Lower back pain and antalgic lean


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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.





Hello Andy,
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 Barrie Lewis



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