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  • tomg
    Member
    Post count: 2

    Thanks for your informative website. Very appreciated.

    I am a 49 year old male, in reasonably good shape, not overweight.
    My symptoms started 11 weeks ago. I have had pain in buttock, hamstrings, and calf and numbness in foot. All on right side. Pain in calf turned quickly into weakness, no further pain there but still weak very weak, almost causes me to limp while walking. I certainly cannot run. Some weakness in hamstrings and buttock as well. Low back pain only lasted 2 or 3 days about in the middle of this period. Symptoms have been steady but varied in location and intensity.
    At 2 weeks I saw a chiropractor who specializes in sports injuries. He thought it could be piriformis syndrome. I agreed since I would have totally doubted I had a disk issue. After 3 weeks of therapy/treatment there was no improvement so I saw a pain management specialist at the orthopedic center. He said have an MRI since it had been going on long enough. MRI showed ruptured disk at L5 S1 with a 9mm herniation. He recommended a nerve block injection. I had that done 6 days ago. Pain lessened for a few days but seems the same or worse now. Also started Physical therapy the following day. The therapy movements I do seem to aggravate the sciatic nerve a lot. I expect some of that but it seems excessive.
    Pain management doctor is suggesting the possibility that the ruptured portion might shrink up enough to provide relief. My question is…..do you think that a 9mm herniation will shrink enough? I have read on your site that you think waiting more than 6 months for surgery is not as good a result as doing it sooner. Also, I do not want to be permanently weakened if it can be helped since I enjoy physical activity. And I cannot be on most medications since I am a commercial pilot. Do you think the microdiscectomy might be a good solution?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    Weakness of the calf muscle (gastrocnemius/soleus muscle) caused by a herniated disc is a problem that in my opinion, needs to be addressed surgically. Pain, numbness and paresthesias (pins and needles) symptoms by themselves can be treated with injections, physical therapy and time. About 70% of the time in that case, conservative treatment can be beneficial. However, in the face of motor weakness, many surgeons including myself recommend a microdiscectomy. Recovery of motor weakness is less certain and a deficit of the S1 root creates problems with walking (the push-off), climbing stairs, hiking, running and in a pilot, more difficulty with rudder pedal control.

    There still is a reasonable chance that motor strength can return without surgery but the odds of good useful motor strength return is less with “conservative care” (injections and physical therapy) than with surgery. There are no studies as of yet that indicate the timing of surgery may make a difference but logically, the faster the root is decompressed, the better the chance of good recovery.

    I think it might be worth getting a consultation from a spine surgeon to get another opinion.

    Dr. Corenman

    tomg
    Member
    Post count: 2

    OK, Thanks for the reply.
    I have a follow up appointment on June 8 and I will ask for a referral to a spine surgeon at that time.

    Thanks again,

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    If you could move up your appointment or get a referral sooner, so much the better.

    Dr. Corenman

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