Valsalva manoever

Valsalva manoever is one of the tests that is used to confirm a slipped disc, primarily in the lower back.

It has been well acknowledged that even amongst the best clinicians in the world there is often disagreement concerning what may actually be causing the pain in your lower back. And research shows that without that assurance, surgery is usually in vain.

The same might be said in the chiropractic setting, the difference being that our procedures are far less invasive; and, if treatment for a slipped disc at one level say, is not succeeding, one can always adapt the adjustment technique. Perhaps the pain was coming from the sacroiliac joint.

There are many structures in the lumbar spine capable of causing pain. The valsalva maneuver is just one of the many tests that your chiropractor will perform in coming to a correct diagnosis; that then leads to the appropriate treatment.

For a variety of reasons, patients often decide not to rush to the doctor or chiropractor when they have an episode of lower back pain. That in itself is not a bad thing; given common sense, and a gentle set of exercises many conditions will pass over of themselves.

However, the presence of a positive valsalva manoevre, should caution you that this may not be just a passing strained muscle. Severe leg pain may be just around the corner. Fortunately it's a test you can do at home when you have an attack of LBP.

When it's positive I recommend you at least stay at home for a few days with greatly reduced sitting, no bending, gentle exercises and intermittent bed rest coupled with pelvic tilts and pulling each knee to the chest; an ice massage followed by heat, cold hot therapy, is the best treatment for pain. Don't get into the bath, and definitely don't try touching your toes.

Also, if the valsalva maneuver is positive, try very hard not to cough or sneeze, or bear down hard on the toilet. Our quick constipation relief page is worth a perusal.

Valsalva manoever

To perform the valsalva manoever sit upright in any chair, and take in a deep breath. Now bear down as though you are trying to have a bowel movement, but make sure your mouth is closed, your nose stopped.

You may even want to pinch your nose.

In effect you are breathing out, but against a closed airway.

This has the effect of increasing the pressure in the chest cavity, affecting the heart and peripheral blood system.

But in this instance, we are interested in the increase in the pressure in the spine and, more particularly, within the discs. Should there be a tear in the annular fibres, then the increase in the  nucleus pulposis will cause pain.

Some authorities speculate that it may be caused by the increased pressure of the venous blood vessels within the spine.

Whatever, pain in the lower back, and perhaps down the leg, is a sure sign that you may have injured a disc in your spine.

You should then do two further tests.

  1. Does flexing the head onto your chest cause lower back pain? In practice patients find this when ducking their heads to get into the car.
  2. Then proceed to do the Slump test for sciatica. The test for a disc in the mid to upper lumbar spine, affecting the femoral nerve is unfortunately more difficult, and not described here.

Should you have leg pain, and particularly if the valsalva maneuver and Slump test are positive, I recommend you consult a professional for advice and probably treatment.

I cannot let the opportunity slip here to point out that interprofessional research indicates you are more likely to end up under the knife if your first consult a medical doctor.

The reasons are many, but I believe that if you can reduce that slipped disc within twenty four hours everything is much simpler generally. After that severe swelling sets in and it becomes more difficult.

Slipped disc

A slipped disc, particularly if the bulge is into the foramen or into the spinal canal causes severe arm or leg pain. It's a serious problem, treated successfully often but not always in the chiropractic setting.

Whether you go for surgery, or consult a chiropractor, you'll have to stop for a period, go for treatment and go through rehab exercises.

Continue with those exercises, otherwise a relapse is the rule. It's a weak point in your back for which there is no cure.

Repeated episodes with more surgery, or chiropractic care is the rule unless you accept the fact the lifetime of back exercises is your lot. That shouldn't be a problem; you give your teeth the same degree of care.

Those exercises take only a couple minutes before arising, and at night; do them on your bed every single day.

Take a positive Valsalva manoever seriously.


Chiropractic treats patients with a positive valsalva manoever every single day; the trick is to understand the seriousness of it, accept that your must follow these slipped disc rules for a period and undergo treatment to reduce the bulge.

If you don't the pain is likely to radiate down the leg, and that's when the surgeon starts to get excited; that you don't want.

› Valsalva manoever

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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.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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Greetings, Dr B.
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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Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

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