Specialist Recommendations


jacojoco's picture

By jacojoco - Posted on 23 December 2013

NB: Originally posted elsewhere on the Global Riders Network and appears via syndication.

I have been suffering lately from lower back pain from disc bulge or degeneration. I had a laminectomy in the same spot in 2000. The back has been good till Sept 2013, but started to go downhill. I can hardly bend forwards and can't sit for a long time. I have been doing some core work, but pain persists and gets worse as the day progresses. I can still ride up to 2 hours, but am not so great afterwards.

Today I am getting MRI done to see what the damage is. I suspect the L4/L5 disc may be shot or on the way out. I am not sure what the next steps are. I have a referral for a Royal Nth Shore Back Surgeon.

I know a lot of people on this site are same age and have similar issues with back. I am hoping for any advice about what has worked and who you can recommend for anyone who is any good around the North side. I will probably try and find a physio and see the surgeon and see what they both have to say.

Thanks in advance for any advice/recommendations for specialists. I am sure there will be lots.

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CB's picture

Hi J
I have a good shoulder surgeon but no experience with back surgery.

I have however had lots of experience with Physios

The best I have come across are the guys at The Body Mechanics at Milsons Point. Lewis Ingram and Mark Green are superb.

Good luck with the back

CB

Matt P's picture

Please see a low back specialist (eg doctor). Your GP should be able to recommend somebody. Failing this, save up your money, buy a flight to Canada, see DR Stuart McGill at the university of Waterloo. He is generally seen as THE leading authority on LBP.

100 people could present LBP in the same area and have 100 different causes so just because one or two methods worked for them (cue comments on "core" training) it doesn't mean it will work for you. Get a proper diagnosis from somebody who is not only qualified but who also has a wealth of practical experience.

The one bit of advice I will give from what I've learned is that an instance of LBP will in most cases arise because something has been wrong for a while. The pain is a bit like the straw breaking the camels back and is a rely caused by a one off no ident unless you are in a bad accident.

Fatboy's picture

Familiar problem.

I too had a disc let go in 2000 - mine was L5/S1. Took up mountain biking about 5yrs later to get some fitness back as I'd gained weight and couldn't do anything. I retired from my 7 day a week passion ... golf.

For years I've been racing enduro's and gobbing down handfuls of Panadeine Forte determined not to let my back stop be doing things. I remember one year of the Convict 100 I'd had about 8 by halfway!

As my fitness has got better I can ride faster with less effort so basically bludge my way to the finish at a speed where I'm doing least damage to my back. I find switchback courses like Stromlo and Mt Annan the worst. Pushing out of slow corners kills my back.

Back in July this year I was sitting in my mate Craig Gordon's lounge room telling him I want to improve my racing so he offered to coach me but his first comment was I need to deal with my back first. He made a phone call to Rob Standen at Penrith Physiotherapy and booked me in for both a bike fit and a look at my back. Rob is a passionate enduro racer himself and Gordo swears by him.

Having a professional bike fit in itself is another topic - well worth the money and did help with my back. The main thing being the freedom in my hip area now as I pedal. My previous setup had my hips resisting leg lift.

As for my back, Rob basically explained how my disc problem is long gone but everything around that area has been compensating so I've been through a process I learning to use the right muscles and being able to 'switch off' muscles in tension. It has been an awesome experience! I'm still not 100% and it will take time. Rob has me tape myself up before a race. I basically need someone strong to put me in a bear hug around my hips while I am taped up to basically pull my hips forward and together. Obviously the fact I need to do this means I'm not right yet and expect it to take some time.

The proof of the improvement was at the 24hr race at Mt Annan a few weeks ago. I hate racing there as it causes no end of pain and I normally lap in 33 min. I punched out 4 daylight laps with fastest 28:00 and slowest 28:24. The fact I was so much faster than normal and grouped my times so close together shows the gains I have made in the last few months.

The lesson I learned from this is not to give up and accept your problem as normal.

hawkeye's picture

While The Body Mechanic is good they don't hold a candle to Steve Hogg for thoroughness. The problem with Steve is the really long waiting list times to get in and see him - the demand is so high.

The upside is he applies the same thoroughness and rigour to his referrals. He doesn't give respect easily. I'd give him a call at Pedal Pushers at Rosebery and see who he suggests.

The problem with surgeons is that to him with a hammer every problem is a nail. I'd explore other options first unless the MRI throws up something specific. I've had surgery in the past for an issue that was in the end resolved by using orthotics. The specialist's focus was too narrow.

thehairynurse's picture

G'day mate. Sorry to hear about your back - they are killers when they go. Physio wise at chatswood there is a place called the bone joint clinic- I've been there and had good success with my back and reliable advice both pre surgery for a number of years and post. I say pre and post because again whilst everyone is different when your disc is shot no amount of physio / massage etc will help. But they can help in mean time. Getting a bike fit will prob help to, and I think the people at cycle northside can help. As for surgeon, the one you saw last time sounds good if it's lasted 13 yrs. I've dealt with patients whose lasted less than a week - i do wonder how well they followed the surgeons post op instructions thou.

Mojo Ridin's picture

Daryl Phillips at Performance Health in Newport is a genius. He's a chiro but barely even touches you. His approach is unlike any other chiro or physio I've been to and he gets results. I usually have one or two appts when something is going wrong and he explains why it's happening and sends you away with the specific exercises to fix the issue yourself. Or he'll tell you if he can't help and you need to see a surgeon etc.

Best of luck getting it fixed.

jacojoco's picture

Thanks for advice. I have had the MRI done, but haven't got prognosis yet. I am thinking about physio at Homebush where I work at Sydney Sports Medicine. Anyone got any reviews? I am not going to run to an op yet. Did some swimming today and feels a bit better. I looked back on previous issues and it was a tear in l5/s1 and a bulge in L4/L5. If anyone is out west I can recommend Sean Mungovan as a physio at Penrith and Blacktown. Also Dr Charles New was the previous surgeon. If I can't get sorted I may go back to these guys.

jacojoco's picture

I have desiccation and bulges on L4/5 and L5/S1. Also a slipped disc on L5/S1 and the bulge is in contact with both L5 nerve roots. Also have arthritis in L5/S1.

So there are a few things going on. I have done a stack of core work, walking and swimming in last 2 weeks. The pool work is the best and I have no pain after swimming.

Sitting brings on the pain and it stays till I do more exercise or swimming. I am able to ride as spent 3 hours out with Hawkeye the other day and pulled up ok.

I am back at work next week out at Homebush and will book in with Sports Medicine out there for a program. The MRI is a great move to understand what is going on.

Fatboy's picture

One word of caution @jacoco.

While I'm singing the praise of my physio now, things were quite different when I suffered my injury. Like you, my disc bulged out and trapped the sciatic nerve causing it to inflame. If the disc for example moves away from the nerve it takes about 3 months before you will know as that's how long an inflamed nerve takes to settle. Any movement in that region can cause the disc to touch the nerve again causing it to inflame again...

In my case I had physio 2-3 times weekly for something close to 2yrs. I would feel real progress over a few months then suddenly 'bang'. The physio would be doing exactly what they had done for months and for some reason the disc touched the nerve again and it would feel like I'd just been hit in the back by a hammer. I'd then go through many months of getting back to where I was then the whole process would repeat. 2 steps forward, 2 steps back...

Eventually I stopped going as I felt I made no progress.

The one thing that did definitely help was traction. If you hang upside down by your ankles you are stretching your spine which stretches your discs and causes them to pull away from the prolapsed state.

As you say, swimming is also fantastic for it. Good luck.

Logan's picture

I had a bulging disc in my L5/S1 which was pushing on my Sciatic nerve, causing huge amounts of problems including tingling and numbness all the way down my left side. I persisted with Chiro for 3 months however that didn't really help and in the end because it was affecting my life so much I opted for surgery.

I had a Micro Discectomy on my L5/S1 and it made the biggest difference, I was pain free immediately and walking within a day or two of the surgery. Took about 3 months before I could go back to playing sport, but since then I have never looked back. I had that surgery 5 years ago now, when I was 24, I thought I was already on the scrap heap at the age of 24 after having surgery, but I M currently the fittest and strongest I have ever been.

hawkeye's picture

Didn't mean to keep you out that long. :oops: Very glad the back pulled up ok.

Edit: snipped. Probably better to ask offline.

Matt P's picture

your LB issues?

Jaco jaco, same Q to you.

jacojoco's picture

I am not 100% sure. In 1999 I had a car accident sandwich and my seat broke and I ended up in the back of the car, but I don't remember specifically hurting the back. Then same year I fell ice skating which did hurt it a bit. I was going to go snow skiing and as the back was hurting a little bit, I got some physio - bad decision. When I was at physio they got me to do all the wrong stretches and then they tried to force bend and twist and manipulate the lower back which herniated the disc and basically crippled me.

I then spent a year trying to strengthen core by doing hydrotherapy and physio almost daily which was working, but then in 2000 the herniated disc developed a tear which trapped the sciatic nerve and I could no longer walk or get up off the ground and had no option but surgery. It was perfect after surgery, no pain and full movement, till I had kids.

I think the real cause of issues was misspent youth in my twenties which weakened the discs which other events exposed. The most recent issues have been brought on by running around while being a ref at a soccer match and carrying my 3yr old for around 3kms in the city.

In the last 10 years I have also done a lot of heavy lifting and also been otb a lot on rides which hasn't helped.

Logan's picture

Initially I injured my L5/S1 in a tackle but it wasn't causing me significant pain, hurt when it happened but physio helped it and all good, what really did the damage was a scrum collapsing, that cause the disc to bulge significantly which cause the numbness.

jacojoco's picture

I have now been to Sydney Sports Medicine at SOP and have some targeted stretches for my condition for hamstring and glutes. Also some tougher core ones. I have improved dramatically in the last 3 weeks with all the core work, walking and swimming. Swimming has been the best. I survived a week back at work, but the bus trips in and out and sitting continues to hurt and press the L5 nerves. Hopefully the increase core work and glutes, hamstring focus will get me where I need to be.

I am definitely in a much better place then I have been for 3 months and when I posted this originally.

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