Weekly Recovery Journal — Lumbar Disc Injury

Summery of page

Injury & Recovery Progress Report

Patient:
Date of Report: 22/08/2025 – 7:30 AM
Condition: 2 x Herniated Discs (Lumbar Spine)
Period Covered: Last 2–3 Weeks (with historical background)

Background of Injury

Original injury sustained August 2024.
Severe pain episodes began August–September 2024, peaking during November–December 2024, with extreme sleep deprivation (up to 5 consecutive days without sleep, even under 20 mg Valium).
Initial treatment plan: Physiotherapy (7 months total) — provided short-term relief but plateaued after 3–4 months. Pain relief became limited, and no further healing progress was noted.

Transition in Treatment

Due to limited physiotherapy results, patient transitioned to a combined osteopathy + chiropractic treatment model (same clinic, coordinated care).
Treatment modalities introduced:
- Manual adjustments (front and limited back adjustments only) → side adjustments postponed to prevent further disc/nerve damage.
- Spinal decompression therapy (traction bed) → aimed at reducing nerve compression and improving mobility.
- Infrared light therapy → circulation and tissue repair.
- Hands-on manipulative therapy → broader range compared to physiotherapy.
Treatment goal: Pain reduction, improved circulation, reduced nerve pressure, and avoidance of spinal surgery.

Notable Events in Past 3 Weeks

Neurological Symptom – “Itching/Ants Sensation”
- After spinal adjustments ~3 weeks ago, patient developed intense deep spinal itchiness, described as “ants crawling inside spine,” unrelievable by scratching.
- Suspected cause: abnormal nerve communication/signaling between upper and lower herniated discs.
- Secondary osteopathic treatment applied → improved circulation and sensation → itching subsided and pain localized more consistently in lower back.
Exercise / Activity Log
- Tuesday gym sessions maintained.
- Activity: 30 minutes light weights (≤10 kg) + treadmill walking.
- 17 minutes treadmill at 1.24 km → pain onset at 90 seconds (sharp left leg pain).
- Continued walking while using treadmill handrails; completed 17 minutes before intolerable pain.
- Symptoms during/after treadmill:
  - Shooting pain left leg → hip → knee.
  - Intermittent loss of left foot function (drop foot episodes).
  - Toes (esp. 3 smallest) often fail to lift → tripping risk.

Current Symptoms

Lower Back & Nerve Pain

Pain radiates left hip → down posterior leg → knee → left foot.
Constant nerve symptoms in left foot (3 outer toes):
- Numbness, tingling, wet/cold sensations, burning, and loss of skin sensitivity.
- Paradoxical: skin touch feels numb, but pain signals are strong.
Pain aggravated by lying down, walking >15 mins, or treadmill use.

Mobility

Walking: limited, requires treadmill rail for support.
Drop foot persists, with occasional complete toe-lift failure.
Daily activity restricted by pain and instability.

Sleep

Severe sleep disturbance continues:
- Average 15–90 mins sleep blocks; frequent waking due to pain.
- Positions trialed:
  - Recliner with padding, pillows, blankets.
  - Side-lying with support (both sides painful).
  - Supine (on back) → instant escalation of pain; radiation hip → knee → toes.
  - Prone (stomach) → impossible due to pain.
- Blanket/sheet weight on left foot triggers pain, cramping, burning, and numbness.
Current strategy: staying awake longer (24–48 hrs) to force sleep.
Despite this, max continuous sleep in last 2 weeks: 1 hr 45 mins.

Progress Compared to Prior Months

Physiotherapy plateau → no further improvement after 3–4 months.
Osteopathy/Chiropractic care:
- Provides broader manual techniques and decompression.
- Early signs of improvement: pain more localized to lower back instead of spreading widely.
- Circulation-related issues (e.g., itching sensation) responded well to manual therapy.
Exercise tolerance remains low but slightly improved compared to earlier months (able to push to 17 mins treadmill vs previously unable to sustain).
Pain levels: Slight reduction at times compared to earlier extreme episodes, but still debilitating and functionally limiting.
Sleep: Still critical problem with minimal improvement since injury onset.

Clinical Summary

Patient presents with two herniated lumbar discs, ongoing nerve compression with associated sciatica, neuropathic pain, and partial drop foot.
Physiotherapy offered short-term management but plateaued.
Osteopathy and chiropractic joint-care model currently providing alternative management with manual adjustments, decompression therapy, and infrared therapy.
Symptoms remain severe, particularly with neuropathic foot involvement and sleep impairment.
Surgery has been avoided so far, with conservative management ongoing.
Current risks: fall risk due to drop foot, progressive nerve dysfunction, chronic sleep deprivation, and risk of long-term neuropathic pain.

Recommendations Moving Forward

Continue combined osteopathy + chiropractic care (manual adjustments, decompression, infrared).
Gradually increase controlled exercise within tolerance.
Monitor and document foot drop episodes for neurosurgical review if worsening.
Sleep management strategies to be readdressed (possible referral to pain clinic or neurologist).
Maintain conservative approach as long as pain/nerve function stabilizes and avoids surgery.

Date/Time: 22 Aug 2025, 7:30 am (AEST)
Location of care: Osteopathy + Chiropractic (integrated clinic), Physiotherapy (prior)

Established diagnoses & imaging

MRI (post-CT):
- L5/S1: Broad-based posterior disc bulge (L>R) with posterior left annular tear abutting the left S1 nerve root.
- L4/5: Left facet arthropathy with mild, non-compressive annular bulging.
- No canal/foraminal stenosis; alignment and conus normal.
CT (earlier, 06 Nov 2024): Shallow left-posterior L5/S1 disc bulge close to the left S1 root; all other levels and SI joints normal.
Clinical picture: Bilateral sciatica left ≫ right; episodes of neuropathic pruritus; prior greater-trochanteric bursitis; severe insomnia; intermittent left toe-lift failure (trip risk).

Current precautions: Neutral spine only, front-facing movement, ≤10 kg loads, no twisting/side-bending under load.

Interval history (last 2–3 weeks)

Pain trend: Slight, intermittent decrease in overall pain compared with earlier weeks.
Physio course: Benefited for ~3–4 months, then plateaued. After ~7 months total with little further gain, moved to osteopath + chiropractor for broader hands-on care.
Current clinic modalities:
- Lumbar decompression table (distraction) → reduces perceived pressure, eases motion.
- Infrared light therapy.
- Manual adjustments: Front-facing/neutral only; side-lying adjustments deferred to protect disc/nerve while healing.
- Emphasis on circulation, movement restoration, nerve decompression.
Neuropathic itch event (~3 weeks ago): Intense deep “ant-crawling” itch in spine after an adjustment.
Secondary treatment to same region improved circulation; itch reduced and pain relocalized to lower back
(consistent with nerve-root irritability rather than a skin issue).

Exercise & function (last 7 days)

Gym (Tue a.m.): ~30 min light training, ≤10 kg, neutral spine only.
Treadmill:17 min, 1.24 km.
- Left leg pain began ~90 sec into walking; progressed.
- Required hand rails most of session.
- Intermittent left toe-lift failure (toes don’t clear → stumble risk); slightly more controllable than prior sessions.

Sitting intolerance (current)

Hard chair: Symptoms escalate quickly (minutes).
Soft/cushion chair: Can tolerate ~15–20 min, then must stand/move.
Pain path when seated: Left low back → posterior thigh/hamstring → behind knee (tight/cramp) → calf → lateral/plantar left foot → toes 5–3 with numb/cold/wet/odd sensation and burning.
Pattern suggests load + neural tension sensitivity of the S1-weighted distribution.

Sleep & positional symptoms (current)

Severe insomnia persists. Typical sleep is 15–30 min bouts; occasionally 1–1.5 h then wakes in pain. Even after ~48 h awake, only ~1 h 45 min sleep achieved.
Historical peak: Early after injury, 5 days awake despite diazepam 20 mg (Nov–Dec 2024 worst months).
Supine: Rapid escalation from left paraspinal/adjacent hip → posterior thigh → back of knee (tight, bending) → lateral foot; toes 5–3 feel numb/“wet/cold/different”; cannot tolerate sheet/blanket touching the foot; cramping/burning up the leg.
Side-lying: Either side provokes pain on the opposite side.
Prone: Not tolerated.
Using recliner/blankets/pillows; variable relief.

Weight trend

Aug 2024: 106 kg.
~6-month plateau: ~85 kg.
Current: 81.9 kg (Tue, gym weigh day; measured 7 days apart from prior).
Patient perceives slightly better mobility and modest reduction in daily spikes with lower body mass.

Assessment (this week)

Ongoing left S1 radiculopathy with central sensitization (amplified pain/itch; severe sleep disruption).
Intermittent toe-lift failure suggests transient dorsiflexion weakness (pain inhibition vs. L4/L5 contribution) — monitor closely.
Sitting-provoked neural tension remains a major trigger.
Sleep deprivation is a key amplifier of pain and daytime dysfunction.

Plan — next 2–3 weeks

A. Clinic care

Continue decompression, infrared, and front-facing manual care as tolerated.
Keep side-lying manipulation on hold until symptoms are more stable.
Add graded neural mobilization (“sliders”) for sciatic/S1 within pain-free range.

B. Exercise

On flare weeks, swap treadmill for upright exercise or pool walking to reduce heel-strike neural load.
If treadmill used: intervals (1–2 min easy walk / 1–2 min rest), stop at first motor change (toe catch/drag).
Maintain ≤10 kg, symmetrical, front-facing patterns; tempo 3-1-3; progress by next-day ≤3/10 rule.

C. Sitting & posture

Micro-breaks: Sit ≤10–15 min, then stand/walk 2–3 min.
Seat setup: Lumbar roll or wedge, slight hip opening (mild recline), feet flat; avoid long slump.

D. Sleep strategy

Prefer 30–45° reclined or side-lying with knee pillow; avoid full supine.
Discuss with GP: a night-time neuropathic pain agent (e.g., amitriptyline/nortriptyline, duloxetine, gabapentin/pregabalin)
to improve sleep and dysesthesia. Avoid routine benzodiazepines.
Heat pre-bed for guarding; brief ice for sharp flares.

E. Escalation / safety

Urgent review for: progressive weakness (true foot drop), saddle anesthesia, or new bladder/bowel changes.
If toe-lift failures persist or worsen, request focused neuro exam, consider EMG/NCS, and updated lumbar MRI per clinician judgment.

F. Tracking & education

Daily log: pain (0–10), sleep minutes,
minutes walked, sitting tolerance.
Reinforce neutral-spine mechanics,
no twisting/side-bending under load, and pacing.

Patient-friendly summary

I’ve had small improvements in pain at times the last few weeks. Physio helped for months but then stalled,

so I moved to a clinic where an osteopath and chiropractor treat me together.

They’re using a decompression bed, infrared, and gentle front-facing adjustments (no side adjustments yet).

A few weeks ago I had a horrible deep spinal itch after treatment; a follow-up session settled it,

Where the pain stayed more in my lower back after treatment.

This week I trained gym light for ~30 minutes and walked

17 minutes (1.24 km) on the treadmill.

Pain down the left leg started at 90 seconds.

I used the rails and kept going until I couldn’t.

Sometimes my toes don’t lift properly,

but I controlled it a bit better than before using rails to help take some weight when walk

Sitting sets off my pain:

hard chairs are worst; on a cushion I last 15–20 minutes before I have to get up.

The pain runs from my left low back down the hamstring,

behind the knee, into the calf, and the

outside/toes 5–4-3 feel numb/cold/wet/different with burning. 5 being start little toe

Sleep is still poor — often minutes to an hour at a time. I’m adjusting positions, using a wedge/lumbar roll,

My weight has gone from 106 kg to 81.9 kg,

which helps a little with mobility.

What foot drop is

Foot drop means it’s hard to lift the front of your foot (dorsiflex), so the toes drag

or you compensate with a high “steppage” gait (lifting the knee/hip extra to clear the ground).

It’s a symptom of an underlying nerve/muscle problem, not a disease by itself. Mayo Clinic NINDS

Classic causes

Peroneal (fibular) nerve injury/compression at the outside of the knee (very common). Cleveland Clinic GPnotebook BMJ Evidence-Based Medicine
Lumbar radiculopathy, especially L5 nerve root (often from a disc issue) — this one lines up with back/leg pain patterns. Cleveland Clinic Physiopedia
Less common: stroke or other brain/spinal disorders, motor neuron disease, severe neuropathies, trauma. Mayo Clinic

Typical symptoms & gait

Toes don’t lift when you swing the leg → toe catch, tripping, or foot “slap” when the heel strikes.
You may hike the hip/knee (steppage gait) so the toes clear.
Numbness can accompany it, depending on which nerve/root is involved. Spine-health DoveMed

How this relates to your scans/symptoms

Your imaging shows L5/S1 disc bulge with annular tear abutting the left S1 root, plus L4/5 facet arthropathy.
Foot drop itself is classically L5,
while your toe numbness in toes 3–5 and lateral foot screams S1 — so you may have
S1 sensory irritation with intermittent L5-type dorsiflexion inhibition (pain-guarding) or a
contribution from the peroneal nerve.
A focused neuro exam can separate these. Physiopedia Cleveland Clinic

How doctors confirm it

Neuro exam: strength of tibialis anterior/extensor hallucis (L4–L5), sensation maps, reflexes.
EMG/Nerve conduction to tell L5 root vs peroneal nerve problem.
Imaging if red flags or progressive weakness. Cleveland Clinic

Treatment (depends on cause)

Treat the driver: lumbar care for radiculopathy (injections/surgery only if needed),
or relieve peroneal nerve compression. Cleveland Clinic
Physio/gait training and dorsiflexor strengthening; sometimes neuromuscular stimulation. Verywell Health
AFO brace short-term to stop toe drag and falls;
surgical tendon transfer only for persistent cases. Cleveland Clinic Mayo Clinic

When to escalate urgently

Worsening weakness, new true foot drop
you can’t overcome, saddle numbness, or bladder/bowel changes → urgent medical review. (Safety first.)

Neck Pain Symptom Summary

Primary Complaint

Neck and upper back pain with radiating symptoms.

Pain Pattern

Origin: Left shoulder area.
Radiation:
- Moves from shoulder into the space between the shoulder blade and spine.
- Extends up the side of the neck.
- Travels further into the left side of the head/temple region.

Characteristics

Pain appears nerve-related and radiating, not isolated to one spot.
Affects shoulder → scapula → cervical spine → side of neck → head.
May suggest cervical spine involvement (nerve compression or disc issue) or muscle/nerve irritation along the cervical-thoracic junction.

Impact

Contributes to neck stiffness.
Can trigger headache-type pain at the left temple.
May overlap with existing lower back/spine nerve pain patterns, indicating multiple spinal segments under stress.

Prepared by: Brentdee
For: Treating GP / Osteopath / Chiropractor / Physiotherapist

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