Lower back pain and antalgic lean

Hi, about 10 years ago, I was in a car accident. I was diagnosed with herniated and bulging discs in my lower back and neck. No surgery was done, only some chiropractic adjustments and massages.

Since then I have mild but fairly consistent back discomfort with the occasional muscle spasm. A few days ago I had a severe muscle spasm that lasted all day. During the afternoon I tried to lift a grocery bag, that had 2 gallons of milk, to help my wife. I was unable to do it and dropped the bag. The pain in my back got a little worse. I put ice on my back for around 20 minutes. After that I went to the bathroom and took off my shirt and noticed in the mirror I had a severe lean to the right (the side of most of my discomfort).

This scared me, so we immediately went to the E.R. The condition worsened as I sat in the waiting room waiting to see the doctor. When I saw the doctor he assumed it was just a bad spasm and prescribed me Flexeril (muscle relaxer), Naproxin, and Hydrocodone for pain. I have been in bed for 2 days, trying to stay off of it. The lean is still very noticeable but not quite as bad as when I left the hospital. I have an appointment with an Orthopedist in a couple of days.

My question is, am I seeing the right person, or should I see a chiropractor? Also, what should I be doing in the meantime to prevent further injury, or to help with the pain/lean? Is this likely permanent? Will this be permanent? Any help would be greatly appreciated. Thank you.

An antalgic lean is a serious sign, almost certainly a sign of slipped disc; what's good is that you make no mention of leg pain.

The other factor that's good is that you are leaning towards the painful side; the so-called postero-medial disc. They usually come right quicker.

Herein lies a danger though. Both medial and lateral discs take six weeks to heal from when it's reduced; chiropractors use various manipulative techniques and orthopaedists no doubt have theirs. The medial won't usually respond to traction. Make it worse, confirmed in the literature.

And because the pain and antalgic lean are usually much improved after a week or two, folk often get back in the deep end too soon, and injury it again. Read our "50 percent less pain" page.

There are potential troubles ahead whichever way you turn, Andy. It takes skilled manipulation to reduce the disc and can worsen; failed back surgery is well known; pills can give you a hole in the stomach and in any case are only treating the symptoms. You wouldn't treat a broken arm with just medication.

Read our slipped disc rules page. Sitting will most likely increase the bulge and prolonged bed rest also doesn't help, but I recommend, together with exercises, and get up every hour.

From today on, do our gentle lower back exercises every morning before getting out of bed. EVERY MORNING. For the rest of your life.

An antalgia is a 'functional' scoliosis; temporary.

Check for a short leg; sometimes an insert in the shoe can do wonders.

I hope this contributes.

Dr B

» Lower back pain and antalgic lean

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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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