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My L5-S1 rupture journey and recovery

I was an avid runner...about 40 miles per week at 8:30 per mile pace. I started to feel pain in my left buttocks around Feb 2011. Onset was gradual, not sudden; no lifting accident or sudden pain or anything like that. I thought it was something with my hip joint. It hurt mostly when I sat, and also hurt when I started out a run, but the pain lessened as I ran.

Weeks went by with the pain getting gradually worse and worse. It also extended down the leg towards the outside of the knee and down further along the outside edge of my foot (classic L5-S1 pain map, I was to learn later). I had some muscle weakness in left calf and numbness in left foot.

Finally I could barely walk from the pain. I struggled to even get down the hallway to the exam room when I finally went to see a doctor in April. He did some movement tests and achilles reaction tests and pretty quickly determined it was something to do with a disc. He scheduled an MRI for me which I did two days later and got the results back the next day. The doctor called and told me I had an "extruded ruptured disc at L5-S1. The size of the extrusion is a very large 1.7cm". OK, the good news is that I knew I was not crazy. The bad news is that it still hurt very badly.

The doctor put me on Vicodin, 3 Advils x 4 times per day, and a muscle relaxant (can't remember the name). Hearing the scary word Vicodin, I only took a half dose of it, 4 times per day. That cut down the pain to a bearable level (maybe a 5 or 6). I spent a 7-8 hours per day lying on the sofa; for some reason, it hurt less than lying on a bed. I did tons of research on the internet, and read many many forum posts. Most of the posts focused on drugs, steroid shots, and surgery as the recommended treatment routes.

I went to see a specialist neurosurgeon; a real hotshot "type A" personality who came rushing into the exam room in his scrubs as if he had just saved another life minutes earlier. He looked over my MRI on the computer screen (seemingly for the first time) and declared, "So, let's get in there and get this taken care of", i.e. surgery. I hemmed and hawed and asked a few questions and finally asked, "Could we maybe…uhh…try to avoid surgery?" He then suddenly flip-flopped and replied, "OK, sure, let's wait and see what happens. Come back and see me in three weeks." I got the impression that if I had asked to try taco-eating therapy, he also would have agreed. His position seemed to be "schedule surgery or get outta here so I can see my next patient." Clearly, I was not impressed. I started my own treatment process (see below), and made an appointment with another neurosurgeon.

While waiting three or four weeks to see the next neurosurgeon, I happened across a medical research paper which concluded that most extruded discs will eventually be "resorbed" by the body over time with no other treatment. The larger the extrusion, the better the results. A sequestered extrusion (split off from the disc, thus lacking in blood flow, had even better results. Those conditions described mine perfectly. So now I had a glimmer of light at the end of the tunnel. (I can not find the link to the research paper, but you should be able to google it and find it somehow. Just be sure to include the weird word "resorption" in your search).

I then put myself on the following treatment routine:

Vicodin half dose, 4 times per day for one week. Then stopped.

Advil 3 tablets, 4 times per day for one month. Then stopped.

Muscle Relaxant: It seemed to make my pain worse so I stopped taking it after three days. Not sure about this one though.

Ice pack on the L5-S1 area 5 times per day for 15 minutes per time.
(Not on the buttocks or leg or anywhere else; be sure your doctor shows you where the L5-S1 area is located on your back; it's higher up than you probably think since your butt is hurting so much! Mark it with a permanent felt pen. In my case, at that time, I had NO pain in that area. So why put ice there? Because that was where the extruded disc "jello" was pressing against the nerve and causing inflammation and the pain I felt elsewhere. The goal of the ice is to minimize the inflammation and thus the nerve irritation. Continued this icing process for one month after stopping Advil.

Physical Therapy: I did not do any physical therapy because I felt it would aggravate the nerve too much at this point. My goal was to focus on keeping the area "calm" via ice and light exercise (i.e. blood flow) in order to speed the resorption process. Also it made no sense to me to do physical therapy for an extruded sequestered issue.

Walking: Very slow at first. I could barely swing my left leg forward which meant I was taking small steps at first. The first week, I could only walk 3 minutes x 3 times per day and I was in great pain (an 8). I gradually increased this to 25 minutes x 1 time per day after one month. After another month, I kept increasing the speed and distance. Now, 3 months after the MRI, I can walk 50 minutes at a good pace and have only light pain (0-1) when walking. My stride is back to normal as well.

(Somewhere during that period, I saw the second neurosurgeon mainly to confirm that what I was doing was not dangerous or a waste of time. She totally agreed that I should stay away from surgery and keep doing what I was doing already. )

Summary: Current pain level when walking is 0-1. When laying down on sofa is 0. Lying in bed is a 1. Sitting in car is a 1-2. Getting out of the car and walking a few steps is a 2-3. Sitting in restaurant seats is a 0-2. Sitting at my desk is a 0-1 but a 1-2 when I stand up after 30 minutes. My back has a slight "grinding" feeling from time to time when I turn to look around or get out of a chair. It's probably the bones rubbing a bit since the disc is now very "deflated" and not creating enough space between the L5 and S1. I will keep following this daily walking regime until the pain totally goes away to a 0 at all times. My guess is that it will be a full year before I reach that goal. Maybe I will start running again then, but have not decided this.

Thanks everyone for sharing your experiences. You really helped me get through a tough time in my life. Hopefully this post will help some others as well. Good luck!


  • It sounds like you're doing well with your treatment walking. My L5-S1 herniated disc healed by itself also but then got Degenerative Disc Disease after and have the same issues with leg numbness and back pain. The DDD showed up about 15 months after the injury from repetitive bending, lifting and twisting from my job most likely they said.

    Try not to turn at your waist but instead move your whole body to turn around and no bending at the waist and crouch instead. Perhaps a treadmill or epiletical will be better for running rather than hard cement if you're able to get back running. Drink a lot of water to prevent the discs from drying out. I hope you heal completely. Thanks for sharing. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Pain is completely gone, and no further issues have popped up. I gained some weight (20 lbs) from lack of exercise, so last week I signed up with a local gym and will try to get back to exercising five days per week. Fearing that running would lead to problems, I have decided to stck with elliptical training instead. It is super boring compared to running, but I think the trade-off is necessary.
  • aholland86aaholland86 Posts: 1
    edited 02/28/2014 - 7:49 PM
    Hi, I was wondering what you did, other than walking, throughout your injury? Did you try any other type of exercise? Roughly how long did it take to be symptom free from the onset? I have foot drop which has significantly improved over the last 4 months but still get piriformis/glute tightness and sciatica down my leg from time to time. How did the rehab/gym go after you started doing strength work? Are you running again? Thanks so much.
  • My Doc told me that running puts a lot of strain on the back. Good choice to go elliptical or treadmill. Cycling is a good option too ( the ones that keep your back straight, not hunched over). Glad you're doing well. Best of luck.
    Progressive DDD
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • I did the epidurals plus trigger shot injection for the piriformis /glute. Then stretching and stim right after injections. I see chiro for this since I had underwent a 4 level surgical surgery in June. My neuro suggested shots and hold off on surgery for as long as possible unlike the ortho surgeon wanted to do a fusion. According to my pain management Dr. His opinion of course less then 40 percent work . My 4 level was cervical had to be done due to inpingement of spinal cord. So far I am getting relief and pain is only 0 as long as I am flat in back and sleep that way. Wish I could find that article.
  • ry123rry123 Posts: 2
    edited 12/17/2015 - 10:17 PM
    This is my developing story ..
    I felt a very sharp pain 1 month ago. Doctor ordered an MRI and result came back as an L5S1 disc extrusion - 1.6 cm.
    I had unbearable pain (9-10) for 2 weeks in my left calf, which developed into a left foot drop. I was put on gabapentin and ibuprofen from the start and oxcycodone as needed. After 2 weeks, the pain reduced to 4-5 during the day, and more in the early morning. The pain during this first month was dominantly in my lower leg. I did PT for 3 weeks and am taking a rest from it planning to return after the pain reduces more.
    I am now 1 month after symptoms started. After feeling much less pain in the last week but hating the gabapentin
    side effects, I started to wind down the medication with Doctor's approval.
    Today, i am feeling strong lower back pain in my left side, and only minor leg pain. I am confused by this as this is the first day during this whole month (except the first 3 days of my saga) that I feel back pain.
    I am curious about the significance of return of back pain for a case of extruded disc, as commonly only leg pain is expected.
    Has the OP or anyone with large disc extrusion experienced a late onset of lower back pain after having only leg pain?


    Liz, Spine-health Moderator
  • Oldhockeypuck81OOldhockeypuck81 Posts: 7
    edited 12/17/2015 - 9:51 PM
    I've had similar sequences and progressions of back pain, extrusion related leg pain, healing and then reinjury from poor lifting or movements. Personally, I really like walking- I've found it does the most good without doing bad- increase circulatory, stability, and safe motion limits to the lumbar system. I'm 57 y.o. 6-0, 200# w/m, played hockey and ride bikes and generally active. I've had l3-l4 stenosis decompression surgery and extruded L3-L4 disc 5 months after the stenosis surgery. I've learned (the hard way) to limit lifting heavy things, no ballistic movements or twisting . The healing process for me seems to be at least 2 months minimum before I feel like I'm not walking on eggshells anymore.
    Life's short, play hard.
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