L4, L5, S1 disc herniations again after surgery 4 years ago

by Shahid
(Lahore, Pakistan)

The Slump test for Sciatica gives you an idea of how the condition is progressing.

The Slump test for Sciatica gives you an idea of how the condition is progressing.

L4, L5, S1 disc herniations again after surgery 4 years ago reminds one there is no cure, only prevention through exercise and common sense.

I have pain in my lower back with numbness in thigh and feet. I had operation in December 2013 but again my disc is herniated in last month.

Though I have relief in pain and have started walk again around 2 km. My spine doctors have again recommended operation.

Hello Shahid,
Firstly, accept that there's no such thing as a 'cure' for what you are experiencing. Long life commitment to back exercises, every morning before getting out of bed, and an acceptance that heavy lifting is not for you is absolutely vital, no matter what treatment you have.

Otherwise it just comes back, then there's a third and fourth operation and even more misery.

Generally my experience is that if the pain in your leg goes away, given time and common sense, it may well heal without surgery.

The thing to look out for is the development of weakness in the lower leg muscles; can you raise your big toe and lift your heel off the ground?

I treat what you have on a daily basis, but I don't think there are many chiropractors in Pakistan, if any.

Chiropractic is moderately successful in treating a sciatica, but again it's not a cure; exercise, exercise, exercise, and avoid heavy lifting.

I hope this helps in making your decision.

Dr B


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Oct 03, 2017
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L4, L5, S1
by: Shahid Sohail

Thank you very much for your detail answer. The Exact word of my MRI report says "
-- Diffuse posterior Disc Herniation at LV5-SV1 Level Causing of Bilateral exiting and Traversing Nerve Roots.

-- Diffuse Disc Bulge at LV4-LV5 level causing Impingement of Right Exiting Nerve Root.


Your Answer has cleared many misconceptions in my mind. I have already foot weakness and unable to lift my left toe. The weakness exists prior to my operation. The doctor had told me before operation that it might not be helpful in removing foot weakness but it would be helpful in giving relief in pain. It happened exactly the same and I was pain free for almost 4 years.

There are a few Chiropractors in Lahore (Lahore is the 2nd largest city of Pakistan) but i have doubt on their abilities. The chiropractor I met was mostly treating with electrolytes and not doing much manual spine adjustments contrary to what I had seen on youtube. In my view if there is temporary relief in pain via chiropractor and disc slip is the same there is no use of it.

Pls. help me in selecting exercises. I am feering that all web exercises related to my problem are not for me. As already told that I have restarted walk and covering 2.5 km (40 minute) without much pain.I am avoiding exercise fearing it might aggravate my problem. I feel numbness in lower thi and on foot and pain in thi area. Also do brief that this numbness is harmfull to my limbs or have any side effect.

I would be grateful for your detail answer.

Good day Shahid,
It's certainly of concern that you cannot extend your great toe; did it not recover after the first operation, or is this something new?

There are always a few ifs and buts; the impingement of the L4/L5 disc is on the right, but the toe weakness on the left; hence my questions as to whether it recovered fully after the first operation. Establishing which level is affecting you is vitally important; an operation at the wrong level would bring no relief.

True, it is likely that after chiropractic correction, further injury down the road may occur; you interpret that as temporary relief. But the surgery four years ago also only brought you temporary relief.

A lifetime of good back care lies ahead of you which every way you turn; otherwise there will be a third and fourth operation.

Good luck.

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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