Some lower back pain and numbness and tingling in feet

by Tom
(Knoxville, TN)

Good morning Dr. Preston. I am a 65 year old male, 165 lbs. who has always been an active person. I had a diskectomy in 1989 for a herniated L5/S1 disk. Before the surgery I had extreme pain in my left leg and foot. I specifically do not remember having much lower back pain during that time, but the leg pain was so extreme that maybe I just didn't notice it.

The surgery was successful in that the pain in my leg was gone. I had some residual tingling, but that also subsided within a few months. No fusions were done to the vertebrae. After the surgery I would have occasional bouts with lower back pain and some numbness/tingling in my left foot.

At one point a few years after the surgery when I was having a lengthy bout with this the doctor recommended having a caudal block performed. I agreed not really doing any research. In my opinion either the procedure was performed wrong or I never should have tried it. It not only did not help, but after it my right foot also started having occasional numbness/tingling when I would have lower back pain. It would not happen every time my left foot would bother me, but would happen occasionally. Since then I learned to manage the lower back pain with the numbness/tingling by always being aware of not doing the wrong things while working, lifting, etc.

An interesting note here is that during all these years since the surgery if I would lift and carry something heavy (>30lbs. or so) I would notice that there was a feeling in my left leg that the nerve was getting pinched in my back and causing slight discomfort in my left leg/foot. Once I would stop carrying the weight, the feeling would go away.

Continuing on, this past March I woke up one morning with a very painful lower back and numbness/tingling in both feet. I really could not attribute it to anything unusual I had done the previous day. I put up with it for about a month then went to see an orthopedic surgeon. He took xrays, then I had an MRI. According to him both showed no real abnormalities nor serious degeneration. He did the leg lift and other tests which did not cause any pain or added discomfort. He gave me a shot of steroid in both muscles (don't know which ones). The shots were sort of right above my buttoxes on each side. He also prescribed a muscle relaxer (those things have never helped me). The shots did seem to help the muscles somewhat. After that, he basically said there was nothing else he could do for me. He said maybe the chemicals (whatever those are involved I don't know) released in that area are irritating the nerves and causing my current symptoms.

Presently I still have some lower back pain and numbness/tingling (plus every once in a while a little pain) in mostly the left foot. I really don't have pain in the foot, just the numbness/tingling which is very aggravating. I will also add that the lower back pain (which is accentuated when I curve my back inward or activate the muscles down there by what seems like trying to lift my buttoxes up toward my back - so you can see I'm not sure what muscles these really are) and numbness/tingling mostly go away when I go to sleep, but then immediately start to re-occur once I am up and either walking or sitting. So it seems to be mechanically aggravated for sure. Some days are worse than others, but because I have always been active, this has really affected my walking and bike riding for exercise. I have been doing various exercises since since all this started, but they have not fixed my issue.

Dr. Preston, can you please give me some advice? I too have been one of those people who have always been skeptical of Chiropractic medicine, but I am at my wits end. I am looking for help apparently outside the usual box of fixes an ordinary doctor would have. Sometimes I get the feeling they don't want to think outside the normal realm, they are too busy for that. Can you help me? Thank you very much in advance. Tom

Hello Tom,
You have a fairly typical course, frankly whether you go the medical or chiropractic route.

That initial episode where you had minimal lower back pain, but a fire in your leg suggests you had a complete prolapse, extrusion of the disc into the canal. You obviously attended a good surgeon. If he's still about, you might contact him.

Obviously sticking needles, scalpals into the spine is fraught with danger and whether that caudal block actually damaged another nerve or not is very difficult to say. It's possible, and obviously what you think. It is a fairly standard procedure however.

Seeing that axial pressure increases your symptoms, and lying down relieves them, you might consider inversion traction. Done every day in your home for about 10-15 minutes, many get great relief. Buy one that is kind on the ankles, they take your full weight. No good if your blood pressure is raised significantly.

Go on with your exercises, they are obviously helping.

Consulting a chiropractor? Well, that's your choice, but whatever route you go you can't expect a miracle from one click. My programme would consist of a course of treatment, depending on the examination, of course; perhaps 8 to ten treatments, then taper off as we add more rehab exercises, and then an occasional treatment, perhaps once in four to eight weeks. It would be unlikely to "cure" you, but hopefully greatly relieve.

A peripheral neuropathy needs to be considered too. Perhaps start with a few B vitamin shots in the butt. They sting!

Good luck, I hope this contributes.

Find a good chiropractor may be your next step.

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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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