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  • Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    A “tilt” (or “list”-better term) from a rotational maneuver is typically associated with an annular tear. This is not a standard finding (most people with annular tears do not develop a list) but is not unusual. These leans (or lists) are associated with individuals with stronger back muscles who can contort their body unconsciously to position themselves away from pain.

    The new onset of left buttocks pain that radiates to the left shin is the annulus now fully tearing and the inside of the disc (nucleus) herniating. The extruded fragment from the nucleus is now compressing the nerve root and leg pain results.

    What I worry about is motor weakness from the nerve root compression. Try a simple test. Can you walk on your heels and then toes without the foot of the painful leg dropping with each subsequent step? If you are unsure, stand on the painful leg and do 10 quick heel raises or toe raises. If there is weakness or if unclear, you compare good to painful side and there is an appreciable difference, motor weakness is present and you need to present yourself to a spine surgeon without too much further delay.

    If no weakness is present (and you don’t feel like you might sprain your ankle or your leg might not hold you up-other signs of weakness), you should at least consider an MRI and an epidural injection to reduce nerve root swelling.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    brandon8
    Member
    Post count: 2

    Hi Dr Corenman,

    I didn’t see your reply until now!! Thanks for you response!

    Well almost 6 months has passed and I feel like a new man!

    I had MRI done and my surgeon noticed sever rupture in my L4 disc. Shortly after I opted to go with surgery. The surgery I had was lamenectomy. As soon as i woke up I noticed pain was gone and I was able to walk immediately with zero pain!

    It has been about two months since surgery and I feel great! The tilt is almost gone, as you mentioned it was tilting to compensate from pain. Because I was tilted for a while my surgeon says I should be completely straightened out in another month or so. Although I really didn’t want to go with surgery it was the best choice I could’ve made! I’m now back to normal activities and feel strong.

    Thanks!!
    Brandon

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Glad you had a good result. Surgery can be quite rewarding.

    It is interesting to note that it takes close to three months for this antalgic posturing to recede even after the direct cause is removed. The cerebellum is a very slow adapting part of the brain.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Princess
    Member
    Post count: 6

    Dear Doctor,

    I am posting on this thread because I would like to add something important. It is true that part of antalgic scoliosis is caused by habit after your muscles get used to the posture, but the muscles also shorten (atrophy) and lose strength. I had antalgic scoliosis and mild sxiatica due to a very large prolapsed disc at the l4/l5 level. This was confirmed by MRI and after several months of no improvement, I was told surgery was my only option. I was unable to stand up straight and joints/muscles adjacent to my spine were in pain. I was unable to walk.
    I was in agony. My husband was very supportive but we were unable to do most of the thongs we enjoyed doing together. With him being at work, I spent most of my day trying various exercises, or putting faith in natural recovery, but that just wasn’t happening.
    I had the discectomy in May last year. The mild sciatica I had improved but the postural problem remained. Immediately afterwards some muscles started getting streched naturally. My pelvis had tilted right and my chest was leaning left. Initially the pelvis had to be moved back to the left. I walked with my pelvis slightly tilted left. This felt more comfortable. All my back muscles were tender and felt tired. The muscles do not have enough strength to begin with and many of them had already shrunk. It takes time for the pelvis to get in the correct position. My physiotherapist started me on some exercises that were designed to assist natural recovery. As mentioned before my chest was leaning left and my midline on that side was caved in. This took an extremely long time to straighten. I think straightening involves stretching, inevitable muscle fatigue (that can make you feel and look worse), and evetual strengthening. While the muscles initially stretch they do not have strength so you keep reverting back to the antalgic posture and that can be frustrating and confusing.
    I think this list requires a lot of physical effort on your part to correct. Postural problems are not just habitual. With this condition you just can’t stand straight until the muscle imbalances are corrected. That in itself is a painful and fatiguong and, for me, even four months into the recovery, I was still suffering. I think the information on this site is good.

    nikolaus
    Member
    Post count: 11

    Hi princess,

    I am not the doctor but i was the opener of the thread. It’s almost two years after my first post but i am still reading this thread since i get notifications whenever someone writes something. I think you were a little bit unlucky.

    So, i am updating my story for the readers. To give them hope.

    Its clear to me, after talking to many many doctors and patients, that each case is unique. Some people live nightmares and others come back to sports in no time. I was like you, seriously, unable to walk more than 1-2m. Spine rotated etc. Everything out of position. Could hardly sleep. Could hardly lift my left foot.

    But, 2 years later, the pain is gone and as is the antalgic position. I didn’t proceed with surgery so I have no idea what happened to the herniation, but I am not going for another MRI unless i feel pain again.

    The process was slow and painful. But to me, it did go away. I can walk and stand as much as i want with no pain at all. I have tested myself walking more than 10km with no pain at all. I can sit for about 5-6 hours with no pain. If my progress continues, i think that i will be able to safely run again in about year.

    Exercises didn’t do shit. Injections nothing. Pain killers nothing. Slowly the body either blocked pain or healed. I have no idea. I dont think it just blocked the pain because i can lift my leg now which wouldn’t make sense if the herniation was still blocking the nerve (in my first MRI the herniation was completely blocking the left nerve). But NO specific exercise helped me. No physiotherapist.

    Only time helped and, in my case, after the initial pain subsided, walking did the trick.

    So there is hope, and i know the body can heal itself because i did. I have no idea if the surgery would be a better option for me and i have decided that if this ever happens again i will proceed with surgery because i had to live through almost a year of pain to see real improvements.

    But, i am not regretting for my choices now (obviously) as i did manage to avoid surgery at least for some years, if not for ever.

    So, i am the living proof that antalgic scoliosis may go away, as can the sciatica and the lower back pain, by itself.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Yours is a great tale of antalgia without motor weakness. One of the indications for surgery is pain that is not tolerable. That word “tolerable” is the catch. If the pain is tolerable, then surgery is simply only one option.

    Antalgia does bring another factor to the decision making process. I have found that antalgia will generally fade away but very slowly. As you noted, this can take up to two years and there are patients with a list (spinal curve) that can last forever.

    In about 70% of herniated disc patients who do not have motor weakness (they have another algorithm they need to follow-see website), the symptoms will slowly fade away. If the pain is tolerable but still significant, patients will generally get better faster with surgery. If the patient does not want surgery, it is a waiting game.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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