facet syndrome? or disc herniation?

12 days ago somewhere between taking a shower and washing my hair, something crazy happened to my back. The symptoms I exhibited included major pain in the whole lower back region (can't remember if one side was worse than the other, sorry), antalgia (to the right), sudden increase of pain w/laughing and changing positions too rapidly, and inability to sit for very long at all (could sit for a short while on the edge of the bed but not in a chair). My pain was relieved by lying down as long as my legs were bent. Walking was not comfortable but doable. I couldn't lean forward from the hips without a lot of support.

I never could pinpoint the exact moment it all happened. A couple days before one of the long muscles running to the right of my spine over my kidney was sore and tight and moist heat helped it. I contemplated a deep-tissue massage Tuesday or Wednesday but decided against it then Thursday morning Bam! Spasm hit, and I was done.

I was incredibly fortunate in that I was able to see a chiro within 4-5 hrs of onset of symptoms (and inexpressibly thankful since he had to leave his Thanksgiving celebrations w/family to see me!!). Among other adjustments, he was able to perform the lie-on-side-upper-leg-bent maneuver when I was lying on my left side and tested the opposite side but wouldn't force it. After treatment (as much as my rigid muscles would allow) he applied electrical stimulation, recommended ice, NSAIDS, and a brace all w/appropriate instructions, and told me some activity was okay especially to keep things from being stiff but to not overdo it. I was told to expect pain going from non-weight bearing positions to anything else.

Post-treatment I was still exhibiting the antalgia and pain but my mobility was quite a bit better. The next morning - less than 24 hrs later - when I returned for follow-up my chiropractor expressed pleasure w/my progress and repeated treatment. This time he was able to adjust both hips! I increased my activity _slightly_ that day but was still worn out. Ice, NSAIDS, and Dad's portable TENS unit were my buddies!

12 days and 2 more treatments later, I'm antalgia-free and mobility has returned. I did used the brace heavily for 3 days then decreased usage of it thereafter. I have restricted (almost eliminated) my lifting since the injury. I have begun doing stretches as per the chiropractor's recommendation- 4 days out of 7 so far. I feel tightness across the hips and lower back but this discomfort I recognize: this typically is how my back feels after long days of sitting or driving.

A quick back history: I'm a 29 yo female, first visited a chiro after sitting through 3-hr long college classes w/a couple 10 minute breaks. Like I said, I'm familiar w/the way my back feels now. I've had on and off chiropractic maintenance since then, only other major event was 5 yrs ago when I had some sacro-iliac joint problems. Usually the first thing someone (massage therapist or a chiro) says when they lay hands on my back "Wow! you are tight!" I have a high pain tolerance (sometimes a good thing, sometimes not) and I carry a lot of tension.

My questions for you are:

Did I slip a disc? or did I have facet syndrome?
The chiro I saw said facet syndrome when I asked exactly what happened but did mention something about disc injury to my family in the waiting room. Can facet syndrome present w/antalgia like I had? And if it's discogenic in nature, what can I do to prevent it happening again? (My confusion here largely stems from conflicting info I'm finding in my research. Some says antalgia happens w/disc herniation only; other sources say it's possible to have antalgia w/facet syndrome, too. Help!)

Should I be building back up to lifting things (while using good body mechanics, yes yes) or should I continue to abstain?
My lifestyle is built around travel so I live from luggage. :\ I am downsizing and switching to backpacks instead of folding garment bags w/only one strap.

I greatly appreciate any insight you can share in my endeavor to learn more about what happened to me. I hope I've not inundated you with too much info.

Hello OR,
I can't give you a definitive answer, but it seems from this distance that you have had a disc injury, the usual cause of antalgias. Were you leaning towards, or away from the pain? http://www.chiropractic-help.com/Postero-Medial-Disk-Herniation.html

I personally think antalgias are less common with facet syndromes, though I've certainly seen them, but mostly in older folk. Younger people of your age are more likely to have disc antalgias. No pain in your leg?

I seems to me that you have been well cared for by your chiropractor, excellent, a bottle of red wine for Christmas!

If your back is continually tight, ask her/her to evaluate you for a short leg.

I'm afraid back pain goes with your life style. Backs don't like sitting.

Yes, I strongly recommend an exercise programme done every morning before getting out of bed. But beware, the wrong exercises can make this worse. Be guided by your chiro.


Accept this will take 6 weeks to heal. You are now in the dangerous time, a set back will likely give you pain down the leg. Avoid deep luxury chairs, generally sit less for a month, and go down on one knee when picking something off the floor. Good luck.
Dr B

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Dec 07, 2011
Thank you!
by: OR

I am extremely surprised and pleased at the quick reply I received! Many thanks.

Does a gift basket w/artisan breads and dipping oils & spices count as much as a good bottle of red? That's what I put together for him - as soon as I could walk around a shop!

My leaning-tower-of-Sara (can you be a 155cm tower?) was bent away from the most rigid muscle. I have a high pain tolerance and I'm afraid I can't remember which side was worse. Best guess is I was leaning away from the pain. And no pain down either leg, though right leg was 3/4 in shorter. (I've been wearing a 1/4' inch lift in my right shoe for several months.)

Thanks again - I'm off to check out the exercises you've recommended.

Why so surprised? Leaning away from the pain is the so-called Postero-lateral herniation.

Careful of that high pain threshhold. Ignore this, or do silly things, and it'll start down your leg and then there's drama.



PS. Sure s/he will love the beads and oils! A Bernard Preston chiropractic book would do just fine too! My alter ego.

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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. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

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 stabs in the groin, 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 spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, 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. Increased range of motion is more difficult than too stiff in my opinion. Our care 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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