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Old 02-27-2012, 04:00 AM   #1
ganeshayogini
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L4/L5 L5/S1 disc bulge

Namaste friends,

I wonder if you could give me some advice.

I am a 28 year old female with a minor disc bulge of both L4/L5 and L5/S1. I have been practising yoga for years, but only began to practise ashtanga daily a year and a half ago, while at the same time carrying around a heavy backpack. I became aware of pain in my back and leg around a year ago and it has persisted - neither improving nor worsening. I have tried chiropractic work and it has not helped. I have continued to practise yoga throughout this time while trying different modifications (which I admit has not been the smartest of choices).

I finally had the courage to have an mri to discover the issue. I wonder if I can still practise with modification- which poses to do, which to avoid. I wonder if I will ever be able to practise regularly again. Many fears and anxieties arise. I also understand that it is a lesson to adjust and be more aware.

Any advice would be greatly appreciated.
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Old 02-27-2012, 06:05 AM   #2
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Namaste and welcome.

I guess my first question is what did your doctor say? After having an MRI and discovering the disc issue, what did he/she recommend? Is your disc bulge posterior or anterior? If you don't know, I would suggest you find out as this would help with customizing your practice. And what of your teacher? Have you discussed this with her/him?

You do not have to stop your yoga practice (asana) but will definitely need to modify based on your answers to the above questions. I have moderate/severe herniation at L4-5 and L5-S1 also. They recommended PT which was mostly asana. For me, extensions (due to posterior bulge) are therapeutic. Keeping the piriformis stretched and core strong has helped immensely. Twists are tricky with back issues and if done, should be done precisely. Pelvis and spine move together.

While we await your answers to above questions I would suggest a more gentle practice. Use heat before practice and ice after. And as you do a more gentle practice, really pay attention to how you move and what you are feeling.

Looking forward to your reply.
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Old 02-27-2012, 06:48 AM   #3
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Thank you so much for your response. Wow, it's so nice to have some support

I am based in Uganda in a village, so I have been practising yoga on my own. When I do get to a class, most teachers just tell me to stop when it's painful, but it's never to the point where it is really painful when I am practising, it is only when I am sitting. I saw an orthopaedic who basically prescribed me pain killers and gave me a list of poses to do (which I already do).

From the report of the MRI it says that I have a mild disc bulge at L5/S1 putting pressure on the anterior cauda equina. But the doctor said from the photos he can also see a very slight bulge at L4/L5.

Any further advice would be so appreciated!
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Old 02-27-2012, 07:49 AM   #4
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What exercises does your doctor have you doing?
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Old 02-27-2012, 08:27 AM   #5
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Hi lotus girl, thanks again!!!

So sorry, I just got clarification and it is actually a posterior bulge (giving an impression on the anterior cauda equina).
They gave me a hand-out of around 16 exercises including pelvic lifts, crunches, hip extensions, twists, push ups, etc.

I mostly have sciatic pain, but on rare occasions I have numbness on my left genitalia (which must be the cauda equina).
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Old 02-27-2012, 11:15 AM   #6
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As mentioned, be careful with twists. They must be done impeccably. Don't use your hand to twist yourself further.

For sciatic pain, try pigeon and the reclined modification of pigeon. On back, knees bend,cross R ankle over left thigh. Weave hand through on either wide of L thigh and bring knees in toward chest. Keep shoulder blades firmly on mat. Hold for at least 1 minute. (same goes with pigeon) Repeat other side.

How do you feel (meaning your back) as you forward fold? As you backbend? How flexible are your hips?

I know, lots of questions! But if your bulge is to the back, "generally" backbends are more therapeutic (like for me) and forward folds must be done cautiously, if at all. Check to see if your hips move as you fold forward. When they stop, you should also. And with sciatica, refrain from seated forward bends like Paschimottansasana which can exacerbate your condition.
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Old 02-27-2012, 12:01 PM   #7
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Welcome Ganeshayogini, in addition to what beneficial thoughts Lotusgirl has already offered you, I wanted to also direct you to many other relevant threads deeper in the forum where similar lumbar and sacrum issues have been addressed by Mukunda Stiles. The posts are often done in a question and answer format, taken from email correspondence shared between himself and his Structural Yoga therapy students, and his own Yoga therapy clients.


Wishing you well in your search,
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Old 02-27-2012, 02:36 PM   #8
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More than 90% of all herniated disc occurrences are movements toward the spinal canal, "posterior" or "backward". It is incredibly rare, almost unseen, to find one that moves forward or anterior.

There are certain sorts of practices that are ill-advised when such a state exists in the spine. Those are practices have one of four elements; lacking alignment, jumping about, moving at a pace such that awareness is diminished (since the two are inversely related), or where there are "mandatory" postures contraindicated for herniation (like Utthita Hasta Padangusthasana).

What I have found to be best for this situation, in both my own practice with my own issues AND in my teaching of classes and privates over the past ten years, is three-fold.

In asana that which creates space; traction and gentle twists in traction.
In meditation looking at your feelings of lack of support and any financial issues that may be nagging (usually over time but not necessarily) AND the use of appropriate colors, light, and breath.
In lifestyle/nutrition eating only the highest quality of foods (in with organics, avoiding "C.A.T.S.), maintaining the three primary nutritional elements (hydration, oxygenation, and alkalinity) and avoiding that which disrupts or agitates the nervous system.

Since you are remotely located and the chance of you getting contact hours with a skilled therapeutically trained yoga teacher are less likely, please avoid forward bends (paschimotanasana, Janusirsasana) and passive twists. If you have a wall rope system then hanging in AMS, ardha uttanasana, and ardha sirsasana will all be helpful - assuming you've found or can find the ability to place your consciousness in the lumbar spine and create the space needed for the discs to go back from whence they came.
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Old 02-28-2012, 12:28 AM   #9
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Good day everyone,

Wow, all of this information is incredible, thank you all!

I am very flexible but my core and my legs are unstable, obviously why this issue has come about. I began to practise with a tight belt around my sacrum for stability, this certainly brought awareness to my poses and I realised how much I had been crunching in order to bend forward. With the belt in place, I was so much more limited and I certainly felt the pain. Without the belt, I am able to fold forward and backward quite easily with a slight radiating pain down my left leg and tightness in my hamstrings.

Thoughts on the use of a belt for support??

I definitely notice the use in the poses you suggest Inner Athlete, but even find that in order to create traction and space I need to bend my legs in AMS as my hamstrings are very tight. Does anyone have any suggestions about strength building? Is running something advisable during this time?

As for meditation, it is interesting you bring up the feelings of lack of support, I have definitely felt ungrounded, it is something I have been working through and know that the physical injury is as much emotional.

Inner Athlete, i'm afraid i'm not so sure about the mix of hydration, oxygenation and alkalinity. I have a very healthy vegetarian diet with a lot of fresh fruits and veggies, whole grains, nuts and oils and at least 4 L of water a day.

Thank you everyone for your support and guidance
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Old 02-28-2012, 10:16 AM   #10
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IA, can you please share what poses you do for spine traction? cause all of the traction poses seem to be similar to FF
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Old 03-04-2012, 02:11 PM   #11
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@nichole

Unfortunately the link you provided comes up empty. I think that people need to do the search themselves. Searching the Mukunda Stiles forum for disc bulge turned up a few results. You might try some different searches.

@ganeshayogini

I'm not a yoga teacher like some of these other fine folks but I do have some personal experience with back problems. First of all, I would say that if you are experiencing pain that has not improved, your problem isn't all that minor. Second I would say that you've been lucky so far that your problem hasn't gotten worse. It can get worse depending on what you do so you need to be mindful all the time until your condition improves, and it is possible for you to take actions that will help your condition to improve.

I have found a book called Treat Your Own Back from the McKenzie Institute to be the best source of information on what to do and what not to do. It's available online. You've already been advised to avoid forward bends, especially seated forward bends and I urge you to heed that advice. Also I don't think running is such a good idea right now. As Inner Athlete said, jumping about or creating a lot of impact on your joints could be harmful. If you have access to an elliptical machine or other type of machine where you can get the benefit of running without the impact, that would probably be OK. Swimming is great for strength and endurance with no impact on the joints.
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Old 03-05-2012, 11:15 PM   #12
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Quote:
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IA, can you please share what poses you do for spine traction? cause all of the traction poses seem to be similar to FF
What please is "FF"?
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Old 03-06-2012, 05:13 AM   #13
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@Asuri,

Treat Your Own Back by Robin McKenzie is quite good I agree! From what my Physiatrist said, there is strict protocol with the McKenzie method (extension) and is not a good fit for everyone. Another really good book is, Back RX by Vijay Vad, M.D. A mix of yoga and pilates.

@ganeshayogi,
Check with your M.D., if you are interested in the above to see if you fit the protocol.

@Gordon,
I am familiar with Traction Twists, but only on back with knees wide and allowing them to fall to one side. But it is the subtle movements that make it wonderfully therapeutic. Moving tailbone toward heels, abdominals engaged then moving to opposite side of twist. I find it a wonderful compliment to my own practice for my back issues. What other traction twists would be beneficial and appropriate?
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Old 03-08-2012, 04:12 PM   #14
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I was hoping CityMonk might reply to my question on "ff" but I'll forge ahead assuming it means forward fold.

There are several ways to create traction in asana. And I believe that is the question. So that's the one I'll answer.

Some traction can be created using the mind in the body. For example parsva virasana (a spinal twist in Hero's pose). Most students do this pose as a passive twist. That is the twist itself is ONLY a rotation. However when the sitting bones are rooted and the sides of the waist are recoiled (or lifted) then the twist is not passive it is active and it is not ONLY twisting it is also lengthening.

However....when I'm talking about traction in a therapeutic context I am almost always referencing the use of props; yoga belts or more likely the wall rope system.

Here are some examples of that use BUT I am not advocating doing ANY of these things without proper instruction.


One
Two
Three
Four
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Old 03-08-2012, 05:08 PM   #15
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IA

if ganeshayogini learns to bring her sacrum/tailbone in and up while at the same time having the semi circles at the tops of her hips move down, and keeping the chest lifted, can she fold forward in dandasana?

I would also think to advise her to introduce herself to her sit bones if she was going to try this. To do this she would sit on a hard, even floor in dandasana with the flesh pulled away from her butt.
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Old 03-08-2012, 05:14 PM   #16
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Also, I believe the Svaroopa style of yoga has a heavy focus on sciatica.
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Old 03-08-2012, 11:37 PM   #17
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@Rd

I'm uncertain I jive with your lingo. But if I do then I would respond in two parts; a) this sounds perhaps like instruction for appropriate forward bending and b) no I would not advocate doing even the most appropriately executed forward bends when the student has bulging discs in the lumbar spine.
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Old 03-09-2012, 02:06 AM   #18
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Just watched http://www.spine-health.com/video/lu...ted-disc-video to get a better idea of this problem. Ouch and wow I can see why that would be a bad idea.
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Old 03-09-2012, 12:16 PM   #19
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The recommendation in 'Treat Your Own Back' is that a person should be pain free for a month before attempting forward bends. That is for people with herniated discs, which is a little more serious than a bulging disc, but I think if you have the same type of pain from a bulging disc then the advice probably still applies. To restore full health eventually you need to get back to forward bends, but if you're experiencing pain then no, don't do it until you are sufficiently healed.

I think a yoga teacher assumes quite a bit of risk if he/she makes a determination that it's OK for a someone to resume doing forward bends. Better to err on the side of caution.
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Old 04-27-2012, 03:00 PM   #20
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Quote:
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What please is "FF"?
sorry...FF=forward fold
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Old 04-28-2012, 04:38 AM   #21
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What exercises does your doctor have you doing?
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Old 04-29-2012, 04:57 AM   #22
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Wow ! I have very similar problem l4,l5 and s1 problem.... Can't fold forward with straight legs (bent legs like child pose or baddhakonasa is ok) because of extreme tightness in left hamstring. Left sciatic problems also. Chiropractor didn't really help me and physical therapy helped very minimally only.

What did help me alot is ART (active release technique) . A massage therapist suggested it to me and referred me to another chiropractor who specializes in ArT.

Art works by "lubrication" or "moving" the sciatic nerve around. After sessions my forward fold would immediately improve alot! Then it would get worse again a couple of days later :/

I'm still not 100%. It's been 2months.
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Old 07-03-2012, 04:34 PM   #23
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pinoyvegasyogi4, have you tried yoga therapy? i'm working with few people (sciatica, THR, ddd, arthritis) and the yoga program seem to be working for them. we do yoga asnas, breath, mudras, yoga nidra. after few classes people go pain free first time in decades....
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Old 07-03-2012, 05:52 PM   #24
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I would love to try that city monk , I have been meaning to. Although, I live in las Vegas and there doesn't seem to be anyone here. The pain is still there and it has been 4months now. Can you recommend some one maybe in California or vegas? Will one session be enough if i find someone in california? How do I even look for these yoga therapist?
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Old 07-03-2012, 09:18 PM   #25
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go look to the directory of therapists http://www.iytyogatherapy.com/therapist.php

i can send you the class i've made for my guys to... it is in excel and you will have to google things or ask me...but it is kinda hard over the email

one session is usually not enough, constant guidance is desirable,

ask therapist to make a list for you so u can practice according to the notes.
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Old 07-06-2012, 03:34 AM   #26
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go look to the directory of therapists http://www.iytyogatherapy.com/therapist.php

i can send you the class i've made for my guys to... it is in excel and you will have to google things or ask me...but it is kinda hard over the email

one session is usually not enough, constant guidance is desirable,

ask therapist to make a list for you so u can practice according to the notes.

Wow citymonk. Turns out there are like 4-5 therapist registered in my city. We have a small yoga community and im really surprised that i have not heard of this people . Any tips on how I should narrow down my selection?
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Old 07-06-2012, 10:34 AM   #27
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Any tips on how I should narrow down my selection?
i'm glad that you found them selection?...credentials...reviews...recommendatio ns...have they worked with similar problem before...free initial consultation....you name it
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Old 09-16-2012, 01:51 PM   #28
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Help!

Hope you guys are doing great.
It has been 3 months I had pain sometimes light some times average in my left leg. Two weeks ago it became worst so I went and got my lumbar spine MRI. Found out that I have herniation or dislocation of a disc between L4 AND L5 just near the hip. The report says;
Loss of normal lumbar lordosis is seen, which may be secondary to muscles spasm. Disc dehydration seen at L5 - S1. At this level there is a left posterolateral and central diffuse disc protrusion causing a moderate to severe left lateral recess stenosis with the left forminal stenosis with thecal compression and a right forminal narrowing.
Mild diffused disc bulge seen at L4 - L5 causing thecal indentation with encroachment and narrowing of the neural formina on either side.
The caudae equina and filum terminale are normal. The paravertebral soft tissues are normal. No facet joint abnormality is seen. The vertebral bodies show no abnormal signal to indicate bone marrow replacement.
So, I went to a good doctor adviced by few of my relatives. He said it could get worst if I would not take it seriously. The medicines he prescribed are as follows; 5 day plan
Neubrol Forte 1+0+1
Otek 1+0+0
Rizik 1+0+0
Alp 0.25 mg 1+0+1
He also gave me an injection called Depomedrol for the inflamation caused due to dislocation.
Third day of this above aforesaid prescription and a complete rest gave me a complete overhaul and I felt just normal. But that day again I went on with my normal routine and when I came back I had this back pain again. Someone from my family adviced to keep a hot bag on my leg and I started using it for which I guess it has got worst. Now I can hardly take 20 to 25 steps and I cannot further move on or lift my left leg due to intense pressure, pain, and numbness in my left foot.
Please advice or help me what is happening with me and how severe it is?
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Old 09-18-2012, 12:31 AM   #29
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Hope you guys are doing great.
It has been 3 months I had pain sometimes light some times average in my left leg. Two weeks ago it became worst so I went and got my lumbar spine MRI. Found out that I have herniation or dislocation of a disc between L4 AND L5 just near the hip. The report says;
Loss of normal lumbar lordosis is seen, which may be secondary to muscles spasm. Disc dehydration seen at L5 - S1. At this level there is a left posterolateral and central diffuse disc protrusion causing a moderate to severe left lateral recess stenosis with the left forminal stenosis with thecal compression and a right forminal narrowing.
Mild diffused disc bulge seen at L4 - L5 causing thecal indentation with encroachment and narrowing of the neural formina on either side.
The caudae equina and filum terminale are normal. The paravertebral soft tissues are normal. No facet joint abnormality is seen. The vertebral bodies show no abnormal signal to indicate bone marrow replacement.
So, I went to a good doctor adviced by few of my relatives. He said it could get worst if I would not take it seriously. The medicines he prescribed are as follows; 5 day plan
Neubrol Forte 1+0+1
Otek 1+0+0
Rizik 1+0+0
Alp 0.25 mg 1+0+1
He also gave me an injection called Depomedrol for the inflamation caused due to dislocation.
Third day of this above aforesaid prescription and a complete rest gave me a complete overhaul and I felt just normal. But that day again I went on with my normal routine and when I came back I had this back pain again. Someone from my family adviced to keep a hot bag on my leg and I started using it for which I guess it has got worst. Now I can hardly take 20 to 25 steps and I cannot further move on or lift my left leg due to intense pressure, pain, and numbness in my left foot.
Please advice or help me what is happening with me and how severe it is?

hello amin i feel your pain... sorry to hear. i have a "big" herniation in my L4/L5 which is surgical but im trying to cure myself holistically. i have been in pain since march... i will share with you what i know and what have learned from other therapist, doctors and most importantly yogis


well first of... my herniation of the l4/l5 is posteriorly.. meaning the disc is going back wards compressing the spinal nerves (90% of injury is like this) mostly on the left side ( thus i have same pain down left leg like you....

forward folding with straight legs is very difficult and painful for me. backbends (even intense ones feel great)

i normally practice a vigorous high power ashtanga practice... i had to stop or very mindfully slow down my practice... ALOT !!!! now i mostly do restorative or yin yoga... there is plenty sequences on youtube if you want to get into it... but ofcourse.. its best to seek out a yoga therapist as stated above or a physical therapist ofcourse...

My advice keep practicing yoga mindfully. seek out help of a teacher. its very simple..... to quote david williams "if it hurts, your doing it wrong"

backbends done properly with or without props should feel very nice to you... does it?


some other therapy i would like to suggest that works for me is... inversion table ( i got mine used $80 on craigslist )

sleeping with a lumbar pillow ( so its like a little backbend when you sleep)

youtube and research the "mckenzie protocol" its an program designed by a physical therapist for disc herniation.

also..... pain meds did not do much for me.... anti-inflamatories helped alot but i cut that out completely and i only do herbal remedies as anti-inflamatories.

please message me for more info or how i may be able to help. good luck to you!
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Old 09-20-2012, 01:29 PM   #30
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L4 L5 S1 buldge...no more horse riding??

lol to the subject ....i am jst so unhappy and pissed at my own mistakes that i have the subject!

@ a small age of 23 only

TIP to all: Never lift anything in life that doesnot relate to your strength...and Never ever overlift!

I have :
1. straighteeneed lumbar curve
2. diffuse disc buldge indenting thecal sac, encroaching bilateral neural formina and probable impingement on bilateral bufdding nerve roots at L4-L5
3. Mild diffuse disc buldge at L5 -S1

cant i do horse riding again? bike riding?

and its been 2 months i cannot even sleep properly....back mains and moreover i can feel a current of numbness in right leg

doctor has advised phisotheraphy and back extension

can anyone throw some light on what exercise should i practice do close this chapter at once and for all and get back to normal
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