page contents Herniation Disc/Bulging Disc/Sciatica/Pinch Nerve-Acupuncture Hamilton

Case Study: Bulging Disc, Sciatica & Pinch Nerve - Acupuncture Instant Relief Pain & Significant Increase Range of Motion of Leg & Lower Back after First Treatment, Centre of Balance Hamilton, NZ. 

As asual, let me give you some idea about bulging disc before I tell you about this case study. Bulging disc is a type of herniation disc, here is the information on herniation disc according the website of Southerncross


Herniated Disc, Bulging Disc symtoms, Hamilton, NZ


Between the bones (vertebrae) of your spinal column are discs that contain a gel-like substance. These discs allow the back to flex and bend, and act as shock absorbers between the vertebrae. When one of these discs ruptures, the gel-like substance can bulge out putting pressure on nearby nerves. 

This condition is referred to as a herniated disc, prolapsed disc, or slipped disc and can cause severe back pain and other symptoms. Treatment is likely to include initial rest and rehabilitation, which will resolve the majority of herniated discs, but surgery may be required in some cases. 

Herniated Disc - Signs and symptoms

Some people may have a herniated disc without experiencing any symptoms. Others have severe, debilitating symptoms. The type of symptoms experienced can be influenced by the location of the herniated disc. The most common symptom of a herniated disc is sciatica. This is characterised by a sharp, often shooting pain that extends from the buttocks down the back of one leg, and is caused by pressure on the sciatic nerve. Other symptoms that may be experienced as the result of a herniated disc include: 

  • Lower back pain 
  • Leg or arm pain 
  • Abnormal sensations such as tingling, numbness or pins and needles in one arm, one leg or buttock 
  • Burning pain in the shoulders, neck, arm or central back 
  • Muscle weakness.


If problems with bowel or bladder function are experienced this may be a sign of cauda equine syndrome – a rare but serious complication of a herniated disc. Immediate medical attention should be sought if this is suspected.  

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Here is the case study:

Photo Before Treatment

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Photo After Treatment

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Mr Wright visited my clinic on 2/10/2014 complaining of throbbing pain in the lower back, worse on the right side, shooting pain down to the right leg and sometimes the left. He had been diagnosed  with a lumbar bulging disc and pinched nerve 2 years ago in Australia.


 

Mr Wright’s pain level was 3/10, a constant dull ache and throbbing pain,  lower back pain mainly on the right side, radiating down both legs, but mainly in the right leg. No pins and needles or numbness. Has been waking up 4 to 5 times at night due to uncomfortable pain, and he is often woken by the pain in his back when he rolls over. He has tried Nurofen with Codeine, or Panadol with Codeine,  or Naprosin,  or Tramadol, up to six tablets a day. He had visited up to 4 different back specialists without any permanent results.

 

Daily Activities:

Sitting: He suffers pain after 15 minutes and has to stand up but then can sit down for another period.

Standing:  indefinitely - it does not make the pain worse.

Lying Down: there is less pain but it is still there.

Walking: He is able to walk but it is limited. He used to be a keen bushwalker but has only been on three bushwalks since the injury.

Washing up: he can wash dishes.

Housework: he has a cleaner in once a week as he cannot vacuum, mop or scrub and he can’t lift weight.

Mowing: he is not able to mow the lawn.


I felt sorry for Mr Wright with his back pain, because it has also caused him to experience low mood, fatigue, annoyance, recent weight loss of 7kg, the loss of his job and the necessity to sell his house in Brisbane.


The following video shows you how I examine and diagnose lumbar bulging disc and pinch nerve, it also shows you how Mr Wright got instant pain relief and significant increase range of motion of leg and lower back after his first acupuncture treatment.



Physical examination before treatment (as shown in the above video):

Bending forward: 40 degrees

Straight leg raise: 45 degrees on the right, 80 degrees on the left side

Some bruised veins visable on his lower back

Temperature from upper back down to lower back is even

Straight leg raising test (SLRT): positive on right side

Bragard test: positive on right side

Faber test: positive in right side

Raising buttock + coughing test: positive

 

Teatment: I applied Master Chen Li Xin Acupuncture theory and Dr Tan Balance Method Acupuncture on Mr Wright. 

I did acupuncture on right sancha combo, L2-huatuo point,right HuanTiao, both ZanZhu, both TaiYang point and blood letting on lower back where those bruised veins appear. 

Mr Wright experienced instant relief from pain, felt no pain in lower back, no radiation down to right leg. 


 

Physical examination after trearment (as shown in the above video):

Bending forward: 80 degrees

Straight leg raise: 80 degrees on the right, same as the left side without pain, but with tightness

Straight leg raising test (SLRT): negative on right side

Bragard test: negative on right side

Faber test : negative in right side

Raising buttock + coughing test: negative

 

Let’s review some of his medical history for this case that he brought in with him.

On 6 Feb 2013 a medical report shows that Mr Wright states that in early October 2012, he was at work and a patient was rolled toward him on her bed. He had to lean over to support the patient who tried to suddenly push off against him and he felt a twinge in his lumbar spine. He reported this injury and stated that at the time the pain was 1/10.  He was given anti-inflammatories and light duties but continued working his hours. A CT scan showed sacralisation at L5 and a moderate central disc protrusion at L4/5 with potential irritation of either L4 or L5 nerve root. Straight leg raise is 45 degrees on the right side and 80 degrees on the left side. Reflexes are intact throughout the lower leg and there is no weakness in extensor hallucis longus or the calves.

 

On 13 March 2013 a medical report shows that Dr Mark Young (sports & Musculoskeletal specialist in Brisbane) had set a wonderful programe for him in March 2013. That programme included a corticosteroid injection to the epidural space to break the pain cycle and exercises for rehabilitation.


On 1 May 2013 a medical report shows that Mr Wright’s lower back pain has significantly improved. That was due to a combination of his core stability exercises and the epidural steroid. Straight leg raise on the right side is 50 degrees and on the left side is 80 degrees.  (Unfortunately, that did not last for long and he’s got worse again.)

 

Medical Brief

It is clear from the radioligical reports that Mr Wright has disc protrusion at the L4/5 level, which is affecting his sciatic nerve.

 

1)    Dr Therese MaGrath, Occupational and Environment Physician, 6th of August 2013 assessed PI-“aggravation of degeneration L4/5 disc with disc bulging and right L5 nerve root irritation-5% whole person impairment”.

2)    Dr Frank Tomlinson, 11th December 2013 confirmed diagnosis and recommended “non surgical therapy” and review by a Pain Specialist” but “if symptoms continued surgery could be considered”.

3)    Dr Mark Young, Sports Physician, 13 March 2013 comments, “There is no surgical treatment for him. His best treatments are going to be exercises and possibly a corticosteroid injection”.

4)    Dr Steven Yang, Briz, Brain and Spine, 18 June 2013 “ The only real option he has is surgery. However if he can find alternative work, surgery can be avoided and he could look at some sort of long term retraining and education”.


A report from Dr Frank Tomlinson on 15 January 2014. Dr Tomlinson recommended Mr Wright to consider ongoing non-surgical therapy and further alteration in his lifestyle, also recommending that he be reviewed by a pain specialist for consideration of lumbar medial branch blocks. Dr Tomlinson believed that the cost of the procedure is approximately $1300. If Mr Wright obtains a satisfactory response in relation to the lumbar medial branch blocks, then he would be a suitable candidate for consideration of radio-frequency lesioning in relation to the lumbar facets. Radio-frequency neurotomy may provide temporary relief for 8 to 10 months and the cost is approximately $1500.

Dr Tomlinson also suggested that Mr wright consider surgery. He recommended that Mr Wright undergo a decompression with a lumbar discectoy and rhizolysis combined with a transforaminal lumbar interbody fusion (TLIF) and a posterolateral instrumented fusion. The cost of these procedures would be approximately $35,000.00. Dr Tomlinson commented that even with surgery, he believed that Mr Wright would have ongoing symptoms.

 

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