L4 LUMBAR SPINE CaseFileL4 LUMBAR SPINE CaseFile tells the story of a young woman who had a serious skiing accident eleven years ago. Mrs M had a serious hyperextension fall when she was 30 years old. Immediately after the accident should started going into an antalgic (Pisa sign) posture to the right, with such sharp pains that she would literally fall to the ground, sometimes 10 x in a day. This is what happened, except skiing:
This is the antalgic sign, or as I call it the Pisa sign! Notice how this young man leans to the right. It's a temporary posture, indicative (in my book) of a serious postero lateral disk herniation. Others have a differing opinion.
The pain in our L4 LUMBAR SPINE CaseFile radiated into the typical pattern her left buttock and down the side of her left thigh. The pain was aggravated by the so called Dejeurine's triad: Pain with coughing, sneezing and bearing down on the toilet. Walking down the stairs caused severe pain in the sacroiliac joint. Sitting was often a nightmare. To add even more insult, she had coccyx pain. She struggled for eleven long years with this condition. Physical therapy helped in the beginning; physiotherapy and antiinflammatories brought minimal relief. A Valsalva test, sign of a lumbar disc protrusion, was painful, as was the Lhermitte's sign: flexing her head and neck caused severe low back pain. Slump test was positive provoking left lower lumbar back pain and a numb feeling in her left leg. Lasegues test was positive, but only in her back. Four of five sacroiliac tests were strongly positive in the left sacroiliac joint. Bending forwards provoked pain in the low back and tight feeling in the left leg. Extension was even more painful. There was weakness in her left lower leg.
AssessmentIt was a confusing example for our L4 LUMBAR SPINE CaseFile. Some tests pointed strongly to a Postero Lateral disk herniation, others to a lumbar facet syndrome, and some to a sacroiliac joint injury. From a diagnostic point of view we like backs to be neat and tidy - but the truth is, in a serious injury, sometimes more than one tissue is injured, hence the confusing signs.The pain in her leg, and weakness in her lower leg was not a good sign. She was on the verge of surgery. And needless to say desperate. (below a link to the common type of lumbar disc protrusion, called a postero medial disk herniation.
POSTERO MEDIAL DISK HERNIATION ... TreatmentThere were no miracles. She had a lot of treatment, more than I am accustomed to giving - 14 consultations over a 6 months period and slowly, slowly the pain reduced. By the end of the period she had little pain.The treatment consisted of lumbar manipulation and the Thompson drop protocol for the sacroiliac joint treatment.
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She does her exercises faithfully, and has accepted the limitations of a weak back - she doesn't do stupid lifting. Alas serious conditions like this are hardly ever cured. It's like diabetes - will need life long management. Primaily, like diabetes, at home: exercises, walking etc, and occasionally chiropractic therapy.
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