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#35305

Had a major L5-S1 ruptured/herniated disk which required a microdiscectomy (2013) because of calf weakness. The time between the weakness and surgery was about 1 week. Right before the surgery and right after, I could not do any single leg calf raises. The calf weakness after the surgery improved a small amount, but it took a lot of work, over a long time. Could do maybe 5 calf raises, but was really hard. Couldn’t run because lost most of my ability to push off with the foot. Had pins and needles and minor nerve pain for years after the surgery. Since the 2013 surgery, have had had 3-4 flare ups, where for a week or 2 I had some moderate/high sciatica pain, sometimes with back pain.

I had a sciatica flare up in Nov 2018 (i jumped over a puddle when hiking). I had major sciatica for a week and 1/2, and I could barely walk. My calf strength was reduced; it seemed to go back to the post surgery levels; no calf raises. Because of the weakness issue, I got an MRI. By the time I got to see a physiatrist (2 1/2 weeks after injury) my sciatica was mostly gone, but a epidural shot was was performed because it was thought it might help with the weakness. The MRI was reviewed and it didnt show nerve compression, and surgery was not recommended. The physiatrist thought the calf strength would come back over time. I wasn’t diligent on strength training for the calf, and didn’t keep an eye on the strength. I think I was frustrated and kinda gave up. Over the last year, I have noticed that the weak calf is significantly smaller than my other one. I am assuming the the 2018 injury damaged the nerve and it never recovered. I never understood why this could happen if the MRI didn’t show nerve compression. Is there anything that can be done now to get some of strength back?

[Donald Corenman, MD, DC]

#35306

“Had a major L5-S1 ruptured/herniated disk which required a microdiscectomy (2013) because of calf weakness. The time between the weakness and surgery was about 1 week. Right before the surgery and right after, I could not do any single leg calf raises. The calf weakness after the surgery improved a small amount, but it took a lot of work, over a long time”.

Unfortunately, some nerves are irreparably damaged from the initial “violence” of the large disc herniation and even timely surgery (which yours was) is not enough to allow allow repair of the damaged fascicles (nerve fibers). Your nerve was probably operating on 50% of the remaining fibers until the puddle jump. I would have suspected a new herniation from that jump but you report no new changes. In this case, it probably was the stretch of the scarred root that caused further damage. Your interventionist hoped “a epidural shot was was performed because it was thought it might help with the weakness” but unfortunately, steroids are remarkably good for pain but don’t work for weakness.

See these for a better understanding:

https://neckandback.com/conditions/how-muscles-recover-from-nerve-injuries/
https://neckandback.com/conditions/peripheral-nerve-anatomy/

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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