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L4 LUMBAR SPINE CaseFile

L4 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:


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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, and less commonly a facet syndrome. Others have a differing opinion.



POSTERO LATERAL DISK HERNIATION ...




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.

  • SLUMP TEST ...

  • Assessment

    It 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 ...

    LUMBAR FACET SYNDROME ...

    SACROILIAC JOINT ANATOMY ...

    Treatment

    There 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.

  • SACROILIAC JOINT TREATMENT ...

  • Even the coccyx pain was gone. We used a coccyx pillow for two months, and external mobilisation of the coccyx. Very occasionally it may need to be done internally.




  • COCCYX PILLOW ...

  • Have A Question about your lower back?

    I receive many questions about Chiropractic. It might be help with a spinal condition, but it might also be from a person who can't walk after a hip operation, or some such thing.

    I will do that by answering your questions personally, but it will be converted to a Web Page so others can benefit from your questions. Omit your name if you like...

    However, do understand that, in the main, I'm going to be directing you (should it be pertinent) to a Chiropractor in your neck of the woods. I'll respond to all reasonable inquiries, but please be specific, and give some details.

    There is no charge for this service, however if you find my answer useful, you might like to consider purchasing my latest book, Stones in my Clog. Gems, both funny and healthful, from the life and work of a Chiropractor. It's only $2.99. (http://www.bernard-preston.com/Stones-in-my-Clog.html)

    Pose Me A Question! Pretty please, in decent grammar and spelling.

    I will never give or sell your e-mail address to anyone.

    Do understand that lower back pain is extremely complex, so I can only give general guidelines. There's no substitute for a careful thorough chiropractic examination.

    Your problem: eg Tingling in feet and legs

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    What Other Visitors Have Said

    Click below to see contributions from other visitors ...

    Tingling in the head  starstarstarstarstar
    Dear Dr.

    Thanks for taking the time and reading my concern and I highly appreciate your advise.

    I injured my lower back in October which lead to ...

    FEMORAL NERVE and leg pain  starstarstarstarstar
    Femoral nerve and leg pain

    I fell 3 mos ago and suffered a tibial plateau fracture which has pretty much healed.

    I also felt a burning strained ...

    pain in left ilium following hip surgery five months ago.   Not rated yet
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    I had a baby on December 15 that was 9.3 pounds and has since gotten up to approx. 22 pounds. I am somtines unable to bend down and ...

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    You ...

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    FEMORAL NERVE

    Hi I was involved in a car accident and my l1 and l2 bones are totally destroyed a procedure was done through my back to keep what I have ...

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    Slump Test

    I am a retired physician who does medico-legal work. Therefore, I review chiropractic records in order to help clients of attorneys receive ...

    Help fo sciatica pain  Not rated yet
    Help for sciatica pain.

    Can a sciatic nerve problem be healed permanantly from pain?

    Mm, that depends! On how long you've had the pain, whether ...

    L5S1 disk degeneration , Modic change, lower back pain  Not rated yet
    Lower back pain and stiffness

    Hi, I has Magnetic Resonance of lumbar spine in May 2009 and it
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    MORE RECENTLY

  • LOWER BACK EXERCISES ... on YouTube.

  • That was a year ago. Today, giving me the impetus to write this L4 LUMBAR SPINE CaseFile, she consulted me again for the first time in eleven months. Exceptionally good months - until she fell on the ice last week. This time she knew not to wait 11 years before consulting a chiropractor! The problems aren't severe and I expect to see her 3-4 times.

    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.

    CHIROPRACTIC THERAPY ...


    Remember to treat any case file, including this L4 LUMBAR SPINE CaseFile with a bit of pinch of salt! They are not scientifically validated. But interesting, and for Mrs M, she doesnt'give a damn whether there is (yet) hard chiropractic research that will convince our critics of the effectiveness of Chiropractic. To go from L4 LUMBAR SPINE CaseFile to CHIROPRACTIC RESEARCH ...

    INTERESTING LINKS

  • More about LOWER BACK AND LEG PAIN ...

  • More about LEG PAIN DURING PREGNANCY ...

  • FOOT PAIN ... can be the cause of your low back pain.

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    Issue #19: Retirement sentiments / Growing Garbanzo beans

    Issue #18: Shoulder Pain / A Walk in the Sun

    Issue #17: Facial Pain / Mussel Facts

    Issue #16: Obesity in the Chiropractic Clinic / Flax seed

    Issue #15: Breastbone pain / Broccoli

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    Issue #05: Safety in the home / Red foods

    Issue #04: Whiplash and the Joints of Luschka / Parsley

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    L4 LUMBAR SPINE CaseFile

    Did you find this page useful? Then perhaps forward L4 LUMBAR SPINE CaseFile to a suffering friend.


  • LOW BACK and LEG PAIN




    L4 lumbar spine casefile

    FALLS



    CHIROPRACTIC HELP How to stop falling



    L4 lumbar spine



    Lateral disc herniation



    BENDING AND TWISTING



    DEGENERATIVE LUMBAR DISC DISEASE CaseFile



    POSTERO LATERAL DISK HERNIATION



    LOWER BACK AND LEG PAIN

    SITTING



    CHIROPRACTIC HELP FOR SCIATICA PAIN

    Short leg?



    LEG LENGTH INQUALITY and Low Back Pain



    Low back and leg pain



    LOWER BACK AND LEG PAIN



    LUMBAR FACET SYNDROME



    SLIPPED DISC SYMPTOMS Case File



    SACROILIAC JOINT TREATMENT



    SPONDYLOLYSTHESIS



    EXAMINATION



    SACROILIAC JOINT Case File



    SLUMP TEST



    Can you stand on one leg on your heel, and raise the big toe? Can you stand on your toes without your leg shaking?



    CHIROPRACTIC TIPS



    Prick your foot with a pin. Is the feeling the same in the other foot?



    Chiropractic Therapy ...what is it?