LOWER BACK PAIN
Keywords: Sacralization of L5 CaseFile, lumbarisation, lower back pain, chiropractic help, leg length inequality
Mrs D, a 39 year old woman first consulted me two years ago. Over the previous three years she had three severe, acute attacks of lower back pain, without referral to the legs. Whilst the acute phase passed, she continued to have nagging backache every day.
Her mother and sister also have episodic lower back pain. This is a strongly hereditary condition.
What finally prompted her to consult a chiropractor was two episodes, one six weeks and the second a week before her first consult. Despite physiotherapy treatments spanning every week for a whole year, and an orthopaedic consult, the condition was clearly going downhill. Sneezing caused extreme pain in the small of the back.
Sacralizations and lumbarisations are not uncommon at the chiropractic coalface. They have a higher incidence of lower back and leg pain.
We call the zone between the sacrum, a solid but slightly movable bone, and the lumbar spine which is highly flexible, a transition zone. Sometimes the last vertebra can't make up its mind whether it is belongs to the lumbar spine, or the sacrum. The result is six or four movable lumbar segments, instead of the regulation five.
They are but two sides of the same coin.
Skullduggery is the word. The search engines have no interest in the word lumbarisation so I've called this page sacralization of L5 but in
fact this sacralization of L5 casefile is a lumbarisation! Six vertebrae
instead of five.
Xrays are particularly helpful in these cases which is why, if there is a strong family history of lower back pain, further examination is advisable. Even an mri if you have the money, particularly if there is any leg pain. They are expensive. The big advantage with mri is that to date there are no known side effects, as there are with xray and CT.
A slim, but strongly built woman, she obviously stood with a pelvis distinctly low on the left side. This led to a mild scoliosis.
Forward bending was strongly painful in the low back. Extension and sideways bending to the left was mildly painful in the left sacroiliac joint, or was it at L5 in that pseudo joint?
On motion palpation, L5 was strongly fixated, due no doubt to the lumbarisation or sacralisation of the lowermost vertebra, which would normally be L5. There was no sacroiliac fixation on motion palpation, despite the tenderness in the joint. Surprising, as it usually gets tight along with L5.
On orthopedic testing, the slump test was positive with a crossed sign; raising the left leg provoked right lower back pain. All four sacroiliac joint anatomy tests were positive on the right. Yet no sacroiliac fixation on motion palpation. Odd!
A heel lift for the short leg.
A 5mm heel lift under her left heel provided instant relief when bending. Simply catering for the leg length inequality is often half the battle in dealing with chronic lower back pain in which a leg length inequality is a complicating factor.
Whilst for most chiropractors, myself included, Chiropractic Help would include adjusting the low back and pelvis manually most of the time, Mrs D responded immediately to the Thompson drop protocol in the pelvis, and the heel lift, so that I've never actually manipulated her back. Within a week the pain was gone.
However she went faithfully through the rehabilitation protocol, another 4 to 5 treatments, making it 12 in total. She also had some neck pain.
She had one slight setback about three months later, which passed with one of the six weekly control treatments. That was eighteen months ago. Since then she has had no pain at all.
Mrs D wears her heel lift faithfully, does her exercises with passion and enthusiasm; they only last one and a half minutes every morning and every evening in bed, before arising and taking to dreamland, and comes now every ten weeks for a control treatment, as we call it in the Netherlands.
She reported this morning that she has had absolutely no problems. Long may it continue! No treatment, no charge.
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Discussion of sacralization of L5 casefile. Lumbarisations, creating six lumbar vertebrae instead of the standard five, and sacralisations, creating four lumbar vertebrae, can sometimes be very troublesome. Each case is unique and one has to work out a protocol that brings relief of pain and disability.
These oddities at the lumbo sacral junction are often associated with other anomalies, in Mrs D's case a short leg, and a pronated foot.
Addressing all the above is what brings success in the treatment of lower back pain; the foot, a subluxated cuboid bone, the short leg, a heel lift, and the pelvis in this case. I still haven't adjusted her lumbar spine. The problem was in the pelvis, but oddly with no palpatable fixation in the sacroiliac joint.
Each back brings its surprises, and peculiarities. Hence the challenge to your chiropractor. Can she or he puzzle it out? With your honest feedback and positive contribution by faithfully doing your exercises, for example, I'm sure!
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 as much detail as you can.
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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.
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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 B has the trophy for the most acute neck in February. He has quite advanced lower neck arthritis for a forty year old, thanks to a severe fall on the head from a trampoline. But this is upper cervical pain. Right rotation is simply impossible. Luckily he is improving rapidly, eighty percent better he says after three treatments. See cervical facet syndrome.
2. Mrs C is a new patient with a long history of lower back pain, hip pain and pain in both feet. We'll see how we get on, Rome wasn't built in a day.
3. Miss U sprained her ankle two months ago, wearing high heels. She still has severe mid foot pain. Xrays and perhaps a CT scan.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of foot. It started after a long drive in the car. Update, she's forty percent less painful after four treatments, but the leg is still numb. Update two; she 60% better, but it's slow and is going to take the full 6 weeks to heal. Further update; a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. Mrs Y, a 70 year old woman is on maintenance care fo a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection in the shoulder. After 4 operations he is incapacitated and going rapidly down hill.
8. Mrs Z, an 78 year old woman is doing remarkably well with a bad sciatica. But at over 200 lbs she is not losing weight, in fact gaining despite my suggestions. She's high risk for a stroke. Referral to a dietician to crack the whip.
9. Mr A, a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. Reassured him it's not hip arthritis.
10. Mrs B, a 64 year old woman has had Scheuermanns disease; it's left with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment, provides she come every six weeks or so for treatment.
11. Mr C, a young engineer fell off his mountain bike injuring his cervical spine and pelvis. Luckily both responded very quickly to a few chiropractic adjustments. Update: his neck is sore again. It all goes back to a whiplash injury ten years ago when he was rammed by a fully laden truck carrying a load of stone. Time for Xrays.
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. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes. Chiropractors shouldn't be treating the elderly? Bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
Greetings, Dr B.
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.
Your own unresolved problem. Pose a question
Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.
You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.
The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.