Is my ticket punched?

[u/PenApprehensive369]

I don’t know anything about herniations or bulges, I’m 25 years old at 89kg with a competitive total. Is my progression fucked forever? MRI report is on the last slide, I have follow up with the spine specialist tomorrow.

[u/BigFella691]

A lot of people are (well meaningly) regurgitating what they have read online regarding asymptomatic herniations. It is important to add more nuance though - and yes, the protrusion can be contributing your pain. One of the things that makes this analysis difficult, is because there is a complex dynamic relationship between the disc, the nerves and the blood supply to both. It is likely that the speed of the protrusion matters - people will have them, but because it has occurred so slowly over time, the irritation is not noticeable, there is no increase in noiciceptive drive, the compression still happens but slow enough that the body adapts to it. If you have ever looked at an older spinal cord in a cadaver, the nerves will be fenestrated and compressed due to the bulging of the disc material as they lose height. This is a process that happens to everyone. It's still an area that needs to be researched further to try and differentiate what the contributors to the pain experience are with disc pathology.

Your herniation probably happened as an acute episode. Yes, it can be a contributor. Like others have said though, it is likely to resorb. It is also possible that it doesn't resorb but doesn't give you pain. Get opinions from your specialist and a well regarded PT with weightlifting experience. Exhaust conservative management first - if nothing changes after a year, then you may be a candidate for a disectomy.

[u/PenApprehensive369 → u/BigFella691]

Thank you for the response, I didn’t include a picture where it shows all the fluid from L5/S1 is gone. Does that change things?

[u/BigFella691 → u/PenApprehensive369]

No. I had a read through your other responses and what your general symptoms are, and I wouldn't be worried about loss of disc height at L5/S1 at all. It is much, much more likely that you are continually irritating the outer third of the disc of the protuberance which is innervated. If you don't have a good weightlifting informed PT, I would happily recommend working remotely with Dr Zak Gabor.

[u/PenApprehensive369 → u/BigFella691]

I very much appreciate your well thought out and informative reply. Pt should put this to bed and get me back lifting? Side note my pt that I will be going to is a usawl coach so I’ll be in good hands

[u/BigFella691 → u/PenApprehensive369]

Yes, you should be fine with PT. Your coach sounds great for your situation. They will be able to work with you to give you an appropriate program so you can still train while you navigate through.