Thursday, January 19, 2012

MRI is back well uh.... on my back

Can't remember if I have written about my back issue that I have been dealing with for about 2 months now and I am too lazy to read back through the blog to find out.  In a nutshell, I have messed up my lower back probably trying to do too much too soon in the weight room.  I have had lower back issues off in on in 2010 training for IMAZ but nothing that has kept me from training.  During the race, I had a flare up for the first half of the bike that was terribly painful.  Eventually it worked itself out and I stretched about every 5 to 10 miles and it helped.

Anyway, more recently I have been having problems between S1 and L5, basically this is where your pelvis joings your Lumbar.  Rest helps but as soon as I started feeling better, I would do somthing and have another flare up.  Really frustrating and with IMCDA in June it is something I don't want to mess with.  So, on my coaches advise I made an appointment with Dr. Anthony Margherita in Creve Coeur.  He was the doctor for Tour of Missouri Pro Cycling Race, numerous marathons and other cycling events.  He understands training and working with endurence athletes so I went to see him.

The Appointment:
- I got a feeling I was dealing with the right guy when I heard him and his resident revieiwing my chart out in the hallway.  He made the comment - "This guy is a triathlete, we need to make sure that we consider his training and races in his treatment"  Okay, I felt really good becuase he already understood my psychosis!  After asking me a bunch of questions, what I was training for, when was it, what was I doing now, what causes flare ups etc... He immediately sent me over for a Lumbar X-Ray.  45 minutes later I was back in his office and we were reviewing them.  He didn't see any structural damage but because of my training he stated he "wanted to be aggressive" rather than a shotgun approach.  Do whatever we needed to do to figure this out now and treat it now so I can get back on track in my training cycle. 

The Pre-Diagnosis
- Based on my symptoms he though that I may have a small rupture in my disc.  The way he explained it is that you discs are like Onions and Jelly filled donuts.  The exterior of the desk is layered like an onion and the middle of your disc (the nucleus) contains a "jelly" like substance.  In a rupture, something causes a hole to be blown through all of the layers and the "jelly" leaks out.  In my case, he didn't think I had a violent rupture but instead he thought that I may have a series of tears that have connected creating a path for the nuclear material to leak out.  Any impact like running, jumping etc... causes the leakage.  The nuclear material is highly inflamatory so when it leak it cuases pain and swelling in the muscles in the area along with swelling in the disc creating the pain I am feeling.  Unfortunately the only way to know is MRI.  I am all for dealing with facts to MRI it is.

- My first one, it took 30 minutes, it was loud, it was me being jammed in a tube, it was unnerving but reassuring knowing this huge machine would produce the facts so I can get past this.  This was Tuesday Morning for my Doc appointment with Dr. M Tuesday afternoon.

The Results and Plan of Action
- Frist off, the images were amazing.  He stepped through the images working his way down my back until he got to the trouble spot.  Sure enough, the disc in question was protruding to the right side putting pressure on the sciatic nerves that run adjacent to it.  You could actualy see the disc on the nerve.  The great news is no strucutral damage and he felt this was a very treatable issue.

The Treatment:
- Heavy doses of oral steroids to get the infamation down.  If Ibuprofin is an anti-inflamatory - this stuff is 1000x that.  I am to take this stuff for 12 days.  I can still bike and swim because that does not affect me believe it or not.  No Running and No impact or core work.  I am to call his office every2 days with a report on if I am getting better.  If this doesn't work, I will then have to get injections.  Think of it as an epidural of sterioids to my spine... SWEEET!  I am on day two...  Keep your fingers crossed.

Moving Forward:
- After this is fixed, his advise is more core work.  Specifically obliques.  He pointed out that everything that I do is in a straight line - road running - straight line - cycling - my feet never get outside my pedals, swimming - limited rotation.  So, the plan once this is done is more core oblique work.  Absolute Fitness here I come.  I will add trail running as well.

When asked if this is a manifestation of the problems I had in 2010 he said most definately.  The fact I have ignored strength for endurance for the past 4 years is coming back to haunt me.  It is what I get for not listening to my coach. 

All for now, have a great week


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