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?

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.

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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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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Mrs T looked like the leaning tower of Pisa; she had a slipped disc at L5 making her lean towards the opposite side. It's called the postero lateral disc hernia; she's much better after two weeks of treatment and will go back to work next week, part time. Lateral discs are more difficult; both take a minimum of six weeks to heal. In my opinion, antalgic patients need what I call exercising bed rest. Sit and it won't get better.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months. He has a pincer deformity in the hip causing the groin pain, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your lower back is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her hip, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Hypermobility is more difficult that too stiff in my opinion. Chiropractic is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

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. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

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.

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