I have been doing research to find out just what the hell happened with my back eleven days ago. More importantly, I’ve been trying to sort through all of the treatment options.
Here’s what I’ve been able to figure out so far:
The lower, curviest part of the spine is called the lumbar spine. This is where the lower part of the body (hips and lower) connects to the upper part of the body (torso, arms, and head). The lumbar spine bears most of the weight of the upper body. Here is a picture of the lower part of the spine. Notice the vertebrae L4, L5, and S1. This is where 90% of back injuries occur.
In between each of the spine’s vertebrae (L1 – L5 are the five lumbar vertebrae) is an intervertebral disk. 25% of the spine’s height is from these disks. As you get older, they dehydrate and compress. This is why people shrink as they get older. Here is an MRI scan showing an L5-S1 disk. Note where the S1 nerves come out. This is important later.
Here is a CT scan showing an L5-S1 disk.
The intervertebral disks consist of two parts, a spongy inner part whose name I forget and a tougher outer part called the annulus. When abusing one’s back (by lifting things with one’s back, having bad posture, not exercizing, being all stressed out, not eating right — all things I am certainly guilty of) the annulus gets distressed and will start to get brittle and weaken, sometimes even tearing or cracking. Then one day you are abusing your back same as usual when suddenly the annulus gives out. Here is a painful picture of this.
This happens with varying degrees of severity, from
(1) a mild protrusion (what I have) to
(2) a herniation where the pulpy center squirts out the hole in the annulus to
(3) a herniation where not only does the center squirt out but bits of the annulus break off and get wedged against a nerve
Number 3 happened to a friend of mine who tripped over her dog while carrying her baby and twisted her back to avoid landing on her baby. The only thing you can do when this happens is get surgery.
Unfortunately, there is not a lot of room in the spine for these disks to expand into. Even more unfortunately, the disks are situated right next to where major nerves are exiting the spinal cord and branching out to the rest of the body. In the lower back, these nerves are going to your legs and other areas that you really, really want nerves to go to. Here is a picture of a disk (B) with a herniation (C) pressing on a nerve (A).
Here is a cheery animation of a herniated disk I found during my research.
Here is a CT image of a herniated disk (4) bulging into to the left S1 nerve root (2). Compare it with the right S1 nerve root (1). (3) is the dural sac, whatever the hell that is. (By the way, these scans are of a 31-year-old male, so don’t give me any nonsense about only old people having back problems, though now I understand why they would be more susceptible.)
There are many things in the back that can cause pain:
1. Muscles
2. Ligaments
3. Tendons
4. Vertebrae
5. Disks (the annulus has a lot of nerves in it)
Because of the way that the back area develops in embryos, it is impossible for the brain to tell whether the pain is coming from a torn disk, bruised muscle, or ligament injury. It’s just one big mass of pain back there. In addition depending on which nerve root is being compressed, different parts of the lower part of the body can feel pain or numbness or loss of control (if you catch my drift).
Another interesting thing about an injured disk is that it sets off a chain of events in the lower back that almost guarantees future injuries. For example, muscles in the back weaken through the immobilization from the pain. Also, the disks don’t get compressed (and therefore get more brittle) due to immobilization. The pain causes more calcium to be delivered which in turn makes the ligaments and tendons more susceptible to injury. The material in the center of the disk irritates the nerves and muscles causing spasms which causes more pain. Also the stress of the pain adds to the strain in the lower back.
With all that in mind, here is a summary of the results from my MRI:
1. L1-L2, L2-L3, L3-L4: no significant disk bulge
2. L4-L5 minimal retrolisthesis and central protrusion
(The vertebrae are very slightly misaligned and there is only a small protrusion of the disk)
3. L5-S1 central protrusion with annular fissure is seen, which neither contacts or displaces the S1 nerve roots.
(The disk is cracked and bulging, but fortunately no pieces are broken off and nothing is pressing on a nerve. Though I have to say that part of my right thigh goes numb after walking a while.)
4. Disk dehydration at L4-L5 and L5-S1
(I have already started the shrinking process. Soon I will be 6′3″.)
So I think I understand what happened with my back, but now I have to figure out what the hell to do about it. Here are the treatment options available to me:
1. Epidural steroid injection
2. Oral steriod treatment
3. Physical therapy
4. Non-steriod anti-inflammatory drugs
5. Go to a chiropractor
I’ll write about the treatments later. I’m going to bed now.
Thanks for telling about this.I wandered what the S1 was.Now I know why I hurt.Thanks man!!
thanks man..really helped in understanding what my doc was talking about. I’ve got a pinched nerve…ouch!
Thanks very much. I did not know what L5 has to do with S1. I have not been able to walk more than 5 minutes at a time when I have to sit down to relieve the pain in the legs. This is going on in the last 14 weeks. Clebrex, Vioxx, physio, chinese pain relief did not help. Will try active physio and perhaps Osteopathy later based on CT scan results. Wait listed to see the secialist Feb 2003. Hope I will survive till then. (68)/play badminton and some tennis plus daily workout. Walking and/or standing is the very painful problem. Appreciate your timely useful information very much.
Thank you, The visuals helped a lot. I have a “small central disc protrusion that is slightly eccentric to the left” at my “LS” junction, which I assume is the L5-S1. Now been in pain for 3 1/2 months, but not all the time (thank Goodness) and in varying degrees. I’m doing physical therapy and massage, but I’m not better yet. If you has any other useful web sites. I really want to be able to do the work I was doing before my injury. (natural resource management / biological research in Alaska).
Don’t take this lightly. I’m a lot further down the road than you; Cervical Fusion, Thorasic laminectomy, countless MRI’s, Myelograms,Cat Scans, EMG’s, Cleveland Clinic Angiogram, and they still haven’t found the problem. What started out as an annoyance has grown into a very serious problem in 4 years. Not only do I have pain in my back, I can’t walk without a cane and all my plumbing; bladder, bowel and sexual functions are screwed up. just went for my 6th MRI and can see a disk bulge at l5,S1. Meet with my surgeon in two weeks. If this is the case, I’m leaning towards laser surgery. Much less intrusive. My laminectomy still hursts after five months. Don’t think I would have opted for it if I had a second chance.
HI I HAVE HAD THE SAM DONE IM 31 I HAD L5-S1 REMOVEDTHEN TEY OPEND E UP AGA THINKING SOMETHING HAD GON WRONG TO F IND THE DISC HAD SP;ITND DROPPED INTO T SAME PLACE AS HE ONE THEY REMOVED ON THE MRI SCAN LEAVING ME INCONTINANT BOWELS AND BLADDER AND NO SEXUAL HEALING HAS ANYONE EVER HAD THIS IM 31 WITH 4 YOUNG DAUGHTERS AND DONT KNOW HAT TO DO I HAVE TO CATHERTARISE MYSELF AND WALK ROUND WITH PADS ATTACHED TO MY ARSE SORRY ABOUT HAT BUT THEY MOVED ME TO ANOTHER HOSPITAL WHERE THE GUY WAS WHO OPENED ME UP AND TOOK MORE OF HE DISC AWAY ANYONE HAD THESE PROBLEMS.HELP
Disk dehydration
Aloha…
Thanks for the great article… I’m a 34 y.o.male on Maui and have been VERY active sportswise until recently. Surfing, windsurfing, Beach V-Ball and a lot more… normally if I don’t exercise daily I go crazy… Now I’m beyond that. I was diagnosed yesterday from my MRI as having a severe left side side L5/S1 heniation and compression witha piece broken off like your friend. Being a big wave surfer I have a HIGH pain tolerance but the Sciatica is unbearable and only relieved by Morphine Sulphate (even then the pain makes it’s way through quite intensly sometimes. It’s been 2 weeks and already the inactivity is making me nuts!!! Is it true that surgery is the only cure and if so why is the “Only” nuero on island telling me to lay around for another 4-6 weeks to see if it improves. I really believe in conservative therapy but I want my LIFE back and if surgery is the only option lets get it over with and have it done in the safest, most advanced and non-intrusive way… help!!! anyone with comments or advice “PLEASE” email me at remaxmaui@hotmail.com
Warmest Aloha
Brian K.
Dear friends
I’ve just 2 months that get a leg and back pain caused by dehydration and bulging in l5_s1.
doctor says me that william exercises is good.please send me the latast news or exercises can help me more.I’m 36 and do not want to live with this pain.
regards.
kh.mirkhani@ikco.com
I have injuries to t-7 t-8 and t-8 t-9 I have herniated discs and they say there is really no treatment. But I have cronic pain and the injury happened 6 years ago I am living with it but how do I fix it anything helps.
Sit or Stand MRI finds missed pathology http://www.openstandupmri.com
The important thing is to strengthen your abs. If the abs are weak it will also weaken and put more stress on the lower back. Physical Therapy will help, but you do not want to move too fast and make the already existing injury worse. It will take time. You also want to do exercises that will help, not make your injury worse. Some will heal on their own and others may not and will require a surgery of some kind. Nsaids such as Aleve can help along with Skalaxin, a muscle relaxant if you are having spasms. Everyones pain threshold is different and injuries vary. Talk to the experts and do your homework. Body mechanics are extremely important at this time. Think before you lift or bend.
I feel for you. I’ve been dealing with back trouble for many years. Chiropractic did not help at all; they just keep you coming. By far the two biggest success stories in my treatment have been a) Core stablization exercise (which I’m sure you know all about) and b) Prolotherapy (which you may not know about). Of these two, Prolotherapy yielded the most dramatic results.
Prolotherapy targets ligaments that have become ‘loose’. Ligaments are like elastic bands that help keep the joints from traveling too far. Ligaments that have been over-streched don’t return to their former self and joint instability results. In Prolotherapy, a solution (mainly dextrose) is injected directly into the ligaments. The body’s reaction is to create scar tissue which shrinks the ligaments.
I recommend looking into it. Lots of info on the web. Like I said, it really helped me.
I just got my MRI, and can’t make out which disc is which. Is there some code I should be looking for on the pics?
TIA
Very interesting site! My back ache started about 15 yrs ago. I knew nothing of low back pain and ignored it since it was bearable. Then about 6 months ago, after working in the garden the pain became severe, and has not gone back to the previous level. An MRI 3 months ago revealed ” Moderately sized annular disc bulges L4-5 and L5-S1 level causing slight deformity of the Thecal Sac without evidence of nerve root impingement. Also, minimal bulges at L2-3 and L3-4 with slight deformity of the Thecal sac. The conus is normally positioned and there is no evidence of spinal canal stenosis. It seems that my entire lumbar area is in trouble. I am thinking of maybe Traction? Has anyone had success with that?
I have back pain also. I found these exercises — they’re little video clips — for free on a site that really helped me if you want to try some of them. I put it under the url it’s http://www.back.com.
good luck
Just 2 years ago I fell down my stairs and bulged my L1 L2 L3 heriated L4-L5 S1. I was in bad shape. The say in the write ups that lose of bowels etc a rare but true. I was there and will never forget the pain. My family doctor left me like this for atleast on month until my husband could not stand to see me like that anymore. I was not walking unable to sit, was in continuios pain.I was being taking in by ambulance twice to be cathidered because i was swelling so much inside that I could not pee. I was then taking in for emergenicy surgury. To this day I am still having problems. Can not lift any thing and walking my bottom swells and goes numb then travels down my left leg into my foot. The numbness is the worst feeling ever along with the pain in my lower back. My disk was removed. The are going to try the epidural steriods now its been 3 months and still waiting. I also get numbness in the private area still. I only wish to be normal again.
misdiagnosed of a injury can cause you a life of problems more case studies http://www.openstandupmri.com
the docters at open standup mri r a joke they only intrest in my back was how much money it was worth especialy when they found out i had 8 surgerys already and neaver have i been treated moer like a piece of crap than by dr GREG WHEELER
this may happen for most workers who work at the office or even the old once, cause when you get no exercise you may actually feel this pain.