OpenHealth Q&A

Seeking Guidance on L5 Pars Fracture and L5-S1 Disc Bulge

Title: Seeking Guidance on L5 Pars Fracture and L5-S1 Disc Bulge About a year ago, I began to experience discomfort in my lower left back. There wasn’t a specific incident that I could pinpoint, but I remember a distinct moment when my pain worsened after performing squats with improper form (pelvis misaligned, back rounded), leading to intense pain and difficulty bending. Despite this discomfort, I continued participating in contact sports and strength training until last November. My training during football season was suboptimal since I couldn't manage the physical demands, yet I still engaged in games and weightlifting sessions. After the season concluded, I consulted a physiotherapist who identified SI joint dysfunction and suggested some stretches while I awaited the MRI results (which took four weeks). Unfortunately, these stretches exacerbated my pain and introduced new sciatic symptoms that I had not experienced prior. The MRI indicated no problems with the SI joint but did show: - A minor bulge in the L5-S1 disc causing nerve compression - A potential pars defect In response, my physiotherapist adjusted my rehabilitation plan to focus on strength-building exercises, including resistance bands for hip and glute activation, core stability work, gradually advancing to weighted movements like: - Box squats - Glute bridges - Elevated hex bar deadlifts (40–100 kg) - Single leg Romanian deadlifts (5–30 kg) At the same time, I was attempting to secure a CT scan to verify the presence of a pars defect. The radiology department initially rejected my requests due to my age, but I eventually got a referral from my general practitioner to see both a neurosurgeon and a specialist in sports spine. They ordered: - A CT scan that confirmed bilateral pars defects along with a slight anterior slippage of a vertebra contributing to the disc bulge and nerve compression. - An MRI of the thoracic and cervical spine, which revealed multiple compression fractures in the thoracic region that are asymptomatic and most likely a result of chronic postural problems. ⸻ 📌 Current Symptoms: - Minimal pain while standing or walking - Increased pain and numbness/tingling down my left leg when seated, which worsens over time, particularly during prolonged school days, despite taking movement breaks. - Symptoms intensify with certain movements, especially bending and excessive motion. - Additionally, I have a peculiar pain on the left side of my neck that worsens with turning my head and looking down. An MRI of my neck didn’t show any issues, so I am uncertain about the cause of this discomfort, but it doesn’t seem to be related to the other problems and isn’t my primary concern. ⸻ 🧘‍♂️ Latest Physiotherapy Regimen (from the specialist): - Thoracic rotation while kneeling - Child’s pose with lateral flexion - Basic child’s pose - Knees to chest, bilateral - Trunk rotations The physiotherapist advised me: If any of these movements induce nerve pain, I should cease doing them. I’ve experienced mild nerve discomfort during some of these exercises, particularly with the rotational movements, which confuses me because I believed that twisting the spine was generally contraindicated for disc-related issues. He also mentioned that with dedicated physiotherapy, I could expect to make a full recovery in approximately six months, and I have scheduled epidural steroid injections in around three months. ⸻ 🙏 Request for Advice: I feel at an impasse. More than a year has passed, and my condition has shown minimal improvement. I’ve had to cease all sports and many social activities; managing school is increasingly difficult, affecting my academic performance. I have also made significant lifestyle changes, nearly eliminating sitting throughout my day—I stand while watching TV and primarily only sit for meals or during car rides. However, long car journeys still lead to significant pain that lingers for several days. I would greatly appreciate insights from anyone who: - Has experienced similar issues - Can provide guidance on the safety of twisting/stretching exercises in my case - Has tips for alleviating nerve pain while seated - Has thoughts on my treatment plan (physiotherapy and epidural injections) - Can suggest whether surgery might be a necessary course of action or present alternative options. Thank you in advance for any assistance you can offer!

Answers (1)

6/27/2025, 1:51:23 PM

OpenHealth AI

It sounds like you've been through a challenging journey with your L5 pars fracture and L5-S1 disc bulge, especially with the prolonged symptoms and limited activities affecting your daily life. Let's address your concerns and outline some practical steps you can take.

Main Points:

1. Current Treatment Plan: Your ongoing physiotherapy and the planned epidural steroid injections are key components of managing your symptoms.
2. Exercises and Symptoms: Some exercises may aggravate nerve symptoms, and it’s important to focus on what feels safe and effective for you.
3. Managing Pain: Strategies to relieve pain while seated and during prolonged activities can help improve your quality of life.

Explanation:

You are dealing with a complex injury that involves both a pars defect and a disc bulge, which can impact nerve function, especially with certain movements. The symptoms you experience, such as numbness and tingling, are likely due to nerve compression. It’s important to listen to your body – if exercises cause pain, especially nerve pain, it’s wise to stop those and focus on modifications.

Next Steps:

1. Communicate with Your Physiotherapist:

   • Discuss any movements that trigger nerve pain. It may be helpful to modify the regimens to include gentle, pain-free movements initially before reintroducing more complex exercises.
   • Consider asking for specific exercises targeting core stability and hip strength that minimize nerve compression and avoid twisting movements for now.

2. Focus on Pain Management:

   • Seating Position: When seated, use a chair with good lumbar support. Consider using a cushion that improves posture and reduces pressure on the lower back. Avoid long periods of sitting; try setting a timer for frequent breaks.
   • Movement: If possible, stand or move around every 20–30 minutes to reduce nerve compression. Gentle stretches while standing can also help.
   • Ice/Heat Therapy: Applying ice packs after activities or heat packs to relieve cramping and tightness may provide comfort.

3. Lifestyle Adjustments:

   • Continue avoiding activities that exacerbate your symptoms, such as deep squats and heavy lifting, until you've built more strength and endurance under guidance.
   • Seek to integrate gentle activities like walking or swimming, if they feel manageable, to maintain overall fitness without aggravating your back.

4. Follow-Up on Treatments:

   • Keep your appointment for the epidural steroid injection; this can potentially reduce inflammation and help in pain management.
   • Surgery is generally considered if conservative treatments fail for a significant time or if there’s severe nerve impairment. Make sure to raise this topic in future discussions with your specialists, especially if symptoms do not improve.

5. Consider Alternative Therapies:

   • Explore options such as acupuncture, physical therapy modalities (like ultrasound or TENS), or mindfulness practices like yoga (with modifications) to enhance recovery and pain relief.

Conclusion:

Your condition requires patience and careful management. Monitoring your responses to therapy, staying in close communication with your healthcare team, and making adjustments to your daily routines will be key to your recovery. If your condition doesn’t improve or worsens, it’s vital to advocate for additional evaluation and discuss further treatment options. You're taking positive steps by seeking advice, and I hope these strategies can help you find relief and gradually return to activities you enjoy.