AMWalker

This post is long overdue for an update. My MRI on 12/20/17 revealed no recurrent herniation, according to my surgeon. I am left to assume that my symptoms were due to nerve root inflammation.

Since then I have had a few more similar episodes, the worst of which occurred after over stretching. I was finally prescribed PT about 2.5 months out from surgery at my behest after having some hip bursitis, which has diminished. I was doing a supine rotational stretch when I felt a pull in my back. The next day after sitting in a theater seat for around an hour and some walking, I had strong back pain and some leg symptoms. It responded to a couple days of rest, ice ibuprofen and some Gabapentin. Needless to say at over 10 weeks out, it was discouraging to have a setback.

Other flare ups have occurred in the four weeks since then, induced by certain PT exercises, ice or twice by tweaking it the wrong was, as in adjusting myself in the car seat. It seems such flare ups are shorter in duration and they don’t travel as far down from the root. My strength and stamina and pain are all improving, but progress is exceedingly slow. I am able to dress myself, do some household chores and even lift and briefly hold my ~30lb son. However, I still have not returned to work as a carpenter, as I feel it would be too demanding and strenuous at this point.

I am less freaked out by the nerve flares now— I have learned how to avoid them and manage them when they occur. I feel fairly confident that eventually they’ll be mostly a thing of the past. I do have some other concerns at this point. Absent a flare up I wake up feeling pretty good, but after four or five hours of being vertical I get a deep pain in the center of the spine, at the level of the surgery and below. Interestingly when the nerve is flared up I either don’t have or don’t notice this bony spine pain. I’m curious what the mechanism for this pain could be, and what the chances are that it might resolve in time. As I say, it’s not constant, but seems to be brought on after being vertical or when my back gets fatigued. Sometimes it seems the more active I am the less I feel it, but then it is generally worse the next day.

I am working to strengthen my back and core, but I must be careful not to overdo it. I would be interested to have your insight as to why I notice the Transverse Abdominus activation exercises creating pressure on the nerve root. It seems the increase in abdominal pressure aggravates it an can lead to a flare up. At this point I am torn between how much to pursue my core strengthening and how much to leave the root unperturbed for healing.

Finally, my calf muscles seem to be the most recalcitrant to recovery. When I do a full body stretch upon waking it occasionally induces a cramp in the calf that creates sore tender spots that last for weeks afterwards. The cramps don’t happen at any time other than while stretching. Is this residual from nerve healing, or could this be indicative of some ongoing impingement? As a lay person viewing my latest MRI, I see some residual herniation in the saggital view that is slight indenting the thecal sac, but I don’t see any cause for alarm in the axial images. But my inexpert reading doesn’t mean much.

I am eager to hear any insight you might have on my condition and recovery. Thank you.

One further question. Could facet joint pain create a similar response? I am feeling a little of a catch when I bend forward and to the right slightly.

Thank you Doctor. I have all but ruled out recurrent herniation, as the sciatica like symptoms gradually faded since the incident. Nevertheless a pain persists deep in the buttock about an inch from the midline and three to four inches down from the incision L5-S1. There is also pain in the hip joint and the outside of the hip, and some along the rear rim of the ilium. I am on my second day of a six day prednisone pack, which is helping.

I am considering sacroiliac strain, sprain or misalignment to be the cause. I have been suspicious of this problem throughout the course of my injury in addition to the sciatica, at various times feeling it to be “out” or “jammed”. A chiropractor has helped in the past and once or twice I’ve had it accidentally readjust on its own, with a “pop” and some relief. It hadn’t been an issue in the weeks leading up to surgery, nor after, and until this latest incident I had all but forgotten about it. With the nerve compression now relieved, it is easier to sort out these overlapping and mimicking conditions. What I thought was sciatica since this latest incident was referred pian in a slightly different area.

I am still at a lack for understanding the mechanism for SIJD as it relates to disc herniation, though I realize there does seem to be a medically recognized correlation. Could the muscle weakness resulting from nerve compression lead to destabilization of thejoint? Mechanical changes in the spine thahave causeD ligament laxity? More important, how shall I proceed with a diagnosis at this point, and when and what modes might I seek for safe adjustment since my surgery?

I appreciate your insight and tireless service to your field. I can’t thank you enough for providing a valuable resource for sorting out these often complicated issues.