Keywords; slipped disc symptoms.
Lower back pain may be associated with a discomfort in the lower extremity, as it's called in anatomical jargon, and very occasionally in both limbs. Sharp stabs or a dull ache on sneezing, coughing and straining on the toilet is the hallmark of a disk injury.
Irritation in the thigh, and down to the foot, on bending forwards and perhaps when bending backwards, or to the side may also occur.
There are four degrees of a slipped disc. In the first three you will have low back pain, which may or may not be severe, and increasing discomfort in the leg. In grade four the lumbar stabs diminish dramatically, but the limb becomes far worse and is likely to become weak and numb.
The sciatic and femoral nerves emanate from the lumbar spine; the former from right at the bottom, and the latter from the mid lower back. They supply different parts of the limb.
Is that pain in your lower limb coming from your back, or something else? Have you a pulled a calf muscle, a tendonitis, a deep vein thrombosis, a partially blocked artery, or one of a heap of other conditions?
The test I use most frequently is called the Slump test, and you can do it at home, but interpreting the results is not straight forward. However, with a negative Slump test you more or less categorically rule out a pinched sciatic nerve in the back, but not a femoral nerve lesion.
It's rare for the pain to get straight to your leg, with no back pain first, but it can happen. Most uncommon.
The four levels of slipped disc (disk) are:
Grade I: Low back pain only
In 60% of the patients with this condition, the pain starts after bending and twisting and, often, heavy lifting. For example lifting and moving a potted plant. Should you sneeze at just that moment, then your back is especially vulnerable.
The low back pain may be severe, or in fact relatively minor.
Grade I slipped disc symptoms are:
The normal disc is a sort of shock-absorber. Notice that the disc is made up of two parts:
Grade II: Low back pain + Leg pain
If the gel in the nucleus tears through more layers of the ring then the slipped disc symptoms will change: pain, or tingling, or a numb feeling, or a tight feeling starts to develop, first in the buttock, then radiating down the leg.
A tear through one or two layers is often called a bulging disc. It hasn't actually reached the nerve. But if it tears through more layers then tingling and pain in the leg will begin.
If whilst busy with some activity, usually involving twisting, and often bending, whilst applying pressure, and you feel a stab of pain in the lower back, immediately stop. Your back is warning you, and if you're lucky the damage is not yet done. Sometimes alas the fibres of the annulus have just torn further, and it's vital to prevent the gel from rupturing right through into the canal.
Take special note of which part of your leg is affected; it gives your chiropractor important extra information.
Read more about patterns of tingling in feet and legs at the link below.
Notice now that the bulge, now called a protrusion, has reached the nerve; if it goes any further, then called a prolapse, sometimes known as an extrusion. These terms tend to be used rather loosely and interchangeably.
Perhaps more commonly, the nerve isn't actually pinched. The fixated joint prevents proper joint nutrition of the hyaline cartilage from occurring. As the cartilage is starved of nutrients and oxygen, it begins to release noxious toxic chemical, causing inflammation of the surrounding tissue, including the nerve root.
The result is radiating symptoms down the leg, the pattern according to which nerve is affected.
Tip @ Slipped disc symptoms
People often think the tightness in the back of the thigh is from a tight hamstring - and try stretching it by bending forwards. It's about the WORST thing you can do if you are having slipped disc symptoms!
Lower back pain? Tightness or pain in the back of ONE leg? Definitely not fine.
Grade III: Low back pain + leg pain + NEUROLOGICAL CHANGES
Whilst I don't believe one has to rush off to the doctor with every snivel, or to the chiropractic with every back pain, should pain, or a tight feeling, develop in the leg then I recommend you don't wait. Get to your chiropractor immediately. The sooner that disc is reduced the less the likelihood of it progressing.
Why? Untreated Grade 2 often develops neurological signs:
Notice in this next picture - an MRI scan - how the gel is bulging deep into the Inter vertebral foramen? Now it's called a prolapse... aka as an extruded disc.
As these slipped disc symptoms progress, your life style will become more severely limited. Your Chiropractor will probably insist you stay at home, not sit at all, and probably spend some of the time lying down, and doing some lower back exercises ...
Grade IV: Minimal back pain + severe pain in the leg.
Mr T is a very fit Dutch policeman. Four months ago after a fall on the beat, he developed the typical slipped disc symptoms. LBP, pain with sneezing and discomfort on bending.
NSAID drugs were prescribed by his doctor, but no reduction of the bulge was attempted; it was seen simply as an inflammation, rather than a change in the normal workings of the disc, what we call the biomechanics of the joint, nor was any rehabilitation attempted; the pain receded.
As part of his job, he often needs to travel long distances in the car, and within weeks he began developing back pain again, and worse, more severe slipped disc symptoms developed.
First pain in the leg, then weakness in the calf, and numbness on the side of his foot. Physiotherapy helped somewhat.
Abruptly, the stabs in his back subsided after a heavy
shower of sneezes. Dutch is a very colourful language. And then the pain in
his leg became very severe. Sitting in the car became quite impossible.
In a grade 4, a fragment of
the disc gel becomes detached from the main body of the nucleus and
becomes lodged in the spinal canal or foramen. Back pain is greatly reduced, but
the leg becomes very uncomfortable; bladder symptoms may develop. In technical jargon, it's
called the sequested disc; ouch.
Can you see the tiny loose fragment?
This scan was only taken after he had already had four chiropractic adjustments, manipulations, of the slipped disc. By then the pain in his leg was already 30 percent less, so we will never know how large the bulge actually was in the beginning.
The Slipped Disc Symptoms of a Grade I or II herniation are treated by chiropractors on a daily basis. It's routine, though I've learned never to take a slipped disc for granted. Nor should you. Research shows that 5% of all those suffering acute lower back pain will go on to develop severe, disabling, chronic pain and no one knows ahead of time whether you could be in that 5%.
My experience is that it's usually those who won't listen who end up under the knife. Who refuse to slow down, stop sitting and if necessary stay at home.
"Those who won't hear, must feel."
- Dutch proverb.
Bed rest in the management of lower back pain remains controversial. Research in fact indicates that bed rest ON ITS OWN has no place in the management of lower back pain. In fact it may worsen the condition.
However, when included in the chiropractic package of the management of very severe low back pain and leg pain, I find intermittent bed rest is vital. The patient may not sit as it increases the pressure in the bulging disc by as much as a factor of 12x; standing and walking for any length of time are well nigh impossible. So what must the patient do? Slipped disc rules ...
Nope, this is not a fancy scan of a disc that is in decay. It's a picture of a nebula taken from the Hubble telescope. It's been called Eskimo because it looks like a face surrounded by a furry hood.
The hood is, in fact, a ring of comet shaped objects flying away from the dying star. Eskimo is 5,000 light years away from the Earth.
It keeps our human problems in perspective. Our sun, in comparison, is 8 light minutes from the Earth.
Is this not a chiropractic case? Perhaps, and for the first twenty five years in practice, whenever a patient had a grade IV slipped disc, also known as a sequesteration, I wouldn't even attempt to treat them; off to the surgeon. However, now for the last ten years, I have started giving a trial period of treatment, limited to four weeks. Well, Mr T is 80 percent better. He can sit normally, and this week he goes part time back to work.
Update; Mr T got completely better, and after three two monthly consultations, was completely pain free, with a full range of motion of the back and a negative slump 7, so I discharged him. He knows to keep doing his exercises.
Update; on a personal note, I am recovering myself from a sequestered lumbar disc, affecting the side and front of the thigh, and inner lower leg, confirmed on mri. With excellent care from my colleague, and a great deal of patience, I have no pain, but still some residual numbness in the lower leg; Femoral nerve damage.
Rehab is absolutly vital whenever a patient has slipped disc symptoms. Otherwise the relentless progression from
Grade I > Grade II > Grade III > Grade IV > Surgery
becomes increasingly likely.
I hasten to say: Not every Grade IV can expect to respond as well as Mr T has. This is a fairly small prolapse, though it was worth a try don't you think? But really the trick is to prevent a Grade IV. Almost invariably the sequestered disk is only caused by neglect on someone's part. Your's, your doctor's, even your chiropractor's ...
Can manipulation cause a Grade IV? Yes, I regret to say I have caused a few in thirty years, particularly in the early years when I was inexperienced. No treatment, chiropractic or medical, is without risk. Even withholding treatment, as happened in Mr T's case, can and often does worsen a disc injury.
Now I've learned not to use brute force and ignorance in the treatment of slipped disc symptoms. Mostly! Occasionally, on a very large person, considerable force is required to reduce the slipped disc.
Interestingly, research shows that if you FIRST consult a chiropractor, you are less likely to end up under the knife.
Anti inflammatory shots in the buttock
This is simply an anecdote, but what's really interesting is the defence's expert witness, a Dr Swamiji Anath's statement.
It's reported in the daily newspaper of 11 June 2013 that a certain medical doctor appeared the previous day before a board of inquiry of the South African Medical and Dental council for not taking due-care when giving an anti inflammatory injection in the buttock for a lower back condition. He apparently put the needle into the sciatic nerve, permanently damaging it.
Said the expert witness in his defence: "Damaging the sciatic-nerve whilst giving a shot into the buttock happened throughout the world and what's more in the best of hospitals."
Lower back surgery
I don't think any chiropractor would consider that lower back surgery is never necessary or advisable. I personally refer to good surgeons when all else has failed, but only if there is significant leg pain. Read more:
LUMBAR FACET SYNDROME
Chronically degenerate facet joints in the lumbar spine can also produce pain that radiates down the leg, frequently to the calf, but also to the front of the thigh and lower leg. Then bending BACKWARDS or TO THE SIDE causes pain in the leg, sometimes with minimal back pain...
I'm not looking here for funny stories. That we'll find a place for elsewhere, and you can find an abundance of them in my books at Bernard-Preston.com. James Herriott genre books.
Here I'm looking for things that you particularly love / hate about a visit to the chiropractor. Share it! If we get too many, and we probably will, we'll split them.
Are there things you hate about a Chiropractic consultation? Let's hear about it. Hopefully even more stories about things you love.
You see, we Chiropractors can learn from your feedback, both positive and negative.
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