I was in Barnes & Noble the other day and skimmed a book by a back doctor. Sorry I don't remember the title or author.

I was hoping he'd have something good to say about some sort of treatment, but the upshot was that you are best off with the least medical intervention.

Even the new disc replacement surgery didn't look promising.

I've had a sciatic nerve problem that I worry may get worse over time, (it's ok now), and I keep an eye out for possible solutions.

Surgery should be your last resort.

David - Take heart - I have had a severely herniated disk and nerve damage, lots of sciatica and spinal arthritis and I continue to ride and to do fairly long rides. Climbing is the big challenge. The weakness makes me very slow and at some steep grade my leg just gives out. What keeps me going is physical therapy, my excellent chiropracter (Carol Goldstein, 212-489-9396) and my physiatrist, Dr. Vijay Vad at HSS who follows it all and gives me lumbar injections as needed. He also does other minimally invasive procedures (radiofrequency) that can help you avoid surgery. Good luck. If you want to talk more, feel free to e-mail.

David, it really helps to have a positive attitude. I have two herniated disks and other spinal problems. Disk Surgery is the last resort after PT, Epidurals, Radiofrequency Ablation. No guarantee with surgery in any case. THese things do get better over time. For what it's worth I have seen Dr Gregory Lutz who is the Chief of Physiatry at HSS. He is terrific.

Thanks everyone for your kind and thoughtful advice.

I'm still searching for an orthopedist or similar who knows cycling -- or even a cycling coach who has worked with cyclists recovering from herniated discs -- so if other suggestions come to mind please do continue to share them.

To fill you in on my search, the closest I've seem to come so far is learning of Dr. Lisa Bartoli at Beth Israel, 646-935-2255. She is an MD who specializes in rehab for back issues, for all sorts of athletes, including professional athletes.

It seems that she doesn't have a cycling-specific background, so I am still on the lookout -- would ideally like to see someone who has experience with long distance cycling.

Thanks again,
David

I strongly second Debbie Rothchilds list of practitioners. Look for a Doctor that will refer you to PT which includes Pilates, as VJ Vad did. You should avoid surgery if at all possible. Email for details.

I used Jose Rodriguez at Lenox Hill (now, my problem was hip-related, not back, but I am pretty sure he does backs as well). Voila, a biking orthopaedic surgeon, and a nice guy to boot.

I used Jose Rodriguez at Lenox Hill (now, my problem was hip-related, not back, but I am pretty sure he does backs as well). Voila, a biking orthopaedic surgeon, and a nice guy to boot.

"For fellow cyclists with herniated discs, wanted to share my findings so far.

The happy upshot: there is real hope for getting back into long distance cycling. Both doctor-cyclists I spoke with felt I could do so, albeit gradually.

1. Dr. Douglas Gillard, at www.chirogeek.com, is an incredible resource. He cycled around 340 miles/week professionally before herniating a disc really badly, and he's spent the past 4 or 5 years learning everything about it in tons of technical detail. He (remotely) looked at my MRI and had great insights nobody else has mentioned. He's in California but offers phone consultations for $100--money very well spent

If you're considering surgery (generally a bad idea) please speak with him first; and if you're not, he's also incredibly helpful.

2. Dr. Stephen C. Rush, on Long Island, is really knowledgeable about the subject and is involved in professional cycling. While he's not a back doctor (he's an oncologist), he has shockingly detailed knowledge especially as it relates to competitive cycling. He is an extremely smart and nice person.

*

Some recovery suggestions from Dr. Gillard. I may be butchering some details so please check with a doctor before doing something you might regret:

A. You want to strengthen your core a lot -- back muscles, stomach muscles, butt muscles -- so your spine doesn't do the work. You also want to avoid lifting heavy weights (ever), twists, and bending. Twists while bending are the worst.

- Swimming face down is great
- Crunches
- Back extensions on the medicine ball or a machine (*not* hyperextended though)

B. Once you've made good recovery progress off the bike, a progression from stationary bike, to mountain bike (with lots of shock absorbers), to road bike; from flat courses to small hills after a few months; from short rides to long rides.

At my early recovery stage I should be taking a day off between each exercise session; increasing the biking by 5 minutes at a time a couple times a week to the extent it's pain-free to do so; and sticking with lower heart rate riding even if it's for (eventually) longer duration. After a month I should take 7-10 days off completely.

C. When you're biking again, get a bike fit. Also, higher handlebars so you're at a 30 degree angle, then eventually 45 degree angle, rather than the 90 degree racing position. All-carbon is best on your spine if you can afford it; aluminum is not.

D. Build up slowly, and listen carefully to your body, to make sure nothing is giving you pain. Slight soreness that's gone away in the morning is okay. Stop if you're hurting yourself.

***

Fascinating tidbit: if you have a herniated disc, you may actually have an ""inflamed facet"" which can be treated instantly. When the pain is flaring up, especially early on, see a pain management doctor who can do a ""set block"" or ""fluoroscopy"" procedure. For 30% of people, this sort of injection instantly eliminates your pain for 12-16 months, after which you need to repeat. I may be butchering the concept and terminology.

***

Thanks to everyone here who has helped with my search. I appreciate all the thought and caring that NYCC'ers have put into your recommendations and suggestions; they have guided this search and my understanding of what to do (and what not to do).

I'd also like to thank Brian Walton, who put me in touch with Dr. Rush. Brian Walton, a former Olympic cyclist, co-leads Cadence Cycling (cadencecycling.com) which is a training center for cyclists that's staffed by top professional cycling coaches. They're in Philadelphia and are opening a center in NYC (near Hudson Street) this Spring.

I'm still on the lookout for a NYC-area physiatrist who is into cycling and focuses on herniated discs, so if you know people who combine the two, please do"

"Herniated disks sound scarey and can be REALLY disruptive, but they're not a death sentence.When I was in grad school a few years ago, I was literally incapacitated for two full months with a herniated disk that was expressed as sciatica I had a very enthusiastic PT who helped me get through it with old school PT, a little pain medication for the really rough parts and a lot of cheerleading (I would recommend him, but he's in California). As soon as I could walk, he had me running. I'm sure that sounds apocraphyl, but I can't tell you enough how helpful it was. The next year I ran a marathon and started racing on the university's cycling team. When I slack off on my core, or take too long off, I get a little ""reminder"" but other than that, my back is fine. Good luck!"

I had a herinated disc for 5 years and then is snaped and got really bad. I had to have an operation in March 1999, I could not even walk 1/2 a block. I went to Dr. Casden at the Beth Israel Spine clinic. He did an excellent job and I was playing golf three months later and riding in three months. I am still going strong. the most important thing to remember is if you do have an operation follow the instructions and do not rush back. I took an extra two weeks after he said I could go back to work.

this is down at south street sea port, it is a must see.
you get to see bodies with implanted artificial knees and hip joints. i found it fascinating.