dull aches in low back and thigh, feeling of foot dragging

[sarag]

as a PT student i was scared of every disease we studied. 2 yrs ago,aged 22, i thought i had tingling in extremities and had a brain/c-spine mri & emg testing. also felt pain at SI joints. findings were normal except for a single point of enhancement on mri at c5 level the dr thought was nothing. the dr also said that he saw "giant" waves in my right quadriceps but that it was still (barely)normal for my age. after learning normal results my symptoms went away except for occasional SI pain and cracking sounds at both hips with movement. i had a full normal rheum. workup a month later from fears of RA.
  i'm calmer and stopped dr visits. last jan at gym, i twisted trunk and felt ache in my right low back, rt buttock, and near ischial tub. by may i started feeling vague pain in lateral thigh, and difficulty with right dorsiflexion. feeling of dragging my foot but gait looks fine. my rt lateral quad feels weak and fatigues more easily than left quad during activity. big toe ext is norm. strength test everywhere is good but my rt leg feels dif overall. i went to orthopedist, all tests, straight leg raise, si joint tests, reflexes, were normal. pain is never shooting, burning, or radiating, just dull aches. negative numbness. an mri of lumbar spine came back with post bulging annulus L5/S1, small posterocentral L4/L5 herniation- mild thecal sac impingement, bilateral intervertebral foramen narrowing at L4/L5 from arthropathy. my ortho dismissed e/t as HNP, but why no radiating pain like normal hnp? why quad weak? could it be something else? doesn't sound like typical L5 HNP???

[busiedriver]

ive just had open spinal surgery 2 weeks ago at first everythng felt good an alot better
now suddenly the numbness is progessivly getting worse have some pain down my left leg but no where near as bad as it was before the surgery
but my left foot is reall yrealy bad the weakness seems to have gotten worse and the pain in my foot is acute especially on the bal of foot it feels lik eits burning buy nor hot more lik emy foot has been stuck in ice for a long time its a very cold burning sensation
does anyone have any ideas what this could be
and is it to be likely due frm my back surgery or do you think it might something different completley
i thought it may even be gout as i read thatgout can also be caused frm surgery its not pain ful to touch and i am definatley dragging the foot along as i walk
if anyone has a idea plse plse plse let me know ill try anything
thankyou busiedriver

[sarag]

you're right in terms of dorsiflexors - i'm able to stand on my heels so i suppose they're strong. inverters and everters are strong. in fact every muscle, when tested is strong.
  my dorsiflexors on my right foot feel weak though - i know that sounds strange. i feel like when i walk i have to actually concentrate on dorsiflexing. the same goes for my quads. they feel strange when they're contracting (mostly on the lateral and middle part, my inner thigh feels fine), yet if you test their strength, they are very strong.
the only obvious difference in muscle strength to me is after strenuous activity. both legs will get charlie horse and fatigued - which is normal, but for some reason my right quad will be much much more fatigued and weak. when i go down steps at those time i feel like my leg might buckle. my right dorsiflexors are the same. i went on a 4 hour hike a week ago and again - my right side was much much weaker than my left.
  my ortho performed a srt on me. every test was negative. my hamstrings are very tight - and i wonder sometimes if that could have affected the accuracy of the test.
  the doctor just answered me today and i see that he wrote that it's possible not to have radiating pain with a herniated disc.
  it could be that i'm nervous so my leg hurts more, but in general i pretty much got over my stage of being a hypochondriac. i almost never go to doctors anymore unless i really need to. i'm just trying to figure out whether to pursue this further or not

[CCF-Neuro-M.D.-PW]

I cannot give you a formal clinical diagnosis over the internet as this site is purely educational

Radiating pain does not have to occur in a radiculopathy (pinched nerve root) in 100% of cases. With a normal neurological examination a seerious radiculoapthy is also unlikeyl, an EMG study may not show anything. A mild radiculoaptjy may still be suspected based on clinical history. In either case conservative treatment results in resolution of symptoms in the vast majority of cases, and things settle down over  a few weeks if there is a HNP. Symptoms to be concerned about are objective weakness and wasting of muscles, fixed senroy deficits, or problems passing urine. If the quad is really weak, and there is areally also a L5 distribution of stympsome, then its possivle that the L4 root is involved. The quads do have some nerve supply from L4. Pain in the lateral thigh is commonly from compression of th esuperfical nerve that supplies the skin there, often compressed with tight clothes, weight loss or gain etc.

Good luck

[emad]

Hi Again :

Dorsiflexors are  weak or not ?

How about evertors and invertors stength ,you have not mentioned them .

Please excuse me to ask you how did you perform the SRT ,could you describe me its procedure?

The test i meant for the hip abductors is called   Trendelenburg's sign .


Sara ,i can confirm that in case of pain ,coordination or movement pattern could be disturbed that is what you describe as overall abnormality .

I

HNP??? what this abbreviation .


Regards
Emad

[sarag]

my hip abductors are fine. my left side does not drop when i stand on my right leg ---> no trendelenberg sign.
i do have dorsiflexor weakness. initially (nearly a yr ago) i literally had to concentrate on walking. my foot just didn't seem to want to come up on it's own during gait. i feel like this is a little better now, but i could be i got used to using different muscles to make it work?
exactly what is the srt? hnp stands for herniated nucleus pulposis - meaning i have a slipped disc at L4-L5. This usually impinges on the L5 nerve root. I have certain things that are typical of this diagnosis - such as pain on the lateral side of my thigh, and difficulty dorsiflexing. however i have quad weakness which is not typical. i also have no big toes extensor weakness that is typical of L5 impingement. That's why i'm confused about this diagnosis and am wondering if my doctor got it right. my pain also doesn't radiate like a typical nerve impingement injury. it just aches.
thanks,
sara

[emad]

Hi Sara Again :

The clues and posts are long ,so i like to concentrate more .

The abbreviation i wrote within my last post ,SRT i meant by it Straight Leg Raising Test ,i mean the components of it ,at its end do you add dorsiflexion or inversion .

Concerning ,dorsiflexion weakness , you said that you do have weakness , could you assure that by just standing on your heels ,if you can this for me means you have good muscle power of both  feet dorsiflexors .

I asked you about the muscle power of invertors and evertors ?

As for MRI report that ,you said there is lateral pulge /comperssion ,Through practical work all clues should  be correlated  .I have to give attention at that report , but if you can be free from pain ,there is no need to put it in mind .


I like to tell you that there something called BELIEF /Meaning within the patient,s  mind ,this is factor of the meaning of pain or the problem could affect the pain percepation .

Regards
Emad
www.somasimple.com/forums/

[emad]

Hi Sarag :

It is my first post here .

I have to begain saying , i heared only about medical student syndrome ,meaning i have not read or no evidence regarding it ,thus syndrome  suugest that medical school students feel that those things they study they suffer .


Concerning your current problem of lumbosacral  pain following sudden injury sprain/strain ,seems you are suffering from just soft tissue problem ,this is hypothsis is supported by more than one clue as i remember from your post ,first the SRT is negative besides to the history of injury ,as well as with SRT there is no radiation .

As for weakness ,I believe pain could lead to limping ,more gait disturbance ,more weakness ,more closed cycle of pain .

There is a test for assesing weakness of hip abductors ,i can not remember its name now ,but you can stand on one lower limb and observe if there is difference .

I can suggest you mangement  composed of neurodynamics and education .

From physio to physio  .

Regards
Emad

[sarag]

i did not write in very complete sentences because where was a limit on the amount of letters this web site would let me use.
i think that a closed cycle of pain is a rational notion if my symptoms were limitted to my low back or any area close by. i can't understand how this theory would explain how i feel like i have to force my foot upward (dorsiflexion) with every step i take.
L5 nerve root impingements can cause pain in the posteolateral thigh & buttock area as well as big toe extensor weakness and even a foot drop. however this doesn't cause quad weakness like i have. i also don't have typical hallux weakness or radiating pain.
  as far as my hip abductors - they are within normal limits. any answers are welcome. thanks!