HDL L5-S1 with sciatica on right foot

by Florin Daniel
(Bucharest, Romania)

My name is Daniel, i am 30 years old, and i recently (about a month ago) had a lumbago episode due to my recurring lumbar disc hernia at L5-S1.

First occurence:
- My first HDL was in december 2010 (~5 years ago). MRI revealed a central disc herniation. Doctors said i should operate soon, but i didn't, i started taking antiinflamatory pills , rested flat in bed (and on the floor), and doing Williams exercises when my sciatica was feeling better.

I also bought an inversion table which i think helped me a lot! Every time i was having pain i used to rest in it for 10-15 minutes and felt great after. I think it took about 3 months to get free from the symptoms, and another 3-4 months to stand in a chair for longer periods of time.
- I started swimming, exercices, etc.

Two years later, i have done another MRI which showed a small protusion only (the HDL was "gone"). I was feeling great!

Second occurence:
- All good (minor pain in my back from time to time) until december 2014 when i was renovating my apartment (lots of weight lifting, stretching, twisting, etc). I got another episode of pain in my lumbar region, and after a few days the pain disappeared from the back region, and I started feeling an intense contracture on the right foot when i walked. The Lasegue test was positive. It was painful, limited but without neurological deficit. I started the home treatment as i did in 2010 and i managed to get rid of the symptoms (quite rapidly), even though i never stopped my renovating activities (just did a minor break between time to time).

Third occurence:
- Until january 2016 (this year), i was feeling good. After the winter, i started feeling pain in my lower back. I started taking painkillers (almost regularly). One morning when i was in the bathroom, i sneezed and "heard" something popping in my back. I knew it was going to some harm. In 15-20 minute i started having pain in my back, and progressively i felt like i have not strength in my lower back. I had the "luck" to sneeze again, and that was the final take for my L5-S1 disk. The pain resulted forced me to rest in bed, and take more pain killers. I went to a clinic and did a session of streching on a horizontal table. Also i visited a chiropractor and did a session. When i did the chiropactic i didn't had any sciatica pain (only back pain) and the chiropractition practically streched everything with ease i must say. After a few days, my
back suddenly stopped hurting, i was feeling like a new born.

I went to work for two weeks (standing in a chair at the desk). In the last week i started having pain in my right leg and buttock when i tried to move around. After the final week at work (and with driving and all) i was feelind very bad (intense pain in leg and bottock on the right side right above the knee), probably my disk had migrated into the spinal canal, iritating the S1 right nerve root.

- since about a week and a half, i am unable to walk properly due to leg pain from the sciatica.
- i have a positive Lasegue test. Painful, limited but without neurological deficit.
- i can sit without pain, but when i get up i feel like something is going down my nerve root as a "claw" hooking it and i feel like i have to move a bit to make it better (but not long).
If i rest in bed , i feel a good relief and i can walk without problems for about 30 minutes before i feel the disk going down again the nerve root.
- i can sleep without pain (rarely i have small nerve pain - but it is gentle)

I went to see lots of neurosurgions and most of them said to go for the operation. Others told me to wait like a month (plus 1-2 weeks) maybe it will fix on its own.

For a week or so, i managed to "control it" only if i rest in bed for longer. I a get a big relieve, and i can start to walk normal again without pain. The effect doesn't take long dough.. Even when i feel relieved after several hours (1-2) of rest in bed, the Lasegue test is still positive!

My questions for you are:
1. In your personal experience, and judging by my history and recent MRI, do you think i have a chance in recovering natural and without surgery? Please consider that in may i have an important event (my wedding), and i have not time to spare..
2. If i am feeling good after resting in bed, why the Lasegue test is still positive (not even a small increase)?
3. Can three months be enough to recover from a lumbar microdisectomy? Example, will i be able to dance at my wedding?
4. I tried to swim and do stretching exercises and even some kiropractice (as i've learned from the past), but it seems to worsen my condition (leg pain increases, i feel my leg more heavy and tired, and it starts to hurt lower then the knee), so i stopped.
5. Which one do you think will be more efficient judging by the time i have until my wedding - to wait for the pain to go away , or the have surgery and irreversibly have my back operated?
6. In your opinion, how long will it take for my sciatica to go away, and what will be best to do in order to fix it, etc?

Thank you for your time in reading this.
Kind regars,

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Feb 18, 2016

by: Barrie

Hello Daniel,
Your history is not unusual and what is encouraging is that you have in past recovered from this, and secondly have responded well to chiropractic adjustments.

The biggest difficulty with a disc herniation is to wait long enough for it the heal after the pain has receded. You obviously went back to sitting and work far too soon.

Prolonged sitting is often the very worst. The pressure in the disc increases dramatically. But prolonged standing is often difficult too, especially is you went into an antalgic posture. Did you look like the leaning tower of Pisa?

The next problem is that it would you seem the chiropractor discharged you too soon. After a difficult case like this, continued care and management is needed to prevent these relapses.

I would go back to your chiropractor seeing the treatment was so helpful, and follow our slipped disc rules carefully.

1. Yes, certainly, but it may be difficult now if you are unable to stop your life for a few weeks, and particularly if you are still sneezing regularly.

2. There's lots of research showing that plain bed rest will not reduce a herniated disc. In fact it may aggravate it.

3. Ask the surgeon, but I would think so.

4. You have to do the right exercises. See the lumbar exercises page in the navigation bar. Swim only lying on your back initially.

5. You can't do nothing. It's either back to the chiropractor, together with an exercise program faithfully done, or the surgery.

6. The leg pain will probably go away quite quickly with surgery but the risk are fairly high. With chiropractic adjustments, usually in less than a month, but then you have to be very careful for another month. Read our 50 percent less pain rule.

Good luck, Daniel. I hope this contributes. It's not a large herniation.

Dr B

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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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