HDL L5-S1 with sciatica on right foot

by Florin Daniel
(Bucharest, Romania)

Hello,
My name is Daniel, i am 30 years old, and i recently (about a month ago) had a lumbago episode due to my recurring lumbar disc hernia at L5-S1.

PAST HISTORY:
First occurence:
- My first HDL was in december 2010 (~5 years ago). MRI revealed a central disc herniation. Doctors said i should operate soon, but i didn't, i started taking antiinflamatory pills , rested flat in bed (and on the floor), and doing Williams exercises when my sciatica was feeling better.

I also bought an inversion table which i think helped me a lot! Every time i was having pain i used to rest in it for 10-15 minutes and felt great after. I think it took about 3 months to get free from the symptoms, and another 3-4 months to stand in a chair for longer periods of time.
- I started swimming, exercices, etc.

Two years later, i have done another MRI which showed a small protusion only (the HDL was "gone"). I was feeling great!

Second occurence:
- All good (minor pain in my back from time to time) until december 2014 when i was renovating my apartment (lots of weight lifting, stretching, twisting, etc). I got another episode of pain in my lumbar region, and after a few days the pain disappeared from the back region, and I started feeling an intense contracture on the right foot when i walked. The Lasegue test was positive. It was painful, limited but without neurological deficit. I started the home treatment as i did in 2010 and i managed to get rid of the symptoms (quite rapidly), even though i never stopped my renovating activities (just did a minor break between time to time).

Third occurence:
- Until january 2016 (this year), i was feeling good. After the winter, i started feeling pain in my lower back. I started taking painkillers (almost regularly). One morning when i was in the bathroom, i sneezed and "heard" something popping in my back. I knew it was going to some harm. In 15-20 minute i started having pain in my back, and progressively i felt like i have not strength in my lower back. I had the "luck" to sneeze again, and that was the final take for my L5-S1 disk. The pain resulted forced me to rest in bed, and take more pain killers. I went to a clinic and did a session of streching on a horizontal table. Also i visited a chiropractor and did a session. When i did the chiropactic i didn't had any sciatica pain (only back pain) and the chiropractition practically streched everything with ease i must say. After a few days, my
back suddenly stopped hurting, i was feeling like a new born.

I went to work for two weeks (standing in a chair at the desk). In the last week i started having pain in my right leg and buttock when i tried to move around. After the final week at work (and with driving and all) i was feelind very bad (intense pain in leg and bottock on the right side right above the knee), probably my disk had migrated into the spinal canal, iritating the S1 right nerve root.

PRESENT:
- since about a week and a half, i am unable to walk properly due to leg pain from the sciatica.
- i have a positive Lasegue test. Painful, limited but without neurological deficit.
- i can sit without pain, but when i get up i feel like something is going down my nerve root as a "claw" hooking it and i feel like i have to move a bit to make it better (but not long).
If i rest in bed , i feel a good relief and i can walk without problems for about 30 minutes before i feel the disk going down again the nerve root.
- i can sleep without pain (rarely i have small nerve pain - but it is gentle)

I went to see lots of neurosurgions and most of them said to go for the operation. Others told me to wait like a month (plus 1-2 weeks) maybe it will fix on its own.


For a week or so, i managed to "control it" only if i rest in bed for longer. I a get a big relieve, and i can start to walk normal again without pain. The effect doesn't take long dough.. Even when i feel relieved after several hours (1-2) of rest in bed, the Lasegue test is still positive!

My questions for you are:
1. In your personal experience, and judging by my history and recent MRI, do you think i have a chance in recovering natural and without surgery? Please consider that in may i have an important event (my wedding), and i have not time to spare..
2. If i am feeling good after resting in bed, why the Lasegue test is still positive (not even a small increase)?
3. Can three months be enough to recover from a lumbar microdisectomy? Example, will i be able to dance at my wedding?
4. I tried to swim and do stretching exercises and even some kiropractice (as i've learned from the past), but it seems to worsen my condition (leg pain increases, i feel my leg more heavy and tired, and it starts to hurt lower then the knee), so i stopped.
5. Which one do you think will be more efficient judging by the time i have until my wedding - to wait for the pain to go away , or the have surgery and irreversibly have my back operated?
6. In your opinion, how long will it take for my sciatica to go away, and what will be best to do in order to fix it, etc?

Thank you for your time in reading this.
Kind regars,
Daniel

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Feb 18, 2016
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by: Barrie

Hello Daniel,
Your history is not unusual and what is encouraging is that you have in past recovered from this, and secondly have responded well to chiropractic adjustments.

The biggest difficulty with a disc herniation is to wait long enough for it the heal after the pain has receded. You obviously went back to sitting and work far too soon.

Prolonged sitting is often the very worst. The pressure in the disc increases dramatically. But prolonged standing is often difficult too, especially is you went into an antalgic posture. Did you look like the leaning tower of Pisa?

The next problem is that it would you seem the chiropractor discharged you too soon. After a difficult case like this, continued care and management is needed to prevent these relapses.

I would go back to your chiropractor seeing the treatment was so helpful, and follow our slipped disc rules carefully.

1. Yes, certainly, but it may be difficult now if you are unable to stop your life for a few weeks, and particularly if you are still sneezing regularly.

2. There's lots of research showing that plain bed rest will not reduce a herniated disc. In fact it may aggravate it.

3. Ask the surgeon, but I would think so.

4. You have to do the right exercises. See the lumbar exercises page in the navigation bar. Swim only lying on your back initially.

5. You can't do nothing. It's either back to the chiropractor, together with an exercise program faithfully done, or the surgery.

6. The leg pain will probably go away quite quickly with surgery but the risk are fairly high. With chiropractic adjustments, usually in less than a month, but then you have to be very careful for another month. Read our 50 percent less pain rule.

Good luck, Daniel. I hope this contributes. It's not a large herniation.

Dr B


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