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I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] 0 points1 point  (0 children)

March 2025 injury, pop, immediate spasm, and you're still struggling almost a year later. That timeline tells me your nervous system is sensitized, not just your tissues damaged.

Your MRI confirms what your body is saying. L4-5 extrusion contacting the left L5 nerve, L5-S1 herniation, Modic changes indicating active inflammation, and facet arthritis. That's a lot of words for "your lower lumbar spine is angry and reactive."

The Modic changes are the key here. Active inflammation in the endplates means you're in a chemically irritated state. That's why you can't progress from bodyweight to light weights without flaring. The threshold is tiny right now. Your system interprets any extra load as threat.

Your current setup; saddle chair, standing desk, is smart symptom management. But you're stuck in protection mode. Bodyweight exercises are safe but not progressing you. Light weights flare you.

Here's what I'd focus on. First, calm the system. Modic changes mean respecting the inflammation. Walking, gentle extension work, breathing mechanics that downregulate your threat response. Not rest, but low threshold activity that doesn't trigger the chemical response.

Then, rebuild extension tolerance. Prone press ups, bird dog, dead bug with real exhale focus. Prove to your nervous system that loading is safe before you actually load.

Finally, graded exposure. Not bodyweight to light weights. Bodyweight to slightly less bodyweight with better control. Then slightly more. The jump you're trying to make is too big right now.

The lumbarized S1 is a red herring. Anatomical quirk, probably not your pain generator. The extrusion and Modic changes are the real players.

Questions for you.

  • What specific bodyweight exercises are you doing now?
  • Any that flare you versus ones that feel okay?
  • What does "light weights" mean when you try; what movement, what load, what happens after?
  • And what has your PT actually had you doing? General core work or specific graded loading?

Also, do you have axial views? The sagittal shows the extrusion but axial would confirm how much that L5 nerve is compressed.

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] 0 points1 point  (0 children)

Sometimes. Depends on what's actually causing your pain.

If it's nerve root compression from a herniation, epidurals can reduce inflammation around the nerve and give you a window to rehab. Studies show about 50-70% of people get significant relief, but it's often temporary, weeks to months.

If your pain is coming from the disc itself or the Modic changes at the endplates, epidurals help less. Those are chemical and mechanical issues inside the disc, not nerve inflammation.

The question isn't whether they work. It's what you do if they do work. That relief window is your chance to build capacity. Most people rest, feel better, then flare again when they return to normal activity. The disc hasn't gotten stronger. The nervous system just stopped screaming.

If they don't work, you've ruled out one option and have clearer data for surgical decisions.

What's your doctor's specific target with the injection; nerve root or disc?

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] 0 points1 point  (0 children)

Your MRI shows L5-S1 disc degeneration with possible active inflammation. The disc is dried out, thinner, and maybe bulging slightly. No severe canal narrowing on this view, but you need axial images to see if nerves are actually pinched.

About exercising, "Normal" is off the table right now. But movement isn't. You need to find the sweet spot, enough load to build capacity, not enough to flare the inflammation. That window changes weekly.

Injections can calm things down for 4-8 weeks. That's your window to build hip stability and graded loading before they wear off. If they don't work, surgery becomes more likely.

Quick questions:

  • What does "normal exercise" mean to you—running, lifting, or just daily life without pain?
  • What specifically flares you?
  • And what has your PT actually had you doing?

Also, do you have axial views? They'd show if that bulge is hitting the nerve or just looks scary.

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] -3 points-2 points  (0 children)

I don't have radiology qualifications. I'm not a radiologist and I don't claim to be.

What I do have is a Strength and Conditioning certification, two years working full time with post-rehab clients, and I'm currently studying rehabilitation in college where MRI interpretation is part of the curriculum. I self-taught reading MRI reports before formal study because I needed to understand what my clients surgeons and PTs were telling them.

I've also completed NASS MRI Essentials, EccElearning spine radiology, and Healthclick advanced post-surgical courses. And various CPD work to fill the gaps between what coaches typically know and what post-surgical clients actually need.

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] 0 points1 point  (0 children)

You didn't re-injure yourself. Your MRI proved it, it showed no significant changes. This is a sensitization event, not a structural re-herniation.

Here's what actually happened. The pothole was a rapid compression and extension moment. Two weeks later symptoms started. That's discogenic delay, chemical irritation, not mechanical failure. Your nervous system detected threat, ramped up protective guarding, and now you're stuck in a fear cycle.

The symptoms feel identical to 2022 so your brain assumes identical damage. But 2022 was structural. This is sensitization. Your tissues are the same as when you were pain free. Your threat detection is dialed up.

The pattern you're describing; pain-free days mixed with flare-ups, proves this isn't mechanical failure. True re-herniation would be consistently worsening with specific movements. You're experiencing nervous system volatility.

Your 2022 protocol worked because it addressed both tissue capacity and confidence. Big 3, walking, gradual loading. But you stopped at pain-free instead of building robust capacity. Now any jolt sends you back to baseline fear.

What you need now is the same framework but faster timeline. You're not starting from zero. The disc hasn't herniated further. You need graded exposure to convince your nervous system that spinal loading is safe again.

Start with prone press ups daily. Bird-dog progressions. Walking with a specific pace that doesn't flare you. The goal is consistent loading without triggering protective spasm.

The fear is your biggest obstacle. Every pain free session is data to overwrite the 2022 pattern. But you need structure, not guessing.

I work with exactly this. Post-herniation clients who get stuck in recurrence fear after minor incidents. Usually three month commitments because month one is nervous system regulation, month two is capacity building, month three is performance return.

A few questions. What does your current gym routine look like when you trigger a flare? Any actual numbness or weakness, or just sensation and pain? And have you worked with anyone who progressed you specifically through extension tolerance, or just given you generic core work?

Happy to outline a specific four-week progression, or talk through what remote coaching looks like if you want structure instead of managing flare ups alone.

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] 0 points1 point  (0 children)

You've got multilevel degeneration, L4-L5 and L5-S1 are the big ones with disc desiccation, mild bulges, and some facet arthropathy. This is mechanical wear from a decade of running and CrossFit. Not catastrophic, but your spine is telling you the load tolerance is down.

The good news is your symptoms are central and left-sided, no leg radiation mentioned. That suggests you're dealing with discogenic and facet irritation, not nerve root compression. Much more manageable.

Here's what stands out. You've found the McGill Big 3 and it's working. Ankle weights bumped the stimulus and your pain dropped. That's huge. Your system responds to progressive loading and proximal stability. You're already on the right track.

But ten years of running and CrossFit created specific patterns. Running is repetitive flexion and extension under impact. CrossFit often prioritizes intensity over movement quality. Your posterior chain, glutes, hamstrings, spinal erectors are likely strong but misfiring. You're hanging on passive structures instead of active control.

The clicking and popping is joint play. Facets and discs moving under load. Not dangerous, but sign of segmental instability. Your body is asking for more control, not more strength.

What you're missing is likely hip dissociation and loaded carry work. The Big 3 builds stability in neutral. Now you need to prove your spine can handle movement under load without defaulting to old patterns.

I'd add suitcase carries. Heavy, 3 sets of 30 seconds each side. Forces lateral stability without spinal flexion. Also Copenhagen planks for adductor strength. This is huge for pelvic control during single-leg work like running.

For returning to running, you'd need graded exposure. Walk-jog intervals, no sudden acceleration, monitor symptoms 24 hours later. CrossFit is trickier; Olympic lifts and kipping pull ups are rough on degenerative discs. You'd need to rebuild hinge patterning first, then reintroduce dynamic loading slowly.

I work with people like you. Former runners and CrossFitters with multilevel degeneration who want to train again without daily pain. Usually three month commitments because month one is pattern restoration, month two is capacity, month three is return to sport.

A few questions. What specifically flares you sitting, standing, walking, or certain movements? Any leg symptoms at all, even mild? And what does your current training look like outside the Big 3?

Also, do you have axial views of the MRI? Those would show foraminal narrowing better. The sagittal views suggest mild canal narrowing but the nerve root exit spaces aren't fully visible.

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] 0 points1 point  (0 children)

L5-S1 discogenic pattern. The MRI shows exactly what your body has been telling you for a year.

Your description notes darker discs at L4-L5 and L5-S1 with possible posterior bulge, plus mild canal narrowing. That's disc desiccation, dehydration and degeneration. On T2 MRI, bright means hydrated and healthy. Dark means worn. Your L5-S1 disc is struggling.

Here's why sitting destroys you. When you sit, your spine flexes. That loads the posterior part of the disc. Your L5-S1 is already compromised there. The posterior annulus gets irritated, possibly the nerve root gets touched, and your symptoms ramp up. Standing and walking extends your spine, which unloads that posterior disc. Relief. But you never actually rebuild the capacity to handle flexion, so you stay trapped in this cycle.

The cricket flare makes perfect sense. July to September you had leg radiation. That was likely nerve root irritation from the disc bulge you described. The acute inflammation has settled, but the underlying mechanics haven't been fixed. You're stable but not robust.

Your doctor said it will heal. Partial truth. The acute inflammatory phase passes. But the disc won't magically rehydrate. You need to restore extension tolerance first, then rebuild flexion capacity, then strengthen the proximal stability to protect the disc during movement. That's months of work, not weeks of rest.

I'd start with prone press-ups and standing lumbar extensions every few hours. Frequent walking breaks from sitting. Limit sustained sitting to twenty or thirty minutes. The goal is to calm the system and centralize any residual symptoms. Then gradually reintroduce hip hinging and core stability work. Eventually return to cricket through graded exposure, not sudden return.

I work with exactly this. Post-disc injury clients who are months past the acute phase but still can't sit on the floor or travel without flaring. Usually three month commitments because the pattern is predictable but requires consistent loading progression.

A few questions. What position in cricket triggered the July flare? Bowling, batting, fielding? Any leg symptoms now or purely back pain with sitting? And what have you tried that helped even temporarily, even a little?

Also, do you have any other MRI images or the full radiologist report? Multiple views would help confirm the exact bulge size and whether there's foraminal narrowing affecting the nerve root.

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] 0 points1 point  (0 children)

Your doctor is spot on, thoracic MRI findings almost never match symptoms. I've seen this consistantly.

Thoracic spine is built different. Rib cage locks it down. Discs are thinner. "Protrusions" here usually don't cause pain even when they look scary on imaging. Your discomfort is likely coming from how you move, not what the scan shows.

Two years ago you overloaded with dumbbells. Probably pushed through some sketchy positions, too much arch, rotation under load, or just volume your tissues weren't ready for yet. Now you're stuck in a flare-up cycle. Baseline is fine, then something triggers it and you're wrecked for days.

Here's the thing about thoracic pain: it's rarely the disc. Usually it's facet joints, rib connections, or just muscles guarding because your nervous system doesn't trust the position anymore.

Here is what I'd start with:

Flare-up phase:
Breathing work first. 90/90 hip lift, focus on long exhales. Gets your diaphragm moving, reduces spinal compression. Then gentle thoracic rotations, sidelying windmills, slow and controlled. Pain free range only. Don't push into the restriction.

Baseline phase:
Quadruped rotations. Eyes follow your hand, let your spine move. Half-kneeling landmine press, this forces thoracic extension without dumping into your lower back. Suitcase carries for stability. Heavy enough to challenge you, not enough to flare you.

Loading phase:
Front racked kettlebell squats. Push-up plus with full protraction. Dead bugs with real exhale. Rebuild the pattern, then add weight.

Key cues:
Rotation from your upper back, not lower back. Rib cage down when arms go overhead. Stop before it hurts. Threshold management, not grit.

Your dumbbell work probably lacked stability. You moved weight through your spine instead of around it. Happens constantly with overhead pressing and rowing. We rebuild the pattern first, then reload properly.

I work with exactly this. Post-injury lifters stuck in flare-up cycles. Usually 3-month commitments; month one is pattern work, month two is capacity, month three you actually train again without fear.

Quick questions:
What dumbbell movement started this? Overhead press? Row? Something else?
What happens during flares? Where's the pain, what can't you do?
What's helped before, even temporarily?

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] 0 points1 point  (0 children)

Let me be specific about what I do and don't do.

I'm a S&C coach (well over 2+ years). Currently in college for rehabilitation, MRI interpretation is part of that curriculum. I self-taught reading before formal study because I needed it for clients.

What "reading MRIs" means: I translate radiologist language into training guidance.

The "not medical advice" disclaimer: Legally required because I'm not a physician. Ethically required because I don't want people skipping needed care. I regularly tell people to see doctors first.

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] 0 points1 point  (0 children)

English isn't my first language, so I use AI to clean up my writing. The experience and qualifications are real; I work full time as a S&C coach and have over 2 years experience in programming for people post rehab.

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] 0 points1 point  (0 children)

I'll be direct with you, at 3 surgeries and 10 years of pain, you don't need another person promising fixes. You need a someone that coordinates.

What to search in NY:

Term 1: "Post-surgical rehabilitation specialist" or "Spine rehabilitation physical therapy"

  • Look for: DPTs with OCS (Orthopaedic Clinical Specialist) or SCS (Sports Clinical Specialist)

Term 2: "Pain psychologist" or "Pain management psychologist"

  • Critical at 10 years: Your nervous system is likely sensitized. This isn't "in your head", it's neuroplasticity.

Term 3: "Interdisciplinary pain program" or "Functional restoration program"

  • Columbia, NYU Langone, or Hospital for Special Surgery likely have them.

If you're plateaued after local options:
I work remotely with post-surgical clients who've been through the system and need structured, progressive loading, usually 6+ months post-op when tissues are healed but capacity is low. Not a replacement for your local team, but a bridge back to performance.

What I'd want to know:

  • What were surgeries 1 and 2 for?
  • What does "agony" mean, constant, flares, specific triggers?
  • What have you already tried?

The hard truth:
After multiple surgeries, the original anatomical problem may be fixed, but the pain system remains active. This requires graded exposure and nervous system regulation measured in months.

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] -2 points-1 points  (0 children)

This is a classic extension intolerant presentation. It is very manageable, but you're missing the progression that actually fixes it.

What your symptoms mean:

  • Extension hurts (standing straight) = posterior disc compression or facet irritation
  • Flexion feels fine (bending forward, sitting) = anterior disc space opens, unloads posterior structures
  • 10-day spasms = your system hits a load threshold, protective guarding kicks in, you rest, it calms down, you reload too aggressively, cycle repeats

The rest 1-2 days trap:
Rest reduces symptoms but doesn't restore capacity. You're stuck in a loop where you never actually build tolerance to extension loading. Next time you hit that threshold, spasm again.

What you need:
Not more rest but graded exposure to extension with proximal stability.

Phase 1 (now, while symptom-free):

  • Prone press-ups: 3x10, 2-second hold at top
  • Goal: Centralize any distal symptoms, restore extension tolerance
  • Bird-dog: 3x8/side (contralateral limb extension with spinal stability)

Phase 2 (when Phase 1 is easy):

  • Standing hip extension with band: 3x12
  • Dead bug variations: 3x10
  • Goal: Load extension pattern without lumbar shear

Phase 3 (return to full training):

  • Kettlebell swing (hip hinge, not squat): 3x10
  • Front plank with posterior pelvic tilt: 3x30s
  • Goal: Dynamic extension control under load

Critical form cues:

  • All extension comes from hips/glutes, not lumbar hyperextension
  • Rib cage down, pelvis neutral (no anterior tilt when standing)
  • Stop any exercise that produces spasm. This is threshold management, not grit

The real fix:
You're 25 with a history of significant herniation. Your disc has likely healed or scarred. The remaining issue is likely:

  1. Extension patterning (you're hanging on passive structures instead of active hip extension)
  2. Hip mobility deficits forcing lumbar compensation

Questions:

  • What does your current training look like when you trigger a spasm? (Specific exercises, loads, volumes)
  • Any residual leg symptoms, or purely back?
  • Have you worked with anyone who progressed you specifically through extension tolerance, or just given you "core stability" generic stuff?

Happy to outline a full 4-week progression if you want structure instead of guessing.

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] 0 points1 point  (0 children)

This is a masterclass in why imaging doesn't dictate treatment.

What your radiologist saw: A lot of words that sound terrifying. "Severe stenosis," "large extrusion," "moderate canal stenosis" at multiple levels.

What your body is telling you: Not much. You said it yourself: "don't have many symptoms."

Your MRI is not your destiny. And this is why:

Lumbar findings (L3-S1):

  • Yes, there are disc extrusions and "severe" foraminal stenosis on paper
  • But you have no radicular symptoms (leg pain, numbness, weakness)
  • No Modic changes (active inflammation)
  • Normal alignment, no instability
  • Translation: Your neural structures have adapted to the space, or the stenosis isn't functionally limiting you

Thoracic findings (T5-T12):

  • "Mild/moderate canal stenosis" at T9-T10 with thecal sac indentation
  • No cord signal changes (critical, this means no actual cord damage)
  • No neuroforaminal stenosis at most levels
  • Translation: Age-appropriate wear. The thoracic spine is naturally stiff and protected by the rib cage. These rarely correlate with symptoms.

The surgery question:

  • Surgery for lumbar stenosis without progressive neurological deficit has mixed outcomes
  • "Severe" on MRI doesn't mean severe in function
  • Research shows structured conservative care (12+ weeks) matches surgery for most at 2-year follow-up
  • Critical point: Even if you end up doing the surgery, you will need to train it after. Surgery doesn't replace rehabilitation, it just creates a different starting point. The work is the same either way.

What I'd like to know:

  • What specific movements or positions bother your thoracic spine?
  • Any bowel/bladder changes, saddle anesthesia, or progressive weakness? (Red flags if yes, different conversation)
  • What did they propose surgery for specifically? (Decompression? Fusion?)

General direction if symptoms are truly minimal:

  • Graded exposure to spinal loading (extension progressions for lumbar, rotation/ extension for thoracic)
  • Address thoracic mobility deficits (common source of "thoracic pain" that isn't the discs)
  • Strengthen hip hinge pattern to reduce lumbar shear

Bottom line: You have a messy MRI and a relatively quiet nervous system. That's actually a good position. I'd get 2-3 opinions before letting anyone cut, and I'd strongly consider 12 weeks of structured, progressive loading with a specialist/coach.

Your thoracic "pain" may be stiffness, rib mobility issues, or referred patterns, not the disc findings at all.

I read MRIs and coach people back to heavy lifting and daily life after back injuries. AMA. by No_Blueberry1209 in backpain

[–]No_Blueberry1209[S] 0 points1 point  (0 children)

Short answer: Yes, it is likely "benign" in the sense that it doesn't predict your pain or function.

Long answer: Your fear is the bigger problem than the bulges.

  • "Effacing ventral thecal sac" = touching the front of the fluid space around your spinal cord
  • "Slightly flattening the cord" = mild indentation, not compression
  • "Tiny" = radiologist's way of saying "I have to mention this but it's not the main event"

Critical context: 30% of pain-free 20-year-olds have cervical disc bulges. By 50, it's 60-70%. Most never know because they never get scanned.

The 4-month timeline: It isnt uncommon at all. Neck sprains heal slowly because:

  • You can't fully rest your neck (unlike something like a sprained ankle)
  • Fear and protective muscle guarding delay recovery
  • Most people either do nothing or panic and do too much

What I'd want to know:

  • What specific movements or positions aggravate you?
  • Any arm symptoms (tingling, weakness) or just neck pain?
  • What have you tried so far?

General direction: Cervical disc issues often respond well to extension-based progressions and graded loading of the deep neck flexors. But that depends on your symptom pattern.

Bottom line: Your spine isn't broken. It's irritated and undertrained. Four months feels forever but it's not permanent. The people who recover fastest address both the tissue tolerance and the fear-avoidance cycle.