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L5/S1 Rupture - treatment options? Can I ever get back to my former self?

AnonymousUserAAnonymousUser Posts: 49,578
Hello everyone - I am a newbie here. I am on the steep part of the learning curve related to what was described to me as a "large rupture at L5/S1". I just saw a neurosurgeon today, and have a TON of questions. First a bit of background - I am sure much of it will be irrelevant - but I gotta start somewhere.

45 yr old male. Very active lifestyle. I love riding and racing motorcycles offroad - and want to be sure I can return to that.

7/19/08 is my date of "injury" though I suspect it was really just the last straw the broke the Mike's back! I have had a lifetime of spinal abuse - going back 18 to 20 years I used to run 50 miles a week, then a time period with lots of backpacking carrying heavy packs in the mountains, and of course MANY MANY miles of off road motorcycle riding, and in more recent years, racing off road. The last straw was a ride on my bicycle - nothing out of the ordinary - but a physical sort of conditioning ride - not a crash off the bike, but shortly after the ride - I could hardly stand. Pain was from hip/buttocks, down thigh, behind knee, into outer calf, outside of foot and in heal. After a few days, the pain eased a bit, but was still pretty bad.

I (Attempted to) ignore it for a few weeks - did a couple more races, pushed much more than I should of. Saw a chiropractor a few times after about 1 month with minor relief, overall was feeling a bit better, but still hurting. I continued to push to hard for about 4 more weeks, pained stepped up significantly. I went for several weeks where I felt lucky to get 3 hours of sleep a night. I finally saw a Doc - did one course of Prednisone - which seemed to help a great deal, and started PT. Doc also referred me to a neurosurgeon , which I finally saw today (a bit of a wait for an appointment). I have now been in PT for about 4 weeks.

I am feeling significantly better day to day. BUT...I am dramatically less active than my norm. I used to walk, hike, ride my mountain bike, ride my dirt bike, work out etc. regularly. I rather actively trained for my races. Now, I am basically inactive - the most exercise I get is 5 minutes on recumbant bike, and the various exercises I do during my PT appointments 3 times a week. Walking - well, sometimes I might manage 200 steps with managable pain, other times, it is only 25 steps before I am hurting. Over the last 2 weeks - I would say on a scale of 1 to 10, max pain level is now maybe a 6 or 7, and basically any time I am sitting still I may have a few hours with no pain, or a pretty low level of pain. Sleeping is at times rough - seems I am generally hurting when I try to sleep and have found I can sleep better on the couch than in bed. I have no clue how I would feel if for example, I headed out for a 5 mile hike in the woods like I used to do. So for me to say I am doing much better, I must note, it is with a reduced "quality of life" as I am not doing the things I love to do.

Onto my appointment with the surgeon today. Mixed bag - hard to really follow him! Initially he was clearly going down the " you need surgery" path (micro discectomy I think?), commenting that I am now almost 16 weeks post injury, and have done the conservative treatment paths I should, and I need to "get it fixed" (he would never say the actual word "surgery".). I commented that I dont necessarily want surgery, but what ever path I take, I want to be sure I can return to my prior level of activity. Suddenly he did a 180, saying I should do 4 more weeks of PT, then see how I am doing. So that is the plan I walked out of his office with.

So, onto my questions! ( about time huh?)

1) Which approach is most likely to allow me to return to my prior level of activity? And so you understand - saying I can no longer ride my dirt bike is not an option!

2) I have read of the steroid injections - should that be considered?

3) I understand the ideal time frame for surgical success is 3 to 6 months post injury. (after exhausting "conservative treatment options") If I do 4 more Weeks PT, to then determine it has not worked and I need surgery, I will be looking at a full 6 months (optimistically) post injury before it is done. Is this really pushing it time line wise?

4) Have I really exhausted conservative treatment options? After this next 4 weeks PT, I would be at 8 weeks PT, 1 course of prednisone, chiropractic care, and 5 months post injury.

Any other bits of advice appreciated!

Thanks in advance.



  • Hi Mike

    I had an L5/S1 injury as well. I injured it about 2 yrs ago and then waited about a yr and a half before surgery. I tried everything else in between. Therapy did nothing and the injections did little. I had microdiscectomy on April 1st of this yr and I'm back to normal. The recovery was about 3+ months. The first week to 2 were rough but it slowly got better. I still felt leg pain and numbness until approx mid July. I herniated the disc playing rugby and I have just recently completed my first season back without any reinjury. So I feel that the surgery was pretty successful. I can't say that I feel 100%. But the minor pain or discomfort that I feel from time to time has not held me back. I'm also about 20 yrs younger than you are so I can't guarantee the same results.
  • Mike,
    I can understand your desire to get back to your life. I was also there at one time, when I had my first surgery. I, in no way, wanted to give up my weight lifting. I injured myself while squatting 200 lbs, and I only weighed 100 lbs myself. (I am only 4'11"). Anyway, I went from doctor to doctor begging to be "fixed." All the doctors told me they didn't want to touch me. Now I'm wishing they hadn't. However, you have a large rupture... that's quite different. I had just a bulge when I was young. I guess what I'm saying (and taking forever to say)is that once you injure the disc, it is not as strong as before you injured it. My doc. told me that when they go in, they do not "repair" the disc to normal again. What they do is take out the material that has ruptured through the weak disc. Exercises and stretches keep your back strong and in proper alignment so that you don't bend improperly again and re-injure.

    As far as bike riding again, you may have to do it differently from now on so this doesn't happen again. For instance, avoid leaning forward while landing, because forward bending with force or weight in hand will push that disc material right out again. (Ouch!)

    My weight training has changed dramatically because of my injuries. However, I have invented my own exercises that work for each muscle group while keeping my back straight; and I continue to exercise daily. The exercises are different, but my back is stronger than ever right now. After 22 years of no back pain, I forgot about watching what I do to avoid re-injury. That's why (I believe) I re-ruptured my disc.

    This is all just my opinion of course. It's what works for me. Hope things go well for you.

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  • Mike, please contact me if you want to get back to normal life. His methods of exercises is working for all of us here at Dulles Airport in Chantilly, Virginia. Find time to read my other post to have an idea how he can make you recover. Remember that he will guide and will stand by you until you achieved your goal. But put in mind that YOU, YOU and YOU ALONE with determination can make things possible NOT him as what others have thought. Right now, he was able to help a 300+lbs postal employee lowered down the pain level to 3 from 9 but became lazy and stopped his exercises as he doesn't want to go back to full duty capacity at the facility. He was scheduled to have a back surgery last August 2008 but postponed it. During their talks, my friend asked him if he will still choose surgery IF the insurance pays everything and said, YES. When he asked the same question IF he will have to pay everything, he said a BIG NO. Before this, he was able to help someone from San Diego, California attained a full recovery but intentionally re-injured himself as he didn't want to lose his long-term disability benefits package. Why? that is self-explanatory. Because he had the "first" hand experience with the pain itself and dealt with the pain for five(5) long years, he knew exactly what to do. He will guide, YES; guide/help you how to lower your pain level to 2 within a week and within a month, the pain will be completely gone. He prefers seeing,meeting and helping people with chronic pain problems with NO previous failed/back surgeries.
  • Mine isn't a disc injury, rather spondy and foraminal stenosis at L5/S1. I do manage to weight train and do cardio. I'm in PT and receiving my second epidural shot next week. I'm pretty certain my issue is running related and I ran a marathon through the pain last May, then went to the doc and got the MRI...

    The doc and the PT have said no running, unless I am pain free, which I adhere to. They also gave me a list of weight exercises with a stable back position, such as bench presses with feet up on the bench, seated curls, etc. I can do use the recumbent bike, stairmaster and elliptical. They also gave me exercises to not do, like squats, one arm rows, back extensions.

    Bottom line is that I would check with your PT/Doc and see what they recommend that you can do progressively without making your injury worse, they are the ones with the expertise to do so.

    I *hated* giving up running, but my mp3 player makes the gym tolerable.

  • Mike,

    Your story is about exactly as I tell mine. I am 41 years old. Very active. Played football, hockey, rugby growing up. Love running. Was training for a marathon. Up to 13 miles. Had done 13 miles 6 times at 8 minute mile pace. I know, that is not spectacular but I am 41 years old. Anyway, I woke up one morning with a horrible hamstring pain. Soon spread to hip and gluteus minimus, really my whole hip. Then spread to my calf, horrible calf pain. Then my foot had the numbness and needles as if it were sleeping most of the time. I went to the doctor initially, who sent me to physical therapy. After a few times and continually worsoning pain I went back and told the doctor that my pain was at a 9 out of 10, taking Vicodin like it was candy was becoming meaningless, and I was going to put a bullet in my head if he didn't help me. He referred me for an MRI that day and the next day they called and sent me a picture. It was unbeleivably obvious how large of an L5/S1 rupture it was. They gave me 2 shots of cortizone/steroid epidural. About 50% of the pain went away in a few days. A few weeks later they did 2 more shots of cortizone/steroid epidural. Maybe 25% more of the pain went away. Remained like this a couple of months. Then pain level started to creep back up a little bit each day. They then did a selective nerve root block. This did no good at all. Pain kept creeping back up a little bit each day the next couple of months. Finally, back up to an 8 out of 10. It had been almost 6 months total. I had not been able to work out or run at all and just walking short distances or standing up was getting pretty bad again. I was getting pretty unhappy with my quality of life and not being able to run or work out or do nearly as much as I wanted to with my family. They told me they had exhausted all non-surgical means and wanted to do a micro discectomy. I met with the surgeon and he gave me a 95% chance that the disc would not re-rupture and that my leg pain would be reduced dramatically. The surgery went well and it has been 2 weeks. I went back to work today. My leg pain is already more than 50% gone and will, hopefully, continue to go away as the leg nerves heal. They told me that since these nerves were crushed so badly for 6 months that they would have to heal. I am already walking 3 to 4 times a day for about 15 minutes without much leg pain. The 1.5 inch incision in my back is already healed. My surgeon told me that I should be running again in 3 months. I'm hoping for the best. Like you, I can not pin the rupture on anything except 41 years of abuse. We think we're invincible until something like this happens.

    Mark in Indianapolis
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  • Thanks for the replies. I would of responded back sooner - I thought I would get email notification of replies, but did not.

    Good to hear from those of you with active lives, and seeming to get back to it. Though, it seems here, and on other forums (racing related ones) more often the ones saying they are back to racing/prior level of activity etc. are the ones having had surgery.

    As it stands now, I will be seeing my Primary Care doc on Tuesday for a referral for a second opinion. Meanwhile I am continuing the PT (which is what the surgeon ultimately concluded). After a long discussion with the PT - no harm in continuing, and if I do end up having surgery, I would go into it with less of a deficit than I would otherwise.

    The last two or three days have actually been rather good. I did a fair bit of walking Saturday and today - some leg sciatica type pain Saturday, and suprisingly little today, though my lower back feels rather fatigued.

    I do need to comment on why so much walking particularly on Saturday - my oldest son was participating in a scholarship competition (FULL ride!) to start his undergrad Pre-PT program, and later his graduate work to become a PT! So, at least I will have easy access to therapy in the future! (hope he gets the scholarship!).

    Here is one thing I cant quite get my mind around - pardon the mechanical (of course, motorcycle related!) analogy -

    Lets say one of the key frame rails on my motorcycle were to crack, and were jutting out such it was pinching off some of the wiring system. Would I decide to simply wire on some additional supports along the sides of the crack, and simply try to ride it more easily, hoping it does not break at the wrong time, and do nothing about where it was rubbing on the electical wiring? No - I would say it should be fixed properly, have the cracked area welded, and perhaps for saftey's sake, have some added gussets welded in (depending on the specifics - I might more likely say the frame should be replaced), and wiring issue would have to be addressed. Bottom line is I would say fix it right, dont go half way and try to baby it along.

    To me, the non surgical options seem to be like doing a half way fix, and then saying you will baby it so it wont break again, and hope the insulation on the wires does not rub through and short out. As I see it, I have a broken part (the disc) and that part is messing with the operation of other parts (the nerves). The surgical option, while I realize it does not totally repair or replace the disc, it does totally remove the parts of it causing the nerve pain. To compensate for the fact the disc is shot, the role of PT then is to brace things up.

    So, why wouldnt I make sure to take steps to make certain I dont have broken parts interfering with other parts? Of course, I realize this is not as simple as the frame on a dirt bike - and I realize there are some huge potential risks. I guess If my Surgeon had given me a better sense of the merits of each approach, I would likely feel much better about which way to go!

    Anyhow, thanks again everyone. I will post back the results of my Doc's appointment (Tuesday).

  • Mike,

    I read your story and thought I would provide some information.

    My injury was L5/S1 with a severe rupture.

    The injury first occured in July '07. The day after the injury the pain level was around a 8-9(10 scale). I blacked out the next day when I tried to walk to the restroom. This is an idea of how bad it was. I went directly to a back specialist who was an orthopedic surgeon. He treated me with methylprednisolone, hydrocodone and a med to help with muscle spasms. When I was injured this time I had little sciatic pain. I started PT within a few weeks and by the mid-October '07 I was feeling great again. I began my normal routine of playing volleyball, basketball, lifting and running.

    Within a few weeks I was in terrible shape again. I began to get really bad sciatic pain in my left side. From my back all the way to my toes. I tried cortisone shots twice. The first time maybe made a small difference, the second time compounded the problem. By the time Christmas & New Year came I couldn't walk erect, couldn't walk on my toes and couldn't straighten my left leg. The pain was a constant 8. The MRI showed a rupture about the size of the end of a finger.

    I had surgery at the end of January '08. I had immediate relief. It has taken a long time to get back to normal but I would say I am 85% there. I have jogged in a 10k. I just began a volleyball league and have been strength training since June. My biggest problem right now is flexibility but it is dramatically better than I was even 2 months ago. I am an impatient person, but I have learned it takes some time.

    I'll give my background if you are interested. I am 31, about 6'1" and before the injury about 180-185. I played volleyball competitively. I trained about 20 hours per week either in the sand playing, doing plyometrics or lifting. I learned that it doesn't matter how good of shape you are in it can get you. I expect to be back doing all of this next summer.

    I feel like surgery was successful for me and thought I would pass along some thoughts.

  • There are pain management Doctors to do the injections. You can find a pain management DR. or get a referral by your family Dr. They are anesthetists that give the injections in the spine and also recommend meds etc. for pain control. Hope things go well for you. Of course it's up to OS or Neurologist to decide to do surgery if necessary to prevent nerve damage. Take care 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
  • I have the ball rolling on the referral for a second opinion. Hopefully I can get in soon.

    Meanwhile - bit odd the last 2 days. I had been managing to feel pretty good, almost pain free when inactive (sitting on my getting fatter hind end!)...then yesterday that seemed to change - now I am back to hurting pretty much all the time - not realy high level of pain, but rather annoying, at times spiking up there. Walking of course still makes it hurt much worse. I am not sure why this would of changed - I did nothing I can think of that would of cause the disc to shift (I assume that is why I am hurting more?)

    More and more it is sounding like the surgical option may not be to bad of a way to go. I dont want to (yet) resort to "pain management" - to me, that is just masking the fact I have something wrong - I would rather first exhaust the fix it options!
  • I hear you, but the issue with going straight to the fix it, at least for me, is that insurance wants to exhaust all conservative (lower cost) treatments before authorizing surgery.

    Personally, I am hopeful that perhaps the conservative treatments work...trying to remain optimistic, since there isn't much else that I can do.

    I sit on ice about 12 hours a day now. I think my butt is frost bit. ;)
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