back pain, L5-S1 herniation

L5 – S1 DISC HERNIATION

Spine is made of 24 movable bones called called vertebrae. There are 5 lumbar vertebrae numbered L1 to L5. The vertebrae are separated by cushion disc which act as shock absobers preventing the vertebrae from rubbing together.https://www.nhs.uk/conditions/slipped-disc/

A herniated disc occurs when the gel-like center of the disc ruptures out through a tear in the though disc wall. The pain is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc.

TREATMENTS FOR DISC HERNIATION

Conservative nonsurgical treatment is the first step to recovery and may include rest, medication, physical therapy, home exercises, hydrotherapy, epidural steroid injections, chiropractic manipulation and pain management.

PHYSICAL THERAPY

Physical therapists can advise you on proper posture, lifting and walking techniques and they will work with you to strengthen your lower back, leg and stomach muscles. The goal of physical therapy is to help you return to full activity as soon as possible and prevent re-injury.https://www.nhs.uk/conditions/physiotherapy/how-it-works/#manual-therapy

EPIDURAL STEROIDS INJECTIONS

The medicine (steroid) is injected next to the painful area to reduce the swelling and inflammation of the nerve. Most patients will notice relief after the epidural injection although the results tend to be temporary. Repeat injections may be given to achieve the full effect.

MEDICATIONS

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation and relieve pain
  • Analgesics can relieve pain but don’t have the anti-inflammatory effects like NSAIDs.
  • Muscle relaxants may be prescribed to control muscle spasms.
  • Steroids may be prescribes to reduce the swelling and inflammation of the nerves. They are taken orally in a tampering dosage over few days.

REST

In most cases, pain from a herniated disc will get better within a couple of days and completely resolve in 4 to 6 weeks. Rest, restricting your activity, ice/heat therapy and taking over the counter medications will help your recovery.

If you don’t respond to conservative treatment, your doctor may recommend surgery.

SURGERY

Surgery for herniated disc is called discectomy. This surgery is an option if your symptoms do not significantly improve with conservative treatments. Surgery may also be recommended if you have signs of nerve damage such as weakness or loss of feeling in your legs.

MICROSURGICAL DISCECTOMY

The surgeon makes incision in the middle of your back. To reach the damaged disc the spinal muscles are dissected and moved aside to expose the vertebra. The portion of the ruptured disc that touches your spinal nerve is carefully removed using special instruments.

RECOVERY AFTER DISCECTOMY SURGERY

Recovery time varies depending on the underlying disease and your general health. The original pain may not be completely relieved immediately after surgery. Aim to keep a positive attitude and diligently perform your physical therapy exercises if prescribed.

Most people can return to work within few weeks with jobs that are not physically challenging. Other may need to wait up to 12 weeks, or more, to return to work for jobs that require lifting or operating machinery.

Recurrence of back pain is common. The key to avoid recurrence is prevention. The following guidelines will help prevent recurrence:

  • proper lifting
  • good posture when sitting, standing, moving and sleeping
  •  appropriate exercise program
  • an ergonomic work out
  •  healthy weight and lean body mass
  • a positive attitude and relaxation techniques (e.g. stress management)
  • no smoking

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