50 percent less pain

Right antalgia seen from the posterior.

50 percent less pain is the dangerous time with spinal conditions. The really nasty backs we see at the chiropractic coalface frequently follow a course similar to the following.

  • An initial lower back injury but it applies equally of course to a sprained ankle or any other joint and even tennis elbow, for example. It often comes after bending and heavy lifting, with a twist of the spine.
  • Pain and restricted movement often begins immediately, but it could be that you go to bed with no inkling you have had an injury. Then, next day on waking, there's drama. It swells during the night and in the morning one is astonished to find one can barely move.
  • Then follows a period of recuperation. There may be treatment, Chiropractic or other, or none at all. The pain reduces and movement increases within a few days or a week or two. 50 percent less pain is the dangerous time.
  • Then either something silly happens, like lifting again, but possibly only a prolonged period of sitting as in a long car trip, or perhaps something unavoidable like a shower of sneezes. You may go into an odd posture, leaning to the side, like the young man above; you don't have to be a genius to spot the sign of Pisa.
  • It's sometimes because you stopped the treatment, thinking it would now get better on its own, and you could save some money.
  • It could be that you weren't put on a rehab program, or you didn't do the exercises faithfully.
  • In short, something goes wrong. Bingo. What started as low back pain now has a nasty extra. Pain and tingling in the leg.

This page was last updated by Dr Barrie Lewis on 3rd December, 2018.

The five grades of slipped disk

Classically, there are FOUR grades of slipped disc, to which I add a fifth (GRADE V), because the onset of weakness in a leg to me is clinically very significant.

Traditionally, either numbness and/or weakness (so-called "hard neurological signs") would indicate a grade III.

Nucleus pulposis

Nucleus pulposis is the gel part of the normal disc; it's the bit that slips when it tears through the annulus fibrosis. Reduction can be done, often very quickly with a skilled chiropractic adjustment but the 50 percent less pain rule still applies; healing occurs much more slowly.

Slipped disc symptoms

Slipped disc symptoms are hugely variable depending on which level has torn and bulged, and how far and in which presentation the nucleus pulposis has progressed towards the sciatic or femoral nerve; understanding the 50 percent less pain rule is fundamental to full recovery.

Bending is usually painful, as is coughing and sneezing and bearing down on the toilet, together all part of the Valsalva manoever.

Flexing the head onto the chest, for example when ducking to get into the car often is difficult, as is sitting.

If the bulge is into the foramen then bending backwards and to the side provokes excruciating leg pain.

Read more at our slipped disc symptoms page.

No matter whether your chiropractor has golden hands; it still takes time for the annulus fibrosis to heal. Play silly buggers too soon and you'll find out what the 50 percent less pain rule is all about.

Grade One:
Low back pain only = Lumbar disc protrusion

It could be severe, or mild. Movement is usually restricted, especially forward bending, sitting is often difficult, as is turning in bed and dressing in the morning. Coughing and sneezing, and straining on the toilet may be painful. Ouch! LUMBAR DISC PROTRUSION ...

Grade Two:
LBP radiating into the buttock and leg

So, before it was prudent, you decided to wash the car. Or take a long business trip, or enjoy sexual intercourse without going through the foreplay, which should include thirty seconds of warm up for the back!

Another stab of pain in the back, and now you can feel the pain spreading into the buttock and down the leg. It could be just a little tingle, a numb feeling, often just a tight feeling at the back of the thigh, or you could have severe leg pain. Grade 2.

Critical, is that when your Chiropractor examines you, there will be no actual numbness, or increased pain on testing with a pinwheel, no change in the reflexes and no weakness.

The SLUMP TEST FOR SCIATICA is likely to be strongly positive. When s/he raises your leg there will either be pain in your naughty leg, or a very tight feeling compared to the other leg. The so-called "Braggard's Test" will be negative.

Grade Three:
LBP + leg pain + increased sensation

We make an important distinction between leg pain WITH and WITHOUT "hard neurological findings". In a grade 3 injury, there are actual measurable changes that your Chiropractor will find. When s/he pricks your naughty leg, it's sharper in parts, usually the back of the thigh, calf and side of the foot (the so-called S1 dermatome), but it certainly can irritate other nerves too, affecting the side or front of the leg.

The Slump test will now be very strongly positive, and the test of Braggard will probably be positive: Pulling your toes towards your head will provoke pain in the naughty leg.

But, in my 5-point grading system, there are still no reflex changes, nor signs of weakness.

By now, your leg may start to be more painful that your back. That's an ominous sign. FEMORAL NERVE tingling and pain ...

Grade Four: The slipped disc symptoms are
LBP + numbness + reduced reflex and specific weakness

As the bulge of the disc increases, so does the effect on the nerve. It could be the sciatic nerve, from the very bottom of your lumbar spine, which would cause tingling, numbness pain in the buttock, and the back or side of your leg and the side, under or top of your foot.

The sciatic nerve affects many muscles, but those affected primarily govern the foot. Commonly there is weakness raising the heel or the big toe.

The achilles reflex is often affected.

Or it could involve the femoral nerve which emerges from the mid to upper lumbar spine in which case you would have pain in the groin, perhaps, and radiating down the front of your leg and inner lower leg. 

This nerve, instead of passing through the buttock to the back of the leg, continues through the pelvis, escaping via the groin to the front of the thigh.

The femoral nerve commonly affects the group of very powerful muscles on the top of the thigh; the four quadriceps muscles. Raising the thigh and straightening the knee is affected causing the knee to buckle on stairs. A profound limp is one of the signs.

The knee jerk reflex is commonly affected.

What is critical in a grade 4 injury is the development of motor signs. The motor nerve that drives the muscles in the leg is affected, so there will likely be changes in reflexes and the ability to stand on your toes, on your heel, or to squat on one leg. The leg feels and is weak. It may suddenly give.

This is now a very serious injury and your chiropractor will almost certainly send you home. You may not sit at all. Bending is forbidden, and you will probably be directed to have intermittent bed rest, with gentle exercises, and walks around the house periodically. Ice is the most effective painkiller. Listen to him or her, and do what you're told, but don't panic. Nevertheless, the surgeon is sharpening his scalpel in anticipation! A scan really is called for but they are expensive.

A lumbar corset when you are up and about may help.

Chiropractors too need chiropractic. Six months ago I lifted a very heavy patient and injured a disc very badly. The prolapsed disc burst into two parts; one bulged into the intervertebral foramen causing severe thigh pain on extension of the spine. The other fragmented into the spinal canal causing vague symptoms in the whole leg as many nerve roots were affected. More about the sequestered disc under a grade five lesion.

This fragmentation of the disc causes severe leg pain and hard neurological signs and symptoms.

I have learnt much about lower back and leg pain from the injury. One thing is to try and isolate what movement provokes the injury. Reflecting on my own lower back, all three times that I have severely injured my own lower back, I was bending and turning to the left simultaneously.

A large prolapse into the spinal canal takes several months to be reabsorbed and 50 percent less pain to be achieved.

Grade Five:
Much less LBP + but your leg is on fire.

Grade Five is the true hernia and you are certainly on the verge of surgery.

Ten years I would not even accept a Grade 5 disc injury case, but surprisingly, I have found that even the true hernia will respond to gentle Chiropractic manipulation, correctly done, in perhaps 50% of cases. If after 3-4 weeks you are not responding, at least 40-50% less pain, a surgical consultation will probably be requested.

The leg and often buttock develops a deep ache that you often can't escape, even lying down.

What's known as sequestered disc with severe leg pain. The radiologist who took the mri was convinced it was a surgical case, but here I am, typing this blog with no pain, and only an occasional tingle in the leg.

But I'm still having chiropractic care; I still my lower back exercises faithfully every morning before arising. Frankly the injury gave me a fright! It's not supposed to happen to chiropractors. I'm lucky to have a daughter who is such a good chiropractor.

50 percent less pain

Here's the deal. Understand that 50 percent less pain does not mean that your condition has healed by fifty percent. More likely 10, and you are now in a very vulnerable period.

You feel 50 percent less pain but in reality you are only 10% better.

If it's your back, one unavoidable sneeze (try blowing your nose, you can often avert a sneeze), one silly movement, a long sit in a bad chair (or even a good one), neglecting to do your exercises, and suddenly a Grade 1 has progressed to a Grade 2, or Grade 3 or 4. If it's your shoulder, it could be an awkward movement that you wouldn't have dreamed of attempting a month ago, but now you might be tempted.

The secret is get properly better before getting back in the deep end of life.

Help for sciatica

Help for sciatica is there, but don't think you just have a bone out of place, and Dr Golden Hands can fix it in one session; miracles we do at once but the impossible takes a little longer; and the 50 percent less pain rule still applies.

  • Don't abort the help for sciatica pain treatment in order to save a few dollars. You may find yourself a few thousand short, even a few tens of thousands. Go for your treatment. "Dan zit je met gebakken peren."*
  • Do your exercises religiously, with great fervour! Every morning before getting out of bed, and whilst you are acute, every half an hour. They take only 40 seconds.
  • Try not to sit too much, especially in the car and the luxury seats in front of the television. Try perching on the corner of a desk, or back of a low-backed chair.
  • If it's your ankle, knee, shoulder... just keep reminding yourself that 50 percent less pain is not equal to 50% healed.

Pelvic and lower back exercises

Every chiropractor will have his/her own ideas on rehab, so discuss it with them but the 50 percent less pain stage is when I begin rehab. You can get some ideas here from YouTube. Lower back exercises ...

Then you will be sitting with baked pears.

All languages I suppose have their quaint sayings, and no one has the faintest idea of their origins; like, it's raining cats and dogs.

Sitting with baked pears is a favourite Dutch saying, and it's trotted out with great regularity; it means having to live with the consequences of a bad decision.

When it comes to musculo skeletal injuries, be it a slipped disc or a tennis elbow, the last thing you want is to be sitting with baked pears. Go through the process to achieve maximum healing, and the minimal chance of a setback. That means rehabilitation and not not stopping with chiropractic help when you have 50 percent less pain.

Anecdotes are of no value, but today we saw a lady for her second consultation, with a very long history of severe lower back and leg pain. Two surgeons said she absolutely must have surgery. After only one treatment she has 50 percent less pain.

Is that a reason to stop the treatment? The underlying condition after one treatment has healed by a maximum of one percent; but she has fifty percent less pain.

Dejeurine's triad of coughing, sneezing and bearing down on the toilet, and laughing too, are often associated with acute disc injuries. The onset of constipation is very unwelcome; it may be caused by irritation of the nerves to the large bowel and rectum, or side effects of medication, or simply the reduced general movement of your body at this time.

Increasing the soluble fibre content of your diet is vital. A green bean salad is perfect, of course; so is virtually all fruit and the beetroot is definitely God's gift to the constipated colon. Pickled beets are part of the solution.

Atherosclerosis, a condition where the arteries become furred up with inflammatory cholesterol plaque doesn't only affect the heart.

Because of the decreased blood supply to the spine smokers have a much higher incidence of lower back pain, and it heals more slowly. They are particularly vulnerable to the Fifty Percent Less Pain rule - in their backs the cartilage in the disc has healed perhaps only 5%, not 10%, when they reach the 50 percent less pain stage! It's all about oxygen.

  • Atherosclerosis symptoms Low Back Pain
Poor blood supply lessens the likelihood of quickly achieving 50 percent less pain.

Back surgery alternatives

Back surgery doesn't just happen to "other people." Every day chiropractors are treating thousands of folk who are experiencing what is known as Failed Back Surgery. It's a medically coined phrase, not just one used by cynical chiropractors.

The very best alternative is to go properly through the rehab phase of chiropractic, and keep doing your exercises for life, just like you brush your teeth.

› 50 percent less pain

Seriously overweight?

Another way, if you're seriously overweight, very often to achieve 50 percent less pain is this vegan weight loss diet.  Actually, it's not really a diet, just a whole different way of living. Vegans are on average over 10 pounds lighter than meat eaters.

On a personal note, I take many of the advantages of the vegan way of life, but enjoy a small-to-moderate amount of animal products.

Seriously overweight folk usually don't realise that most often it's the refined carbohydrates, not fat, that cause you to be that way. Type glycemic index into the search engine and find out about the difference between the healthy carbohydrate in a green pea as compared to the carb in white rice, for example.

Simple vs complex carbohydrate is no straightforward matter either; raw honey has a much lower glycemic index than white bread for example.

Searching for something specific? Just type it in here: 

Have A Question about your lower back?


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.

Stop! Are you about to write on a not so smartphone? Don't. The chances are good you are wasting your time and won't get a reply.

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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.

I will never give or sell your email address to anyone.

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 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.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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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.

Hilton Chiro Clinic

Hilton chiropractic clinic is one place to realise less pain with treatment and strict adherence to the exercise regime.


Drs B Lewis and J Ackerman work hard to achieve healing of your pain.


An unrushed experience in the Midlands of KZN is where you find chiropractic help.


Breastbone pain is one of the conditions we excel in.


Lumbar facet joint pain is the most common condition treated in chiropractic clinics.


Foot and ankle pain are not treated by all chiropractors, but remains the treatment of choice for a displaced joint.