L4 and L5 sciatica left leg

by Chris
(Sydney, NSW, Australia)

My problem originated from lifting heavy boxes on 30 May 2013 which was further exacerbated by moving warehouse 21 days later, on the 21 June 2013. After 21 June I could virtually not walk and had leaning tower of Pisa!

It gradually got better, and could walk. Since my injury I have good and bad weeks/months and I have been to remedial massage and physio appointments. I was hoping the problem will eventually go away like most of myasthenia injuries.

After still having non stop manageable discomfort and having some bad days/weeks I realised unfortunately this was chronic and wasn't going away and saw a back specialist this year and he arranged a MRI and it was diagnosed I have a " posterior and left para central protrusion of L5/L4 disc causing focal stenosis, with associated compression of the transiting left L5 nerve root in the lateral recess".

Recently I have had another flare up in last 3 weeks, but this time Voltaren and pain killers, back rest and being off work for 2 weeks had not changed things. I am again leaning tower of Pisa with question mark back. It's as bad as when it first happen. The other flare ups were manageable. The pain was so agonising and my worry of so many days off work, I decided to get the nerve block needle prescribed by specialist under CT scan. That was done just over a week on Thursday! I was praying that the needle was going to eventually work and give me pain free back and I could go back to work. But even after waiting 3 days, and a week later it hasn't resolved the pain.

As I write this to you, I'm flat on my back and seek your advice whether a good chiropractor like yourself could help with my issue. My leg and back are extremely sensitive when I bend, and when trying sitting in a car is unbearable. I can't drive. When I do try and drive I get this unbearable burning sensation in calf muscle. The pain is in the lower left back and I find it hard to put socks on, on left side. When I stretch I find it hard to stretch forward and to left side of leg. Surprising can stretch backward more. I can also do the Mckenzie stretch back wards where you lie stomach down and raise your body with your arms. It's standing, walking and especially sitting in a certain angle ( car ) that is painful.

So if I do see chiro should I only see them when it settles down first by taking meds or it's ok for them to work on it now in its agitated state? Also do you know of any good chiropractors in Sydney, australia that has the knowledge and experience you have with lower back? Reading your blog you really understand my problem. I

Thank you in advance for your advice and recommendation and your terrific website. Please let me know what you think I should do. I only wish you were here in Australia so that I can see you.



Hello Chris,
Thank you for the compliments. It's not good obviously, as you've already figured out.

However, there are some good signs. Firstly that bending backwards doesn't increase the pain and in particular cause pain in the leg. That means that there isn't an extrusion into the foramen.

Secondly, para central discs usually respond much more quickly to manipulative treatment than lateral discs. However, you've had this for 18 months so there's not going to be any quick fix.

To confirm this though:
* is Pisa leaning towards or away from the painful side?

* sitting in a normal chair; if you straighten your right leg parallel to the ground, is it more or less painful than straightening the left leg?

* Does straightening the right leg give you pain in the left LEG? That's one of my ominous lumbar signs.

Of critical importance is the presence of weakness in the leg muscles, paresis in medical jargon. Can you lift your big toe off the ground? Can you stand on your left toes, raising the left heel, right foot off the ground? Hold onto a chair for balance.

You can certainly have treatment in this acute phase but this is a delicate and difficult condition; it's going to take someone with experience to get you out of the hole you're in. Start talking to friends and family, and your doctor, to find a good chiropractor. There's sure to be someone in your lovely city. Find him. Or her.

Start doing our lower back exercises for a slipped disc; you'll find them in the navigation bar. Don't pull the knees hard onto the chest.

Accept this is going to take six to eight weeks minimum for recovery. Complete recovery longer. Probably six months of being careful. Stay at home and don't sit. Use ice for pain control.

There's some confusion in my mind; the exiting nerve in the L4-L5 foramen is the L4 nerve root in my understanding. But a central L4-L5 disc is indeed more likely to affect the L5 root, but not in the foramen. Have a look at the page called Femoral nerve damage (use the search function), but it's the level above yours, affecting the femoral nerve.

Let me have some answers to the questions above.

I hope this contributes.

Dr B

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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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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.

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