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L5/S1 losing patience, gaining confusion

Hi everyone! I'm glad to have found this community. I'm a moderately healthy mid-twenties girl who woke up the morning after a nice workout this past Christmas with some pretty severe "hamstring pain"... which turned out to be sciatic pain related to disc protrusion at L5/S1, a slight protrusion at L4/L5, and slight spinal stenosis.

How the heck did I get here?! Years of bad posture? Perhaps going too crazy with my workout regimen? I don't really know. I lost about 40 pounds in the past three years, and had completely taken on a new identity as exercise enthusiast, so it is really depressing to face this type of setback.

I've tried many remedies and what has proven the most effective for me are the steroid injections. I'm awaiting the 3rd... and really hoping this does the trick, because I do NOT want surgery. Most days, I feel as if my symptoms are not severe enough to justify it (although after a night of tossing and turning trying to get comfortable, I woudl revise that statement).; however, I don't want to deal with these symptoms forever.

And the clock is ticking because I am getting married in 11 months :(

I am the MOST confused about how to deal with physical therapy at this point. I went biweekly for a while, and the pain changed quite a bit. It mostly eliminated the sciatica in my leg, but moved pain to my back-- and triggered foot tingling. still have massively sharp pain in my buttock whenever I flinch or lay down. During my last visit, the therapist recommended that I stretch my piriformis muscle and abandon the backbends and press-ups.

And of course, now that I've eliminated them, when I try to lay on my stomach, I get excruciating pain in my back and buttock. So maybe I shouldn't do that?

I've thought about seeing a different therapist but it is very expensive for me. Maybe it would be worthwhile though?

I am also confused about how I should be "taking it easy" with my exercise vs. keeping up with physical activity. I do know that I definitely sleep better when I work out. I am gradually accepting that running (Even short distances) is only making matters worse at this point, but I am hopeful that my elliptical machine (without the arms) isn't harming anything.

It is very hard to stay optimistic about this. Any tips on improving emotional health or decreasing physical pain are appreciated!


  • Hi & welcome!

    When you say "disc protrusion" do you know if it's bulges or herniations? That makes a big difference. Did your MRI show that they were contacting any nerves? What kind of steroid injections have you been getting? I'm so glad you've found something that's offering some relief. It's important to find a different 'Blend' of things. Injections & PT are a good start. For the emotional side of things I like aromatherapy with visualization & meditation. Really anything that takes your mind off of things. I've started some different hobbies too.

    Piriformis muscle problems can present in a very similar way to sciatica. I'd check with a specialist. My husband suffers with this muscle pain & a large part of the solution for him is is targeted physical therapy exercises & stretches. Lots of sideways walking & 'rubber band' work & plenty of stretches. In many cases it's very manageable with PT & dont forget the ice. He has his routine & doesn't actually go unless he needs a little extra instruction. When he has a particularly bad flare he also gets prescribed a muscle relaxant & an anti-inflammatory. I know it's very painful. If he stops his routine it flares.

    I'd ask a specialist what's causing the 'sciatica' & go from there. Sometimes it takes a while to fully identify our pain generator(s). What type of specialist are you seeing at the moment to coordinate your care? Don't be afraid to keep pushing for answers. Your PT isn't the best person to diagnose the cause of your pain.

    I have disc problems (among other things) & my husband has piriformis muscle syndrome.. We've both been told no running! Have you considered specialist yoga, aqua therapy etc. to replace it? There are plenty of ways to exercise that aren't jarring or hard on your body.

    I hope you enjoy your time here. See you on the forums. ;-)
    Osteoarthritis & DDD.
  • LizLiz Posts: 7,832

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • and unfortunately, some diagnosis' can overlap, either by symptoms or areas where the pain flares. A visit with a surgeon can help to pinpoint that. A consult with a board certified surgeon does not mean that surgery is likely or inevitable, just helps to pin point the cause of the pain and the treatment options for the particular condition.

    www.spine-health.com/.../exercise-and-physical-therapy-disc-disease- treatment-and-pain-m
  • Hi everyone - sorry for the delay in my response! I figured I would get an email notification so I hadn't checked (my mistake!).

    EG: Thanks for your reply! The MRI confirmed it was a herniation at L5/S1 (and I think a slight bulge at L4/L5). I believe it is contacting my sciatic nerve, although I'm not sure about others. Good question-- maybe I should push for more info.

    I've been receiving "Lumbar Trans Injections" (my understanding is that they are the standard steroid rather than a nerve block).

    What type of specialist have you found to be the most helpful for you? I've been seeing an orthopedist for my primary care, and supplementing it with PT (somewhat helpful, but I stopped because the therapist told me it wasn't really working). Maybe it's time to consult with this mythical "Pain Management Specialist" that I've heard about? I find the healthcare system so challenging to navigate.

    I am about 12 days away from my 3rd epidural, and finding my pain to be increasing, so I am panicking about the next step. Sometimes it's hard to stand up straight. Holding extra weight also really hurts. What's the most concerning now is that my PT exercises (press-ups and backbends) really hurt my back now. I'm not sure if it's because I stopped them for a while or if I did something to make my herniation worse.

    About the piriformis thing... my physical therapist has said that I have crazy muscle spasms in that general "butt" area. I am hopeful that it could be the larger cause of my pain (because it seems to me like it'd be easier to treat!) but I have a feeling it's not.

    Sandi: Thanks for your reply! I can't seem to get those links to work... Any ideas?

  • Hi I've been through the same thing in my early twenties but ended up having the surgery as it deteriorated very quickly. Running for me is a big no no and is hugely frustrating as I used to be very fit and run or cycle a lot. Perhaps try plates and acupuncture as these both helped me to some degree to alleviate some of the symptoms. My physio suggests exercising but only in short bursts and nothing which aggravates the sciatic nerve (cycling, running, swimming on your front). I personally wanted to avoid surgery for as long as possible and have continued to have problems but I know people who seem to have had an easy road afterwards. It's not an easy thing to deal with.
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