Hip and nerve pain post-surgery

by Joel
(Webb City, MO)

Numbness in leg

Numbness in leg

Hip and nerve pain post-surgery.

Hi, I submitted a question a few months back and you were kind enough to respond, so I am hoping for the same luck this time.

I had a microdiscectomy at L5-S1 a little over 5 months ago. The original symptoms were low back pain and sciatic pain and numbness in right leg and behind. The sciatic pain was quite severe and appeared to be relieved immediately after surgery. However within a few weeks it returned, although not as severe. Along with that pain came nerve pain in my ankles (both), mainly on the inside of the ankle, but sometimes it can be on the outside as well. It is worse on the right side, but present on the left side, same with the pain in my behind. Additionally I have now developed fairly severe pain in my right hip, also my left hip, but again not as severe. By the way, the surgery was deemed a success and the surgeon feels there is nothing left to be done surgically. Most of my ongoing issues are being attributed to slow healing nerves and that I must just give it time.

So I have multiple questions:
1. Is it common for a compressed nerve in the lower back to cause issues in the feet?

2. If that is the case, why would that pain not start until after surgery? Especially is the nerve compression has been relieved.

3. The pain in my right leg often doesn't feel like nerve pain exactly (I am taking gabapentin btw), it is more like bad muscle pain that is not relieved no matter how much a stretch. Could this still be due to sciatic irritation/inflammation?

4. Could the pain in my hips still be a result of all this? Or is it more likely bursitis or tendonitis? The pain originates right around the joint, but can extend down the outside of my thigh.

5. Last but not least,do you agree with the assessment of "slow healing nerves" and "give it time"?

Thanks so much for your time!

Hello Joel,
Your tale of woe is not uncommon and the possible reasons are many, from the surgeon botched it and pinched a nerve, to you never took it seriously post surgery and didn't follow instructions, to no rehabilitation was recommended, or you didn't do the prescribed exercises. I could add to the list.

Not of that helps you because you are five months down the line; the milk is spilt.

I'm going to give you some tests to do; please do them very carefully, cause they can make the condition worse. If it hurts, stop.

1. Bend slowly forwards, then backwards, and then to the side. Tell me EXACTLY what you feel in each position.

2. Sitting in a kitchen chair, ask a friend to raise your left leg parallel to the ground. Dorsiflex, pull the toes to your head. Slowly flex your head onto your chest. Remember what you fell. Drop the leg. Now have him raise your right leg and repeat. Again, tell me EXACTLY what you feel.

3. Lying on your tum on a bed, bend the knee, and have your friend gently lift your left knee off the bend. Repeat with the right knee. Exactly what do you feel?

Your questions.
1. Yes, it is common as both the sciatic and femoral nerves go down to the feet. Can you raise your big toe? Can you stand on your right toes, lifting the heel? Get support from a chair.

2. I can't answer that; ask the surgeon.

3. Yes, very much so. Nerve pain is often a deep ache in a muscle that has been denervated. Are there any little twitches in the muscles of the lower leg? Fasciculations? Your response to the tests above will answer this.

4. It sounds like nerve pain to me. Again, the tests above will probably answer this. Is there groin pain? Look up meralgia paresthetica using the search function at chiropractic help.

5. At two months, I would have agreed. At five...?

Give me accurate, exact answers if you want a further response. Take the time, and write them down. Most folk couldn't be bothered and then get irritated with me.

Have you had another MRI? It sounds to me like there's another joint above L5-S1 that is being problematic. It may have been there originally, or you may have injured it post surgery. Or the nerve may have been injured during surgery. Inner ankle belongs to the femoral nerve.

That's it. Could you scan a lateral view from the MRI and send it to me? Or copy it digitally if have the CD.

Dr B

» Hip and nerve pain post-surgery

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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