[LC_IN_NYC]

#31649

Thank you, this is helpful to consider.

The low back symptoms seemed to come on gradually over a few days. In addition to general pain certain movements do trigger specific sharp pain, so perhaps there is a tear. It does also seem possible that different positioning could have also aggravated pain, as with my neck pain I increased sitting and lying down than normal. I’ve been walking more which seems to be helping the pain slowly subside.

Either way it seems that the solution is to be cautious for now? thanks again, it’s so helpful to have a second opinion as I navigate this long recovery.

LC

[Donald Corenman, MD, DC]

#31662

Give this three months to settle down. Be cautious in your activities but try to ignore your lower back pain best you can. At the end of the three months, reassess your symptoms and compare how you will be doing then to how you are now. I would assume you should be 50% better in three months.

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.

[LC_IN_NYC]

#31664

Dear Dr Corenman,

Thank you. This is reassuring and I appreciate it. Things have improved from where they were, so hopefully they will continue to do so even if slowly.

Separately, I hoped to gain insight on one final issue that has accompanied my injuries and recovery process. My C6-C7 herniation seems to have been caused by the multi-month period of lying with my head propped up on a pillow to cope with my low back pain, or standing looking down at my laptop and phone. I have since made multiple ergonomic adjustments and am wearing a soft collar, and things seem to be improving well.

Before the cervical herniation, I was treating cubital tunnel in both arms that I believed to be from my supine positioning and iphone use. Ulnar nerve pain in both arms came on in October, two months after surgery, but I had warning signs prior with my pinky/ring finger falling asleep in flexed positions. My physiatrist and surgeon provided ulnar nerve stretches which helped, but I wake up nearly daily with my hands “asleep.” Since the herniation has shifted from just part of my hand to include either my entire hands or today my index and thumb. It can happen in both arms but moreso has been in the left; my cervical herniation also caused left-sided arm pain (now mostly diminished). This resolves within about a minute or two of waking.

Is there a chance that the two are linked? My surgeon thinks it is just the cubital tunnel, but after recovering from severe foot drop I am afraid of the same happening to my hands. I am doing gentle ulnar arm stretches (minus the neck components) twice daily but want to be sure I’m not neglecting any preventative mess as it’s. It feels as my injuries are competing for my attention, and I just want to be as careful as possible moving forward.

Appreciate any further guidance you have, thanks so much again for your time over these past several months of posting. That should be my last question for now :)

Best,
LC

[Donald Corenman, MD, DC]

#31694

Generally, the C6-7 HNP will cause middle finger paresthesias and cubital tunnel syndrome will cause ring and small finger paresthesias. As you have found out, cubital tunnel syndrome increases with elbow flexion and is reduced by extension. Middle finger paresthesias generated from the neck are increased with neck extension and reduced by neck flexion. With any question, a nerve conduction study (EMG/NCV) would be the next step.

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.

[LC_IN_NYC]

#31871

Dear Dr Corenman,

Happy new year and thank you for this response.

The cervical pain is slowly subsiding and centralizing, though arm and hand pain is not gone from my life it has become manageable. My back pain, too, still has me disabled but I am able to walk 2-4 miles a day and sit for longer periods. I still get nerve aggravation and have residual numbness and causalgia in my foot that experienced near total foot drop, but the strength is back except for my big toe.

My surgeon has cleared me for physical therapy and I finally have my first appointment next week. It will be exactly 4 months since my revision L4/5 discectomy, and 6 months since my original procedure. I was advised by both my surgeon and physiatrist that I should not do therapy except for walking until now due to the extent of my injuries. The C6/7 herniation and holidays only further slowed things.

Do you have any advice for making the most of therapy? I understand that it is crucial element of rehabilitation, and I’m afraid that the hesitation in getting me moving will actually be detrimental to my making a full recovery in the long-term. Could that be the case? Prior to this, I traveled every month, rode my bike around NYC weekly and enjoyed spinning, practiced yoga, hiked avidly, worked long days and went to events or concerts after without tiring, etc. I’m fearful that I’ll never get back to my normal level of activity after this ordeal, and though I can’t turn back time, appreciate any advice that will help me advance more in my recovery.

[Donald Corenman, MD, DC]

#31897

You have to take “baby steps” to advance your activity and range of motion. It is sometimes hard to know how much stretch and load your root can take before you active the inflammatory cascade. This cascade will not be apparent until 8-10 hours after the activity when pain will increase. I would only slowly advance your activity and measure how hard you work, how much time you spend on any particular endeavor and your range of motion. Think in terms of “slow” as your tissues have to adapt to the increased stress.

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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