As is customary for me, I've continued to research all of the various options in front of me with the most important being whether or not to have surgery. I've come across the following from a number of sources, this one from Harvard Health Publishing, a publication of Harvard Medical School, called "When is back surgery the right choice". Among other things it says this (emphasis mine):
The telltale sign of a disc problem is sciatica—pain that radiates down the buttock, thigh, back of the leg, or calf. For new disc pain, conservative care is the best first step. If sciatica persists or worsens despite conservative care, you might consider discectomy to relieve pain by removing the portion of the disc pressing on nearby nerves.
However, studies suggest that a year of conservative therapy is about as effective as discectomy. Therefore, the decision to have discectomy depends on whether you prefer more immediate pain relief.
OK, I'm not the most patient of patients but given Covid-19, inability to travel, etc., I've found myself asking "what's the rush?" especially if the end result one year later is the same.
So based on that, the pendulum is swinging toward not having surgery.
I have a pre-surgical exam this coming Thursday. I'm hopeful the person I'm seeing (a PA) will be knowledgeable and that we can have a discussion about the various options. We'll see.
Since I previously said I wasn't going to write about my health woes and would restrict myself to writing about riding, I'll add some updates there.
I continue to ride the recumbent exclusively. As noted previously, I've found that the more acute angle created when reaching for the bars on a DF is definitely harder on my back. I don't know at this point if this will pass when my back is fully healed or whether that means I'm going to be on the recumbent forever.
Also in the unknown category is how much to ride, even on the recumbent. I've found that 30-40 miles is my current limit. As a ride goes past 25 miles or so the sciatica starts to take hold (forefoot gets numb, calf gets "tight"/crampy feeling, hamstring starts to burn). Stopping and stretching a bit helps but no matter what I do when I finish the ride my foot is numb and I've got pain the full length of my leg. It subsides after a while but this does seem to be consistent.
I'm not sure what about riding the recumbent is irritating my back. As noted, it is better than the DF but 30-40 miles seems to be an absolute limit. I can make it worse by pushing harder but that limit seems to be pretty absolute even for easy rides. I did 30 miles today with hardly any climbing and I did what little climbing there was in a really easy gear. My average watts for the ride was 100 which is pretty darned easy and yet at 25 miles or so the sciatica flared and I had the pain described above post-ride.
So the question is: am I prolonging the injury by continuing to ride, even on the recumbent? Would I be better off not riding at all for a period of time? To put this in perspective, were I to have surgery I wouldn't be able to ride for somewhere between 2-6 weeks (I've seen both ends of that range in the literature). The "upside" if you want to call it that is I probably wouldn't want to ride for a while if I had surgery.
So continue to keep the back at a low boil or stop riding for a while?
For the moment, I'm going to continue riding. Mostly because I'm so damned limited in what I'm able to do that the notion of just sitting all day, every day, would drive me mad with boredom. I'm hopeful that the back will continue to heal even with a relatively steady diet of 30-40 mile rides.
Stay tuned!
