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Acute herniated disc from deads- MRI

gotgame

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Had this case today and thought I would share

26 year old male with acute deadlifting injury 7 weeks ago. He went to a chiro who took x rays, said his "alignment was off" per the patient and had been seeing him for 5 weeks without things getting significantly better, although maybe a bit ( likely from dessication). 2 weeks ago he went to a PMR doc who worked this MRI and here I come in...

Couple of key points. He is 26.. his 4-5 and 5-1 levels are dessicated already ( arent bright like the others) which shouldnt happen until later in life but from repetative axial loading i see this all the time.

I put arrows on here for you guys. This is a huge herniated hitting all his nerve roots...no way in the world was any chiro manipulation going to help this. All that treatment did was delay diagnosis and accurate treatment, patient is now more likely to be left with more permanent issues. You need to know what you are treating before you treat blindly.
 

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gotgame

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damn that pic sizing came out badly..

FIXED! (Bio)
 
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jpkoepse

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Unfortunate but very interesting to see.

What can be done?
 
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goal245

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How much was he deadlifting, how often etc? Did he just do something stupid and try to lift more than he should?
 

gotgame

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How much was he deadlifting, how often etc? Did he just do something stupid and try to lift more than he should?

He was a big boy and did a lot of powerlifting moves. He hurt himself pulling 4 plates for reps but said he has done more before.

I mean look... i was all about powerlifting in the early 2000's but truthfullly the human body only evolved to handle so much weight before it starts to give its just the way it works. Its like puttting a bigger and bigger engine in a car and racing it... eventually the engine power is going to excede the capacity of something on the car and its gonna break. I doubt humans throughout the last million years were routinely lifting 500lbs loading their axial skeleton.
 

gotgame

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xman280

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I have something like that , nn- diagnosed officially - it is not herniated, but everytime i try to do deadlift with 400+ it pinches my nerve really bad. I can do heavy squats, heavy goodmornigs and all, just deadlifts...and officially - i dont have a herniated discs...( i have some bad injuries in my 20s - lower back...)
 

Bio

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I have something like that , nn- diagnosed officially - it is not herniated, but everytime i try to do deadlift with 400+ it pinches my nerve really bad. I can do heavy squats, heavy goodmornigs and all, just deadlifts...and officially - i dont have a herniated discs...( i have some bad injuries in my 20s - lower back...)

You don't have something like the person in the MRI.
 

xman280

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You don't have something like the person in the MRI.

ok dude, whatever, i didnt even try to read the MRI , i was just saying i have an acute issue with lower back, not chronic...
 

Bio

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ok dude, whatever, i didnt even try to read the MRI , i was just saying i have an acute issue with lower back, not chronic...

All you do is bullshit just so you can get attention in EVERY thread.
 

MooseKnuckles

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Had this case today and thought I would share

26 year old male with acute deadlifting injury 7 weeks ago. He went to a chiro who took x rays, said his "alignment was off" per the patient and had been seeing him for 5 weeks without things getting significantly better, although maybe a bit ( likely from dessication). 2 weeks ago he went to a PMR doc who worked this MRI and here I come in...

Couple of key points. He is 26.. his 4-5 and 5-1 levels are dessicated already ( arent bright like the others) which shouldnt happen until later in life but from repetative axial loading i see this all the time.

I put arrows on here for you guys. This is a huge herniated hitting all his nerve roots...no way in the world was any chiro manipulation going to help this. All that treatment did was delay diagnosis and accurate treatment, patient is now more likely to be left with more permanent issues. You need to know what you are treating before you treat blindly.

I herniated L4/L5 Siatic nerve pain and right leg was going numb and before I had an MRI I tried a Chrio he said same thing x-ray and alignment was off after first treatment I ask him shouldn't we know for sure before we go any further, he disagreed, but I got an MRI instead and found out disc had large herniation tried 2 injections and eventually got a microdiscectomy May 2016 and it was a very successful surgery, and a huge relief
 

WhyIncision

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For my own curiosity...what are the patient's SSx?

Honestly, seems like the chiro didn't do a accurate history and physical examination. Mechanism of injury and ssx for a posterior central disc herniation would be jumping out at you.
 

frink71

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Couple of key points. He is 26.. his 4-5 and 5-1 levels are dessicated already ( arent bright like the others) which shouldnt happen until later in life but from repetative axial loading i see this all the time.

Would love to hear more of your thoughts on this, sounds like regular work even with 3-4 plates for squats and deads is hastening this?

This worries me, I love lifting like crazy, hence I wanna do it when I'm 80, I err alot on the side of all things longevity these days, I can deal with being small lean and hungry as long as I still thrash my squats and deads! haha

What do you think, chronic squats and deads over the long haul not gonna be worth it even without acute injury?

Good chance most of us already have dessicated disks 20 years in advance of our age??

Hmmm.... I did think it was strange my brother kept seeming taller
 

ThinkTank

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18 year old injury to my back from deadlifting (really from poor flexibility). I believe it to be worse than your friends.+


* Disc desiccation L2 to L5
* L3-4 disc bulge, with indentation of the ventral margin of thecal sac


Explored surgical options, however they wanted to perform a spinal fusion and I opted not to get that done. Kept me out of the gym for years until....I worked on my flexibility. This allowed me to return to the gym.

No longer can do most leg exercises, squats, and limited deadlifting (rack). Certainly no longer ego lifting.

Daily pain went from miserable, to barely noticeable with the stretching of my hamstrings and gym workouts. I have other issues related to the imbalances this has caused, such as hip issues. They are all manageable.

I basically went from taking a painful minute to stand from a seated position, to being reasonably normal.

My point being....Surgery may not be the best option.
 

gotgame

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I guess my point was simply making sure to limit the amount you lift and instead try to increase the intensity other ways ( drop sets, volume etc). Unless you truly are a competitive athlete you really dont need to be risking injury every day, something will give at some point.

So many times in a day im dealing with a patient and I will say " I DONT KNOW". Thats the truth. I have a professional relationship with a very good chiro who does a lot of legal work. At least once a week he calls me saying hey Dr GotGame, i have this patient and im not sure if i should be managing him or if he needs something else, lets discuss. So many times i see chiros willing to collect a check when there was no way on earth anything they were gonna do was going to actually help and it only delayed proper treatment. Then other times i am so thankful so have them on board for conservative managment and help the patients when its appropriate.

I can't believe that cars get more proper attention then people at times. Would a mechanic ever just start treating your car without ever doing a proper diagnosis and looking under the hood first...very rarely. Yet in people we do blind patient management...how freaking hard is it to find out what is wrong first and then treat accordingly.
 

goal245

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Compare Ronnie Coleman to Someone like Jay Cutler or Dexter Jackson.

Ronnie trained all out 100% heavy, too heavy, he's paying for it now big time

jay and dexter train smarter and more reserved and can continue doing so for many more years probobly
 

chinaboy

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Good post. I have a bunch of MRI pics saved of the worse of the worse that comes into my work. I should post the some time. I love when people come in thinking something needs to be popped into place because a chiropractor told them they are "out of alignment".

I wouldnt think he would need a fusion. A discectomy yes but fusion not yet. He is only 26 l, an athlete and still has some disc height.
 

gotgame

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certain people NEED to train heavy and really push those anatomic limits. I work with some pro athletes ( soccer, football and tennis) and people who really need to hit that genetic max potential and your careers depend on it then yea lets see what your body can handle and be smart about it but with them i have a very high threshold for pushing the limit and yea they get injured but we catch it early and treat accordingly.

You aren't gonna hit your absolute max vertical jump or lowest possible 40 time training like a bber...you have to push that limit but you have to be smart about it and when injured seek appropriate treatment. No topical cream is gonna help a macerated meniscus ( yea pro athlete last year kept trying that and said it was working...yea ok..)
 

bieberhole69

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How much was he deadlifting, how often etc? Did he just do something stupid and try to lift more than he should?

I likely did some serious disc damage years ago warming up on deadlifts (speed pulls to prime CNS, no belt because I was no-belt crew at time--only mention because I was probably not consciously keeping core tight like belt forces) around 405lbs. Only pulled once a week FWIW and low volume. I didn't have insurance at the time and never found out but took 6mos before I could reach down and tie my shoes again.

Deadlift is an inherently high-risk exercise (compared to others). Not that I'm anti-deads (I still do them) but it's easy to get one little thing wrong and wreck yourself, especially when you're fired up and adrenaline is going crazy.
 

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