The really nasty backs we see at the Chiropractic Coalface frequently follow this course:
* An initial injury to the spine or pelvis, 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 little twist at the hips.
* 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.
Searching for something specific? Say, " Pinched nerve in neck ". Just type it in here...
5 grades of slipped disk
Classically, there are 4 grades of slipped disc, to which I add a fifth, because the onset of paresis (weakness) in a limb to me is clinically very important.
Grade 1: Low back pain only
It 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!
Grade 2: LBP radiating into the buttock and leg
So, 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 leg. It could be just a little tingle, a numb feeling, 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.
SLUMP TEST 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 3: LBP + leg pain + increased sensation
We 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.
Grade 4: LBP + numbness + reduced reflex and specific weakness
As 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.
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 treatment for pain control. Listen to him or her, but don't panic. Nevertheless, the surgeon is sharpening his scalpel in anticipation! An MRI scan may be called for.
Grade 5: Much less LBP + but your leg is on fire.
Grade 5 is the true hernia and you are certainly on the verge of surgery.
Ten years ago 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.
"Struggle, difficulty, and other forms of adversity help people develop some of their most positive traits and characteristics. As I reflect on my life, I believe the difficult times were also the times I learned the most, and the occasional setbacks were often the best things that ever happened to me."
Dr Mardy Grothe
Aside: Do you get Dr Grothe's free weekly newsletter? You should, marvellous. webmaster[AT]drmardy[.]com
50 percent less pain
Here'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.
Don't abort the treatment in order to save a few dollars. You may find yourself a few thousand short, even a few tens of thousands. Go for your treatment.
Do your exercises religiously, with great fervour! Every morning before getting out of bed.
Try not to sit too much, especially in the car and the luxury seats in front of the television. Try perching on the corner of a desk, or back of a low-backed chair.
If it's your ankle, knee, shoulder... just keep reminding yourself that 50 percent less pain ≠ 50% healed.
LOWER BACK EXERCISES
Every 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 ...
This month two things coincided. The pole beans in my garden have been prolific and I discovered Glycemic Index. Nothing new about GI, but I'm Johnny-come-lately!
And pleasantly surprised to discover that the delicious green bean, all legumes, in fact, have a very low GI. The production of glucose in the blood stream is sustained and slow, just what you need to keep you going, without producing an insulin rush.
The reason is simple. Beans are full of soluble fibre, they have in-built vegetable protein, and one usually adds some form of fat to improve the flavour. Here you read about our Cooking Green Beans and a Green Bean salad recipe.
COOKING GREEN BEANS ... we use olive oil in the salad.
Yup, you guessed it. 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... and smokers have furred up arteries.
ATHEROSCLEROSIS SYMPTOMS Low Back Pain ...
STOP SMOKING PERMANENTLY
This is not a book for you if you are not serious about quitting smoking. Because having read it, you will never be a comfortable smoker again - Allen Carr, an ex-smoker himself, destroys all of the excuses that smokers typically bring forward to justify their deadly habit.
But if you are serious... buy it! A marvellous help. Smoking knocks ten years off the average life, more if you are unlucky, and the end is almost always S-H-one-T! Unless you are lucky enough to have a heart attack. Then it's SHIT for your family. Excuse the French but we are talking hee about life and death, nothing less.
MAKE UP YOUR MIND TODAY, AND SET A DATE WHEN YOU ARE GOING TO QUIT.