L5-S1 Annular Tear

An L5-S1 annular tear refers to a tear in the outer layer (annulus fibrosus) of the intervertebral disc located between the fifth lumbar vertebra (L5) and the first sacral vertebra (S1). This type of injury is common due to the significant mechanical stress this region endures, as it supports much of the body’s weight and is highly involved in movement.

Annular tears can lead to disc herniation or leakage of the disc’s inner material (nucleus pulposus), causing pain, inflammation, and nerve compression. Symptoms may include lower back pain, sciatica, and limited mobility. Early diagnosis and treatment are critical for managing symptoms and preventing further complications. In this article, we will go over all of these in detail.

What Is an Annular Tear in the L5-S1?

An annular tear in the L5-S1 disc occurs when the outer ring of the intervertebral disc (annulus fibrosus) develops a tear or rupture. This disc is located between the last lumbar vertebra (L5) and the sacrum (S1), a critical junction in the spine that bears substantial weight and endures repetitive stress.

When the annulus fibrosus is compromised, the inner gel-like core (nucleus pulposus) may protrude or leak, irritating nearby nerves and causing localized pain, radiating leg pain (sciatica), or numbness. This condition can result from aging, trauma, or repetitive strain.

Symptoms You May Notice

An L5-S1 annular tear can cause a range of symptoms that vary from mild discomfort to severe, debilitating pain. These symptoms often depend on the extent of the tear and whether it affects nearby nerves. Here are some common signs you might experience:

Neck, Mid or Low Back Pain and Muscle Spasms

Pain originating in the lower back is the most common symptom, though the discomfort may extend to the mid or upper back and neck if the tear leads to muscle tension. Muscle spasms can occur as the body reacts to the injury, resulting in stiffness and restricted movement.

Radiating or Sciatic Pain

If the annular tear irritates the sciatic nerve, you may experience sharp, shooting pain radiating from the lower back down through the legs, commonly referred to as sciatica. This pain may worsen with movement or prolonged sitting.

Tingling and Numbness in Arms or Legs

The tear may compress nerves, leading to a tingling or “pins and needles” sensation in the arms or legs. Numbness, particularly in the legs, is often a sign that the nerve root is being affected.

Limited Flexibility

Pain and inflammation from the annular tear can significantly limit your ability to bend, twist, or perform activities that require flexibility. Movements that engage the lower spine may exacerbate discomfort, leading to further stiffness and decreased range of motion.

Common Causes of Annular Tears

Annular tears in the L5-S1 disc can occur for a variety of reasons, ranging from natural wear and tear to sudden trauma. Understanding the potential causes can help you to identify risk factors and take preventive measures.

Natural Degeneration Due to Age

As we age, the intervertebral discs naturally lose water content and elasticity, making the annulus fibrosus more prone to tearing. This process, known as disc degeneration, is a leading cause of annular tears, especially in individuals over 50.

Certain Occupations or High-Impact Activities

Jobs or activities that require repetitive heavy lifting, bending, or prolonged sitting can place added strain on the lower back. Over time, this constant stress can weaken the disc and lead to an annular tear.

Accidents

Sudden trauma from car accidents or falls can cause acute tears in the annulus fibrosus, especially if the spine is twisted or subjected to direct impact. These types of injuries may lead to immediate pain and inflammation.

Sports Injuries

High-impact sports like football, gymnastics, or weightlifting can create excessive pressure on the lower back, leading to disc tears. Repeated jarring or twisting motions increase the risk, particularly in the lumbar region.

Improper Lifting or Movement

Lifting heavy objects with improper forms, such as bending at the waist instead of the knees, can result in a tear. Even everyday movements like bending or twisting awkwardly may cause or worsen an annular tear, especially if the disc is already compromised.

Common Treatment Options for Annular Tears in the L5-S1

Treatment for an L5-S1 annular tear depends on the severity of the tear, the extent of nerve involvement, and the patient’s overall health. Both non-surgical and surgical options are available, aiming to relieve pain, reduce inflammation, and restore mobility.

Early intervention can often prevent the condition from worsening, while more advanced cases may require specialized care. Below are common treatment approaches to help manage this condition.

Hot/Cold Therapy

Hot/cold therapy alternates between applying heat and ice to the affected area. Heat increases blood flow, relaxes muscles, and reduces stiffness, while cold therapy reduces inflammation and numbs sharp pain. Using this method can help reduce pain and inflammation in the lower back due to the annular tear.

Massage Therapy

Massage therapy helps to relax tight muscles, improve blood circulation, and reduce discomfort associated with annular tears. It can help ease muscle spasms caused by nerve irritation from the tear. Although massage does not directly treat the tear, it can enhance overall recovery by reducing pain and stress in the surrounding tissues.

TENS Therapy

TENS therapy involves using electrical currents to stimulate nerves through the skin. This stimulation can reduce pain signals sent to the brain, providing pain relief. While it does not heal the annular tear itself, TENS therapy is often used for managing chronic pain and improving patient comfort during recovery.

Epidural Steroid Injections

Epidural steroid injections (ESIs) involve injecting corticosteroids directly into the epidural space near the affected disc to reduce inflammation. By minimizing inflammation around the nerves, ESIs can alleviate pain, numbness, and tingling caused by an annular tear. This option provides temporary relief and is often used in conjunction with other therapies.

Annular Tear Repair

For more severe cases or when conservative treatments fail, surgical options like annular tear repair may be considered. Techniques like endoscopic discectomy or laser spine surgery can be used to directly repair the tear and relieve pressure on the nerves. The goal is to stabilize the disc, reduce symptoms, and prevent further disc damage.

Unfortunately, with discectomies, removing part of the disc that is torn/herniated can lead to advanced degeneration of the disc and eventually leads to continued disc degeneration.

Patients who underwent standard discectomy showed a fivefold greater cumulative incidence of moderate to severe (grade ≥ 2, Kambin severity scale) lumbar disc degeneration at a mean of 5.5 years follow-up than those who underwent microdiscectomy (1)

NSAIDs

The other day I was evaluating a patient and reviewing the treatment options for their spine condition. After discussing prior treatments, we got to the topic of medications taken for pain relief. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years…..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day. I was shocked, considering she was pre-diabetic and with high blood pressure plus the kicker of it is that her PCP (primary care physician) is ok with this…

Other Related Spinal Conditions

An annular tear may not occur in isolation and can be related to or contribute to other spinal conditions. Understanding these related issues can provide insight into your overall spinal health and guide effective treatment.

Degenerative disc disease: As discs lose hydration and flexibility with age, they become more prone to tears, including annular tears, leading to ongoing back pain and discomfort.
Herniated disc: An annular tear can cause the inner disc material to leak out, leading to a herniated disc, which may compress nearby nerves and cause severe pain or sciatica.
Spondylosis: Age-related wear and tear on the spine, known as spondylosis, can weaken the discs and increase the risk of an annular tear.
Neck pain: While L5-S1 affects the lower spine, related conditions may cause strain or compensatory pain in the neck, particularly if there are altered posture or movement patterns.
Back pain: Chronic or acute back pain is a common symptom of annular tears, especially if the tear causes instability or irritation in the surrounding muscles and nerves.

Spinal Stenosis

Spinal stenosis is the narrowing of the central spinal canal and is a cause of significant pain and disability. Common causes of spinal stenosis include disc protrusion, facet overgrowth and ligamentum flavum thickening. Surgery is often chosen when conservative therapies fail despite the lack of convincing evidence that it is a superior treatment option. Are there alternatives to back surgery for spinal stenosis? Yes. Regenexx DDD utilizes precise platelet injections into the facets, muscles, and ligaments to treat the lumbar stenosis, treating all of the components of the issue, which is crucial. Spinal stenosis is often an age-related condition attributed…

Sciatica

Disc herniation, disc protrusion, overgrowth of the facet joint, and thickening of the ligaments can result in nerve root compression or irritation, causing symptoms of sciatic compression. Some causes of sciatic compression can be interrelated with the following conditions: Degenerative disc disease, Spinal stenosis, damage or injuries to the discs, spondylolisthesis, piriformis syndrome, osteoarthritis. The symptoms of sciatica include pain in the lower back, buttock, and down your leg, numbness and weakness in low back, buttock, leg, and/or feet, pain increase with movement, “Pins and needles” feeling in your legs, toes, or feet., loss of bowel control, and incontinence. Sciatica can be treated…

Get Diagnosed Properly To Get The Best Treatment

Identifying the exact cause of your symptoms is crucial to receiving the right treatment and avoiding further complications. A proper diagnosis ensures that your condition, whether an annular tear or a related spinal issue, is addressed with the appropriate treatment plan.

Early intervention can prevent worsening pain, improve mobility, and enhance your quality of life. If you’re experiencing persistent back pain or other related symptoms, consult a healthcare professional for a thorough evaluation and a tailored treatment approach.

Experience The Centeno-Schultz Clinic Difference

Newer technology in ortho-biologics such as PRP (platelet-rich plasma) or BMC (bone marrow concentrate) may be a better option with fewer side effects, allowing for natural healing and preventative for long-term degeneration.

Click the pages below to learn more:

Want to know more about your condition? Talk to us and we will help you get your back in good shape.

Click Here

Our L5-S1 Annular Tear Doctors

If you have been dealing with a L5-S1 Annular Tear and are contemplating surgery, call and set up an evaluation with one of our experts who can further evaluate you and your candidacy for a surgery avoidance.

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

Back Fusion

Spinal fusion, also known as back fusion, is a surgical procedure designed to help severe spinal instability that causes severe pain or nerve injuries. It involves permanently connecting two or more vertebrae in your spine to eliminate motion between them. This article will delve into the intricacies of spinal fusion, exploring the reasons behind the…
Understanding the Thoracic and Lumbar Spines

The thoracic spine and lumbar spine make up a vital nexus of stability and mobility in the human body. In this exploration, we delve into the biomechanics and complexities that define these regions, unraveling their significance in posture, movement, and overall well-being. Understanding the thoracic and lumbar spine not only illustrates the mechanics of our…
Understanding the Role Of The Thoracic Spine Muscles

The thoracic spine plays a critical role in the stability and mobility of the upper body. Comprised of twelve vertebrae and an intricate network of muscles and ligaments, it serves as a central pillar supporting the structure and movement of the body. Understanding the role and function of thoracic spine muscles is pivotal for anyone…
Exploring the Lumbosacral Joint: What Should You Be Wary Of?

The L5 S1 joint, or the lumbosacral joint, is a critical joint. It lies between the lumbar segment of the spine and the auricular processes of the sacrum. The L5-S1 joint plays a vital role in transmitting the weight of the body via the sacrum and ilium downwards. The weight is distributed to the femur…
What Is The Cervical Spine? Understanding Its Role And Functions

Neck pain is a significant contributor to worldwide disability, affecting people of all ages and both sexes. According to the Global Burden of Disease Study 2019, neck pain is the fourth leading cause of years lived with disability (YLD) globally, accounting for 43.9 million YLDs. Neck pain can be caused by various factors such as…
What is a Cervical Disc?

There are 23 discs in the spine: 6 in the cervical region (neck), 12 in the thoracic region (middle back), and 5 in the lumbar region (lower back). The disc’s function is to provide flexibility and stability to the spine. The disc absorbs approximately 70% of the forces placed on the spine in multiple movements…
How To Release A Pinched Nerve In The Shoulder

A pinched nerve in the shoulder occurs when a nerve is compressed or irritated anywhere along its path, from the nerve root where it emerges from the cervical spine to the area in the shoulder it supplies. This can lead to shoulder pain, numbness, and pins and needles, and can even affect the movement of…
PRP for Herniated Disc, Bulging Disc, and Disc Protrusion

Dr. Pitts discusses PRP for Herniated Disc, Disc Bulge, and Disc Protrusion Transcript Hello, everybody. This is Dr. John Pitts of the Centeno-Schultz Clinic, where we are the leaders and inventors of much of the field of interventional orthopedics, which is basically treating and diagnosing musculoskeletal, orthopedic-type problems using injections and regenerative agents rather than…
Watch Dr. Pitts Perform a Disc Treatment Using Stem Cells

Today, we invite you into one of our interventional orthopedics procedure suites. Dr. Pitts will be performing an advanced image-guided stem cell injection into an L4–5 disc to treat a patient with an annular tear and low back pain. Watch the video below, and you can also review terminology and equipment in this post below…
How Disc Bulges in the Lumbar Spine Cause Your Leg to Hurt

Specialized doctor discusses lumbar disc bulges, epidrual steroid injections and stem cell therapy

References:

Schroeder, J. E., Dettori, J. R., Brodt, E. D., & Kaplan, L. (2012). Disc degeneration after disc herniation: are we accelerating the process?. Evidence-based spine-care journal, 3(4), 33–40. https://doi.org/10.1055/s-0032-1328141