Wednesday, March 22, 2006

Ever look inside a spine?

The first day in weeks it's not snowing in the morning and I am not able to ride to work. Today after work I had an appointment for a lumbar epidural injection. I know that sounds random but let me give you a little history. About 1.5 years ago near the end of cross season I started to feel some wierd stuff going on down my left leg. At the time it was no big deal and had no real effect on my cycling performance, in fact that year I was 10th at elite cyclocross nationals. Later that winter it got worse but only on long road rides, I started to see a colleague of mine and worked on some specific lumbar multifidi strengthening and stabilization. I also started working on some L hip tightness that had been building for years from a bad crash. I saw no benefit from the strengthening and continued to have problems on long road rides. Intense mountain bike rides and races were not to bad and I had some good results on the mountain bike last tear. Later in the summer I was to busy trying to finish up our new house to race but tried to defend the E100 title, after about 4 hours I had a bad flare upand was not able to continue. Once cross season came around I was able to manage my radicular symptoms because of the relativly short races. Following cross season I started nordic skiing and then some short rides. Once I tried to do some longer rides my radicular symptoms got worse. A PM&R doc I work with did an needle EMG on me and found some S1 sensory neuropathy, meaning most likely I had some nerve root irritation. So I went to a PM&R sports/back doc and had some imaging done. The MRI showed some minimal disc bulge at L4-5 and L5-1 with the possible contact of the L5 nerve root. Other wise my films looked great.

This is a T1 sagital view showing some mild bulging of the low lumbar discs. From this view no nerve root irritation can be seen, the axial views are better for that.

For further diagnosis and possible treatment of any chemical nerve root irritation I had a selective nerve root injection of L5 but had no appreciable improvement. By this time I was having buttock, posterior thigh, and lateral foot pain regularly and actually short bike rides seemed to help. Performance wise I was doing ok and only had a little trouble at the St. George mountain bike race., but felt fairly strong and rode well. It has been 3 weeks since that injection and today I had an interlaminar injection that should bath a larger area. Following the injection my buttock has been a little numb but I have yet to see any change in symptoms, this may take a few days to determine its effectiveness.

Here is my spinal injections under under floroscopy. The top one is the SNRI and the dark you see is the dye to locate the nerve root and the cathater and needle to insert the steroid. The bottom picture is today's injection which is more medial and between the lamina.

Hopefully I will see some improvement because as any athlete knows, injury is very frustrating. Prior to the 1st injection I took a break from the bike to see if that would help, it had no effect and I was depressed. In the event this does not help I will continue trying new things, the body is so complex, you just never know. Sorry to blab on but my story may resonate with other bike racers out there dealing with injuries. As a physical therapist this has been frustrating because I fix problems like this for a living but can't seem to touch this one. Hopefully I pull things together and have a good mountain bike season, maybe the lack of training will actually help me stay fresh. To quote Trebon "Training is for those who suck!"

Anyway, tomorrow should be good. It is my day off work and the weather seems to be looking up. I may go for a ride with climb-um Jones. I also so have some good house projects going and some serious playing with Eva on schedule.


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