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Neurology (Expert Forum)
posterior annular disc tear
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posterior annular disc tear
by shamrock, Jan 01, 2007 12:00AM
On November 6th, I had an MRI and I was diagnosed with a posterior annular tear at L5-S1. I also have a minimal diffuse disc bulge at L4-L5 (no spinal stenosis). What triggered my symptoms was pain in my left calf. Within a month I started experiencing back pain. I have been told that the leg pain is most likely a pinched nerve or the pre-cursor of the back diagnosis.
I have been undergoing physical therapy twice a week for at least 6 weeks. The exercise regimen has been modified a few times, but nothing really seems to help relieve the pain. Do you suggest pursuing another opinion or continuing to work with the physical therapy a longer amount of time?
I find very litte relief late in the day. However, when I wake up in the morning I feel normal for awhile. What do you think this indicates? I do not work and am able to vary my routine but nothing seems to change the fact that the pain comes back by mid-day.
The 2 doctors involved are my GP and the DO at the P/T clinic.
Thank you.
I have been undergoing physical therapy twice a week for at least 6 weeks. The exercise regimen has been modified a few times, but nothing really seems to help relieve the pain. Do you suggest pursuing another opinion or continuing to work with the physical therapy a longer amount of time?
I find very litte relief late in the day. However, when I wake up in the morning I feel normal for awhile. What do you think this indicates? I do not work and am able to vary my routine but nothing seems to change the fact that the pain comes back by mid-day.
The 2 doctors involved are my GP and the DO at the P/T clinic.
Thank you.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Jan 24, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The pain in your left calf and subsequent back pain may be due to a pinched or irritated nerve (pain from a L5/S1 nerve root would be felt or 'referred' to the calf area). When there is an annular tear then some disc components can leak out and either compress or irritate the nerves. Many people without out any back pain can have findings of annular tears, compressed discs and bulging discs on MRI. Thus it is unclear who will have diabling pain just from an MRI. I would suggest an EMG of the left lower extremity to evaluate for signs of radiulopathy (damaged nerve root). Conservative therapy with physical therapy, pain medications (NSAIDS and sometimes narcotics) along with epidural steroid injections are usually preferred for the first line of treatment. If after 6 months of conservative management, you are still having significant pain, and functional limitation then you should see a surgeon, neurosurgeon or orthopedic spine surgeon for possible disc fusion surgery.
I hope this has been helpful.
The pain in your left calf and subsequent back pain may be due to a pinched or irritated nerve (pain from a L5/S1 nerve root would be felt or 'referred' to the calf area). When there is an annular tear then some disc components can leak out and either compress or irritate the nerves. Many people without out any back pain can have findings of annular tears, compressed discs and bulging discs on MRI. Thus it is unclear who will have diabling pain just from an MRI. I would suggest an EMG of the left lower extremity to evaluate for signs of radiulopathy (damaged nerve root). Conservative therapy with physical therapy, pain medications (NSAIDS and sometimes narcotics) along with epidural steroid injections are usually preferred for the first line of treatment. If after 6 months of conservative management, you are still having significant pain, and functional limitation then you should see a surgeon, neurosurgeon or orthopedic spine surgeon for possible disc fusion surgery.
I hope this has been helpful.
Member Comments (2)
by mike1105, Jan 01, 2007 12:00AM
had the same thing. if your problem is like mine, youve got muscle spasm/trigger points. you need a qualified expereinced trigger point therapist (or get the trigger point manual by Clair Davies and fix this yourself). I doubt you MRI reading/findings have anything to do with your symptoms. all your muscles are connected. If you develop a spasm in one place (calf for instance) muscles in other places will try to compensate to keep your musculature in balance. there are specific exercises and stretches for low back pain-- see a website by Jolie Bookspan. Your calf should be treated often w trigger point therapy to break apart the trigger point. I saw a therapist in chicago named Sharon Sauer (Myopain.com). she was the assisstant for Janet travell, who has passed on, who wrote the book on muscle pain.
by hazel958, Sep 20, 2008 01:58PM
A related discussion, back pain for two years was started.
by mar63, Sep 28, 2008 11:41AM
A related discussion, MRI interpretation was started.
