by Mary Robinson, Physical Therapist
Unfortunately, 80% of the population will at some point in their lives experience back pain, and physical therapy is a key component to keeping most people out of surgery.
Case Report: Conservative Treatment for a Lumbar (Lower Back) Herniated Disc at L5-S1
What leads someone to a surgeon?
- Excruciating, unrelenting pain affecting quality of life
- Decreased function (decreased strength, balance etc.
- All conservative treatments have been exhausted
The first reason listed above brought Sean to NS2. After sustaining a lumbar injury doing some heavy squats for exercise, he eventually developed severe pain radiating down his left leg. The pain was so severe he could not sleep, sit, or really function. Upon evaluation, it was confirmed he had decreased strength in his left gastrocnemius (calf muscle). He couldn’t lift his heel off the ground, and it was affecting his gait. After viewing Sean’s MRI of his lumbar spine, our surgeons and spinal intervention team concluded a conservative approach would be best. The MRI showed a very severe L5-S1 herniated disc that had an inferior fragment compressing the nerve causing pain to radiate down his leg AND severe weakness in his leg. Although this was a very serious diagnosis, we were ready to try multiple conservative treatments to decrease pain and rehab his gastrocnemius (calf muscle) to full strength. It is important to note that we very frequently checked for the following: worsening pain, continued strength loss, and continued gastrocnemius (calf muscle) atrophy. If any of those continued to progress, surgery would have been more of a reality.
Here is what we did!
Physical Therapy:
Traction - Unloading, the inversion table and a specific L5-S1 distraction were utilized to decompress the nerve affected by the herniated disc. We were able to centralize disc pressures and relieve severe pain throughout these treatments. For Sean’s specific injury, we maintained an “extension biased” program in order to avoid lumbar flexion and continued disc disruption.
Neutral Spine Strengthening and Education - Lumbar stabilization exercises are very important and research suggests that early intervention of core stabilization post injury creates a better outcome for the patient.
Gastroc (gastrocnemius - calf muscle) and overall left leg strengthening - Sean’s calf muscle was so weak we started with electrical stimulation throughout total gym calf raises and progressed to weight bearing calf raises as he gained strength. Although his strength returned to very similar to his non-involved leg you can tell his left calf muscle looks a little different. His left hamstring and glutes were also slightly affected and we made sure to strengthen those as well.
Spinal Intervention:
Sean received two transforaminal epidural steroid injections on the left S1 nerve root. A transforaminal injection is a long acting steroid injected in the opening of the side of the spine, known as the foramen. He had one injection quickly after his MRI was reviewed and then an additional injection two weeks later. Physical Therapy was continued throughout receiving injections, which continued to decrease pain and treat his strength deficits. Our spinal intervention physicians offer both diagnostic and therapeutic treatment options through minimally invasive procedures. A speedy recovery from these procedures allows you to quickly return to activities and work.
Every patient’s injury and situation is different, but for Sean we were able to resolve his pain and increase his strength back to levels preinjury. He is continuing to perform high intensity weight lifting and he just completed an Ironman triathlon. Going forward he understands that it is important for him to maintain a neutral spine with weight lifting and avoid extreme heavy lifting as he did before.
If you are hurting and want an accurate assessment, a team approach that views surgery as an option only after other options are considered, and access to specialists trained at some of the finest medical facilities in the country – make an appointment at NS2 today. We are Mississippi’s Spine Center.
