AMWalker

After a little investigation and feeling around on my back/buttock, I suspect the nerve may have been temporarily entrapped in the foramen, but I can only speculate. Is this is indeed what happened, is it likely to be a persistent problem given the collapsed disc space? Will it be ameliorated by enhancing the muscle tone on supporting structures that have lost time as a result of the injury?

Also, might I reach out to you again should I have further questions? Happy Holidays to you.

Thank you Dr., I appreciate your reply.

I will pursue a referral to a qualified Physical Therapist who is hopefully experienced in back rehab. My flexibility I think is particularly limited, as it was prior to my injury and has only gotten worse since I’ve been limiting my motion for almost seven months now. My core strength I think is fairly good and my BMI very low (5’9”, 125lbs). I intend to take my rehab slowly, but I wonder if I’ll gain the confidence to return to my physically demanding job as a carpenter. My surgeon described my annular defect as “fairly large” and the HNP as “huge”. I think I had two or possibly three episodes of herniation once the initial defect occurred.

My concern with the multifidus arises because it has been a persistent tender spot since the initial injury. Prior to the full height of the radicular symptoms, I had thought my issues had been resolved after a few trips to the chiropractor, and I ventured on a family vacation that required an ~11 hour car ride. While applying sunscreen to the low back a few days into the vacation I felt the extremely tender spot right along the spine on the left and I knew something wasn’t right. Thirty minutes into the return trip I got a searing pain in my left hip that I could not resolve positionally and basically everything was downhill from there. I did continue to work the next two months, including two hours commuting each day, but this eventually became too much.

While I did learn to identify muscles innervated by S1 in the leg, it was a while before I realized that the multifidi are innervated by dorsal rami of nerve roots in the lumber plexus. I’m not certain I have my terminology correct, and this underscores my inexpert understanding of this complicated topic. In the course of receiving two ESI’s my physiatrist asked about tender, painful spots in my back and was able to put her thumb directly into it, eliciting a jump. On the second shot I believe she even injected some steroid intramuscularly, as it felt different from the first shot. It did seem to help with the tenderness, which hasn’t been as bad since then, and seems to have improved post surgically.

What concerns me most, in addition to my apprehensions about returning to my work, is the rehabilitation of that small muscle and the small deep hip flexors. I read one study that indicated that atrophy of the multifidus was radiographically evident in as little as a few months. I also understand that it can be difficult to isolate in exercise and rehab. I’m also concerned with the relatively small amount of muscle mass I have to “give” to atrophy/weakness given my body size.

This process has changed my outlook on the future and I am in the process of accepting the new limits that are on my body. There is after all a lot to live for and I have many reasons for which to be thankful. That said, I am eager to do all that I can return to as full of function as possible, for myself and my family, while also limiting the possibility of the recurrence of this type of injury. I do believe that knowledge is a key part of insuring this process goes as smoothly and successfully as possible, so I hope you will forgive me being long winded.