Postero medial disk herniation

Leaning towards the side of pain

Postero medial disk herniation when the sign of Pisa leans towards the  pain.

Pisa sign

LEFT lower back pain

The medial disc is an enigma; it's easier to treat with chiropractic adjustments, and it responds much faster than its cousin the lateral disc, but it still takes 6 to 8 weeks to heal.

More medial discs end up in surgery because the pain often goes away after a few treatments, so the patient resumes normal living, bending and sitting before the disc has healed; and perhaps ignoring the rehabilitation program. So, it happens again; and yet once more. And then ultimately the patient goes under the knife when the leg pain becomes severe. That won't be you, though.

Notice here that our friend is leaning to the left; towards the side of pain. Easy come, easy go is the name of the game with medical discs. Or, more to the point, easy go, and comes right back with a vengeance.

The pain may be gone in a few days, but it still takes at least 6 weeks with chiropractic treatment for the disc to heal, and perhaps longer if you've had the pain for some time. The disc has a poor blood supply and healing is only complete several weeks after the pain has abated. It's vital that you follow our slipped disc rules if you want to escape the knife.

The antalgic list, also known as a functional scoliosis, meaning it's temporary, is a very serious sign. Both standing and sitting are painful, and walking often nigh impossible.

Controversially, massaging bed rest is in my opinion the only option. It's not back by research which indicates that bed rest is not the solution to back pain.

Notice how the bulge in the picture below is in the so called armpit, medial to the nerve. Now our friend gets relief by leaning towards the painful side; to the left.

In short, with a postero medial disk herniation you get relief by leaning towards the side of pain.

Remember, not all disc bulges go into an antalgic posture; it is in my book however, a very serious sign, often the prelude to radiating pain down the leg if those slipped disc rules are not taken seriously.

You'll soon notice that I'm not advocating just bed rest for a slipped disc. It's bed rest, plus exercise and ice once the disc has been reduced with chiropractic manipulation.

The lower discs affect the sciatic nerve and it's not difficult to test if the nerve is pinched; you can do it yourself using the slump test.

The higher lumbar discs affect the femoral nerve and that's more difficult to test for.


An antalgia, leaning towards the side of pain, is characteristic of the postero medial disk herniation.

Take this antalgic posture seriously; it's often the prelude to a serious sciatica.

Slump Test

Sitting, in an ordinary chair, straighten your leg on the painful side parallel to the ground. It probably hurts, in the back, and perhaps in the same leg. This is the first phase of the Slump test for sciatica...

Now straighten the opposite leg. With the Postero Medial Disk Herniation, straightening the opposite leg often, though not always, hurts even more - on the opposite side. Usually in the back on the opposite side of the back. If it hurts in your opposite leg, then it is considerably more complicated. You will need to go to bed, and be patient. This isn't going to get better quickly.


One of the characteristics of the Postero medial disk herniation is that it sometimes may flip-flop. One day you are leaning towards the painful side. The next day away from the painful side. It's what makes this type more difficult to manage. Your chiropractor will have to be on his/her toes. And so will you.

Home treatment

Different doctors will have different opinions, but my advice with regard to the postero medial disk herniation is:

  • Go to bed until you can stand up straight. It's usually a few days, depending on how long you've been looking like the leaning tower of Pisa; it's known in medical jargon as an antalgia. Not continous bed rest; that's not advocated in my book.
  • Do some specific exercises that your chiropractor will prescribe for you. Do them every hour, and more often if you want.
  • Ice your back twice a day or more often; it's the best painkiller too. Follow the cold with a little warm, moist heat; a  shower or a hot water bottle. Don't get in the bath.
  • Every hour roughly, though there's nothing magical about 60 minutes, shall we rather say regularly, get up and walk around. Go to the toilet, make a sandwich, perch on the edge of a desk for a bit, but don't sit. When your back starts talking to you, go and lie down again.

  • Please try very hard not to cough or sneeze. Blowing your nose will often stop a sneeze but you must be quick; don't delay.
  • Follow your chiropractor's instructions to the letter. This is a serious condition. Research shows that a higher percentage of patients with medial discs end up in surgery. I believe that is simply because patients, and sometimes their doctors too, aren't prepared to, or don't understand that they must wait out the six weeks before playing silly buggers again.
  • Follow your chiropractor's rehab program earnestly. Please, take it seriously; then everyone ends up happy. Except the surgeon; he's just lost out on his annual ski holiday. Seriously, I'm not knocking good surgery, I refer patients to good neurosurgeons on occasion.
  • Don't sit for several days, and then as little as possible until you are much better. Sitting dramatically increases the pressure in the disc. Let me say it again. Don't sit initially, and then for graded periods only.
  • Do not bend over if you have to pick something up off the floor. Go down on one knee; again, one knee and not both. Don't squat and absolutely don't bend and twist simultaneously.
  • Smoking. Every day is a good time to quit, but it's vital now. Research shows it's the most important factor as to whether your back heals properly, or not. At least cut back hard for a few weeks. Better still Stop Smoking Permanently ...
  • Some new research shows that Lumbar belts or corset help patients with low back pain in regards to pain and function. Wear a belt for a week or two, especially if you simply have to go back to work. Try not to wear it all day. Lie down periodically during the day for five minutes and do the exercises.
  • Say your prayers and take your postero medial disk herniation seriously. The pain will probably go away quite quickly, but remember it comes back quickly too if you aren't sensible. Believe me, I've been a chiropractor for over thirty years.

Daily Exercise Routine DER

Absolutely nothing is more important that a DER if you suffer from chronic back pain. You will be able to identify here with Matt's struggle with his back. How construction work was the cause, but office work and long hours driving made it even worse. Read more about his daily exercise routine.

From the coal face

Anecdotes on health care abound, and let's be quite clear: scientifically they have no value whatsoever. Having said this, you may find this anecdote on a severe Postero-Medial slipped disc interesting. This man had severe leg pain with a compromised motor nerve preventing him from raising his heel from the ground. Click here and scroll down to 18-03-2009 … SHORT ANECDOTE

50 percent less pain

Once your chiropractor has reduced the postero medial disk herniation you will stand upright and there will be a dramatic relief of pain. But it WILL take 6 weeks to heal, perhaps longer, even though the pain may be gone in a week or two; beware especially when you have 50 percent less pain.

Do yourself a favour and go through the full rehab program, otherwise the chances are good that you'll be looking like Pisa again within a few months. 50 PERCENT LESS PAIN ... the dangerous time.


The worst thing for the low back is the chair. Exercise is what will improve your spinal health. But heavy sports like squash and tennis, and gardening require that you follow the rules religiously. Lower back exercises every morning before getting out of bed, do a warm up and cool down program assiduously before sport and gardening

I used to suffer myself occasionally from a lumbar disc protrusion at L5 S1, but my back has gone from strength to strength since I have started heavy gardening in my semi retirement. But then I have a chiropractor in the house, my daughter, who cares for me periodically. I do my lower back exercises very faithfully, and have a treatment from her every six weeks. It's a good formula; it works.

So, what the real cost of low back pain in society? It has become the most expensive item in many Western countries' health budget. It could become your most expensive item. Take the first attack seriously, don't assume it happens only to other people and get started on your own daily exercise routine.

In fact, I promote back exercises, like brushing teeth, for everybody, whether you've had a back problem or not. After all 80 percent of people are going to suffer these potentially crippling attacks of lower back pain periodically; these exercises take less than two minutes. Do them before getting out of bed every morning.

In fact, once you're in the groove, you can do them whilst still in that indulgent period between sleeping and waking. Wake up slowly and whilst saying your prayers or planning the day your body can go through the first moments of preparation for that busy day.

Are you leaning away from the pain? The second common disc injury is called the postero lateral herniation, and you lean in the opposite direction; away from the pain. It needs to be managed quite differently but both demand a life long commitment to a daily exercise programme; or, suffer from chronic disabling lower back pain.

Postero medial disk herniation

I'm under no illusions about the difficulty of stopping smoking, but neither shouldn't you be; it really is the most significant factor as to whether all forms of treatment for your lower back and leg pain will succeed or not.



Lower back and leg pain

The seriousness of lower back and leg pain is of course that it can pinch the Femoral Nerve ... the nerve that supplies in the main the groin and front of the leg, or the sciatic nerve which innervates mainly the back of the leg and foot.

The Femoral nerve test is difficult but you can test yourself for sciatica at home... SLUMP TEST for sciatica

› Postero medial disk herniation

Slipped disc nutrition

Slipped disc nutrition is a vital part of making sure this doesn't occur repeatedly. Also capsaicin health benefits will help reduce pain and inflammation; eat more jalapenos.

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.

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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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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?

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