How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31263
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
Type Your Health Question Here...
Dr. Arun Phophalia is online now
A new question is answered every 9 seconds

I am a nurse and had injury on the job three mths ago. My

This answer was rated:

I am a nurse and had injury on the job three mths ago. My mri shows L4 L5 foraminal disc protrusion abuting nerve and L5 s1 broad based protrusion abuting S1 nerve root within spinal canal and neural foramin. I have had two rounds of po steroids and PT with pain down both legs and unrelieved by meds. Still awaiting workers comp for neuro surg consult. Anything else I can do to releive pain. Not getting any better and as a nurse I really do NOT want any surgery.

Hello Lisa,
I am Dr. Arun and will be helping you today.

What is your age?
Do you have radiculopathy symptoms too; numbness, tingling, pain, weakness in lower limb?
How severe are your symptoms?

Customer: replied 3 years ago.

I'm 40. I have been a nurse for 17 years. I have numbness tingling like electric down mainly left leg but pain also moves to groin and also to right thigh hip. Pain on and off is severe ache but again has flared up to constant shooting down legs even with no movement. Worse sitting and walking. I have had sciatica on and off for years and tx with chiro and massage therapy which has always helped. After moving pt off gurney I felt pop and sense then three months ago I have had little relief with flare up again this past week with PT. Workers comp denied my docs request for neuro surg consult and wants me to see a neurologist. My workers comp co also read my mri which my doc felt was conflict of interest. The mri showed osteophytes at t12 with mild stenosis and the L4 L5 and S1 have disc dissication. I wouldn't care about the finding except the pain is dibilitating. I don't want to use pain pills either as I see everyday the trouble they cause.

Hello Lisa,

The surgery is indicated in following cases;

1) Increasing pain
2) Severe excruciating pain.
3) Bladder and bowel involvement.
4) Failure of conservative treatment.

Usually initially a neurologist is consulted and if he determines that issue is significant enough; neurosurgeon is consulted. Collective measures as following are recommended, meanwhile (many of which you have already tried);



1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:

a) Avoid activities which increases the pain.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor


2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants


3) Local analgesic gels or sprays / ointment


4) Hot fomentation


5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.


6) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.


7) Lumbosacral corset or support or brace; this is important in cases due to injury

8) If obese or over weight, reduce weight for long term benefit.

9) Epidural steroid shots

10) Surgery is usually last resort, when the above conservative measures fail. You can start the following exercises;

1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.

2) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).

This is a slide show for the exercises (you can pick up your own set, which suits you);

You can consult following specialists;


a) Orthopedist

b) MD in Physical medicine and rehabilitation

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.


We have recently implemented a new rating and feedback system. Please be aware that you are rating my courtesy and service as a professional. If you have any questions whatsoever, or there is anything I can clarify for you, please temporarily bypass the rating system by clicking “Continue the Conversation” or "Reply."

Clicking either of the lowest two options reflects poorly on me so please reply to me if there is anything else I can do to help before choosing those options. I appreciate your patience while we work out the kinks. It's important to me that you are 100% satisfied with the service I have provided you. Thank you.

Customer: replied 3 years ago.

I have been doing PT...bracing excercises...e stim tx...working with therapists. Unfortunately I cannot limit what causes pain as it is sitting and walking both of which I need to do to work and live. I have lifted...bent 90 degrees etc since the injury. I guess my question is with the mri results and my ongoing symptoms would epidural injections be appropriate? Why would neurologist need to be seen to evaluate symptoms? Is there some kinda of a test a neurologist would do the internal md isn't qualified to do? Wouldn't a neurosurgeon review actual mri films? I feel this process has been drug out due to it being workers comp and even the physician I'm seeing feels it is odd to have neurologist consult instead of neurosurg. I'm hoping injection may help bc at this point I have seen little to no improvement with me following and participating in numerous of what you listed above.

Hi Lisa,

The neurologist is considered to have slight bias for the surgery. So it has been a convention to consult the neurologist in worker's compensation cases. The neurosurgeon would review the original films of the MRI and do not go just by the MRI report, apart from assessing by physical exam. Epidural in your case has significant chance of abating your symptoms. The neurologist would usually get the following additional studies done;

1) Nerve conduction velocity study (NCV)
2) Electromyography (EMG).

It is privilege assisting you.

Dr. Arun
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31263
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 6 other Health Specialists are ready to help you
Customer: replied 3 years ago.

Thank you. that's what I was looking for. Just wanted to know what other tests they might run and if it was normal for neurologist to be consulted bc my doc felt this was odd. I'm sure its bc workers comp trying to find any way to not have to pay for something. Awesome when you have spent your career taking care of people. Thank you for your advice.

You are very welcome, Lisa.

Worker's compensation do go a bit slow and their protocol as you know and understand is slightly deviated from standards of protocol.

Wishing you all the very best.

Thanks for the excellent rating.

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Previous | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ

Meet The Experts:

  • Family Physician

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    Emergency Medicine and Family Practice for over 26 years
< Last | Next >
  • Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    Emergency Medicine and Family Practice for over 26 years
  • Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • Dr. Ketch's Avatar

    Dr. Ketch


    Satisfied Customers:

    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    Board Certified NP, MS, RN. Private practice & hospitalist
  • Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    U.S. Physician/Surgeon in Neurosurgery
  • Dr. Gupta's Avatar

    Dr. Gupta

    Doctor (MD)

    Satisfied Customers:

    Vastly experienced MD Physician with 19 years of experience.