Extreme Lower Back Pain with antalgic posture and unable to turn in bed

by Kerry
(Pembroke Pines, FL, USA)

Where does it hurt if someone lifts your leg? Slump test.

Where does it hurt if someone lifts your leg? Slump test.

Extreme Lower Back Pain with antalgic posture and unable to turn in bed requires very careful management; an MRI will help identify the level involved.

I have been having lower back pain for a few weeks now that seem to get progressively worse. I sleep with 2 pillows under my feet but when I stand, I have the antalgic posture which I try to straighten by the method of the Mackenzie wall press. However, walking for a bit starts the pain in my buttock region and if I sit to drive or sit for any amount of time, I get pain in my calf and thigh; it's not a linear pain but the pain would be in the buttock and then felt in the left calf or buttock, left calf & lower back of thigh region. It becomes extremely difficult to get out the car after sitting for any time.

Also, while laying in bed, I find it extremely difficult to turn from either laying on my back to one of my sides or vice versa. I stayed home for a week but had many doctors appointment including 2 visits with the Chiropractor that didn't help. I've seen the Chiropractor for 2 weeks now at a rate of twice a week with no help.

I've been doing the Mackenzie stretches which helped in my pain but I know more needs to be done. I return to work on Monday & I am terrified as I sit at a computer all day & I know the pain I will be in will be unbearable.

I find that the pain is concentrated right now in the buttock region, to me around the SI joint but it could just be a false disposition though I find if I can relieve that area, I'm in less pain which I can tolerate. Unfortunately, my doctors have not prescribed any medication for me as I recently found it I was pregnant. I'm not planning to carry the child to term especially with the amount of pain I'm in.

I just want to know what else can I do at home to relieve pain so I can sit for a bit & walk. I found my Chiropractor unhelpful as the progress I've made so far was due to lumbar herniated disc exercises suggested by YT PT. Any help is greatly appreciated. Thank you.

Dear Kerry,
You're between a rock and a hard place; the management of an antalgia is complex and if not correctly done, leads progressively to hard neurological signs; loss of reflex, numbness and an inability to raise the big toe, or raise your heel. Watch for these signs.

Then if you continue with your normal life, surgery is imminent.

Frankly most of the painkillers don't touch this acute pain anyway. Let alternating ice and warmth be your friend. Don't sit; if you do the chances of surgery increase dramatically. Don't go to work until the antalgia is resolved; alternating lying down, with gentle back exercises, and arising every hour for as long as you can manage to go to the loo, make tea; no housework.

Chiropractic manipulation is an art learned the hard way; and along with it, if you are sitting and bending, and continuing largely with your normal life, cannot succeed. There's a large hole in your disc through which the gel has bulged; anything that increases the pressure in the disc, such as sitting, means that even after a very successful manipulation, the nucleus will slowly leak through again.

I don't know the ins and outs of your case obviously, but I personally would have treated you more frequently, and wouldn't have allowed you to drive to consultations.

You have obviously lost confidence in the chiropractor you have been consulting; antalgias are tough and frankly none of us wins all the time; I don't. One good sneeze can change everything.

One of the great difficulties is that the level is not always clear; most likely it's at L4/L5 or L5/S1; higher would affect the femoral nerve. You can even have a hernia at two levels making treatment and management yet more difficult.

Since you are not getting better, insist now on an MRI; it will resolve many of these conundrums and is safe in pregnancy. Then start asking around for the name of a more skilled and experienced chiropractor.

Accept now, whether you go for surgery, chiropractic or some other form of treatment that simple, gentle back exercises done every morning for the rest of your life are your lot; it will come back even after the most successful treatment and how soon depends on whether you do those exercises and use constraint when it comes to bending and lifting.

I have treated thousands of cases like yours, and in fact personally had an even more serious injury myself; they are resolvable but it takes skill, restraint on your part and a high level of trust between doctor and patient.

There's no need to abort your baby.

Have a look at our slipped disc rules.

I hope this contributes.

Dr B

» Extreme Lower Back Pain with antalgic posture and unable to turn in bed

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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.

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