LornaParticipantDecember 6, 2018 at 3:30 amPost count: 2
Dear Dr Corenman,
Thank you for this wonderful forum. I hope that you can help me with a question about calf muscle weakness?
I injured my back rowing about 9 weeks ago. An MRI showed a significant disc herniation at L5/S1. Walking was incredibly painful but sitting or lying down gave relief, which was opposite to previous sciatic flare ups I had had. When the pain to my (right) leg started to ease, I noticed that I was limping. I couldn’t raise onto tiptoe at all on my right leg, although lying down I had good power pressing down with my foot. I had a micro discectomy 3 weeks ago. This has helped with residual pain but not with the calf muscle weakness and I am continuing to limp. I now walk with my right foot turned outwards as this helps me to push off from the side of my foot. If I try to walk “normally” I very quickly get what feels like cramp in my right calf which eases if I stop to rest and massage my calf. I have no idea if this is sciatic pain or the muscle getting tired.I have read your website carefully and I understand that it is not possible to tell at this stage whether the leg weakness and limp will get better. What I would be interested to know is whether there is anything that I can do to keep up strength in the calf muscle while I wait to see if the nerves reattach themselves and whether there is anything I can do to lessen the cramp in my leg when walking? My initial thought was electrical stimulation but I see that you don’t recommend that within the first six months. I can raise on tiptoe if using both legs and then if I lift my good leg, stay on tiptoe on my bad leg- for a short time with great effort. Is this a beneficial exercise or could I be doing more harm than good? Would you recommend seeing someone (e.g. a physiotherapist) to help with the calf weakness or should I just let everything settle down for now? I am just anxious to avoid a long term limp if it can be helped.
Thanks so much.Donald Corenman, MD, DCModeratorDecember 7, 2018 at 7:57 amPost count: 6631
Muscle that has been denervated (lost nerve connections) must reconnect before it functions properly. The connection can be made by sprouting from small nerves nearby, by functional recovery of the radicular nerve (removal of the compression) and by healing down the nerve sheath which takes multiple months to years.
There is one paper in the literature that notes that the healing mechanism of “sprouting” is reduced with electrical stimulation.
You can work the muscle now with training and weights as best you can. It will take time to recover and you won’t fully know how much better you will be for at least a year.
Dr. CorenmanPLEASE 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.LornaParticipantDecember 11, 2018 at 8:05 amPost count: 2
Thanks for your reply. That’s really helpful.
Perhaps a question that is impossible to answer: from what I have been able to gather online, electrical stimulation that one study has shown inhibits “sprouting” is applied directly to the denervated muscle; what if electrical stimulation were applied to the back where, I presume, the damage has been caused? The aim would be to try to speed up healing down the nerve sheath whilst, hopefully, not getting in the way of “sprouting”, in order to enhance the chance of a good outcome for both options. Perhaps it doesn’t work that way- I don’t know!
I’ll try the weights in any event. Many thanks for your input.
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