Gastronemius weakness/Fatigue with walking

Tagged: leg weakness and peripheral neuropathy

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Pafrmboy
Participant

January 26, 2013 at 2:53 am

Post count: 8

#7809

Hi. Great Forum!! I’ll add my situation to the pile!

I developed this issue some 5 years ago when I was running and began to feel some numbness in my left foot.(I used to run about 10-12 miles per week). It was like I lost orientation of my left foot. I felt that I might trip. It was not every time I ran though. I’d slow down and it would go away.

It progressed to having some medium type back pain attacks over the next year and then the back pain all but disapeared. Sciatica and left leg occasional numbness then developed over the next 2 years to the point that I had to sit down sometimes. As soon as I sat down for 5 mins, all was OK.

During the last 18 months all sciatic pain is gone, but I developed left medial gastronemius weakness. It affected my gait and I could not stand on toes on the left side with the right foot elevated. Of course this led to knee pain, as the lateral gastronemius picked up the slack.
I had atrophy in the left medial gastronemius too.

Amazing the right leg was always OK and then suddenly a few months ago..like overnight, the right medial gastronemius was quite weak. I was alarmed! It happened so quickly. What is more weird is that the left leg is regaining strength!! ( I can stand (weakly) on toes using both feet), but feel that the left leg is doing most of the work. Both the right and left LATERAL gastronemius(s) are strong.

Again I have NO significant back pain except some tightness and an occasional ache. I take no meds except NSAIDS and not even those daily.

My main issues are now “push off” during my gait. If I walk long distances, I am exhausted. (My legs anyway) I feel I’ve climbed a mountain. I sometimes feel that I might fall backwards, as the plantar reflex strength is quite weak in both feet. However at times during the day, the strength suprisingly better! It’s up and down. If I do inversion therapy for 10 mins, the strength is better, but it does not last.

I am a Registered nurse and do spend alot of time walking. I also can’t run well and get knee pain on the push down stroke, while riding my bike. I know this is form the compensation of the lateral gastro and tendons doing all the work.

I have had (2) MRIs and the last one 7/2012 was similar to the first. Revealing:

1. The L5 S1 disk is dehydrated and mildly narrowed.
2. There is a 3 mm left paracentral disk protrusion of L5 S1 that compressed the thecal sac and abuts the left S! nerve root. This could account for left S1 raduculopathy.
3. The remaining lumbar levels are normal.
4. Note is made of a transitional s1 s2 intervertebral disk space.

I also had a nerve conduction/EMG done and it revealed:

1. Active and chronic denervation in L3/4 and L5 S1 myotome, suggestive of LS polyradiculopathy. Left worse than right.
2. It also demonstrated evidence of sciatica, left worse than right.
3. Differential diagnosis include lower LS plexopathy and multifocal motor neuropathy. Motor neuro disease is possible, but patient’s clinical presentation is not suggestive of this issue.

I’m 48 male, not overweight, or diabetic. No other chronic diseases, no hypertension, essentally pretty healthy.

How can this issue/disk shift from left side to right so fast? Do disks move? Maybe a loose fragment? Could a rupture have happened and spread to the right side that fast? Ideas?

I have not had a surgical consult and really don’t like the idea of surgery. (Nurses HATE surgery and I’m an OR.ICU nurse)!! Am I a fool to NOT want surgery?

I have tried a steroid dose pack about a year ago and it helped significantly.

I guess I deal with this, as I have little to no back pain. But I feel the weakness, although manageable, is starting t

Will this resolve with conservative treatment, or might this be permanent? I mean this has been an issue for years. (Hoping for resolution).

Scared and worried!(and being a typical nurse)!

Todd

catmadni
Member

January 26, 2013 at 8:36 am

Post count: 25

#7811

I understand that you would like Dr Corenman to respond first. However I am recovering from compression of my S1 nerve root. I am compelled to respond with some advice.

If you have symptoms of motor weakness don’t wait to releive the compression. Mine was the same muscle as you. It came suddenly. Although I felt I reacted quickly, I continue to have weakness following discectomy. Now there is little to do but wait for the rein elevation of the muscle which could take many months

I have received good advice from Dr C via this forum post surgery. Good luck

catmadni
Member

January 26, 2013 at 8:38 am

Post count: 25

#7812

I have a spelling mistake. Reinervation

Pafrmboy
Participant

January 26, 2013 at 8:58 am

Post count: 8

#7813

I know I am into the weakness issue 1 year. I hope it’s not too late. Having surgery with little to no improvement, would be something fun to do.

I wish you well with your strength gains. I know that nerves are pretty resilent.

Donald Corenman, MD, DC
Moderator

January 26, 2013 at 4:37 pm

Post count: 8660

#7816

It appears at face value that you have motor weakness from a disc hernation but I am not so sure that is the case. You first developed loss of proprioception sense in your foot (lack of position sense). This was due to running.

This is distinctly unusual to lose proprioception even if you had foraminal stenosis (see website for description of this condition). Only about 10% of patients with foraminal stenosis develop weakness and virtually all of them initially develop pain in their leg with standing and walking (running included). Without pain and paresthesias (pins and needles) radiating down your leg, this raises a red flag for diagnosis.

You then report intermittent back and left leg pain and paresthesias for two years, activated by standing and relieved by sitting which does associate with the diagnosis of foraminal stenosis. However, if this was foraminal stenosis, this does not fit with an S1 nerve (the nerve that innervates the gastrocnemius muscle). The S1 nerve leaves the pelvis through the sacrum (S1 foramen) and not through a foramen that can be compressed. It is the only nerve that cannot be compressed by foraminal stenosis in the body as this foramen is made up of solid bone and cannot be compromised by degenerative change.

The fact that your right leg gastrocnemius also became weak so suddenly is an indication that this problem is a neuropathy. A neuropathy is a “sickness” of the nerve itself and not from mechanical compression of the nerve in the back. Your MRI corroborates your neuropathic condition (no compression of the right nerve and only minimal compression of the left).

The EMG result also reenforces that this is a neuropathy as there is involvement of the L3-4 myotome where there is no compression noted on the MRI.

I hope the neurologist that performed the EMG pointed you in the right direction. This is a condition that needs to be treated by a specialist neurologist that treats progressive neuropathy. I am no expert here but there are some medications that can possibly interrupt this process.

Steroids that “helped” this condition probably have worked in this case because steroids interrupt the immune system temporarily. It is the immune system most likely here that is overactive and could be contributing to your nerve injury. You do not need surgery but do need a specialist neurologist that can appropriately diagnose you and lead you down the correct treatment path.

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.

Pafrmboy
Participant

January 26, 2013 at 9:13 pm

Post count: 8

#7819

Well, I am following up with the neurologist again next week. I will ask some additional questions. I do have an appointment with a surgeon and have the MRIs in hand on disk. I will hopefully get some more direction after these appointments.

I really appreciate your feedback Dr. Corenman. You make some very valid points!

So the gastronemius weakness cannot be attributed to compression due to anatomy?

I really appreciate your feedback Dr. Corenman. You make some very valid points!

I will report back.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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