Creeped Out

At the end of April (2018), Elle and I drove to New Orleans to attend JazzFest.

JazzFest has superb music and is the only festival I know of where people recommend the food. The Cuban Sandwich is spectacular if you get the chance.

The drive is between 9 and 10 hours from Austin. We stopped a few times – fuel, restroom, walk around a bit. I drove the first 3 hours.

Some of you know this section of my back story but many of you might not. And it helps to know it.

In 2008, I fell while snow skiing. It was more of a flip that ended too soon. I blew out a lumbar disc. The image below is the MRI of the herniation. The thing that looks like pony tail outlined with an orange colored line is the nucleus pulposis – the jelly-like substance inside the disc, that burst through the annual ligament.

Intervertebral Disc Herniation

Once the nuclear material has escaped, there’s no way to stuff it back inside. You either surgically remove it or wait for your body to digest it.

The outcomes of surgery versus a non-surgical route, after two years, are the same. If you’re patient, disciplined you can avoid the inherent risks of surgery one of which is death.

I waited and did a bunch of things to help my body (and my mind) heal.

One of the the problems though, regardless of treatment choice, is that the disc shrinks. Losing all that nuclear jelly stuff causes the height of the disc to change.

When the disc shrinks, the segment – two vertebral bodies and everything in between – is a lot less stable. It shifts, shimmies, slips and slides when you move. These movements are tiny – millimeters – but a tiny force multiplied a million times can become a powerfully destructive force.

In the medical science world, the things that happen after a disc herniation are collectively called the “degenerative cascade”.

The loss of disc height and the micro collisions that occur in the facet joints, the micro tugging on ligaments causes physical changes in the segment. Facet joints become deformed, ligaments thicken. These things cause a narrowing of the canal through which the spinal nerve passes.

Over several years, I gradually rebuilt my physical capacity. Prior to the car trip, there were few things I couldn’t do. Sure, sometimes my spine might be stiff or sore for a couple of days but that was about it.

Okay, back to the trip.

Do you remember “Silly Putty”? Hard to believe, as kids (or adults), we could find it entertaining given the current culture of digital distractions.

This glob of colored goo has some interesting characteristics. It’s malleable. You can create all sorts of shapes with it or just mash it with your fingers as a stress reliever. I use it to strengthen my hand and fingers for playing my horn, guitar and sometimes just as a way to think.

It will bounce if you drop it from a couple of feet but if you toss it off a roof top, it will shatter.

Silly Putty creeps. It slowly deforms under load even if the load is just from gravity.

If you set the putty out on a counter top and leave it, eventually it will collapse into something like a pancake shape.

My spine has several discs that act a lot like silly putty. Exposure to load over a long time, and the disc begins to expand. In physiology, this phenomenon is referred to as “creep”.

When the tissues creep, you can get symptoms. The severity of which depends on the degree of creep or stretch.

Cyclists struggle with this. Most cyclists sit in a relative state of lumbar flexion and their spines can “creep”. Sustained flexion or repeated flexion of the lower back causes creep and instability which in turn leads to pain. 1)Little, J. S., & Khalsa, P. S. (2005). Human lumbar spine creep during cyclic and static flexion: creep rate, biomechanics, and facet joint capsule strain. Ann Biomed Eng, 33(3), 391-401.

I thought I was past all this. But in hindsight, I rarely sit for hours at a time anymore. Changing position was part of my rebuilding strategy and it has become a habit. Riding in the car for 9 hours was way more than what my discs were used to or could handle.

Result? Symptoms. Hip pain, leg pain and tingling and some lower back pain.

I made it through two days of the festival and spent the last day in the hotel room to deload my spine and do my best to prep for the return trip home.

The things you can do to prevent the creep or reduce it is place the lumbar spine into more extension – create more of a curve. I used to use an inflatable beach ball and why I didn’t on this trip, well, good question. You put a small amount of air in the ball, place it against the lower back when you sit. The ball helps reduce the flexion of the spine. Then, after an hour or so, you put a bit more air in the ball. This changes the curve and after a while, you let some out.

The idea is to have the lumbar curve changing every hour or so. Doing this reduces the risk of creep.

Good news is I’ll get past this. Bad news is that it takes time. The disc, ligaments, joint capsule – all of that tissue of the spine has a low metabolic rate (rate at which it uses energy) which translates into a prolonged rebuilding time.

But the good news is I’ve been through it before.

That’s all I have for now.

Thanks for reading.

 

 

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References   [ + ]

1. Little, J. S., & Khalsa, P. S. (2005). Human lumbar spine creep during cyclic and static flexion: creep rate, biomechanics, and facet joint capsule strain. Ann Biomed Eng, 33(3), 391-401.