Lower back pain due to disc protrusion and annular tear L5-S1


Q: I had a MRI of my lower back Impression small central disc protrusion and annular tear at L5-S1 without thecal sac flattening or nerve root contact my pain is off and on. One day its at 7-8 and i cant do anything, others days im pain free. Im 30 yr. I have had this pain for over 6 or 7 yrs. I have had lots of PT, nothing works. Will my dr prescribe me any meds that will help with the pain? I take tramadol and flex. They do not work at all.


A:    Apparently the herniated disc is compressing the root nerve, causing inflammation (neuritis) that is producing the pain. In the younger patients, as you, lumbar radiculopathy may be a result of a disc herniation or an acute injury causing impingement of an exiting nerve. In the older patient, radiculopathy is often a result of spinal canal narrowing from bone (osteophyte) formation, decreased disc height and degenerative changes due to aging process. The conservative treatment strategy usually includes: a physical therapy program aimed to reduce pain and inflammation, and the use of anti-inflammatory medication (Aleve, Motrin), also a re-education of your habits and posture in order to improve your quality of life. You should be independent in a stretching and strengthening program and continue with these exercises under the periodic supervision of a physical therapist initially and then completely on your own. If after all these, you still continue having pain, I strongly recommend you an evaluation by a Spine specialist to explore if the surgical treatment is an option for you.

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