I've dealt with low back pain for the last 8-9 years. I've had two MRI's and they've both shown an L5-S1 herniation.

Saw a pain management doc last week and he's recommending a corticosteroid injection. 5 months out from Ironman AZ and I'd like some relief. The back tightens up on the bike after a few hours. Ran the Houston Marathon last year and my lumbar started seizing up on me about mile 22.

Just looking for some advice from some folks that aren't selling me something. I had bad tendinopathy in both elbows a few years ago and injections in my elbows did help me quite a bit. TIA!

Had it 3x for herniated discs in my neck. Also have sciatica from pinched discs in my lower back. Got the steroid epidurals in my neck each time under light anesthesia which wound up helping both locations. Eventually it won't help anymore if you have a more serious condition than a simple pinched nerve and inflammation.

Not sure if you're located in Houston but I can recommend a pretty good chiro in the area if you want to try that route before going to corticosteroids.

I appreciate the replies. I'm close to Kerrville.

I've tried a few chiros in the area, and haven't gotten much relief. The pain isn't unbearable by any means, but I'd like to be in as close to "top form" as possible, and not uncomfortable during my longer rides.

Yea, unfortunately the problem with herniations from my understanding (to be clear I'm no doctor), is the only way to fully, and as permanently as possible, relieve the pain is surgery. Every other option is just management.

Kwade23 said:

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Yea, unfortunately the problem with herniations from my understanding (to be clear I'm no doctor), is the only way to fully, and as permanently as possible, relieve the pain is surgery. Every other option is just management.

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Yep. Steroids worked for a couple years for me, but I had to have a disc removed and two vertebra fused to finally fix the problem. Sounds terrifying but I had a very good outcome from it.

Just get the microdiscectomy. I did PT, pills, shots, etc, for three years trying to avoid surgery. Once it herniated I just did the microdiscectomy at l5-s1. Should've done it way before.

I always recommend going the conservative routes before doing surgery. Get a surgical consult, but surgery often has the highest risk of complications. There are a lot of factors to consider. Getting surgery when you're younger is always better than when you're older, for example. But there's also no guarantee surgery will work. Some surgeons will even say, depending on what the problem is, that you should hold off on surgery until you're starting to have weakness. Again, depends on the surgery indicated.

Yeah, that's where I was at. Had pain in my arm from the bad disc, this eventually led to weakness (nerve damage). It's taken the better part of 2 years to get back to almost baseline in that arm. Don't put it off as long as I did.

I had a herniated disc at the same location 10 years ago. I received 3 epidurals and they provided very little relief. Pretty painful to receive too. I started getting regular adjustments 2-3 times a month and what I feel finally corrected it was an inversion table. I worked my way up from 1-2 minutes at 45 degree decline to 10 minutes fully inverted twice a day, along with 2 Aleve twice a day. After about 6 weeks I had no more pain. I still use the inversion table periodically and it helps loosen up my back as needed.

I had L5/S1 herniation and did several rounds of epidural steroids. They worked well and gave me lasting relief, but it always came back. I went to Donald Hilton in San Antonio and had a microdiscectomy back in 2008. I'm still pain free and ran full marathons in 2018 and 2019. I still run 20-28 miles/week at age 48

Same experience as others, I did two shots for L4/5 herniation and both provided temporary relief. Its an uneasy process to get the shot in your back but worth the few weeks/months of relief. Got microdicectomy surgery and it was the best thing I ever did, I was on the sideline about 3 months then generally back to normal by month 6.

The vast majority of people recover just fine from disc herniations without needing surgery. A good neurosurgeon only cuts on a small percentage of their patients. I have had thousands of patients as a physical therapist not need surgery from disc herniations.

FTA03 said:

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I had a herniated disc at the same location 10 years ago. I received 3 epidurals and they provided very little relief. Pretty painful to receive too. I started getting regular adjustments 2-3 times a month and what I feel finally corrected it was an inversion table. I worked my way up from 1-2 minutes at 45 degree decline to 10 minutes fully inverted twice a day, along with 2 Aleve twice a day. After about 6 weeks I had no more pain. I still use the inversion table periodically and it helps loosen up my back as needed.

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I've been in the same boat. Hanging from a pull bar to decompress my spine followed by some deep back bends off the floor (think cobra pose - yoga) really helps.

There was a point I thought I'd have to stop lifting / yoga. Then I found the book The Back Mechanic by Dr. Stuart McGill. That was a huge help and I'm lifting heavier now than I have in years.

Maybe others had bad experiences with the steroids. All of mine were under light anesthesia so I never felt any pain. I feel for those that did that without anesthesia because i heard it sucks.

My injections I had a local, but I also rested my head in a doughnut shaped pillow that they pumped nitrous oxide into. Wasn't any big deal at all. The local stung for a couple seconds of course, but then the injection itself was just a little pressure.

I had an L5-S1 herniation that was causing me major sciatica pain from my left butt cheek all the way down my leg that started at the start of 2020. It was awful. I received two epidural spinal injections, one around June and the second around August 2020. The first one fixed around 70% of the pain approx and the second one got rid of the rest. Been 4 years now and been pain free. I was 40 at the time and had been lifting pretty heavy consistently for 20 yrs up to that point. I'm a lot more careful now with my load and form than I was in my 20-30s. Also I had started running on concrete in March 2020 when all the gyms shut down for covid and I'm pretty sure I was heel striking the pavement which didn't do my back any favors.

Nothing bad to say, the shots worked great in my experience.

Everyone gets a L5-S1 disc bulge, pain guys will always rec LESI,

Not everyone is symptomatic,

Treatment algorithm is:
Time, then PT, then meds vs LESI, then if clinically needed surg

You may only need 1 LESI, but you also might need them every 3mo (or anywhere in between)

Just cuz 1st doesn't work, does not mean next won't

There is very little downside, if you are symptomatic, I would try it

I know pretty much all the pain docs in the area. I'll be happy to give you recommendations if you would like them.

Thanks. I've been authorized through Dr. Shaw. Heard good things about him.

Appreciate all the help and insight!

Yes I have not worked with him but I'm have met him and know the neurosurgeon he usually refers to. Nothing but good things is what I hear.