5 year follow up data...

Its been a long time between posts but given the high traffic to my site I thought it worthwhile on updating those interested on my personal journey with back/leg pain and a severe lumbar disc herniation. Essentially (big touch wood here…) I made a full recovery with the following landmarks over the past 5 years:

• Return to full training for surf lifesaving ironman racing in 2015

• Winning the state surf lifesaving ironman title each year from 2015-2020 and top 10 in national title ironman as well as 2 bronze medals in teams from 2015-2019 (2020 event cancelled)

• Repeat MRI at the end of 2015 showed ongoing severe disc herniation despite marked reduction in back/leg pain

• I continued to be careful with pacing, heavy lifting, repetitive bending and sitting in an unsupported position. Over a 3 year period these provocative activities became progressing less painful

• My foot numbness continued to slowly improve, eventually resolving completely in 2019

• With high intensity activities (eg trying to perform aggressive surfing manoeuvres/turns) the numbness still can return… I still need to be careful!

• The limp I developed from the weakness in the left leg resulted in other injuries due to compensation (eg my right hip) which I continue to manage with good results (although this is at time frustrating…)

For me this experience supports my research and clinical focus on respecting pathology when developing a rehabilitation and return to sport program in certain cases. It also shows that a positive response to rehabilitation can occur even though my MRI scan didn’t change. The scan is important information, but severe injuries on MRI are not a life sentence and people can improve without any change on the scan!

Injury resolution and tissue healing in disc injuries is slow and continues over many years. The application of rehabilitation principles is important long term. I have no doubt if I didn’t pace my symptoms would have returned.

The overall recovery of people with severe back problems is likely to be positive if carefully managed! An important caveat… every person with back problems is different. My case is only one example and there are many different scenarios and rehabilitation approaches required for individuals. The input from expert practitioners in working out an individualised rehabilitation program can be helpful in this regard.

I look forward to hopefully closing off the back pain aspect of this blog and focus more on my clinical and research pursuits. There is a lot going on with new plans for a range of clinical trials and ongoing improvement of our clinical performance at Advance Healthcare.

Anatomy of a flare up... and recovery...

After my last post I returned to training in surf lifesaving on a surf ski.  This involves sitting pulling a paddle through the water with flexion and rotation of the back.  Not great for a recovering disc but I was going well.  And then... I fell of my bike landing on the sore side.  As our research shows discs are often worse the next day and sure enough the day after this fall I had severe left leg pain.  I thought this was a flare up that would recover quickly (like I explain to my patients) and so after 3 days rest I rode my bike (remember it helped my leg pain before) 300m.  This caused significant worsening and the onset of calf weakness (I couldn't stand on my toes) as well as foot numbness.  The next 4-6 weeks was a dark a place as I think I've ever been.  After recovering well, my injury deteriorated further than I thought possible and all I could do was rest (mostly on my stomach over a bean bag) and take Panadol Osteo, Lyrica and Voltaren.  A 2 week trip to Noosa (after a very very long drive taking breaks every hour to lie down) proved the circuit breaker and through swimming, core training, very gentle yoga and eventually some bike riding I began to regain some function.  However I still struggled to walk more than 100m.

But that was only the beginning.  I had booked a 50th celebration in New Zealand and Fiji with friends and family... a once in a lifetime experience of surfing, fishing and mountain hiking.  I had to set a plan to get myself right by December.  This period taught me so much about the pain and distress my patients go through as well as the value of a carefully managed rehabilitation program.  Almost incredibly I achieved my goal and had the best time of my life celebrating my 50th even though I'd lost so much fitness and had put on 10kg.

Bella, Nick and me at Cloudbreak, Fiji

The mackerel that didn't get away!

I am now back in full training and did pretty well at the recent state titles.  The year of my back injury placed an enormous burden on my friends and family; resulting in strains that only now are being rectified.  I am still frightened of my back recurring but have learned so much about how to manage my problem long term.  I'm optimistic!

Hopefully my story can help give hope to the patients I see every day.  If nothing else it has helped me to understand the difficulties they face with severe persistent pain.  For that I am grateful.

Jon listed in top 0.5% of back pain researchers internationally

Over the past few years I (in conjunction with my team of PhD students from STOPS Back Pain) have published a number of papers in peer reviewed journals.  As a result of this activity I have been listed in the top 0.5% of back pain experts in the world.

We are about to publish a much greater number of papers and so look forward to this ranking further improving!

Cycling and radiculopathy

For those of you who don't understand what radiculopathy is... when a disc bulges (or herniates) in backwards direction it can press on the nerves that form the sciatic nerve.  See the picture and arrow... ouch... this causes leg symptoms including numbness and weakness.  Sadly I experienced this after over training (its common in males of my age).  It took 2 weeks of virtual bed rest, anti-inflammatory medication and anti-nerve pain (neuropathic pain) medication to start things settling.  For many physios the idea of cycling  (where your back is flexed) is not a good thing for disc problems.  But I've found in clinical practice that cycling can be really helpful for radiculopathy as it gently get the nerve moving and sliding in the spine and the leg.  Nerves need to move too!

MRI scan of a disc herniation causing radiculopathy

Sure enough after a gradual build up of cycling my leg symptoms have gone (much quicker than if I'd had surgery).  After every session on the bike my leg felt better.  I'm up to 20km moderate rides now and hope to start increasing walking (which is still a problem), kayaking and surfing soon!  Stay tuned...

Jon experiences back pain

One of the main reasons I became interested in back pain was because of an injury I sustained as a physiotherapy student.  After lifting a patient I was astounded that the experienced physiotherapists I saw couldn't help me.  I managed to rehabilitate myself from a moderate severity disc injury over a period of 12 months.

I have been relatively pain free, and fully functional until recently.  My surf lifesaving interest has seen me return to paddling (which I did a lot of as a young adult) and over the past 4 years I have become more and more serious in my training regime.  Unfortunately a combination of marked increased training volume/intensity, a larger blade size and poor recognition of symptoms (my initial pain was a hamstring pull) has led to a serious disc herniation with radiculopathy.

Its been quite an amazing experience to rehabilitate myself with a more severe

Me at the Australian titles back in the day...

problem and I plan to document the detail in the coming months as my recovery continues.  Needless to say I've learnt a lot including a serious dose of empathy for my patients!

I guess the lesson is careful monitoring of training parameters and athlete response, particularly as you nudge into middle age!

Cheers

Jon