# Lower back attack. **DISCLAIMER: I AM NOT A MEDICAL PROFESSIONAL. THIS IS FROM PERSONAL EXPERIENCE ONLY. DO NOT RELY ON THE INFORMATION ON THIS PAGE. TALK TO YOUR DOCTOR.** ### How it happened (Note: I'm not telling this story as a 'boo hoo, my back hurts', but more as an explainer for other people that may be experiencing the same thing, with the hope that it proves useful to others.) In the summer of 2020, I managed to screw up my lower back. Despite being [[too damn tall|tall]], up until that time I had effectively zero trouble with it. How did I do it? Seems like a combination of factors: 1. General age- and genetics-related decline in disc health 2. Polishing the roof of my car 3. Carrying a 50lb/25kg dog crate up the stairs at 3am, without any warmup, to help calm our dog when 4th of July fireworks were freaking her out in the middle of the night 4. Tricep extensions on all fours without tightening my core (the final straw) While doing number 4 (above), I felt something odd in the base of my spine and immediately stopped. However, over the next few weeks, I had a pretty much constant ache deep in my right butt cheek. I tried [piriformis](https://duckduckgo.com/?q=piriformis&atb=v311-1&iax=images&ia=images) stretches, foam rolling, and sitting on a tennis ball to address it, but nothing seemed to help. After a few weeks, it got significantly worse, to the point that I couldn't really move off the bed. Going to the bathroom involved a semi-controlled fall off the bed, army crawl, and an excruciating effort to get up onto the toilet. To move from room to room, my wife would stand hunched over in front of me, I would drape myself over her like a backpack, and she would drag me behind her. Taking a shower was out of the question, and taking a bath required a lot of howling as I eased my body from the floor over the side of the tub. In short, I was a mess. Oh, did I mention I started a new job that same summer, and did my onboarding and first few months of work remotely from bed? ### Background: Anatomy Since that summer, I've done a bit of research to try and understand for myself exactly what is happening. One of the most helpful things was learning the anatomy of what happened. Three major components of our spines are (1) the vertebrae themselves, (2) a series of discs that sit between them, and (3) nerves that emerge from the spinal cord and go to various parts of the body. When everything is functioning correctly, they work together to allow movement in multiple directions, while feeding signals from the body to the brain via the nervous system. Let's take a quick look at how the spine is put together. In the image below, the "Spinous process" is the part you can feel when giving someone a back rub, and the "Vertebral body" is the part furthest from the skin. The black area is the spinal cord, the blue area indicates nerves coming off the spinal cord, and the cyan area shows the disc between vertebrae. ![[back cervical vertebra.png|500]] *A vertebra from the neck, but the overall idea is the same. Image source: [Wikipedia](https://en.wikipedia.org/wiki/Intervertebral_disc#)* The discs between the vertebrae are supposed to be a squishy, gel-like substance surrounded by a tougher fibrous material that keeps it all together. As you move your body, the discs squish and expand in place, allowing movement of the spine. ### Diagnosis After several weeks of significant pain and immobility, I finally went to the doctor to figure out what was going on. (Sidebar: I almost wasn't able to get into the car, due to the need to bend my back to get into the seat and the resulting excruciating pain. My wife drove; there's no way I could have driven myself, and every little bump in the road was crazy painful.) They did an MRI and found the source of the problem: my lower back was borked. In particular, the area around the the second-lowest (L4-L5) and lowest (L5-S1) discs, just above the pelvis. My discs were in relatively bad shape. The back side (next to the spinal cord) of both discs had ruptured, allowing the inner gel to bulge out (up to 16mm in areas) and press on the spinal nerves and potential the spinal cord itself. And my lowest vertebra (L5) slipped out of place, moving backwards by 7.1mm versus my pelvis (S1). ### Fake news And that explained why all the stretching in the world wasn't helping my piriformis: The issue wasn't directly with the muscle itself, but instead it was due to my disc pushing on the nerve bundle that went to those muscles. My body was giving me fake news: my butt itself was fine. ### Big needles and big relief The doctor started me off with steroid injections in my spine to get things under control. I ended up doing two rounds of injections. With the first injection, I went from about 95% incapacitated to about 40% incapacitated in the course of about 24 hours. It was absolutely amazing, and gave me hope that I might be able to get back to a functional state someday. Several weeks later, I had my second injection. That one took me from 40% incapacitated to about 5-10%, again in the course of about 24 hours. Amazing. For both injections, they gave me medication to make me a bit loopy during the procedure. Despite that, the first injection was likely the most painful medical procedure I've ever had, including getting my gallbladder removed. (But do not let that stop you from getting it - the results were magical.) I went into the second round with serious trepidation, but it was almost painless; I think it had to do with how much the first injection reduced the swelling. ### Stretching and movement I've learned that three things are critical in recovery and maintenance: keeping the lower back in alignment, keeping it moving, and building core strength. After the injections, the doctor prescribed physical therapy. I went to the first day of therapy, but was not impressed by the therapist nor how poorly they were dealing with covid protocol, so I didn't return. Several weeks later I called my doctor to say my back was getting worse (back to about 25% incapacitated), and he asked me how the physical therapy was going. 🤨 I switched to another physical therapist and got fairly serious about doing the stretches, and that helped get me back to the 5-10% level. Since then, I've been fairly consistent with doing the exercises. When I slack off from doing the exercises, my back starts to hurt again until I get back into the rhythm. What helped me the most in sticking with the program was learning more about the anatomy of why movement works - the stretches relax muscles and tendons around the lower spine, allowing it to align itself correctly, and the exercises strengthen the core muscles, helping to hold the spine in the proper alignment throughout the day. ### Behaviors I've learned - Don't slouch when sitting. It curves the lower spine outward, which seems to push/squeeze my discs towards my back and into the nerves. - Don't overextend my spine forwards when sitting (e.g. pushing belly button towards the table), which seems to squeeze the bulged bit of my discs and causes them to swell - Make sure to sit with my ears directly above my shoulders, my shoulders directly above my hips, and my back straight. This keeps the back muscles from having to compensate for the counterweight of my giant head when it's leaning forward. - Stand straight (see previous bullet) at all times. It took several months to get used to it (especially because I'm quite tall, and used to slouching to fit in/hear other people), but now it has become an ingrained habit. - When possible, sleep on my back, with a large pillow under my knees; from what I've read, this is the best for reducing pressure on the lower back discs. If not, sleep on my side with a moderately big pillow between my knees. - Use heat, IcyHot patches, or a hot tub to loosen up the muscles, sometimes followed by ice to reduce the swelling. - Don't sit on the couch with my legs stretched straight out, but instead have my knees bent at 90º. If I do want to stretch my legs out, I try to lay flat on my back with my legs at a 90º angle and something under them to prop them up (imagine sitting on a chair, but with the chair back flat on the couch). - I'm tall enough that the headrests on most plane, train, or bus seats hit me right just below the neck, throwing my upper body forwards and creating a nasty curve in my back. I've learned to carry one of those inflatable lower back pillows (my favorite is the Thermarest) - it pushes my spine back into a largely vertical orientation. Lifesaver. ### Numbness and tingling While I'm largely back to normal these days (except when needing to carry heavy items or exerting myself for long periods), I do sometimes have tingling, numbness, or pain in my feet. Sometimes it feels like my foot has fallen asleep, or sometimes it feels like I stepped on something sharp. That's fake news again. There's nothing actually wrong with my feet - instead, it's still due to the discs impinging on the nerves in my lower back. It looks like something out of early-1900s pseudo-medicine, but it's actually true: there are [charts](https://duckduckgo.com/?q=spinal+nerve+function+chart&t=ffab&atb=v311-1&iar=images&iax=images&ia=images) that show which parts of the spine are related to innervation of various areas of the body. I tend to get this numbness and pain in the bottom center of my feet, and in the middle three toes. And if I look it up on these charts, it's directly related to the nerves coming from the S1 and L5 vertebrae: exactly where my back troubles began. So, when I get that pain and numbness, it's an early warning sign that I need to get more proactive at working on flexibility and strength. ### Final thoughts I need to stay on top of my exercises. My understanding is that if the nerves are impinged on for long enough, they may become permanently damaged, which can create lifelong issues with pain, balance, and (thanks to a recent conversation, I've learned) incontinence. If you have comments, corrections, or more information, I'd love to hear from you. I'm @semiperipatetic on Threads.net. And, remember: **DISCLAIMER: I AM NOT A MEDICAL PROFESSIONAL. THIS IS FROM PERSONAL EXPERIENCE ONLY. DO NOT RELY ON THE INFORMATION ON THIS PAGE. TALK TO YOUR DOCTOR.** ∎