Advice on disc protrusion

[Sonj]

Hi there. I'm not actually a physio, but am working towards getting into Uni to study physio. Came across this site and thought I'd ask for some advice about a problem I am having with my back.

9 months ago I was out hill-walking and experienced tightness in my left buttock, and back of knee (lateral side), as I walked downhill I experienced a nerve type pain in the inguinal area also. This pain came on and off over the next month but I just thought I'd strained a muscle or something and kind of ignored it. Then I drove to the Lakes (5hr) did some rock climbing (carrying lots of gear!) and drove back home. 3 days later was VERY sore in left leg, stabbing in bum and radiating pain down back of thigh to knee.

Went to GP who thought I'd poss torn a ligament and he put my down for some NHS physio. While waiting, I booked in for some private physio. She thought I'd fatigued deep muscle in back which was irritating sciatic nerve and causing radiating pain. Had massage and Ultasound which greatly helped but the pain returned a few days later. On second visit, nothing she did helped. She said that my nerves were extremely sensitized at that point and there wasn't much more she could do and recommended I go see an Osteopath. I wasn't too keen on this, so waited for my NHS appointment.

When this came, they diagnosed a slight bulge in disc (L5 I think) and gave me back extension exercises to do (cobra pose- 10 reps every hour) This helped and I was in much less pain. The therapist said I could continue with my hillwalking. I went down to Wales to do some walking and 3 days there I became very painful again so came home. I hadn't been doing my extensions as much as I should have either, naughty!!! By the time I got home, I was in excruciating pain, evil stabbing from buttock right down to toes. Therapist said to continue with the extension exercises. Only problem was these exercises now caused MORE pain. Even moving back ever so slightly sent the stabbing pain down my leg. This went on for a few weeks with the therapist insisting this was the right exercise for me, and me trying my best to do it, but suffering much pain. Got fed up, as it seemed to be making things worse, and I booked an appointment with a Chiropracter.

By this point as well as stabbing pains down my leg, I was getting a stabbing in the sole of my foot and an intense gripping pain in my lower calf. The chiro diagnosed bulge in the disc, inflammation of the facet joint and tightness in my SI joint, he thought that the SI prob had probably caused the disc problem. After just one manipulation the stabbing pain down my leg disappeared. I was left with just the calf pain, foot pain and a burning in my thigh. The calf pain would be very bad at times, like something was twisting inside. On a scale of 1-10 it was around 7ish. Now, I have been seeing the Chiro for around 5 months now and the calf pain has gone and the pain is now focused mainly deep in my bum.

He thinks that Piriformis is very tight, and also TLF is tight but doesn't seem to be doing much to be trying to release them. I have started to do stretches at home and over the past week have got much relief. I am still sore and tight in my bottom when I walk, tho it does ease after a short time. And during the night, I wake in pain every few hours. I'm sore first thing in the morning but it eases as the day goes on, only to get sore again at night. Pain is now at a level of between 2 when good and up to 5ish when bad. I still cannot hillwalk or climb without it flaring up, and when it does flare, the calf pain comes back again. I have recently been for an MRI and am waiting for an appointment with the Ortho consultant. My GP had a nosey at the results on his pc and says that I have a large disc protrusion but there is no evidence of it compressing the nerve root. Now it seems to me, that my muscles are possibly spasming to protect my nerve root from being compressed. Am I correct in assuming this???

What my query is, is that I am wondering what will happen to the protruding disc? Will it eventually go back into place or will it continue to degenerate. If it is the case where the disc is beyond healing, then does this mean that I will continue to suffer until it degenerates completely??? 9 months seems an awful long time to be having this problem for, esp when the 'experts' keep telling me I will be better in 6wks, then a couple of months, then perhaps half a year. Sometimes it seems that the pain is only better because I am avoiding doing things. I never sit down, I eat lying down, I study lying down. The only time I sit is to drive my car. And to drive any distance longer than 20mins in the car I have to take 30mg of dehydracodeine to cope. I cannot hill walk or climb without a flare up of the pain. And I have not slept properly for the past half year and this is affecting my studying now. Any advice??? Do you think the Ortho will want to operate if there is no evidence of nerve compression? And I think the main thing I'd like to know, is will this blasted disc ever heal or will I just have to put up with it and manage the pain until it has degenerated completely. I will put these questions to the Ortho and to the chiro when I see him next, but just after some more opinions really, though I do know you can't really give me much advice over an internet forum! Oh, should also add, that I go for an hour long walk in the morning, followed by 2more 20min walks during the day and eve. When I am lying down to study, I get up and stretch and move around every half hour also. And I try to stretch out my piriformis, TLF, gluteals, hamstring and calf 3x a day. Hamstring on affected leg is VERY tight.

Phew, sorry for long winded post!

Thanks in advance for any tips on what will become of my disc

[alophysio]

Hi,

Thank you for the informative post. I wish more people put as much history down as you did...don't apologise for it! The more info the better.

A few things.

1. The disc doesn't actually have to be touching the nerve to make it sensitive. The chemicals from the NP do a great job of doing that.
2. There is evience that disc resorption occurs in disc bulges that are trans-ligamentous (that that go thru the posterior longitudinal lig).
3. This is now a chronic problem and research has shown that central sensitisation has occurred.
4. Leaving the NHS physio was a good thing - If the treatment is making you worse, why keep doing it. The same goes for the chiro. Was able to relieve some pain but not the back pain and 5 months of treatment is a long time. I would say you need a change in treatment approach (IMO).
5. Physio at NHS gave you MacKenzie exercises but probably wasn't trained in it because extension pain is not an indication for extension exercise.
6. You are spot on in assuming that the muscles are trying to protect you. They are sensitised and you probably have changed your motor patterns to accomodate this problem.
7. You have a loding problem because you avoid sitting so much (loading the spine into flexion). Does it hurt to cough or sneeze?
8. is hamstring on affected leg actually tight or is it neurological tensioning - i.e.do you get more hamstring length if you plantarflex your foot? What is your SLR like?

Lastly, I think there is help available for you but you will need to find someone who can do motor control retraining. I believe Mark Comerford is someone from the UK. Otherwise, anyone trained by Peter O'Sullivan, Paul Hodges +co, or Diane Lee's courses should be able to nail it.

Out of interest, are you able to fill out your history based on the form attached and post it with the headings? A comprehensive subjective is always helpful...

Thanks

Thanks

[Sonj]

Thankyou for the reply.

To be honest, I'm not really after any diagnosis of problem, or advise on problem as such, it was more that I was wondering what would happen to the disc itself. But if there is evidence that protrusions can go back into place then this is good.

Am not sure, but am assuming that as it is a protrusion I have, and not an extrusion, then the NP will be contained and not able to cause irritation to nerve. But the stabbing pains in bum and leg were def caused by something irritating the nerve/root, wether from the protrusion itself which has now started to 'go back into place' or wether due to irratation from surrounding structures, ie tight muscles etc, I am unsure.

After a week now of doing my stretches the pain relief is astounding!!! And I managed a 45minute drive yesterday with no painkillers needed and no flare up of symptoms which is a great improvement.

The Chiro did advise that I start stretching the piriformis and gluteal muscles, he just didn't advise me what exercises to do, but in his defence, I had a muddle with my appointment time that day and he just managed to squeeze me in as he is very busy, and perhaps there wasn't time for him to go over which exercises I should do. He did say, that any I do should cause a stretching type feeling in the muscle but should cause no pain to my back or SI. The stretches I am doing are just ones that I found on the internet. For the past couple of days I have now managed to try doing some back extensions and can manage them now pain free, but not full extension, just partly.

I tried to sit again last night on a firm chair with good posture and back support, but after 5mins the pressure became too much so I had to get up and had pain down to knee. Coughing used to be painful but is now just more uncomfortable. Sneezing is evil, LOL!! I have to brace myself for the stab of pain that it will cause. Stab of pain is in the sacral area. Infact majority of pain is around here I think, it is hard to tell at times, as the pain is deep. I feel no pain whatsoever in the L5 area, just a slight bruised kind of feeling if I push into that area with my fingers.

I agree that 5months seems a long time for treatment, but I do feel loathe to part with the Chiro as he has helped ALOT, even if there is not much focus on my muscles. And I have to admit, that over the course of seeing him, I havn't always heeded his advice. He has told me that I can continue climbing (he is a climber himself, and understands the physiology of climbing) but that I must be very aware and careful of how I move. Climbing involves certain moves to scale up the rock or wall face. Now, he has advised that I keep my moves small and fluid, avoiding any jerky moves, any lunging and scrunched up movements, or any high steps with the affected leg, bearing weight onto this leg. Basically any type of movement which compresses my back. This is why the hillwalking is so bad just now, as the downhill walking, causes too much compression. If I climb in the manner advised then all is fine, but I have often found myself pushing it, and going for harder moves, which result in flare up of pain. I have subsequently been going climbing less as pushing myself in my sport is one of the joys of climbing and I soon become bored doing easy moves. I am thinking that the time length of my recovery is due to my own fault in pushing myself too much, rather than anything the Chiro does, or doesn't do. Also, as I am lacking in sleep, I have become somewhat run down, and have had the flu twice in the past 5months, coming from rarely ever having any infections of any sort. The flu, both times put me to bed, and unable to exercise, and this, with all the coughing and sneezing at the time, made things flare up badly and set me back. I think I will continue with the Chiro for the time being but if my condition does not improve in the next couple of months then I shall research this 'Motor Control Training'. Thanks for the tip, re that.

Yes, I get more hamstring length with plantar flexion. SLR used to cause a violent stabbing sciatic like pain, but now just causes a tight, stretching type pain in bum, hard to pinpoint from where exactly.

Anyway, thanks again for the reply and like I said, I was more just curious as to what was going to happen to my disc. And I have many queries for the Ortho in a couple of weeks and for my next appointment at the chiro, just impatient for the answer I guess.

[alophysio]

Hi Sonj,

Your irritated nerve root is sensitised by the nucleus pulposus - apparently the chemicals can exit via fissures in the disc. It is unlikely that the bulge itself is the cause of the irritated nerve root because it has been shown that asymptomatic people can have apparent bulges onto nerve roots without pain. Mechanical stimulation of the nerve root is also fairly benign but when it is sensitised, this is when problems occur.

As for resorption of the disc, it will need to be transligamentous to occur. Now a protrusion can be transligamentous just like a gloved finger can go thru cling wrap. Once past the PLL, an inflammatory process occurs which begins the process of resorption..

I am glad to hear you are doing well. You will now have first hand knowledge of why listening to your therapist will be something your patients will have to learn to do!!! As they say in the classics..."Physician heal thyself!".

As for the motor control thing...There is no reason why you can't research it now and use it to complement your treatment from the chiro. It sounds like your chiro is doing a good job and giving the right advice but you still have pain on sneezing 5 months down the track. This seems to indicate to me that you are unable to control the intraabdominal pressure generated during the sneeze. An intact "core" or "inner unit" or "local system" is required to help in this area. Developing your coordination and endurance in your "core" ill help dissipate the forces generated. At present when you sneeze, the force is being sent thru the weakest part of you abdominal cavity - the injured disc.

In my honest opinion, waiting to see if just the good chiro treatment alone will help this problem before trying the exercises seems to be like saying "I will learn to kick a football with my left leg after i have mastered scoring goals with my right". You can get away with just having chiro treatment but wouldn't your body appreciate the extra help that the exercises will give you?

Anyway, I think your chiro sounds like what a good physio should be doing for you. They have really started to embrace the whole rehab side of things and if we as physios don't stay on our toes, we will become obsolete.

Good luck and let us know what the doc says - please note he is an orthopaedic SURGEON so by definition he prefers to cut. If you are not a "cutting case", he may not be interested in you, especially if his waiting list is 3 months long!

[Sonj]

Thankyou again for your thorough reply.

Yes, the Chiro seems very good. I must admit to being very hesitant in seeing him at first as I had heard alot of bad stories of chiropracters previously along with some good stories too of course. And this one was recommended to me by several people who had suffered from back problems. Seems to be that just about every one either has had or knows someone who has had a back problem.

I understood that some folk could have a protrusion and have no symptoms but didn't realise that it could press on nerve and there be no pain. The private physio that I originally saw did say that it was very sensitised. At the beginning the pain seemed to be very 'exagerated' ie - one time my friend just barely touched my hip and it sent me into spasms of agony, she was quite bemused as she had really just brushed past me nothing more, lol!

I take it by resorption, you mean the disc protrusion going back into place as it were, as opposed to reabsorption, where perhaps the disc degenerates and is reabsorbed by the body???

Aye, guess it will do no harm to research the Motor Control thing just now. I have never heard of it before, hopefully there will be someone in Scotland, nearby who practises this!

Yes, my core is pretty weak just now. I used to do alot of pilates, as core strength is very important to climbing to keep you close to the wall when on steep or overhanging ground. The pilates was really helping there, but then I got lazy and out of the habit of doing it so regularly. I hadn't done any core exercises for around a year before my disc going and I do wonder if this, along with the very heavy weights you have to carry when winter climbing in Scotland and the often very steep ground you have to cover, contributed to my disc going in the 1st place.

As for the surgeon, the Chiro knows him and says he values his opinion greatly as he is very good. He says he is not 'scissor happy' as it were, and will not choose to operate unless it is 100% necessary and as there is no nerve root compression and I am alot better, I am confident I shall escape his knife! Hopefully he will not be too brusque with me, as many ortho's can be, having had experience of them after breaking my wrist a few years back. Ended up with extensor tendinitis which physio cured a treat and made me develop an interest in it. The human body, muscular and neurological is such a fascinating and complex subject. How one disorder in some part of the body, can effect a multitude of different parts elsewhere, so much to learn........

I also had an appointment at a pain clinic recently, where I had a loan of a TENS machine. Found it helpful but a real hassle to use and the electrodes didn't seem to stick well to my skin, so I gave up on it. The pain specialist I saw also does Acupuncture and has booked me in for a course of that, but my appointments aren't until June (blasted NHS waiting times!) and I'm hoping that I will be all better by then!!! She has also made an appointment for me to see about having an epidural, which I am none too sure about. I detest taking drugs of any kind and it was months before I had to relent and start taking painkillers, the physio I was seeing said she had never had a patient not take painkillers for nerve pain before, and I should not be so stoical, hehe! So the thought of pumping drugs into my spine, does make me shudder somewhat. And I have heard stories of steroid injections weaking joints in the long term, wether this is true or not though, I do not know. That was another thing, she prescribed me Amytriptyline to see if it would help me to sleep better and said I would probably need to work my way up to 50g a night before it would be effective for pain relief. I have been on 50mg for the past week now, and I'm wondering if it is this or the exercises and stretches I am doing that is giving me relief, or a mix of both. I'm highly tempted to stop taking the Amytriptyline to see if the pain comes back as it is making no difference whatsoever in helping me get a good nights sleep and that's why I was willing to try it in the 1st place.

Aye, I will post again once I have seen the Ortho and let you know how I got on. Thanks again

[sdkashif]

According to Melzack and wall depression has been mentioned as a concomitant of chronic pain and it is therefore natural that many types of antidepressant drugs should be prescribed. They help the patient natural depression but they also sometimes have a surpringly powerful effect on pain which appears to be independent of their action on the depression. These drugs act by increasing the concentration in brain and spinal cord of the amine transmitters such serotonin. These amines are thought to play a role in inhibitory mechanisms, especially the descending controls. It may therefore be that the antidepressant drugs have a double action, one to help depression and one to increase the effectiveness of existing inhibatory mechanisms. So it is a possibility that you may getting the benefit of analgesia by antidepressant amytriptyline. Although the exercises have also a role in pain relief as aerobic exercises are thought to increase the endogenous opioids resulting in the pain relief.

[Sonj]

Hi there.

Yes, I finally succumbed to trying Amytriptyline a couple of months ago. I have always been able to 'grit my teeth' and just get on with things regardless of the pain, only using codeine when really bad, or during the night. But I thought the Amytriptyline might help me sleep better. So far it has been of no help whatsoever for sleep. Taking codeine before bedtime, I can fall asleep fine, the problem is that I wake a couple of hours later in pain and then have to wait an hour or so before I can take more painkillers because of the paracetemol. Last night I got just over 3hrs sleep, yawn!! I have tried Tramadol also but found it useless and all it did was make me feel like a zombie.

It actually dawned on me last night that the therapist at the pain clinic said I would need to work up to 50mg of the Amytriptyline before I found any pain relief from it. Now, I have been on 50mg for a couple of weeks now and it crossed my mind that perhaps I have been feeling alot less pain over the past week due to the Amytriptyline rather than the stretches I am doing, or perhaps a mix of both. I am curious to know which it is that is helping so I stopped taking the Amytriptyline last night. It will be interesting to see if there is a return of worse pain or not. If there isn't then I won't be taking it any more, as it does nothing whatsoever in helping me sleep through the night.

[junior_physiotherapist]

Hallo Sonj:

after along describtions and advices to ur steps u'll be the the head of ur desicion regarding ur patient as every one in medical fields should have a practice and a clinical sense..

this link really is very intersting u can search more and u'll find more through this link
www.spine-health.com

Beat of luck

[sdkashif]

Dear Sonj I giving you some information of management of musculoskeletal pain which contain some basic points while managing the disc related pain and other musculoskeletal painful problems of the spine.

You need to determine whether you are suffering from anterior element pain, posterior element pain, movement related pain or mechanical pain without postures or movement exacerbation (static sensitive).

Anterior element pain

Anterior element pain has been defined as pain made worse by sustained flexion of lumbar spine. Anterior element pain is made worse by sitting and is relieved by standing. Patients assume hyperlordotic posture to relieve their pain. Fracture of vertebral bodies and prolapsed intervertebral discs produce anterior element pain. Extension exercises and press ups are more likely to produce remission than flexion exercises. This is because flexion exercises increase the intradiscal pressure whereas extension exercises unload the discs. Therefore, extension exercises advocated by Cyriax and McKenzie are logical for patients with anterior element pain. Lesions resulting in chronic anterior element pain are obscure; it is tempting to assume that anterior element pain is discogenic in origin, but there is no evidence for this. Unlike the acute group, the patients with chronic anterior element pain may respond to manipulative techniques.

Posterior element pain

Pain is worse by increasing the lumbar lordosis, standing and walking. It is eased by maintained forward flexion, sitting and hip flexion (with or without knee extended). Patients who have structural or postural hyperlordosis, who have facet arthropathy, and who suffer from foraminal stenosis show features of posterior element pain. Pain from rotation and extension is usually of facet origin. Flexion treatment frequently improves the facet disease, spondylolysis, flexion dysfunction and certain types of derangement. Prescription of hyperextension exercises may make the condition worse.

Movement related pain

Patients with movement related pain are most comfortable at rest; pain is precipitated only by activity and jarring. Heavy manual work, repeated twisting, fast walking and running (especially on hard surfaces) and traveling in car on rough grounds all precipitate pain. Movement related pain occurs in traumatic fracture dislocations, in symptomatic spondylolysis or spondylolisthesis and as a result of chronic degenerative segmental instability. Diagnosis may be confirmed by lateral flexion and extension roentengenograms of the lumbar spine and noting abnormal translational movement. A basic scheme of progressive stabilization by strengthening regional and segmental musculature isometrically should be considered. According to Grieve mature patients and those in most pain may need to start abdominal exercises with knee bent and progress more slowly. Side lying stabilization techniques and dynamic abdominal bracing may also be used. Home exercises should be efficiently monitored and the patient taught avoidance of posture and activities known to constitute his specific additional stimuli.

Mechanical pain without posture and movement exacerbation ( Static Sensitive)
Patient with static sensitive low back pain have the have an inability to maintain any one position ( other than lying) for a normal length of time and obtain relief by changing position and moving. Many of these patients appear to have a discrete structural disease, such as scoliosis.

Altered pattern of muscle recruitment have been clearly delineated. One of the most common of those is overuse and early recruitment of low back muscles. Another pattern associated with low back pain is over use of hip flexor (iliopsoas) and weakness of abdominals. It is frequently important to retrain the gluteal muscles and inhibit overuses of lumbar extension, a maladaptive pattern.

Dynamic trunk stabilizers, aside from gluteal maximus which originates or inserts into the lumbodorsal fascia, are the latissimus dorsi, transversus abdominis and internal obliques muscles. The main purpose of strengthening these muscles is to produce a forceful couple that is designed to stabilize the trunk and effectively controls the antigravity weight line or the way in which this area bears weight.

There are many types of isometrics exercises and Grieve provides some good examples to improve power of gluteal and abdominal muscles in the treatment of chronic low back pain, including abdominal wall and abdominal bracing exercises. These exercises avoid the higher intradiscal pressure and emphasize the eccentric control, free breathing and maintenance of functional position of spine. When performing exercises for upper abdominals, the feet should be plantar flexed to inhibit action of psoas.

Isotonic exercises can be helpful for some patients and may be used in all patients as progression of exercise programme, with or without manual or mechanical resistance.

Spinal Bracing:

A number of mechanical supports have been advocated. Spinal bracing seems justified in patients with osteoporotic compression fractures, spondylolisthesis, or segmental instability and in some patients with spinal stenosis- although no controlled studies have demonstrated its efficacy precisely. Approximately 80 to 90 % patients wearing a simple support describe some benefit. The mechanical effect includes prevention of excessive motion and a reminder to wearer not to exaggerate the lumbar load. Thoracolumbosacral corset has been prescribed in spondylolisthesis patients for a period of 3-6 months. This decreases pain in many patients during the acute episodes. In the mean time exercise programme to stretch the lumbar extensors, hamstrings, psoas, lumbodorsal fascia, teach pelvic tilting and strengthening programme for abdominals and avoidance of lumbar extension helps in relieving the condition.

References:

1-Management of Common musculoskeletal disorders, Physical therapy Principles and methods, 2nd edition, By Darlene Hertling and Randolph M. Kessler

2-Tidy's Physiotherapy, 12th Edition, By Ann Thomson, Alison Skinner, Joan Piercy

3- Textbook of Orthopaedic Medicine, Volume 1, Diagnosis of Soft Tissue Lesions, By James Cyriax

4-Mobilisation of Spine, A primary handbook of clinical methods, By Gregory P. Grieve, Fifth Edition

[Aisha_kb]

Hey Sonj,

I have found your posts and the replies that you have gotten very interesting and especially the last post by sdkashif was very informative.

I was just wondering what is the latest on your condition thus far? Any changes? Have you found any new information regarding your condition?

I would like to make an observation for you... having treated quite a number of patients with disc protrusion, there is a good relieve of symptoms with physiotherapy, and on the long run, with continued followups, i have found that those who FOLLOWED THE GIVEN ADVICES and CONTINUED with exercises moving gradually on to more difficult ones, have gotten great relief, no pain symptoms AND no further problems.
They do admit only when they do the wrong position or discontinue exercises end up feeling similar symptoms but not as severe on initial diagnosis.

Sadly, they have not bothered to take another MRI to see what has happened to the disc, so there is no idea what has happened to the disc and i have not gotten a satisfactory answer from anyone.

So please if there is anyone out there who can shed some light to this issue.. Let us know.

Yours,
Aisha.

[gogo girl]

Why didn't you ask your chiro these questions? If you did what was his/ her answer? It is very dangerous to diagnose and treat over the web/phone or by mail

[Sonj]

Firstly can I say AGAIN that I was not after a diagnosis and yes it isn't good to try and get a diagnosis over internet etc. I was merely wondering what happens to a disc once it has prolapsed and this question has been answered. I wasn't seeing the Chiro for another few weeks, and the question just popped into my head, hence the post. I saw the Chiro Wed past and he said that there will more than likely be some resorption but that disc would continue to degenerate but once I am sorted it should hopefully be pain free! It has been explained to me that once a nerve has been irritated or damaged it can take anything up to 18 months to be symptom free.

To sdkashif, I seem to have anterior, posterior and static sensitive type pain. The pain is relieved upon movement but ONLY if I walk for over half an hour. And walking downhill makes things worse.

I stopped taking the Amytriptyline and the pain came back straight away so I have started taking it again. The Chiro said to keep taking it as it is calming down the pain enough for me to exercise more thoroughly and to do the stretches and we are hoping that we can break this cycle of flare up and inflammation irritating the nerve, which causes muscles to tighten, which further irritates nerve etc etc etc. He reckons that another month or so and perhaps this cycle will be broken and get me moving properly.

I went for a 6 hour walk yesterday with a gentle incline and decline but over fairly rough ground. Going up was no problem but coming down there was alot of tightness in the SI area and my stride was very shortened (which caused alot of problems trying to ford a river!!! ) but there was no pain whatsoever and once down and on the flat it loosened off again and I was able to walk at a very fast pace. Hoping now, that there is no flare of symptoms building up over a few days which there has been in the past after downhill walking.

To Aisha. Yes, I have found that if I follow advice and instruction to the letter that things start improving and I think that the symptoms have lasted for so long because I push myself too much too quickly at the slightest sign of improval. If I do too little things flare up but if I do too much things flare up also, it's hard to find the right balance at times and probably doesn't help that my personality type is one that likes to push my boundaries. But I am slowly learning to listen to my body more when it's telling me ENOUGH, ease off!

Anyway, here's hoping that the continuing exercises will benefit. After a week and half I can now straighten and lift my affected leg to knee level when lying down and plantar flexed, and can almost fully dorsi flex the foot in same position. Can now do a back extension with arms almost straight and can now nearly touch my knees when flexing forward. This is all relatively pain free