(Keywords: Slipped disc symptoms, chiropractic help, sequestered disc, tingling in feet and legs, Pisa sign, Slump test, postero lateral disk herniation, help for sciatica pain)
Lower back pain may be associated with pain in the leg(s), low back pain on sneezing, coughing and straining on the toilet, pain on bending forwards and perhaps pain in the leg on bending forwards.
There are four degrees of 'slipped disc'. In the first THREE Grades (I - III) you will have low back pain, which may or may not be severe. In Grade IV, the back diminishes dramatically, but the leg pain becomes far worse.
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. Low back pain, pain with sneezing and pain on bending.
Anti inflammatory 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 disc, nor was any rehab attempted. The pain went away.
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 pain 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. Back pain is greatly reduced, but
the leg becomes very painful; 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% less, so we will never know how large the bulge actually was in the beginning.
CHIROPRACTIC CARE @ Slipped disc symptoms
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 ...
Is that pain in your leg 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 nerve in the back.
It's rare for the pain to get straight to your leg, with no back pain first, but it can happen. Most uncommon. SLUMP TEST ...
Nope this is not a fancy scan of a disc that is in decay. It's a picture of Nebula NGC 2392, 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 a dying star. Eskimo is 5,000 light years from Earth.
Keeps our human problems in perspective! Our Sun in comparison is I believe 7 light minutes from the Earth.
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Meantime, use the search function near the top of the left column to find more information about subject material mentioned on the page, where links have probably been removed.
Not a Chiropractic Case? Perhaps. For the first twenty five years in practice, whenever a patient had a Grade IV slipped disc, also known as a sequestered disc, I wouldn't even attempt to treat them. Off to the surgeon. However, now for the last five years, I have started giving a trial period of treatment, limited to four weeks. Well, Mr T is 80% 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, completely painfree, with full range of motion of the back and a negative slump 7, 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.
Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.
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.
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