What would be the next step

[Odetta]

Last May, I fell carrying my sons' book bags, down a step or two. I broke a toe and severely sprained my back. After a few weeks, I started having sciatica. Turns out, I ruptured/extruded/herniated (which one? do they mean the same thing? I can't remember what the doctor said.) a disk in my lower back.

In August I went to an orthopedist, who prescribed an NSAID and non-narcotic pain reliever, and physical therapy. I did not really take the pain reliever, because even the non-narc kind still makes me loopy, and i don't like that feeling. The NSAID seemed to address most of the pain.

The physical therapy helped, but then it ended. Then I went through a time when i did not do the exercises like I should, and now the pain is back, worse than before. I am starting to do the exercises again, but it hurts to even do them.

I'm out of refills on the prescription NSAID, and just do over the counter now. It makes the pain...passable.

Thing is, I want it gone, never to return. Is there any hope of that?

The orthopedist told me that extruded/etc. disks repair on their own within 9 to 12 months, and the meds and the therapy are really to manage the pain. It's been 9 months, and no repair in sight.

I realize I should be doing my exercises more consistently. I'm hoping that starting back on them, I can regain the ground that I lost. But what if that is not enough? What are the next steps that I should expect? Shots? Surgery? Just living with it?

 

[Jeffwhosoever]

You need to see a doctor if things aren't better by now. It is impossible for someone to tell you what to do specifically, even if we had MD degrees, because one would need to review your x-rays, perhaps get an MRI done, look at your inflammatory blood marker signs, etc. Start with your GP or go see another orthopedic surgeon.

 

[Senator Cheese]

As Jeff mentioned, there's no way to diagnose anything over the internet, let alone to make any recommendations in regards to therapy. However, since you generally asked what "further steps" could look like, once you've seen a doctor, that would depend on the corresponding diagnosis.

If the cause remains a herniated disk, then it depends on the severity of the symptoms and the extent of the herniation. Most herniated disks completely resolve on their own, as your doctor has already explained to you. Following steps should outline how this is managed in Germany, I am not sure if the guidelines are similar to the US but they can't be all too different, since an American body is the same as a European one.

1.) If the pain medication you are receiving is inadequate, you may have to step up in the sense of taking the opioid and perhaps even being perscribed a more potent opioid according to the WHO pain ladder.

2.) Mobilization is usually considered crucial in fighting back pain. It's essential to see a doctor to ensure that no other injury/disease is the culprit - and to receive the required pain medication to help ease you back into your exercises.

3.) Getting a shot of corticosteroids or anaesthetics into the proximity of the compressed nerve root might also be an option, if pain persists.

4.) Although it lacks backing studies, the intrathekal (that means giving the drug into the spinal canal) application of corticosteroids (Triamcinolon) has been proven to be effective in surpressing the inflammation if all else fails. This might be an option in some clinics, though I'm not sure how many doctors actually do this.


Surgical treatment is usually reserved only for patients that suffer from such an extreme herniation that their vegetative and motor functions are impaired. This includes progressive muscular failure, or the inability to pass stool/urinate.

As Jeff correctly said, it's important to see a doctor, because noone can diagnose anything over the internet. I just thought I'd share this information with you because it might calm you, seeing as how quite a lot of people are afraid of surgery and this is necessary in only a small fraction of all herniations. I do hope that you'll feel better soon!

 

[Odetta]

Thank you for your responses. I have a doctor appointment scheduled. It's been 10 months, and the doctor originally said that it could take 9 months to a year for it to heal on it's own, and it's no better. I just wanted to have some idea of what she may suggest so that I'm not blindsided by a recommendation for surgery or something. I don't think it's bad enough for that. Anyway, again, thanks for sharing.

 

[Bobinator]

Here's a couple of interesting home remedies you can make for yourself cheap... and Natural!

https://www.youtube.com/watch?v=Z1LGU_kefdU

https://www.youtube.com/watch?v=O15aCb4y9Vk

 

[drjean]

Hello? Do your exercises! (((hug))) OOOO I KNOW how difficult it is, but if your back doesn't heal, you will be doing them THE REST OF YOUR LIFE anyway and still be in pain! Put them into your routine and do them do them do them!

The weakest part of the back is at L4-L5...the lumbar section (low back) and yes, inflammation there can cause the sciatica. IF you had severe sciatica, you would be doing your exercises and dumping in all the pain med you could get...so don't let it get worse sweetheart....

You need to strengthen your stomach muscles (without reinjuring your back) and your hamstrings...both are very important in maintaining back support...and good posture, proper walking ... all these your PT should have taught you..if not, ask and see if you can return to PT and learn what you need to do...

your back is so important...and it will only get worse and can disable you permanently if you don't take care... please... from someone whose back was injured in an industrial accident... do what you should!

 

[christopher morgan]

I know this is an old thread but I had a crushed disc at L4/L5 when I was 24 years old and lived with the pain until now at 58 and avoided a fusion operation I have to keep my legs and core muscles strong as this helps stabilise your back. Anyway I hope everything resolved for you Odetta. May Our Lord protect you from pain, Christopher Australia

 

[leematthew1234]

You will want to have an MRI done along with an x-ray to rule out fracture and nerve damage. You also should ask your doctor if it could be referred pain from a non-musculo-skeletal disorder. To manage the pain you may want to resign yourself to taking opiate pain killers. For a back injury, depending on how liberal the clinician is, they will prescribe you either Ultram 50 mg (Tramadol) or Vicodin 7.5/325 mg (hydrocodone/ APAP) the pain medication will make you more functional.