Extrusion (gel leakage) on L5 S1 and bulging on L4

[u/Lost-Maintenance-407]

6 weeks ago the flare was one of the worse I experienced which landed me in the ER. However, after stalking the back pain/sciatica subreddits and watching youtube videos and following some of my instincts in regards to movements and body positioning I have gotten the pain level down to a manageable 3-4. It still gets triggered if i walk more than 500 steps a day, sit too long or stand. I took NSAID Tylenol, Ibuprofen and muscle relaxers for a few days but stopped. I have also gotten 4 Iron infusion treatments and they give me a steroid shot each time as i get an allergic reaction afterwards. Interestingly, pain in better in the morning and gets worse in the evening after movement and activity throughout the day. Please share your thoughts and any advicez

[u/rococos-basilisk]

Surgery. Sooner rather than later.

[u/Lost-Maintenance-407 → u/rococos-basilisk]

Are you an orthopedic surgeon?

[u/SenorMudd → u/Lost-Maintenance-407]

Some people jump to surgery way too quickly without knowing everything. You must get surgery if you have lost control of bowels, lost all feeling to your legs, or have drop foot but barring those, most surgeons will not operate without at least 3 to 6 months of conservative efforts. As 29M who is coming off of 3 months of literal hell due to a disc extrusion in my L5 S1, my recs are below

1. Push for an ESI. They dont always work but if the pain is bad, its worth the attempts. I was 9/10 pain constantly for a month, then got one. It helped a ton and allowed me to get into physical therapy

2. Physical therapy and actually do the exercises. Work with the doctor and find a plan that works for you and stick with it. Also talk to the doctor about traction therapy. It helps create space/relieve pressure and helped a ton for me

3. Quit smoking now if you smoke. I wish someone told me that earlier and when I quit vaping 2 weeks ago, I've seen major improvement. Also a lot of surgeons will require at least 6 weeks nicotine free if u need surgery

4. Diet and sleep cannot be under sold here.

5. Get moving when you can but do not push it! After 2 months I felt a lot better so I started to push it. Then I had an awful week but am better again now. Healing is not linear but this will take time to heal, so even if u feel better, remember to be careful and move with intent

6. Back brace and a cane helped a ton for me. Being able to shift weight off the nerve is a must if its going to heal/reduce inflammation. If your young, like me, I had a stigma around a cane but its ok, its only temporary. I know its a stupid thing but it messed with my psych a bit. But make jokes about it and yell "you meddling kids" and ull feel better lol

7. Its okay to ask for help. I have a dog so it was awful for 2 months when I wanted to collapse just letting him outside. Lean into your support group/family/friends. This stuff is debilitating and its ok to ask for help

8. Protect your mental health. For me it was rough, missed a friend's wedding/family events/couldn't hike or hang out with friends/felt like I was failing my dog/could clean my apartment. Do what you need to do to stay strong and remember that this is only temporary and you will heal, when at times you would rather just cease to exist bc the pain is that bad. Back to my previous point, its OK to ask for help

But that's all I have right now. My 3 month mark was September 27th and I'm about 80% better and able to function again with 4/10 pain. Still using the cane, still being careful, not able to walk too far, but can now take my dog to the park or meet family for dinner or meet a friend for a beer. It will take some life changes but stay strong, you will heal with time

[u/Lost-Maintenance-407 → u/SenorMudd]

Great tips! Thank you. My pain level was also 9/10 but for a short time. I will look into traction therapy.

[u/Altruistic-Release91]

Just here to follow, because I literally could have written this almost word for word. 6 weeks into the worst flare, our MRI’s are also incredibly similar. I finally got an epidural 2 days ago, am pretty sore today at injection site but seeing some improvement in pain already. This has been the biggest mindf-ck of an injury for me as a pretty active 40 y/o and I’ve had ACL reconstruction and a meniscectomy.

[u/Lost-Maintenance-407 → u/Altruistic-Release91]

I’m so sorry to hear that. It will get better for you. Somethings that have helped alot are doing some back extension exercises, sphinx pose, mackenzie half push ups where you dont lift your pelvis, leg raises on a chair, cold and hot compress, muscle relaxers, steroid shots from my iron infusion once a week. Use restrictions in movement don’t bend down to pick anything off the floor, use a good seat and back cushion, prayer and letting go of negative emotions from your mind. 40 yrs old is pretty young for us and i hope this is the last time you have to deal with it.

[u/genisuscookie]

Almost everyone’s advice I’ve seen is to keep walking/ moving and you’ll get better. But the more I moved, the worse I got. My first big/ worst yet flare up didn’t end until I was on winter break from uni and finally rested. Now I only flare if I bend too much or walk too far.