50 percent less pain
(Keywords: 50 percent less pain, nucleus pulposis, slipped disc symptoms, help for sciatica pain) 50 percent less pain is the dangerous time with musculo-skeletal injuries. The really nasty backs we see at the Chiropractic Coalface frequently follow this course: * An initial lower back injury but it applies equally of course to a sprained ankle or any other joint and even tennis elbow, for example. It often comes after bending and heavy lifting, with a twist of the spine. * Pain and restricted movement often begins immediately, but it could be that you go to bed with no inkling you have had an injury. Then next day on waking... It swells during the night and in the morning one is astonished to find one can barely move. * Then follows a period of recuperation . There may be treatment, Chiropractic or other, or none at all. The pain reduces and movement increases within a few days or a week or two. 50 percent less pain. * Then either something silly happens, like lifting again, but possibly only a prolonged period of sitting as in a long car trip, or perhaps something unavoidable like a shower of sneezes. You may go into an odd posture, leaning to the side, like the young man above: The sign of Pisa. * It's sometimes because you stopped the treatment, thinking it would now get better on its own, and you could save some money. * It could be that you weren't put on a rehab programme, or you didn't do the exercises faithfully. * In short, something goes wrong. Bingo. What started as low back pain now has a nasty extra. Pain and tingling in the leg.
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Classically, there are FOUR grades of slipped disc, to which I add a fifth (GRADE V), because the onset of weakness in a leg to me is clinically very significant. They are...
Grade One: Low back pain only = Lumbar disc protrusionIt could be severe, or mild. Movement is usually restricted, especially forward bending, sitting is often difficult, as is turning in bed and dressing in the morning. Coughing and sneezing, and straining on the toilet may be painful. Ouch!
LUMBAR DISC PROTRUSION ... Grade Two: LBP radiating into the buttock and legSo, before it was prudent, you decided to wash the car. Or take a long business trip, or enjoy sexual intercourse without going through the foreplay, which should include thirty seconds of warm up for the back!Another stab of pain in the back, and now you can feel the pain spreading into the buttock and down the leg. It could be just a little tingle, a numb feeling, often just a tight feeling at the back of the thigh, or you could have severe leg pain. Grade 2. Critical, is that when your Chiropractor examines you, there will be no actual numbness, or increased pain on testing with a pinwheel, no change in the reflexes and no weakness. The
SLUMP TEST FOR SCIATICA
is likely to be strongly positive. When s/he raises your leg there will either be pain in your naughty leg, or a very tight feeling compared to the other leg. The so-called "Braggard's Test" will be negative. Grade Three: LBP + leg pain + increased sensationWe make an important distinction between leg pain WITH and WITHOUT "hard neurological findings". In a grade 3 injury, there are actual measurable changes that your Chiropractor will find. When s/he pricks your naughty leg, it's sharper in parts, usually the back of the thigh, calf and side of the foot (the so-called S1 dermatome), but it certainly can irritate other nerves too, affecting the side or front of the leg.The Slump test will now be very strongly positive, and the test of Braggard will probably be positive: Pulling your toes towards your head will provoke pain in the naughty leg. But, in my 5-point grading system, there are still no reflex changes, nor signs of weakness. By now, your leg may start to be more painful that your back. That's an ominous sign.
SCIATIC OR FEMORAL NERVE tingling and pain ... Grade Four: LBP + numbness + reduced reflex and specific weaknessAs the bulge of the disc increases, so does the effect on the nerve. It could be the Sciatic nerve (from the very bottom of your back) which would cause pain in the buttock, and the back or side of your leg and the side or top of your foot.Or it could involve the Femoral nerve in which case you would have pain in the groin (perhaps) and radiating down the front of your leg. What is critical in a Grade 4 injury is the development of "motor" signs. The motor nerve that drives the muscles in the leg is affected, so there will likely be changes in reflexes and the ability to stand on your toes, on your heel, or to squat on one leg. The leg feels and is weak. It may suddenly "give'. This is now a very serious injury and your Chiropractor will almost certainly send you home. You may not sit at all. Bending is forbidden, and you will probably be directed to have intermittent bed rest, with gentle exercises, and walks around the house periodically. Ice is the most effective painkiller. Listen to him or her, and do what you're told, but don't panic. Nevertheless, the surgeon is sharpening his scalpel in anticipation! An MRI scan may be called for. A lumbar corset when you are up and about may help.
Grade Five: Much less LBP + but your leg is on fire.Grade Five is the true hernia and you are certainly on the verge of surgery.Ten years I would not even accept a Grade 5 disc injury case, but surprisingly, I have found that even the true hernia will respond to gentle Chiropractic manipulation, correctly done, in perhaps 50% of cases. If after 3-4 weeks you are not responding, at least 40-50% less pain, a surgical consultation will probably be requested.
50 percent less painHere's the deal. Understand that 50 percent less pain does not mean that your condition has healed by 50 percent. More likely 10 percent, and you are now in a very vulnerable period. You feel 50 percent less pain but in reality you are only 10% better.If it's your back, one unavoidable sneeze (try blowing your nose, you can often avert a sneeze), one silly movement, a long sit in a bad chair (or even a good one), neglecting to do your exercises, and suddenly a Grade 1 has progressed to a Grade 2, or Grade 3 or 4. If it's your shoulder, it could be an awkward movement that you wouldn't have dreamed of attempting a month ago, but now you might be tempted.
Very important ...
PELVIC AND LOW BACK EXERCISESEvery chiropractor will have his/her own ideas on rehab, so discuss it with them but the 50 percent less pain stage is when I begin rehab. You can get some ideas here from YouTube. LOWER BACK EXERCISES ..."Then you will be sitting with baked pears."All languages I suppose have their quaint sayings, and no one has the faintest idea of their origins. Like "it's raining cats and dogs"!"Sitting with baked pears" is a favourite Dutch saying, trotted out with great regularlity. It means having to live with the consequences of a bad decision. When it comes to musculo-skeletal injuries, be it a slipped disc, or a tennis elbow..., the last thing you want is to be sitting with baked pears. Go through the process to achieve maximum healing, and minimal chance of a setback. That means rehab... and not when you have 50 percent less pain.
"Dejeurine's triad" of coughing, sneezing and bearing down on the toilet, laughing too are often associated with acute disc injuries. The onset of constipation is very unwelcome... it may be caused by irritation of the nerves to the large bowel and rectum, or side-effects of medication, or simply the reduced general movement of your body at this time. Increasing the soluble fibre content of your diet is vital. A green bean salad is perfect, of course; so is virtually all fruit and the beetroot is definitely God's gift to the constipated colon.
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Because of the decreased blood supply to the spine smokers have a much higher incidence of lower back pain, and it heals more slowly. They are particularly vulnerable to the Fifty Percent Less Pain rule - in their backs the cartilage in the disc has healed perhaps only 5%, not 10%, when they reach the 50 percent less pain stage! It's all about oxygen...
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50 percent less pain
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