5/5 (2)

Prolapse in L4 / L5 after heavy lifting

Events: 39-year-old woman with proven prolapse in L4 / L5 after heavy lifting. The pain is localized to the lower back, buttocks, calves and feet - and has not improved since the pain first started. She has tried several therapists in conservative treatment and has now decided to try a private back operation at Volvat. It should be mentioned that a public orthopedic surgeon would not perform the procedure.

Also read: - Prolapse in the back? Read more about it here!

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Age / Gender: 39 year old woman

Current - your pain situation (supplementary about your problem, your everyday situation, disabilities and where you hurt): Have had prolapse L4 / L5 (ie between fourth and fifth lower back vertebrae) since October 2015 when I bent down and lifted some boxes.

Was on MRI in January 2016 where it was first detected, then by a surgeon in March 2016, they would rather not operate due to fear of "post-prolapse" (they say in the disc below). Was treated by a chiropractor, physiotherapist etc., and then took a new MRI in May 2016 - just like in January.

Then I walked like that, with pain in the buttocks and calves, as well as a foot that aches only I walk a few steps, and start to limp. Was on MRI again this May - and the prolapse was the same as last year, but there was a narrow passage in the spinal canal due to fluid, so Dr. Sjur Bråthen at Volvat recommended surgery by filing away some bone so that there was more passage and possibly take remove the prolapse if it has dried out.

This was now in June - and I got an appointment with a surgeon in November. Have done all the exercises I have been given but do not work. I have received the TENS device, it works there and then when I use it, but not afterwards. Now the pain has picked up again, and there is lightning, pulsating pain down the leg .. I respond very well to all new treatments / exercises, but after 2 times there is no effect anymore. It is said that a prolapse usually disappears after 2 years, so you can cross your fingers. Now I have reached the stage where I want to operate because I can no longer bear it like that. Do you have any good advice and measures?

Topical - pain location (where is the pain): Lower back, lower part, and down in the buttocks, calves and feet.

Topical - pain character (how would you describe the pain): Toothache. Lightning and pulsating pain that "shoots" down the leg.

How do you stay active / in training: Exercises from chiropractor and physiotherapist - no long-term effect.

Previous imaging diagnostics (X-ray, MRI, CT and / or diagnostic ultrasound) - if yes, where / what / when / result: MRI examination January 2016 and MRI May 2016. MRI May 2017.

Previous injuries / trauma / accidents - if so, where / what / when: When I lifted the heavy boxes.

Previous surgery / surgery - if yes, where / what / when: Going for an orthopedic assessment in November 2017 at Volvat.

Previous investigations / blood tests - if yes, where / what / when / result: Yes, with orthopedic surgeon and doctor.

Previous treatment - if so, what kind of treatment methods and results: See above.

SVAR

Hello and thank you for your inquiry.

Rating: It seems as if you have tried most of the treatment, exercises and training - at least to the extent that you have had the energy for it. Exercising the muscles sufficiently to relieve the intervertebral discs and lower joints is an almost inhuman task without the right support system around them - especially as it can cause aggravated pain in the beginning - and here it may seem as if you have failed a little in my eyes. Holistic treatment where factors such as nutrition, exercise, exercises and other variable factors are the only way to get out of the "prolapse ditch" for many.

Damage process and cause: A prolapse (protrusion of the nucleus pulposus through the annulus fibrosus) can occur due to prolonged misload or by sudden overload (as in your case) - it is believed that many may have a genetically weaker structure in the intervertebral discs than others and that these are more prone to prolapse . Many people have asymptomatic prolapse where the soft mass that has passed through the wall does not press on any nearby nerve root - while others (like you), have prolapse with affected nerve root and associated pain and impairments associated with the affected nerve root (different nerves go to different muscles and areas on the skin among others).

Further measures: Of further measures, it appears that you have already been thoroughly examined within the imaging diagnostic examination - especially MRI examination. A good clinician should be able to determine with almost 100% certainty which structure is affected by orthopedic tests and neurological tests - without the use of MRI.

It also seems like you are looking at an operation as the 'ultimate relief' from all your pain. Unfortunately, this is not always the case and more and more research shows that structured training over time outperforms the scalpel in the form of better results and effect. An honest question you need to ask yourself before going under the - private - scalpel is whether you have really given physical exercise a real chance? Especially in light of the fact that - presumably - a public orthopedic surgeon would not operate on you based on his examination. An operation will always leave scar tissue - which can potentially give you the same ailments you are experiencing now. It should also be mentioned that there are other differential diagnoses (myofascial pain syndrome etc.) that are possible adjacent causes for parts of your pain picture.

Exercises and actions: Sitting still and lack of exercise leads to weaker muscles and often more pain-sensitive muscle fibers. Regular exercise increases blood circulation to the injured area and then takes nutrients to the intervertebral disc and soft tissue. If you have been weak for a long time, it may be beneficial to set up an exercise program with the help of a physiotherapist or other publicly authorized clinician - a program that is personally tailored for you. If the pain is too strong to exercise, then symptom-relieving treatment should be combined with exercise until you have "upstairs" again and can exercise without major pain.

But when exercising for those with prolapse one recommends low abdominal exercises (ref: McGill, Liebenson). You can see a selection of these here: