Postero LATERAL Disk Herniation

... leans AWAY from the pain

Keywords; postero lateral disk herniation, chiropractic, antalgia, 50 percent less pain rule.

This is a serious condition seen every day in the chiropractic clinic. It's bread and butter for the chiropractor, but should never be taken lightly. It will take a minimum of six weeks to heal. Injure your back again within that period and you are asking for serious trouble, and the likelihood of radiating pain down the leg.

A lumbar disc protrusion herniation  may, but not necessarily, cause an antalgic list to starboard as you can see in the case of this young man. In the case of a postero lateral disk herniation, should you go into this antalgia, you will lean away from the side of pain.

A scoliosis is a permanent twist in the spine, but an antalgia is temporary; you wake up one morning with severe lower back pain and find yourself looking like the leaning tower of Pisa. After the disc has been reduced you will again stand up straight as normal. 

A postero lateral herniation is the more common type, and is less likely to lead to surgery five percent of the time if one follows one thousand cases. But it is a serious condition, that must never be taken lightly; it bites.

I had an interesting case last week with radiating pain down the leg; I reluctantly suggested they cancel the long drive to Spain for the summer holiday, or she should fly; sitting must be avoided as it increases the pressure in the disc twelve times. They chose to go ahead with it; this week I'll find out how she made out. 

Antalgia - the sign of Pisa

Notice how in the picture on the left, that the disc bulge is LATERAL to the nerve root. You will get relief by leaning to the right, pulling the nerve root AWAY from the bulge.

Leaning towards? Or away from the pain? Or, just struck straight forwards, unable to straighten up?

The Rules

  • Get to your chiropractor quickly. The postero lateral disk herniation is not the time for the wait and see what happens approach, which I usually advocate with pain. One doesn't need to run to the doctor with every cough, nor to the chiropractor with every little pain. But if you have the sign of pisa, don't wait.
  • Stay at home at least until you can stand up straight again for 24 hours. It will take a few days at least, and sometimes a few weeks. Massaging bed rest may be necessary.

  • Try very hard not to sneeze or cough. A quick nose blow will usually abort a sneeze.
  • Immediately start putting an ice compress on your back for 20 to 30 mins, perhaps alternating with a little heat. At least twice a day. It's also the best painkiller.
  • Stay out of the bath. Shower only.
  • Don't sit, not at all, until you are up straight. Perching on the edge of a desk is okay.
  • Your chiropractor will advocate a rehab program. Make sure you go through with it. Otherwise you will again be all bent and twisted in a few weeks or months, with a much greater likelihood of leg pain sciatica ...

Leg pain

Postero Lateral disk herniation causes pain that may radiate down your leg. If you are in an antalgic posture, you will be leaning AWAY from the painful leg.

For details of the pain patterns in the leg, click here: Tingling in feet and legs ...

What is a herniated disc? A disc consists of two parts, an outer ring of tough fibres, and an inner bubble of gel. In the so-called slipped disc, both the Postero Lateral Disk herniation, the Postero Medial disk herniation and the (Far) Lateral disc herniation the bubble of gel herniates through the tough outer ring. At this link I have described in detail what may be happening in your back. Read more … Slipped disk ...

A herniated bubble of gel in a slipped disc? No, a photograph of the Cat's Eye nebula taken from the Hubble telescope. Beautiful, eh!

50 Percent less pain rule
Lower back exercises

The moment you come out of the antalgic posture, the pain decreases dramatically. Now comes the dangerous period: you feel 50 percent less pain but the annulus fibrosis has probably healed by less than 10%. The central gel, the bulging nucleus pulposis has been reduced, so you have much less pain and are standing upright, but now at least six weeks must pass before that tissue has completely healed. Beware!

I advocate doing a set of very gentle exercises even when your back is extremely painful. Movement within the joint is what prevents a huge amount of fluid - swelling - from invading the disk. But you do need to be discrete and sensible. You are not out to make the Olympic team!

Important considerations if you have pain in the leg

  • Maignes syndrome is a lumbar facet syndrome, but high in the lower back, not right at the base which is the more usual site. What's confusing is that the pain often radiates to the buttock, groin and front of the thigh.
  • Tingling in the toes may be caused by a Mortons neuroma ... which is a benign irritation of the nerves in the forefoot.
  • Pregnancy too is a time when many women complain of back pain and sometimes there is Leg pain during pregnancy too.
  • The merry devil is upper leg pain or just a numb feeling, usually on the side of the leg, caused a "double crush" syndrome: the nerve is affected in the back AND in the groin where the Lateral Femoral Cutaneous nerve emerges from the pelvis. Meralgia Paresthetica

Useful links

Have A Question about your lower back?

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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.

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lower back pain 
Hello doctor, I am a 26 year old female in relatively good health. For much of my life I was significantly over weight but for at least 4 years I have …

lower lumbar clicks and cricks when I turn or carry weight, now sciatica symptoms 
I have had cricking and clicking in my lower back for several years. No pain, just that I know it isn't right and I am trying to fix it before it gets …

leg pain not helped by operation Not rated yet
leg pain not helped by operation Hi I'm 46 years old relatively healthy and not over weight; I recently had a discectomy on 04/12/2014 on my S1 …

tingling in right foot and calf and sharp pain behind my knee. Not rated yet
I am definitely leaning away from the pain. I cannot stand up straight or my buttock tightens and becomes very painful.So I am leaning away from the pain …

Sensation Not rated yet
I sprained my lower back 2 weeks before tournament. During the course of the tournament, bruised my hip an pulled my groin. Five days later, there was …

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Interesting challenges of the day

1. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks she was 75 percent improved; no longer vomiting or falling. She's not enjoying the Brandt Daroff home exercises.

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

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You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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