weak great R toe, cold top of foot, instability in ankle & knee, pain upper butt to inner buttock

by andrew
(gorham, me, USA)

Have you ever gone into an

Have you ever gone into an "antalgic" posture like this?

» Weak great R toe, cold top of foot, instability in ankle & knee, pain upper butt to inner buttock.

I have had two l4 l5 surgeries...Aug 2014, then Jun 2015.
Im 33, great health & a former triathlete, I had a car accident October 2011 and things have gone down hill...constantly. I was told "off the bat" that I definitely needed surgery but basically fought off the invasions for 3 years; things did get really freaky when my R ankle got a bad pinching feeling and developed numbness & weakness. Based on what I know now wish I fought longer to avoid the knife, but all advice said nerve was getting clobbered in a major way.

I now have substantial odd numb feeling in R major toe, inability to lift with any strength, pinching in Achilles tendon, ankle & knee instability, knee pain, ankle pain, "back" pain (although not really back...,more in upper buttock running down inner R buttock.

I'm now on gabbapentin, oxy (sparingly)& aleve. I struggle constantly to get medical care as MRI shows relatively clean from S1 - L4. No one understands this...seemingly at least! I just want to get back to exercise & health but don't know how. Maybe it's living in Maine that's giving me challenge? Any help I would greatly appreciate it.

ps. I can send any number of MRI, myelogram or xrays...if this site & an actual response is possible.
Andrew H

Hello Andrew,
You're between a rock and hard place; fundamentally you have what is known in the literature as "Failed Back Surgery".

There are many possible reasons, which I will recount, since it may have a bearing on the future. Sometimes it's simply that both chiropractic and surgery are an art, and perhaps your surgeons just didn't have the dexterity and skills needed. Or, it could be that you acquired a hospital infection. Perhaps you are a smoker, but that's unlikely if you're a triathlete. Sometimes it's that patients start sitting and bending too soon, return to work before it was advisable, have a slip or stumble, or do something plain stupid like lifting a box of books.

For the future, think about these things, and others; apply you mind to getting better. Writing this letter is the first step, and it's very healthy. At the end of the day each of us is responsible for our own health.

From today onwards, I recommend you begin a simple exercise program, done in bed, every morning before arising, for the rest of your life. Do them faithfully whether you hurt or not. You'll find a link below to lower back exercises.

There is no one size fits all, so think about which of these exercises is helping, and which may perhaps be hindering your progress. Perhaps get advice from an exercise therapist. Start slowly and the rule is that you may "feel" it, but they shouldn't cause pain. As an athlete you'll find them frustratingly simple; accept it.

Lie down for short periods during the day, and do the exercises. They take less than two minutes.

Accept that for a time there are some things you shouldn't do and possibly should never again do; lifting the deep freeze and moving the grand piano, the vacuum cleaner, and sitting in a bad chair. In fact sit less.

You make no mention of having seen a chiropractor; perhaps consider making an appointment for an examination and report of findings with no treatment at all; you then go and weigh was has been said.

Finding a good chiropractor is not always the easiest, same as finding a good surgeon. Start talking to friends and family and your doctor until you hear a name that comes up highly recommended again and again.

Lastly, accept that you have an incurable, but probably treatable condition. Like diabetes. Don't expect your chiropractor to fix the problem, cure you, because it's probably not going to happen. You may need to go for an occasional regular treatment for the rest of your life. You have what are known as "hard" neurological findings; weakness and numbness.

Think about swimming and or walking daily. Ask if you have a short leg because that may impede walking. Then a simple inexpensive insert in your shoe may be indicated.

It's complex, Andrew, and I'm afraid there isn't a simple solution. Keeping fit is vital, a healthy non inflammatory diet and being careful are all part of the future.

Inversion traction sometimes helps in chronic cases like yours.

Do two little tests for me.

1. Bend slowly and carefully forwards, backwards and sideways and tell me exactly, specifically what you feel.

2. Sitting in a kitchen chair raise first the good leg, and then the naughty leg parallel to the ground. Precisely what do you feel?

Let me know; I hope this contributes.

Dr B

» Weak great R toe, cold top of foot, instability in ankle & knee, pain upper butt to inner buttock.

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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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Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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