Since early this year, I’ve been recovering from two disc herniations and am still on that path. I’m lucky that I both caught it early and that they are, in the grand scheme of things, not extreme enough to warrant surgery. Add to my luck a remote job with a flexible schedule for taking time off to rest and to go to doctors appointments. It’s still been painful, scary, slow, and frustrating. I’m documenting the approach I took, what I bought along the way (I’m very minimalistic so anything I purchased was necessary), and what the timeline has been like. I’m obviously not a doctor and this is almost more for my own future records but I’m sharing in case it helps. At this point, I feel confident in saying that I’m on the right track and am dealing with minimal symptoms but remaining that way still requires dedication.
Tips
- Use ChatGPT to understand MRI results and prepare for the doctor appointment so you can come in informed. For example, I asked ChatGPT to explain the results across varying levels of expertise (spine ortho, PT, college student) and asked it numerous questions about herniations so I could better understand my body and the treatment it would need.
- Be an advocate in your own care. I had to call every day sometimes multiple times a day to get properly scheduled for the CT scan and MRI.
- Don’t push through pain with back injuries. You need to do the opposite! This was hard for me to psychologically wrap my head around.
- Drink lots of water and take tumeric. It didn’t occur to me that drinking water would be hugely important for this injury and tumeric was suggested by my PT.
- Find a way to do decompression: hang from a pull up bar, traction machine, etc.
- Get a proper ice pack (don’t rely on frozen veggies). It genuinely helps to have something that appropriately fit on my back.
- Cut muscle relaxer meds in half or in quarters as you see fit. I wouldn’t have been able to work if I was on the dosage he wanted me to be on.
- Map out a few walking routes of varying lengths, without hills ideally, to get a sense of how far you can go and to better help with tracking.
- Keep copious amounts of notes with specifics (dates, length of symptoms, what led up to symptoms, body position, etc).
Items purchased/used
- Cushion lab cushions for labrum and seat.
- Portable TENS unit used while icing and also before travel.
- Tumeric supplements.
- Ice pack for back (bought from my PT place).
- Aspercreme with 4% lidocaine patches (bought at walgreens, told my doctor pal that it’s what they use in the hospital).
- Aleve roll on.
- Wave scraper.
- Massage gun (so cheap, works great, recommended by PT).
- Epsom salt (bought at walgreens).
- Heating pad (girlfriend loaned me hers)
- Tumeric (bought at walgreens).
- Epsom salt for hot baths (bought at walgreens).
- Pull-up bar for hanging (already had one)
Timeline
January
January 18th: I went to a spine doc complaining of some back pain and mainly some longstanding coccyx pain. Based on an initial x-ray, the spine ortho doc I saw was worried about two things: a stress fracture in my sacrum and potentially an annular tear based on the spaces between my discs in my lower back. He wrote me a script for PT and, freaked out, that same day I went to my very first PT appointment. He also put in orders for a CT scan which, looking back, I should have pushed for an MRI for better visualization.
January 26th: I went back to the spine doc post CT scan to talk about the results. He felt there was an S4 stress fracture but wanted an MRI of both my low back and sacrum to confirm whether I was dealing with two issues or just one. This initial diagnosis of a stress fracture in my sacrum ended up making treatment harder both in terms of what exercises I was given by PT and how I approached recovery. Below are the questions I asked the doc with help from another doctor pal:
- What do the results say and what results matter?
- If this were a loved one, what would matter to you and what what you do to modify your approach to exercise?
- What should I tell my PT based on these results?
- What can I take for pain (topical, oral meds, braces, tens unit, non pharma, etc)?
- Is there any other imaging or repeat imaging you want to do in the future?
- What are you anticipating for a follow up appointment/what directions do you want to pursue?
- Any thoughts on chiropractic care or massage at this point?
This last question is key as I could have benefited from massage then but, with the assumption being a stress fracture of my sacrum, both massage and PT really wouldn’t help. It also wasn’t clear with a stress fracture what I could or couldn’t do so, rather than fully resting, I kept walking, trying to go to the gym, etc. which was a big mistake. I also was told to eat more at the doc appointment and had a doctor pal tell me that I likely needed blood work where I would see some nutritional issues. This didn’t line up with how I knew I cared for myself and felt wildly off but it was the line of thinking at the time. I started eating in excess to help heal.
February
For the first part of this month, there was very little PT could do with me since a stress fracture of the sacrum only gets better with immobility. I lost a lot of unnecessary time at this point and my symptoms grew worse. Soon after my MRI on the 16th, I was rendered nearly immobile for close to two weeks. I had near constant nerve sensations, couldn’t get comfortable, and struggled to care for myself. Once the most acute part of this subsided, later in the month, I started a log of symptoms to share with each PT visit. This includes notes like:
Woke up once Monday night with my left foot asleep while sleeping on my back evenly.
Sitting on the couch both big toes went numb within 30 minutes and went away when I walked around.
Lightly numb big toe on left side after evening walk (walked less) and standing (not from sitting). Only numbness that day. Some tightness in calves throughout the day.
Feb 16th: MRI was finally done and soon after I got my results. This is when I used ChatGPT to weed out some initial questions and when I started furiously watching YouTube videos to understand more (terminology, treatment courses, causes, etc).
Feb 20th: I had a follow up appointment with my spine ortho doc who kindly let me record him while he answered my questions (always ask!). I highly recommend asking if you can record folks as it helps to play back later, share with others for perspectives, and ensure you got the information right. Below are the questions I asked the doc:
- What do the results say and what results matter?
- What’s the prognosis? Do you expect I can heal from this?
- What are the range of symptoms I can expect?
- What are the signs that things are more serious and I need to come back in?
- What should I expect if I begin healing over the coming weeks?
- What’s causing the coccyx pain? Could this be referred pain?
- What should I tell my PT?
- Thoughts on chiro? Thoughts on hanging from a pull up bar for decompression?
- Anything I should track for you that would be helpful/how can I best communicate with you?
- What follow up do you expect? What direction do you anticipate?
He then prescribed me two meds: an anti inflammatory and a muscle relaxer. I took the anti inflammatory in full each day but I tried to limit how much of the muscle relaxer I took. I was way overprescribed — one would knock me out and he wanted me to take three a day. At most, I took one a day and at night. I also got in the habit of cutting them in half or even in quarters.
Implementing a strict routine
It was after this doctor’s appointment that I was able to actually start doing things that would help what was going on. Before this time period was incredibly stressful as I was having symptoms far outside the range of what would be expected with a stress fracture in the sacrum. This understandably really freaked me out and made it hard to know what to do to make things better. At this point, I implemented my own system, combined with PT, to provide routine and care for my body. I did this almost exactly every day for just over a month:
- Morning walk (~20 min)
- Morning hang (two rounds of 30 seconds)
- Oatmeal and water water water
- Ice and tens in the morning/midday
- Lunch and water water water
- Midday hot bath or shower or heating pad (heat on glutes)
- Midday walk (20 min)
- Afternoon hang (two rounds of 30 seconds)
- Afternoon/evening walk (20 min)
- Ice and tens in the afternoon/evening
- PT exercises
- Take meds and supplements (tumeric!).
I had the following as general guidelines in the same note:
- Hang five times for 30 seconds
- Do 2-3 small walks per day
- Drink more water
- Switch up position throughout the day (don’t stay in one position for hours)
- Listen to pain and be conservative
During this time, I continued to take notes about nerve symptoms, PT exercises that didn’t feel great, and began tracking as best as I could how far I could walk until nerve symptoms started. Sometimes I could hardly get out the door before nerve symptoms began.
March
March was incredibly monotonous at the beginning as I was deep in my healing routine. It also included a fun adventure with a salivary gland infection and a canceled birthday trip plus work trip.
March 12th: I had my first massage appointment with a clinical massage therapist (this is not a relaxation massage). My left side was pretty strongly locked up at this visit.
March 22nd: I was cleared by my PT to very lightly go to the gym. This was a huge win for me and also something I didn’t feel ready for in many ways. I stuck to very limited range of motion movements, very light weight, and very quick sets.
March 25th: I had my second massage appointment and remember feeling really normal for the first time.
At the end of the month, I was feeling intermittent nerve sensations but was well on my way to some level of normalcy.
April
Early April I completed a Phoenix to Seattle drive to bring my girlfriend back to WA. This led to a fairly big flare up with my back, manifesting as sharp pain in my piriformis, a return of some nerve sensations, and some discomfort in my back. I had worried about this road trip throwing my back off so I had already lined up both PT and massage upon returning before adding in my first chiropractic visit where I could get access to a traction machine all in the same week.
April 1st: I had a quick check in with the spine doc and was essentially cleared. He encouraged me to do PT 6 weeks a year to “keep me out of his office” which he later explained would allow him to go straight to injections if I needed it for a flare up in the future. This was mid roadtrip.
April 8th: massage to loosen up my piriformis and back post road trip.
April 9th: PT to do the same. I bought a massage gun after this PT visit along with the scraper linked above.
April 10th: first chiropractic appointment with a very minor adjustment and time on the traction machine.
By the end of the week, with lots of vigilance and care, I was getting back to where I was pre-roadtrip just in time for a flight from Seattle to Orlando.
April 14th – 21st: I spent a week in FL visiting family. For the flight, I brought my lumbar spine pillow from cushion labs, took an anti inflammatory, and tried to get up as much as I could during the flight. I also packed the tiny massage gun with me! The flight didn’t aggravate it and I used the massage gun daily to keep everything in check. During this week, I went to the gym 5 times and felt increasingly solid with each visit.
April 22nd: Massage + chiro, including traction table time.
April 24th: I had a bike fit done at the PT place to help ensure that getting back into biking wouldn’t aggravate what’s been going on. I highly recommend folks do this in general and am kicking myself that I didn’t sooner.
April 26th: Completed a nearly 6 mile return ride! This was done with guidance from PT to start very small, implement the changes she asked for, and build up.
April 29th: Massage + chiro, including traction table time. At this point, more focused on some pain in my achilles than anything back related!
April 30th: Completed a 7.5 mile ride, going a bit further and faster than the first ride.
Interspersed in the above were trips to the gym, where I’ve felt increasingly capable albeit remaining limited (ie not squatting, benching, etc). I still try to ice each day, use the massage gun, take tumeric, do my PT strengthening, etc. Most recently, I held a plank for over 2 minutes which is not something I ever thought I’d have a reason to do.
What I would have done differently
- Pushed for an MRI over a CT scan.
- Get into massage sooner.
- Get into decompression or traction machine sooner.
- Increase water consumption sooner.
- Slowed down on physical activity sooner.
- Not eaten in excess when it was assumed to be a sacral fracture.
I frankly blame the misdiagnosis of a sacral fracture on all of the above.
What I’ve learned thus far
These injuries have a mind and pace of their own. The best and most you can do is to simply listen to where you are each day. I remembered a PT I had in my ACL recovery telling me that you can’t expect your body to do the same thing day in and day out. I was very much reminded of this advice during recovery and still have to remind myself of the same. This healing path is not linear, flare ups are expected, and recovery is done through listening not pushing. This last part, learning to listen rather than to push, has been incredibly profound to embrace in general.
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