Dr. Atul Prakash
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 19-year-old girl, currently suffering from lumbar or lower back pain. The pain started suddenly two months back and I have never had a history of back pain. There is intense pain in my lower back. Currently, I cannot bend down, sit for a long time, squat properly, and carry heavy things amongst many things. Sometimes, I feel a sharp pain and a numbing sensation on the side of my hip. I have consulted several doctors and done an MRI scan of my lumbar spine but I am not getting a proper diagnosis for my problem. I would appreciate it if I could get a second opinion on what could be the problem.
Hello,
Welcome to icliniq.com.
I have seen the reports (attachment removed to protect patient identity). The MRI diagnosis is of a disc bulge L4-L5 and a mild disc prolapse L5-S1 but both the discs are currently hydrated though L5-S1 is not maintaining the disc height. Primarily, L5-S1 is the source of back pain. Your symptoms could also be coming from core weakness (or muscular) or could be an SI joint in origin. I need more clinical information and examination findings to confirm one from the other.
Patient's Query
Hello doctor,
Thank you for your prompt response and diagnosis. I highly appreciate it. Attached is the report (findings) of the MRI scan done. I hope it will help you further in my diagnosis. As for clinical information, I have seen a couple of doctors and I have not been given any specific treatment and mostly the diagnosis is a degenerative disc and a lifetime condition that I can only manage through taking strong painkillers and wearing a lumbar belt. However, being this young, I want to believe that there is a solution to my constant pain. I seek your help. Thank you.
Hello,
Welcome back to icliniq.com.
The disc L5S1, as it prolapses through the annulus and abuts the theca, both structures start getting irritated and cause the sensation of pain. Over the period of time, the disc will start to dry out and back pain will ease and the pressure reduces. This is followed by a period of reduced symptoms but back pain returns as the facet joints start to get affected. This is the natural history of a disc prolapse without radiculitis. If you say the pain is debilitating, and you are looking at surgery for the pain, it does not reduce in three months. You will need a confirmation discogramand if this replicates your symptoms, then disc replacement may be an option you want to think of.
Patient's Query
Hello doctor,
Thank you so much for the further diagnosis. What am I required to do so as to heal naturally, without having to get the surgery? I would really appreciate it if you could guide me on the proper treatment I need as I have not received it, and that is my main problem. I do not know what I need to do and what I need to avoid during this period so I may heal. Thanks.
Hello,
Welcome to icliniq.com.
The discs unfortunately do not heal and they do not have any blood supply either. The cause of disc prolapse is often a innate weakness in the annulus and this is genetic. The best is to start strengthening your back as soon as your pain subsided, this is also accompanied by precautions and some lifestyle changes. See a good physiotherapist who will guide you initially and guide you with day-to-day issues. It is not everyone who had a disc prolapse needs surgery in the end, but it is often these small disc prolapses that cause more trouble.
Patient's Query
Hello doctor,
What am I required to do so as to make the pain subside? Also, if I understand correctly, the disease is genetic. So, is it a life long condition? If the pain manages to subside in three months or so, will it stay that way, or come back in the future?
Hi,
Welcome back to icliniq.com.
Time, physio - deep massage to relieve spasm, painkillers , anti-inflammatory tablets and the avoidance of aggravating factors as unprotected lifting, sneezing, coughing, etc. A positive frame of mind is very important. Yes, for many people this can become a life long condition that they have to deal with, adapt and live around the problem and have a fruitful life. Surgery often is reserved only for intractable symptoms leading to loss of work, lifestyle, etc.
Patient's Query
Hi doctor,
Can I do yoga? Because, physiotherapy is a little difficult for me to get in my place. In addition, will weight loss help in reducing the pain?
Hi,
Welcome back to icliniq.com.
Sorry, I did not ask about your weight. What is your BMI, height, weight and build type? Yes, yoga and pilates are good for core strengthening and gentle swimming is another option. You should explore that if you have not. But, listen to your body cues.
Patient's Query
Hi doctor,
I am 166 cm tall and weighs 74 kg. So, my BMI is 26.9. I am a medium build slowly leaning towards slim. I am a mesomorph, meaning it is easy for my body to lose and gain weight when I diet and exercise properly. I also gym a lot, and lift and squat moderate to heavy weights. However, I may change physically but the weight on the scale almost always remains constant. Yes, I used to swim a lot. I will get back to it and see how my body responds to it, thank you.
Hi,
Welcome back to icliniq.com.
Yes , the condition does not choose who it affect. You have all the right notes. I am sure this is just a blip. You will be able to come out of this unscathed, have patience and be ready to change. All the best.
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Orthopedician and Traumatology
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