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