Postero-medial slipped disk

Antalgia postero medial disc herniation

Postero-medial slipped disk means the bulge is in the axilla, or armpit, under the nerve root. Sometimes you may take up an antalgic posture; in this instance leaning towards the pain which I call the Pisa sign.

However many disc patients do not go into an antalgia. It's an ominous sign and, controversially in my book, I think the person who finds himself looking like a question mark should stay home and have massaging bed rest coupled with exercises.

One of the bizarre signs of this condition is that some people oscillate. They go to bed leaning to the left, and wake up in a right antalgia. It's particularly difficult clinically as your chiropractor may have to change the manipulation completely.

Bulges in the lower lumbar spine affect the sciatic nerve; the pain and tingling tends to go down the back of the leg. Any weakness usually affects the foot and ankle. Are you able to lift your big toe?

And can you raise your heel and stand on your toes on the affected leg?

In the mid lumbar spine any herniation would likely affect the femoral nerve; pain and tingling affects the front of the thigh and inner lower leg. Any weakness would cause the knee to give way, particularly on the stairs. 

Coughing and sneezing are usually painful, and can seriously aggravate the condition, and your chiropractor will be looking for a positive Valsalva manoever.

Together with bearing down on the toilet, these constitute the so called Dejeurine's triad.

This page was last updated by Dr Barrie Lewis on 20th July, 2019.

Pisa sign left

Postero-Medial Slipped Disk

Notice the disk bulge in the armpit, under the nerve root. That is the postero-medial slipped disk.

PM disc graphic herniation

I both love and hate treating patients with the medial herniation.

Why is that? Because they usually respond much more quickly than the person with the lateral disc; he leans away from the pain. Patients with a medial prolapse think I have golden hands. However there is that big question mark.

It is a big one; will you go on doing your exercises?

Both the medial and the lateral disc herniation take six weeks to heal with chiropractic care, assuming you go quickly to him when you know you have done something serious to your back. Reducing the bulge before the swelling and inflammation set in makes all the difference.

Interestingly, research proves that you have a significantly greater chance of ending up under the knife if you first consult your medical doctor; of course I am partisan but there is strong science backing it up.

Now, let us consider that question mark. Because the pain is nearly gone in ten days or so, you stop the program of treatment, forget about the lower back exercises and go back to tennis, golf and gardening; before those fibres of the annulus have healed, and whack, you injure the disk again just as it is healing nicely.

Research shows that far more postero-medial injuries end up in surgery than lateral disks. But they really are much less problematic. If you go through with the Chiropractic Help, do the rehabilitation, and wait out the six weeks, then you can expect a good outcome.

How do you know whether you have a medial or lateral disc injury?

Sit in an upright kitchen chair and slowly straighten first one leg parallel to the floor.

Lower the leg, and now raise the other foot until the limb is parallel to the ground.

If it causes no pain then you can place increasing tension on the nerve root by slowly flexing your head onto your chest, and then dorsiflexing your toes; pulling them towards your body.

This test should really be done passively; in other words, someone else should raise your leg, and dorsiflex the ankle. It is known as the Slump test for sciatica.

Crossed sciatic sign

If raising the opposite leg increases the pain more than raising the leg on the painful side, the so-called crossed sciatic sign, then you may have a postero medial slipped disk injury.

Say for example you lifted a heavy cupboard and developed sharp right lower back pain. If then, while doing the Slump Test, straightening your left leg causes more pain than straightening your right leg, then you probably have a medial disc protrusion.

Was is often confusing is the old gold standard straight leg raise of Lasegue sometimes produces results at odds with the Slump test.

Lower back and leg pain

Lower back and leg pain go hand in hand. If the bulging disk reaches the Sciatic or Femoral nerve then you will experience pain, tingling, numbness and perhaps weakness in the limb. This is true whether it's a postero medial slipped disk or a lateral disc.

The sciatic nerve affects mainly the back of the leg, calf and foot, whereas the Femoral nerve supplies the front of the thigh and the inner lower leg. Either way it's serious.

S1 dermatome changed and updated.

Sciatica without back pain

One of the most challenging conditions at the chiropractic coalface is sciatica without back pain. It can cause profound disability and weakness in the leg and, if chiropractic treatment is to succeed, do not delay. This patient was lucky, only because he came within days of onset.

The precise diagnosis is often difficult in the absence of scans which because of the cost are usually not immediately available.

Whether it's a medial slipped disk, or lateral, both a femoral nerve lesion and sciatica without back pain are usually very difficult.


Whilst chiropractic has magic moments, and this is particularly true of the postero medial slipped disk, most of the pinched sciatic or femoral nerve conditions that cause severe leg pain require dedication on the part of the DC and compliance from the patient.

Your chiropractor will not win if you are not following the slipped disc rules and the specifics of your condition. If you are not willing or able to adhere to your chiropractor's requests, then it's best in my opinion to go straight to the surgeon; the chances are they he won't win.

And if are not willing or able to adhere to the surgeon's instructions, then you are faced with the prospect of failed back surgery, or FBS; it's not uncommon in the case of the non-compliant patient; sometimes, no matter what the circumstances, you simply have to stop.

And if you do not adhere to your chiropractor's requests, then you are in serious danger of falling into what is known as the Failed Back chiropractic file. Every person with a postero-medial slipped disk must take it seriously, stop whatever you are doing for at least a few weeks, do the exercises, go for treatment, or bear the consequences; disability and lifelong pain.

Useful links

  1. Chiropractic Help
  2. Leg pain
  3. Postero medial slipped disk

If you have found this postero-medial slipped disk file interesting and useful, you will enjoy my Bernard Preston books; they are about real people who have had these problems, cunningly disguised to hide their identity.

They are fun books really; about the amusing and interesting, and sometimes tragic things that happen at the chiropractic coalface. Light bedside reading. Only $4, help me sell a million. Really, this is a great book, and even if you do not like it, only a very small amount is lost. In Stones in my Clog you will learn a lot about the Dutch people and why this is such a powerful little nation. I left so many friends behind.

They are much cheaper e-editions, to be enjoyed on your tablet or Kindle. You could read it on your PC but that gets a bit tiresome.

Google appears to frown on too many links, so phrases in bold, like that Stones in my Clog above, need to be copied and pasted into the Site Search function in the navigation bar on your left if you want more information.

Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

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 have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is 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 is 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 pain-free. 

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 is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has 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 stroll 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; he has a short leg.

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. X-rays 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 few months 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 is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year 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 could not 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 should not be treating the elderly most medical sites state but that is so much bunkum.

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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 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is 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 a DC does.

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 will love them. Priced right at $2.99, though Kindle fiddles the amount without telling me.