Herniated Disc: L5-S1

author : AMSSM

comments : 4

Fast forward to now after many triathlons and marathons, my back is worse than ever. What helps lumbar back issues? Shots, physical therapy, surgery?

Member question

I had an MRI done a few years ago after approximately one year of lower back discomfort and having my back occasionally give out on me. The MRI showed disc herniation (L5-S1). The neurosurgeon I went to see said I should not change my active lifestyle whatsoever, but he did recommend re-visiting my back issues if they persist several years down the road. He recommended several things: stretching, chiropractor, core strengthening, etc. I'm a horrible patient and have done none of the above.

Fast forward to now after many triathlons and marathons, my back is worse than ever. I have an appointment with the same doctor later this month to discuss having another MRI done. What helps lumbar back issues? Shots, physical therapy, surgery? I'm afraid to have surgery because I fear it may be the kiss of death and will prohibit me from continuing to train. That being said, with the way I feel now, surgery is going to be needed in the not so distant future.

Answer from Christopher A. Gee, MD, MPH
Member AMSSM

Hello,

Unfortunately, this is a common problem and is often difficult to deal with.  I agree with your neurosurgeon’s recommendation to stay active.  Maintaining core strength and appropriate weight can really go a long way towards off-loading sections of the spine that are at risk of injury, or exacerbation of underlying problems.  While approximately 70-80% of patients with disc herniations will get better with conservative treatment, there is a significant group that will continue to have problems. 

The mainstay of treatment has traditionally been physical therapy.  In combination with anti-inflammatory medications, rigorous PT can improve core strength, flexibility, range of motion and level of pain.  It is something that will likely need to be continued as a home program for many patients because if they slack off, the pain and dysfunction returns.  This does take a good commitment and a dedicated therapist to help you get through, but it will likely be the most beneficial option over the long term. 

Another good option for treatment that doesn’t involve surgery is epidural injections.  These are performed under fluoroscopic guidance to ensure the proper placement and basically target the particular offending disc with high concentrations of steroid and numbing medicines.  This can be very effective for many patients and can help to stave off surgery in patients who have haven’t gotten better with physical therapy.  The injections can be repeated and in many instances it improves pain levels to a point that patients are able to perform their routine activities and thereby get their strength and motion back.  Furthermore, there are some studies that suggest that if there is good relief of pain with this procedure, then surgery could be helpful. 

Oftentimes, the last resort for many patients is surgery.  In the correct patient, this can be very effective, however, it should only be considered when all other treatment modalities have failed.  The problem with surgery is that it cannot be “undone” and while it may address the issue at a particular vertebral level, there is the risk that additional pressure will be dispersed to adjacent vertebral levels once the surgery is complete.  Obviously, there are numerous types of surgical procedures and sometimes they are the only option available.  However, patients should fully understand the risks and benefits of undergoing surgery prior to going under the knife. 

Make sure you fully discuss your options with your neurosurgeon and be ready for a lot of hard work to ensure that your spine stays healthy.  Good Luck!

Christopher A. Gee, MD, MPH
Assistant Professor
Associate Program Director
Primary Care Sports Medicine
University of Utah

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date: August 30, 2012