Sacralization of L5 casefile sometimes creates a dilemma for the DC.
This page was last updated by Dr Barrie Lewis on 1 January, 2019.
Mrs D, a 39 year old woman first consulted me two years ago. Over the previous three years she had three severe, acute attacks of LBP, without referral to the lower limbs. Whilst the acute phase passed, she continued to have nagging backache every day.
Her mother and sister also have episodic lumbar problems. This is a strongly hereditary condition.
What finally prompted her to consult a chiropractor was two episodes, one six weeks and the second just a few days before her first consult.
Despite physiotherapy treatments spanning every week for a whole year, and an orthopaedic consult, the condition was clearly going downhill. Sneezing caused extreme pain in the small of the back; that's often a symptom of a disc injury.
Sacralizations and lumbarisations are not uncommon at the chiropractic coalface. They have a higher incidence of lower back and leg pain.
We call the zone between the sacrum, a solid but slightly movable bone, and the lumbar spine which is highly flexible, a transition zone. Sometimes the last vertebra can't make up its mind whether it is belongs to the lumbar spine, or the sacrum. The result is six or four movable lumbar segments, instead of the regulation five.
They are but two sides of the same coin.
Skullduggery is the word. The search engines have no interest in the word lumbarisation so I've called this page sacralization of L5 but in
fact this sacralization of L5 casefile is a lumbarisation; six vertebrae
instead of five.
Xrays are particularly helpful in these cases which is why, if there is a strong family history of lower back pain, further examination is advisable. Even a scan if you have the money, particularly if there is any leg pain. They are expensive. The big advantage with MRI is that to date there are no known side effects, as there are with xray and CT; ionizing radiation is dangerous.
A slim, but strongly built woman, she obviously stood with a pelvis distinctly low on the left side. This led to a mild scoliosis.
Forward bending was strongly painful in the low back. Extension and sideways bending to the left was mildly uncomfortable in the left SIJ; or was it at L5 in that pseudo joint?
On motion palpation, L5 was strongly fixated, due no doubt to the lumbarisation or sacralisation of the lowermost vertebra, which would normally be the fifth lumbar. There was no sacroiliac fixation on motion palpation, despite the tenderness in the joint. Surprising, as it usually gets tight along with bottom back bone.
On orthopedic testing, the slump test was positive with a crossed sign; raising the left leg provoked right lower back pain. All four sacroiliac joint anatomy tests were positive. Yet no sacroiliac fixation on motion palpation; odd.
A heel lift for the short leg.
A 5mm heel lift under her left heel provided instant relief when bending. Simply catering for the leg length inequality is often half the battle in dealing with chronic lower back pain in which a leg length inequality is a complicating factor.
Whilst for most chiropractors, myself included, Chiropractic Help would include adjusting the low back and pelvis manually most of the time, Mrs D responded immediately to the Thompson drop protocol in the pelvis, and the heel lift, so that I've never actually manipulated her back. Within a week the pain was gone.
However she went faithfully through the rehabilitation protocol, another 4 to 5 treatments, making it 12 in total. She also had some neck pain.
She had one slight setback about three months later, which passed with one of the six weekly control treatments. That was eighteen months ago. Since then she has had no pain at all.
Mrs D wears her heel lift faithfully, does her exercises with passion and enthusiasm; they only last one and a half minutes every morning and every evening in bed, before arising and taking to dreamland, and comes now every ten weeks for a control treatment, as we call it in the Netherlands.
She reported this morning that she has had absolutely no problems. Long may it continue. No treatment, no charge.
Here's the discussion of sacralization of L5 casefile. Lumbarisations, creating six lumbar vertebrae instead of the standard five, and sacralisations, creating four lumbar vertebrae, can sometimes be very troublesome. Each case is unique and one has to work out a protocol that brings relief of pain and disability.
These oddities at the lumbo sacral junction are often associated with other anomalies, in Mrs D's case a short leg, and a pronated foot.
Addressing all the above is what brings success in the treatment of lower back pain; the foot, a subluxated cuboid bone, the short leg, a heel lift, and the pelvis in this case. I still haven't adjusted her lumbar spine. The problem was in the pelvis, but oddly with no palpatable fixation in the sacroiliac joint.
Each back brings its surprises, and peculiarities. Hence the challenge to your chiropractor. Can she or he puzzle it out? With your honest feedback and positive contribution by faithfully doing your exercises, for example, I'm sure!
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