L5/S1 disc bulge and facet joint hypertrophy

by Shyla

Hi Sarah,

I've had sciatica for 3 weeks now and for further investigation I had an MRI scan.

The report was as follows:

Nearly complete S1/2 disc, with a dehydrated L5/S1 disc with a posterior disc bulge. At L5/S1 there is a mild, broad based annular disc bulge. On the right side, there is small focal protrusion of disc material into the right lateral recess which must be compromising the transiting right L5 nerve root. Moderate facet joint hypertrophy causes mild narrowing of the central canal. Elsewhere there is mild facet joint hypertrophy but no significant disc, cord or nerve root compression.

I'm worried that irreversible damage has been done to my back. I was hoping you could give me some advice.

many thanks

Comments for L5/S1 disc bulge and facet joint hypertrophy

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Jun 07, 2013
Facet joint problemL5/S1
by: Jean Harris

Hello Sarah, do you remember me, I was your" little worry" at Back in a week several years ago in Cornwell. Well, everything was going fine until Feb of this year slowly my lumber spine was getting worse and worse, lots of burning in the right side buttock and groin pain, pain in my knee and foot, and can't sit that is my biggest problem. When I try to sit it feels like I am sitting on broken glass. Physio has given me a steroid injection in L5 3 days ago, no improvement at all. Should it have worked by now? And why can't I sit.? I am supposed to be going on holiday on Saturday to America, 81/2 hour flight, I won't be able to sit for 30 mins never mind 8 hours, looks like this holiday will have to be cancelled. Any suggestions what zi can to to get some sin relief? Good to hear you are still jet setting around the world.
Kind Regards,

Apr 14, 2013
tennis ball therapy
by: Godwin

I heard you on ABC Overnight 3 days ago, and today practised your tennis ball excercise on my lower back & WOW ! for the first time in about 20 years I got instant relief !!!

Apr 04, 2013
l5/s1 disc bulge and facet joint hypertrophy
by: Shyla

Hi Sarah
Thanks for your reply. I live in West Yorkshire. Hope you've recovered from your jet lag. I've been seeing a chiropractor since the past couple of weeks. His initial treatment made my problem worse but after a couple of sessions, he changed his treatment after which my back went back to its state before I went to see him. The biggest problem is getting really painful trigger points first thing in the morning. They are difficult to release and are extremely painful. When I cannot release them, I have to take painkillers during the day as well. Some days are better than others and I can do without painkillers during the day. I suppose it depends on what happens to my back during the night when I'm lying down. The chiropractor looked at my posture and like other practitioners also said that I didn't straight...that the right side of my body was slightly twisted. I'm tempted to ring up the NHS Centre and ask them if the MRI scan showed anything in the piriformis region.

Apr 03, 2013
about your back
by: Sarah says:

Hello again Shyla,
I'm sorry to be off the air for so long but I have been in the UK running both a Back-in-a-Week in Cornwall and a two different Masterclasses in the UK. I have been back home in Sydney for a week, flat with jet lag.
I'm glad you took in the videos and now are going at your back at a different tempo. You will find doing it much more slowly makes the muscles relax more (it certainly sounds as if they are very tight).
To have the knee pain it would seem that you have a high lumbar problem. You might include 'the floor twists' here too in your regime between repeat goes on the BackBlock, which are in the book.
Just make sure you keep at it. It seems quite stubborn which may indicate you have some nerve root tethering around the nerve root as well.
Where doi you live?

Mar 17, 2013
l5/s1 disc bulge and facet joint hypertrophy
by: Shyla

Many thanks for your reply again. That's really interesting that the piriformis trigger points are referred pains. My physio has been trying to release the trigger points for quite some time but they keep coming back.

I've been having back pain and recently severe knee pain since the last 10 years. The back pain started getting worse after I fell when ice skating. I slipped, knees in the air and straight on my bottom and my whole spine shook quite badly. Ever since, the back pain has been progressively getting worse. I've been to physiotherapists, osteopaths and acupuncturists.

Over the years I've been told that my back pain was due to the pronounced curve in my lower back and tightness in my back muscles. One physiotherapist tried to loosen the tightness in my lower back and finally gave up. She then asked me to go to a craniosacral physiotherapist. I spent tonnes of money for those treatments and still there was no improvement. The osteopaths tried various things as well and then gave up after around 10 sessions. During this time, my knee pain would improve for a bit and then bounce back again.

I've noticed there are trigger points all over my upper and lower back as I've been using the tennis ball. I've always been good at stretching and doing yoga. My husband bought me your book some years back and I did try the exercises that were recommended in the book. But I recently watched your videos and I think I wasn't the exercises correctly. I wasn't doing them as gently and subtly. I had also joined a gym for 3 months to strengthen my core muscles and my knees...but nothing seemed to make any difference. In fact, my knee pain increased as my back got worse.

I'm just baffled about my back now. I sit at a desk for long hours so this definitely is one of the causes. I've got a gym ball which I'm hoping to use instead of the chair once the sciatic pain subsides. I wonder if tightness in my back muscles is causing problems in spine or if the spine is causing the tightness in my back. I've been referred to a chiropractor and my first visit is on Friday.

The sciatic pain seemed to improve recently and then it came back again, although it isn't as bad as it was a couple of weeks back. I'm taking Amitryptiline (an anti depressant), Codeine and paracetamol for pain relief. Do you think I should take some anti inflammatories as well?

I'd be interested to know what you thought the cause of my back pain was.

many thanks

Mar 15, 2013
more about disc bulges and treating L5-S1 facet joint problems
by: Sarah says

Yes, I do mean you to mobilise the facet joint itself with the tennis ball, not the piriformis. Although you may FEEL the pain in your buttock (and yes, it may be piriformis spasm, but it can also simply be referred tenderness) it is rather like you treating the effect and ignoring the cause of your trouble. You have to find the source!
Also, you may like to read here - http://www.simplebackpain.com/computerposture.html - what I have to say about sitting up unsupported (on a fit ball, or a kneeling chair) if you have a bad back. In short, you are making your back work too hard when it is in recovery mode and this will keep muscles compressing and the bulge ’out’. In answer to your question about 'will the bulge disappear'? If you can relieve the compression by getting the muscles to behave, to will get rid of any bulges. It is the vertebrae squidged together, especially at the problem level, that causes the bulging.

Mar 12, 2013
l5/s1 disc bulge and facet joint hypertrophy
by: Shyla

Hi Sarah, many thanks for your prompt reply. I really appreciate it.

I've been using a tennis ball to try and release trigger points on and around the piriformis, where I feel pain and almost like a burning sensation. That particular trigger point isn't budging for some reason.

Was wondering if you suggested I use a tennis ball on the L5/S1 area. I'll try that now.

Also, do you think the disc bulge will reduce in time? I've started using a gym ball to sit on to improve core strength and to mobilise my lower back.


Mar 12, 2013
about your recent sciatica
by: Sarah says

Hello Shyla,
You are in luck, because whatever else is going on, you have time on your side. Three weeks is recent in the overall scheme of things, no matter what the pain levels.
It seems very much to me that the facet joint at L5-S1 is responsible for your leg pain, rather than the focal bulge of the disc here.
You will know from reading me (Back Sufferers' Bible, Chapter 3 is best for you) that the facet joints are very different from the discs, and the most common cause of leg pain when inflamed. They have a huge blood supply and a nerve supply to match. This means that they are very 'mercurial' in their response the mild trauma and can swell out of control if they get clobbered with any type of wrench or even a chance awkward movement. ON the other hand, the intervertebral disc on the other side of the nerve is much more sleepy and difficult to annoy.
It used to be thought in the old-fashioned 'backworld' that sciatica meant a slipped disc. This is not the case. Indeed I feel that the disc only bulges as a result of the muscles clenching to protect the annoyed facet joint - in other words, the bulge is a 'response' not a primary action. Best to get the engorgement away from the facet and then the bulge will pale away as the protective muscular compression comes off.
I am going to suggest you try to use a tennis ball to mobilise this joint and disperse the swelling yourself.
To do this you lie on the floor on your back, with your knees bent. Place the tennis ball under your back on the side of the pain and lower your weight down upon it. You will have to wriggle around slightly to find where the 'sweet spot' of pain is (it WILL BE quite painful when you find it) and try to relax your body down onto it, without flinching.
Once in position (it may take some finding to get the exact spot) you move minutely to mobilise the joint. Only continue for about 2 minutes.
It is interesting that you seem to have an extra mobile link in your spine. This is unlikely to be related to your pain.

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