Andrew Siegel MD 3/12/2022
“Don’t it always seem to go, that you don’t know what you’ve got ’til it’s gone.”
Joni Mitchell, Big Yellow Taxi, 1970
And so it is with many things in life, including our health. We rarely appreciate our good fortune (health and wellness) until it is compromised.
I have always enjoyed being physically active and consequently have had my share of athletic injuries–fractured wrist, rotator cuff tear, biceps tendonitis, tennis and golfer’s elbow, iliotibial band syndrome, hamstring pulls, Achilles’s tendonitis, plantar fasciitis, etc. Miraculously, all these weekend warrior impairments have resolved. The healing powers of the human body!
The injury that stands out from the rest is the herniated lumbar disc that I sustained playing paddle tennis a few months ago. This debilitated and incapacitated me more than any previous injury. It humbled me and left me with a newfound appreciation for back pain and compassion and empathy for those suffering with nerve impingements (pinching of nerve roots) and radiculopathy (the symptoms caused by the pinching of the nerve roots including pain, weakness, numbness, and tingling).
I enjoy playing paddle tennis, especially since it is one of the few sports that can be played outside in the winter. I am a novice player, having started playing only a year or so ago. In mid-November, my Upper Ridgewood Tennis Club partner and I, both in our 60s, were soundly defeated by two tall, twenty-something Knickerbocker Club players in a F-team (beginner level) match. At one point in mid-match when I stroked the ball, I felt a searing pain in my lower back, but I was able to soldier through and finish the match.
Shortly thereafter, I developed what seemed to be left sciatica-like pain. The lower back pain was tolerable, but the left hip and shin pain was severe. The pain was worst in the hip and I felt as if I had a fractured hip. I had no choice but to put myself on the injured reserve list for paddle tennis and for my indoor tennis.
As the days progressed, a pattern of the pain emerged. Oddly, it was quite variable in intensity, usually most pronounced in the morning upon arising and often improving somewhat over the course of the day. I suspected I might have herniated a disc because of the back pain in conjunction with the sciatica-like pain. I rested, took Motrin, rubbed Voltaren (anti-inflammatory) gel on my lower back, and hoped that the situation would resolve. It did not.
I called my sports orthopedist friend/neighbor for advice. He advised me to take a 6-day Medrol (steroid) pack and Flexeril (for back spasms) and if unimproved, to obtain an MRI of my lumbar spine. Unfortunately, the Medrol and Flexeril did not help. I called my radiologist colleague who arranged an MRI of the lumbar spine.
My MRI (see below) showed a lumbar 4/5 disc herniation with impingement of the left L5 and S1 nerve roots, and a questionable compression of the right lumbar 5 nerve root as well.
Translation: The central portion of the disc (protective cushion between the vertebra) herniated (moved out of its normal position) into the spinal cord space, encroaching upon and compressing nerve roots.
(Attribution: Laboratoires Servier, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)
I continued to restrict my activities, limped around, and used Motrin for pain. Eventually, I started feeling somewhat better and in late December resumed playing paddle tennis. Unfortunately, that return to the court was brief because while striking a ball, I felt a similar searing lumbar back pain in the same location as 6 weeks prior. The difference was that this time the lumbar pain was more intense. The radiculopathy that accompanied the pain was also more intense than previously experienced.
The left leg pain was 8/10 at times, perceived in the left hip and the front and side of the shin, with a lesser component on the right side. I had no improvement after an additional 6-day Medrol pack. I was miserable. The pain was particularly bad when trying to sleep and left me struggling to find a comfortable position. The pain was consistently most intense when first arising and for a few hours thereafter. At breakfast time, I paced around our kitchen island both because of the pain and since I discovered that moving helped somewhat. At times the pain seemed to temporarily abate, but was consistently provoked by bending, straining, coughing, arising from supine to standing, getting in and out of a car, sitting, and externally rotating my hips. Putting on my left sock in the morning was agony. What seemed to help the pain was exercise, physical activity, and alcohol!
My close friend who is a podiatrist recommended that I read Healing Back Pain: The Mind-Body Connection by Dr. John Sarno, the premise of which is that stress and other psychological factors play a key role in back pain. It was an interesting read and although stress certainly contributes to all sorts of pain syndromes, clearly my herniated disc with radiculopathy was a mechanical issue.
I consulted an excellent orthopedist colleague who specializes in the spine. He reviewed my MRI, examined me, and recommended special McKenzie exercises, avoiding torso rotational exercises (paddle tennis, regular tennis, etc.), but advised that I could still work out in my basement (treadmill, elliptical, exercise bike, etc.). He recommended Naproxen (Aleve) and to be patient since many herniated discs will eventually dry up and wither, allowing the impinged nerve to decompress. He counseled that if the situation did not improve, an epidural injection of a steroid/local anesthetic would be in order.
The situation persisted. Again, it often felt like I was walking around with a broken left hip. I was an unhappy camper. I wondered if this would be a chronic condition and if I was doomed to living with a permanent disability. I felt like crying. Although initially I was most disturbed because I was unable to participate in the sports that I enjoyed, subsequently I no longer cared about the sports participation–I just wanted pain relief and to feel like a normal human being.
Ultimately, my spine orthopedist performed an epidural injection of a steroid/local anesthetic to try to reduce the inflammation around the impinged nerve root. It was truly not a major ordeal, a brief outpatient procedure performed in an ambulatory surgery center under local anesthesia in which he used fluoroscopy (real-time video x-ray) to precisely localize the impinged nerve root. The entire procedure took less than 15 minutes.
Lo and behold, after a few days my pain reduced to a 2/10 as opposed to 8/10 — not gone but tolerable and livable. Two weeks later I returned to gentle paddle tennis and did well. A week after, I played paddle tennis again and regular tennis for the first time in 3 months.
My status is that I am still not perfect but am significantly better. I feel like I have my life back. My left leg is still achy at times and a big sneeze, cough, or bend sometimes irritates my sciatic nerve in an unpleasant way. However, I am much improved and am no longer on the injured reserve list, and hope that nature, time, and patience will allow complete resolution. I wear a lumbar support belt when I play paddle or tennis. I am not sure if it is beneficial other than giving me psychological support and that positive effect one gets when placing a band aid on a painful cut. A friend whom I play tennis with generously gave me his inversion table that he swore helped his lumbar disc issues, so that is a new addition to my basement workout equipment that I have been using daily.
The positive that came out of my disc experience is a newfound appreciation for good health–our greatest wealth–as well as absolute sympathy, compassion, and respect for those suffering with back pain and neuropathy.
NY Times article on How Simple Exercises May Save Your Lower Back
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. He is the co-founder of PelvicRx and Private Gym. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
Our Greatest Wealth Is Health 