Question
QUESTION: 74 yo male with NEW (2-3 weeks), persistent -- all day -- bilateral calf cramping, sitting, walking, whatever. Not PAD. VERY uncomfortable and restricting all activities.

Bilateral herniation at L3-L4 and moderate stenosis at three levels -- L2-L3 (central), L3-L4 (central) and L4-L5 (lateral). L5-S1 is fine.

Long history of bilateral pain in hamstrings and quads. Also mild-moderate sensory-motor polyneuropathy diagnosed 2012. I'm VERY dubious that the quad and calf pain are caused by the stenosis or herniation.

I think I understand the idea of sciatic type pain radiating into the hamstrings and down the legs based on the nerves, but am dubious about calf cramping or quad pain from what I've read about L3-L4 and L4-L5 problems. And I'm thinking pain in these regions of the leg may be related to something other than lumbar spine. Hoping you can elaborate on leg regions/symptoms affected by herniation and stenosis. It would be awful to consider spine surgery for leg pain if it's not caused by the spine.

ANSWER: Hi, Tom.

Sciatica-like pain in the calves and nerve-effects in the thighs (shooting pains or numbness) come from compression forces at the place where low back and pelvis meet:  the sacrum (lumbo-sacral junction).

Please see this entry:  | http://lawrencegoldsomatics.blogspot.com/2011/04/understanding-sacro-iliac-joint

It's not typical sciatica, which is fairly easy to resolve with clinical somatic education (a few sessions, only).

Herniated discs can and do compress nearby nerves and may cause sciatica, but I don't think that's the case, here.

Nor do I believe that surgery will avail you. Those compression forces are not a surgical situation, but a functional one (or more properly, dysfunctional). Your muscle-movement memory would be the target of retraining to normalize the forces going through you and converging on your lumbo-sacral junction.

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QUESTION: Makes sense...doesn't sound like the sciatica I've read about. No shooting pains. I'm trying to understand the nerve compression effects. I know there's significant pressure from the herniation on the left L4 nerve. Also stenosis at that level. Would either of these conditions be the cause of DEEP bilateral pain in the quadriceps?

MRI also shows disc protrusion contacting both L5 nerve roots. Would that cause bilateral cramps?  I'm trying to account specifically for the kind of pain I'm experiencing. I've been reading about dermatome theory relating to disc herniations but that looks more like distribution of pain along the skin, not deep muscular pain. Comments?

Answer
The dermatomes don't apply just to the skin, but to all places in the region the nerve serves.

It may feel like cramps; if you rub the region and nothing changes, it's not cramps, but nerve compression pain, which may be interpreted as deep pain. When sensory nerves are compressed, they report pain or numbness; when motor nerves are compressed, loss of muscular control results.

In any case, the approach of choice would be to normalize the forces going through the affected region by normalizing muscular tension patterns, as spoken of in the entry on S-I pain.

If it's truly calf cramping, it will resolve very quickly with the following exercise pattern:

http://somatics.com/video_pages/calf_stretch_replacement_video.htm

If it doesn't resolve, it's likely nerve compression.