Monday 8 April 2013

MRI results, back injury

I've had by MRI results.  The spinal surgeon in London has reviewed the results and the diagnosis is that I have a Pars defect of my L5.  This is a healed fracture of an old injury, probably in my teens.  This can be very clearly seen below.  I've circled the break. I'm not an MRI expert but I'm pretty sure that's it! Click to enlarge

That is the primary injury, though that occurred years ago. 

But what I have now, likely as a result, is Lumbosacral disc degeneration disease  (DDD).  Basically, the disc is not as thick as it should be, it is thinner, more dehydrated (it's darker in colour). Look at the nice thick whiter discs above for a comparison. Consultant explained healthy discs are usually like crab meat and 85% water.  If they degenerate they turn dark as they lose water content, and get thinner.   You can see it circled on this different type of MRI scan.

DDD happens to pretty much everyone as they advance in age, but my old injury plus my running has accelerated mine.  This combo is what is giving me low grade lower back, buttock and hamstring pain all the time.  The pain increases as I run to about 10 miles, at  which point I effectively sieze up and struggle to shuffle along.

Ultimatey the disc collapses in time, and then the pain can go away.  That however will take the next 20 years. So I will be a pin free 60 year old at least, and resume my ultra running career then perhaps?

Well, I'm not quite ready to give up yet, so what are my treatment options.  If it was so bad I could not get out of bed then I could have the disc removed and the vertebrae fused together.  This might work, but in 5-10 years it would put so much stress on the other disc that the same would happen and I may end up worse.  Because I am still able to walk and run short distances without too much pain, then surgeon says I am not a case for surgery, and I agree with him.

So what's left?  Combo of two steroid epidural directly into the spine, periodically.  It's just a temporary fix to settle it down and would potentially need repeating every 6-12 months if it works.  I can als try some ongoing chiropractic, hamstring stretching and back strengthening to help ease the symptoms.  It's my hamstrings that murder me as well as the miles pass by, so I think a solid and regular hamstring stretch routine may be called for in an effort to lengthen them.  These strategies are all pain management, beause disc degeneration is not reversable, yet.  I think it will be one day, but medical technology is not there yet.  We'll need some kind of breakthrough, maybe stem cell repair, who knows? I found an old study where a 5-10% improvement was found  by taking Gluco and Chondr supplements, but that study is hardly statistically significant, being a case study of 1.  I've always been very skeptical about the benefits of taking those two, but I guess it can't really do any harm can it.

Oh, there is one more option.  I could take up another sport.  Cycling or swimming! I'll bear those options in mind while I book in for an injection pretty soon and see if that settles this down.  Maybe I can eek out a few more years.  If not, then I could end up one of those MAMIL's you have read about (Google it). Despite this very bad news, I remain optimistic about my chances of returning to long distance running by using a combination of the strategies outlined above.

However, I also have race directing to keep me occupied.  Dusk til Dawn Sunlight takes places in 6 weeks, and The 12 Labours of Hercules takes place in July.  So, it's not all doom and gloom and it looks as though I finally know what's wrong, and can try and do something about it.

Have a good week!