Malenia VS L5S1 Disc Herniation
[alpha] may edit some of these takes
Malenia is a notoriously difficult boss in Elden Ring. An L5S1 is a notoriously difficult boss in modernity.
Both are allegedly beatable, but theres a ton more documentation on Malenia I think. Tons of gamers have beat and lost to her, have been able to iterate their ability several hundreds of times in a week. A disc herniation has a longer feedback loop, I'd say roughly a quarter per strict regimen tested, and a smaller but concerningly increasing community of players. They talk about this boss in the bible, an angel gives jacob sciatica, so now its kosher to not eat the sciatic nerve.
Imagine your spine is a big mac, except the buns are more like hockey pucks and the meat is a jelly donut. This jelly donut is flexible, allows us to bend forward and back. The pucks sandwiching the donut protect the spinal cord. Now imagine putting pressure in one side of this sandwich, the jelly donut would explode its contents to the other side. Instead of jelly imagine a slightly hard, solidified fiberous mass. Then imagine that pressing on a specific part of the spinal cord, specifically the nerve that runs down the buttock to the feet.
This is a herniated disc (my best analogy I challenge you to explain it better) L5,S1 explains the specific pucks in the spinal cord sandwiching the disc of concern, and is typically the most common.
A ton of desk work people have L5S1 disc herniations. They bend at the hips sitting for 8 hours a day and look at a screen at between laptop -> monitor height. When the content is lower and far from eyes, you instinctively bend forward. This is well documented, in fact they made a model of a future gamer which I found so hilarious I still share this image with people.
This model has a really high likely hood of having a herniated disc. If he doesn't feel pain down his button through his leg, he is likely asymptomatic. In fact I'm willing to be most desk workers have some level of herniation. If you have "sciatica" which is a super general term for low butt leg pain, there is a very high chance its a mild disc herniation.
I got my L5S1 disc herniation while trying to solo move a mattress into a NYC apartment. I never did any deadlifts, didn't know proper form, so I picked it up with my upper body rather than my legs. When you do this the spine takes a ton of the load and pushes down on that jelly donut really hard.
This was 2023, I'm still not fully healed. I am supposedly at my peak physical condition. What follows next is a log of everything I've tried and know that works.
First you need to diagnose its even a disc herniation. The easiest is to get a spinal MRI.
At the bottom you see the exploded jelly donut pressing into a white mass. MRIs are miraculous machines using the most cutting edge electromagnetics and cooling, but $1k per scan is a bit pricy of a feedback loop. Easiest way to diagnose without spending a band is if lying on your stomach provides relief. They say sciatica can be caused by a tight piformis, so if reversing your spine and pulling your disc from the nerve provides relief then its more likely a disc issue.
There are two paths a man can take to resolve this pain.
- super surgical path
- Temporary surgical path
- The conservative path Elon took the super surgical path, he replaced his neck disc with an artificial one. Stress is a very high irritant to the nerve and extraordinary results probably require lots of stress. He might be onto something here, perhaps we should be prototyping the most cutting edge advancements in tissue engineering. I'm just vary of putting a plastic polymer in my body. This surgery can fail, I know its not the exact same but Luigi Mangione vertebrae slipped, failed a surgery, crashed out, and is now in prison with sbf, diddy, and maduro.
The temporary surgical path, a microdisectomy, is what most people do is have the jelly cut out so it is not pressing on the nerve. While it provides immediate relief it doesn't guarantee long term resolution because theres more jelly for the donut to release if not careful. It also leaves permanent scar tissue in the back. My dad got one and he kept his same habits so he still has some pain.
I think that this solution is speedrunning what the body is eventually trying to accomplish. The body is trying to essentially consume a foreign entity in your spine, so just manually cutting it out speeds up the process. The reason why this takes so long is because the spine is the biggest avascular tissue in the body, meaning there is no direct blood supply. I am seriously warming up to this solution.
Conservative is what is encouraged by many, especially on r/sciatica, because it addresses the problem that got you there in the first place like bad posture, sedentary lifestyle, weak lower back muscles, diet, stress, etc. The endgame take I have is to get to an optimal style lifestyle that keeps your spine healthy, and if you're pain doesn't resolve in a satisfactory time try a microdisectomy.
The 3 pillars are back muscles, diet, and stress. One pro of having a disc herniation is that it provides immediate feedback in pain when you've failed to adhere to one of these.
When you first experience a ton of pain, you will recognize quickly that bending at the hip produces pain. So as long as you stand, walk, or lie down straight you are fine. As long as you don't sit, you'll be fine. Unfortunately due to modernity, you can't do this 24/7. You need to commute to your local wework, consume some caffiene, produce some symbols on a screen by eod so the company can capture some value, ideally more than they are paying you. This usually means you have to sit down on a desk for >9 hours a day. Not sitting also means you can't go out and eat at restaurants, drive, take long flights, etc, its heavily dehabilitating. The first response is to suggest a standing desk, which works for the pain, but I cannot get any deep work done without sitting down. Standing still upright for a long time is intense, even more than walking. It's like running a background process consuming 30% of your compute. The best thing here is to get some desk chair monitor setup that allows your hip to sit at 135 degrees, apple vision pro might have potential here. I tried hanging a monitor above my head while lying down, didn't work for me.
The best exercise hands down for this condition is the back extension. In fact I suggest straight up buying a roman chair, it'll be <$100 on amazon. Weak lumbar back muscles encourage your body to slouch forward, which passively triggers the pain. Walking helps alot too but is too time consuming for its value.
Aside from general inflammation the biggest theme in diet is hydration. They say staying hydrated is important because discs dehydrate throughout the day, but I could never isolate this variable, I drink a normal amount of water, I'm fine. I tried living without caffiene, a dehydrator, and noticed a small difference, I still drink a bottle of green tea every day ~60mg. Alcohol will dehydrate and inflame your muscles, which may pinch the nerve, so I don't recommend drinking hard. I did consume a beer every other week and it didn't impact me too much. A sleeper idea I got was from this popular video of a MIT trained spine surgeon disallusioned by the healthcare system, where he claimed the hospital would encourage pushing surgical options despite seeing success in suggesting low sodium diets, which makes sense since sodium dehydrates you. As I was testing this I noticed its extremely difficult to eat low sodium diet outside because restaurants are incentivised to give you delicious food, not healthy. And "healthy" places tend to feature calorie counts, not sodium levels. Due to this I starting cooking and found this experiment pretty successful, but I cannot isolate whether its because I just ate less inflammatory foods and I was concious of the ingredients I was consuming.
Stress is bad of course but I discounted how much impact it had on me. The biggest lever you can do is to leave stressful people and jobs. I'd say 50% of my pain subtracted when I left my job.
Overall I'm fine now, I can fly to Korea on economy for ~14 hours no problem. I still can't do a hamstring stretch. I still do back extensions, and I'm concious of the amount of sodium in my food choices. I fear that when the stress picks up on a difficult challenge I may falter. If by 2028, I am unable to output at the speed I want, at the stress I want to tolerate without pain running down my butt I probably will get that microdisectomy.
In conclusion. I beat Malenia, and I haven't beaten my L5S1 disc herniation. So by the transitive property
Malenia would probably lose to a L5S1 disc herniation