Physical Rehabilitation Medicine/ruptured L-5


QUESTION: My 23 year old son has had moderate to severe lower back pain/sciatica for the past 4-5 months. An MRI showed that the L-5 is ruptured.  My son has been receiving PT and traction which has not helped.  He had an epidural which helped for about two weeks and then the pain returned.  One day, he had to lean into the wall to support his body while walking to the bathroom.  He had a second epidural three days ago and is continuing with pt/traction three times a week. How long do we go with the conservative route before seeing a spinal orthopedist?


I'm sorry to hear about the pain your son is in.  Sometimes a best solution is a surgical intervention, although it's best to avoid this if possible.
There is no reason to wait to see an orthopedic surgeon.  Seeing a surgeon doesn't mean you must do surgery.  I advise you go and discuss the options that are laid out. I also advise seeing several doctors, there are usually more than one surgical solution advised.  

The epidurals haven't shown themselves to be much help.  I am assuming that an MRI was done.

Has your son tried any kind of corset like back support?  This may help reduce compression of nerve roots.

Sometimes though surgery is really the best solution.  Younger aged people who have a significant disc bulge sometimes do worse that middle aged people with a bulge because young people have more volume and material in the central part of the disc that displaces with the rupture.

Best regards,


---------- FOLLOW-UP ----------

QUESTION: Is a spinal doctor or a neurosurgeon the best type of doctor to see if surgery is being considered?

That is a good question.  Primarily you need to do your homework and ask your local trusted sources such as your family doctor.  You can see several doctors.  Seek help from a surgeon whether its a neurosurgeon or an orthopedic spine doctor.  Ask lots of questions, and be sure you feel comfortable with your decisions.

Best regards, Rachel

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Rachel Katz, PT, SEP


I have expertise working with recovery from car accidents, RSD/CRPS, neck and back pain and chronic pain. I can answer questions about pain that is not responding to expected patterns of recovery. I can address pain issues that are associated with traumatic events, and veteran associated pain issues. If you have had abuse or periods of significant stress in your life, your pain issues may be more complicated. I authored A Consumer Guide for Recovery from Car Accidents which discusses many aspects of injury recovery as all as specific detail about PTSD, traumatic brain injury, and protective involuntary muscle spasm. The link is: I can't answer questions regarding pain medications, or some specifics related to surgical interventions.


I have over 30 years experience as a Physical Therapy clinician. I taught swimming in Michigan and skiing in Aspen. I have experience in analyzing movement patterns and muscle control. I treat all areas of pain in the body including headaches, neck pain, back pain, shoulder injuries, plantar fasciitis, nerve compression, and knee pain. I have had personal experience with chronic pain, RSD, car accident injuries, PTSD, and traumatic brain injury (TBI). Muscle spasm and pain is a common component of injury and response to traumatic stress. Posture patterns and habits of how your body is often used can also contribute to pain. Restoration of movement and the senses that enable you to feel it are key. Rachel developed and implemented a stress reduction program for inmates within the Boulder County jail's drug and alcohol recovery program in 2005-2006 based on trauma healing principles from Dr. Peter Levine.

Rachel holds a BS in PT from the University of Colorado Health Sciences Center. She has over 30 years experience as a clinician. She has over 1500 hours of post graduate continuing education in many Manual Therapy and Exercise approaches. She completed her training in Somatic Experiencing under Dr. Peter Levine in 2000. This 3 year program trains therapists in treating traumatic stress conditions. Rachel has developed a body of work integrating her training and unique insights into complex pain issues. She is the developer and instructor for Sensory-Motor Manual Therapy, which is a State approved 2 day work shop for Massage Therapists through the Boulder College of Massage Therapy.

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