Pisa sign and sciatica with disc protusions at levels L4-L5 and L5-S1

by Alexandre
(Sydney, Australia)

Antalgic posture

Antalgic posture

Pisa sign and sciatica with disc protusions at levels L4-L5 and L5-S1 is going to be difficult and my book needs intermittent bed rest.

Hi there,

Reading through your website, I understand I have postero lateral disk herniation. I am the Pisa leaning to the right, away from the pain.
I have been carrying this for now 1 year or even more.

The pain has now become very bad, and it is very hard to stand and walk. Sitting is okay for some reason.

I am pretty desperate of finding a solution, but hate the idea of going under the knife.

Was wondering if as part of my rehab, I should try to lean toward the pain or lean right away from the pain in order to fix it, a bit like a side McKenzie. I notice that neither influence it somewhat. It doesn't quite make sense to me.

I have seen countless chiropractors and osteopaths in Sydney without any success. Can you recommend anyone?

I was also wondering if you were to recommend ozone injections as a potential solution. I know it is very controversial but apparently some people are having the greatest success.

Many thanks,


Hello Alex,
You're in a tough place and frankly there are no easy solutions. Surgery isn't one either but if you are developing paresis in your leg it has to be considered.

If you've seen "countless" chiropractors and osteopaths then something is going wrong. Have you given someone a chance, or are you expecting a "one treatment" miracle?

My advice for what it's worth is as follows:
1. Start doing our lower back exercises every single morning before getting out of bed, and several times a day. They take one minute.

2. Use alternating ice and heat on your back daily.

3. If you really are in an antalgic posture, looking like the tower of Pisa, go to bed and follow our slipped disc rules. This is controversial as there's lot of research discouraging bedrest. You'll notice ours is different though, with exercises every half an hour, getting up every hour and going for a short walk around the house.

4. Put a small lift in your right shoe.

5. If there's a swimming pool nearby, then get in several times a week, lying on your back and kicking up and down the pool. Not if it means travelling some distance.

6. Don't bend and absolutely no vacuum cleaning, sweeping, lifting.

7. Decide which you feel was the best of the chiropractors or osteopaths, and stick with him or her for at least a month, and follow their instructions to the letter.

I know this is all tough, it means taking a month off work, opting out of housework and quite a lot of money. The alternative is gathering momentum on the slippery slope where you find yourself.

Good luck, I hope this contributes. Let me know how you get on.

Dr B

» Pisa sign and sciatica with disc protusions at levels L4-L5 and L5-S1

» Pisa sign and sciatica with disc protusions at levels L4-L5 and L5-S1

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Jan 12, 2016
by: Alexandre Reyter

Hi B,

Thanks for your quick answer.
I'm pretty aware it is a serious problem and that lying down for a long period of time is probably effective.
Any recommendation about the Mckenzie Side-glide I talked about?

Many thanks.

I don't know much about it; if it's not working then there's probably no point in continuing.

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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