Question
I am a 28 yr old former college football player and currently a military man. My question applies to a theory of mine involving the development of 9 disc hernias (3-cervical,3-thoracic,3-lumbar) for absolutely no apparent reason. Surgeons tell me that surgery is needed in my lumbar(Fusion) and cervical(still talking), but can not explain why I went from having 4 hernias (3-lumbar, 1-cervical) to 9 within the past 2 years. So quickly here is the info and the question.
13 years ago I had a 20 foot fall the basically jerked my legs away from my upper body, not an impact, I caught myself with my arms only. I felt a pop and severe pain down my right leg and in the small of my back. Doctors believed the spasms and radiating pain down my right leg to be muscular injury. I was bed-ridden for 2 months, doctors then gave me injections in the muscular areas of my lower back on the right-side only. Help was minimal, but they got me back on my feet. No MRI scans were done.
The next 9 years I had reoccurring pain only in the small of my back with severe muscle spasms that completely limited my range of motion. These spells lasted for 3-4 days and happened twice a month. OTC meds and core strength training helped enough and I stuck it out being a football player.
Year 10-Late 2004,the same pain came with severe radiating pain down my right leg, but never went away. MRIs were taken and showed L3-4 & L4-5 Disc bulge & L5-S1 disc protrusion (5mm x 5mm)and degeneration with a c5-6 protrusion (1mm x 1mm). None of the disc showed signs of nerve compression on the MRIs. The L5-S1 was black and had decreased disc space. Surgeons believed the protrusion was extremely close to the nerve and could move during compression(sitting/standing) resulting in the severe pain and the L5-S1 disc degeneration was some proof that this injury happened many years earlier and the two bulges were more recently caused by the degeneration in L5-S1. Also, the MRIs showed 4 schmorl's node hernias. I know these usually are not significant but it is the number of them that worries me.
Now, presently these 4-disc hernias plus the 4-s. nodes have become a total of 9-disc hernias(bulges & protrusions)and 7-s. nodes in my t-spine. Disc hernias are:
--3-cervical all with annular tears and some nerve compression ( Radiating arm pain with numbness/weakness in fingers-thumb,index,middle) the protrusion is 1mmx4mm up from 1mmx1mm.
--3-thoracic bulges with annular tears and one nerve compression.
--3-lumbar-2 bulges and one protrusion, only difference here is that the protrusion went from 5mmx5mm to 5mmx11mm. No nerve compression seen. (Right and left radiating pain pointing towards the S1 nerve root, according to doctors, and indication of facet syndrome)
Question: Before my back pain went from twice a month to constant. I had lost 30 lbs in muscle. I was a body builder at 225 lbs with 4% body fat who joined the military. At basic I lost 20 pounds of muscles, I had no fat to burn off with all the running and no weight training. Now at just over 200 lbs. I broke my shoulder in training, which took two years to fix with surgery. Once again I could only run and no weight training because of my shoulder. I kept the fat off, but now I was at 190 lbs.
I graduated from college and became a regional manager for a large oil company and worked 130 hours per week. No weights or running and I put on 30 lbs of fat. I do not have a gut. With all the body building my body learned to disperse the fat evenly over my body. You can not tell, but calipers tell me that I am 22% body fat now.
With the latest MRI showing that the number of damaged disc going up. I wondered if something was already causing disc compression making it easier for bulges and protrusion to occur. Going from 4 to 9, is unexplained because all I did was drive hundreds of miles per day. So how could sitting for long periods in a large vibrating truck cause hernias throughout if it was not extremely easy to do so.
Looking at military records I did notice that I lost all that muscle down to 190 lbs but never lost any height. I was still 6'3". When I stated to gain fat weight, throughout my body is when I actually began to shrink. I am now at 6'2" and this is well documented in military med records. I progressively lost height as weight was gained.
My theory is that my body frame was very large with muscle and the loss of muscle made my frame thinner, which allowed me to shrink as weight was gained in fat instead of muscle. If I gained muscle I believe my frame would have been the same keeping pressure off my disc. As I gained more fat, my body frame shrank in height and began to add compression to my disc.
It took two years for the 4 hernias to become 9 and during that time my symptoms steadily became worse and in more areas, all documented. When the 9 hernias were discovered I was the heaviest I have every been. This added weight disbursed throughout my body, instead of just in my gut like most, I believe allowed my body to become more compressed. If I had a "beer gut" this would not happen, except just in the lower back areas. This full body compression made it easier for my disc to bulge or to become protrusions. Adding the compression of sitting for long periods of time,at work combined with existing compression and pressure in the disc from my shrinking body frame, equals disc injury.
Could increasing muscle mass,& loosing weight, increase my frame size again and allow less pressure on my disc and relieve some pain. Since surgeon believe that the protrusion do move, couldn't they move less or not at all when my frame is larger and stretched out. If this is possible than why does no one address this. I cannot find any literature on a case like this which, to me, seems like an obvious observation to a physician being thorough in a patients history. If this has not been addressed than take my case and begin the research, I would gladly volunteer.
If someone noticed that I needed to gain more muscle to prevent injury than maybe I would not need multiple surgeries now. Also, muscle growth could be a method of treatment for preventing lower back pain which it seems there is less of a concern on preventing than treating. Right now I have left my large income job and will work the family ranch. This gives me the time to build my frame back up. I will let you know what happens. However, if someone loosing muscle rapidly could increase the chances of disc injury. Than I think getting muscle back on that person quickly, like athletes, would benefit and possibly save their lives. In my case,I have life changing surgeries or build muscle mass quickly. I am out of time and I think that anabolic would work great in my case. It is like choosing the lesser of two evils. This is a case were steroids could really help, short term use only though, not abuse.I think working out for muscle with anabolic help would be not as dangerous as taking years of narcotic pain medications. At least working out with anabolics the addiction or rather the dependency would be health, nutrition and determination.

Answer
Dear Clifton,

Okay, the first problem was when you had the previous trauma, and the doctors didn't take an MRI!  Anytime you have radiating pain down the legs, you have to suspect a disk problem...the original doctors you had should have performed orthopedic tests to see if they could reproduce your pain in various positions.  These test are very easy to perform, add great diagnostic value, and would have taken 5-10 minutes to perform. Then they should have ordered the MRI.  They completely mishandled your injury, and my opinion is that this is where the original problem began.  With proper management, and rehabilitation, you could have been back to normal in 4-6 months...I have seen this in many patients.

Concerning the football, body building, armed forces service, and driving; all of these activities increase compression on the disks which will only further degenerate the injured tissue. A normal disk resists compressive forces, but when injured, compressive forces actually make the problem worse.  Specifically concerning the driving position, the stress on the disk is over two times the normal stress of standing.  Research has shown that over the road drivers frequently herniate disks due to the repetitive compressive forces generated inn the seated position...this is why the air ride shock seats were invented for bus drivers, truckers etc...

As far as you situation is concerned, I would not recommend that you use anabolic steroids to continue "building up your frame".  First, all steroids have been shown to cause cartilage degeneration in the joints, and muscle bulk will not provide stability to the spine, the weight gain will actually make the problem worse.  Large pecs and biceps do not make you more stable, and the increased loads of heavy weight tanning is hard on the spine. You should be more concerned with stability of the core musculature, especially the multifidus muscles which support the disks. pilates and yoga would be a better alternative for a positive outcome.  There is a book written by a physical therapist on training of the multifidus muscle that is very good...I believe it is called The multifidus back pain solution...you should get it.  Additionally, A man by the name of Pete Egoscue has written a few books on rehab for pain and increased function.  They are all very well written and simple to read...easily found on the internet.

So...surgery...fusion...if you have the fusion, you will likely need another fusion surgery in 5-10 years.  This is very common due to the fact that if you fuse the vertebra to disallow motion, the joints around the fusion will have to increase their motion which will wear them out = further accelerated degeneration!!  Disk replacement surgery would be a better option, but you will have to go to Europe to have the procedure.

Alternative:  Intervertebral Disk Decompression.  I have seen this therapy work well for many patients, and as a bonus, it has also been shown to decrease the pain from facet syndrome as well.  Some brand names for you to research:  Accuspina, Lordex, Chatanooga, DRX 9000, Spinal Aid.  The literature states an 86% success rate with this therapy, but more research needs to be conducted to verify this stat, and "success" needs to be specifically defined.  I would opine that 65-70% success rate is more appropriate concerning the alleviation of pain....probably lower for the actual rehydration of the disk material, but you should research this option.  Decompression is often sold in packages for 5-6 thousand dollars, but this is too high in my opinion, 3-4 thousand dollars for a package is more appropriate.

Hope everything works out for you Clifton, whatever route of treatment you choose.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net