Question
hi there
in relation to a previously asked question
i have a very similar problem
can you advise on what exercises to do?

many thanks

jason




Expert: J. Shawn Leatherman, DC, CCST, CCSP
Date: 10/11/2006
Subject: Numbness in leg causes

Question
I have been having problems.  From about my left knee down to my ankle I have a numbness on the top/shin area.  If reminds me of how my legs felt when I had a spinal for my c-section, and how my belly felt around the incision after my c-section, it just doesn't feel right, I can feel it, it just isn't right.
My ankle is sore, and my hip/buttock/low back is sore, so I am thinking a pinched nerve. I also have a cramp in my foot at times.
I went to a chiropractor today, he didn't seem to worried, he adjusted me and for a minute or two it did get a little less numb feeling.
My question to you is, does this sound serious or would you agree that a few adjustments can probably fix me up? (That is basically what the chiropractor I seen told me)
If it isn't from my hip or ankle what else could it  be?
I am 28 female caucasion, otherwise healthy.  I have been aching.
Thanks for all your help!

P.S. No known injury, I do sit on that leg, and have pretty poor posture, I sit at a computer, and sleep on my stomach which makes it worse.  I have been having a shoulder problem long before this started, I don't think it is related, but thought I would put it out there just in case.



Answer
Dear Numb,

What you have described is classic for referred pain patterns and neurological pain patterns.  When there is dysfunction with the vertebral articulations in the lumbar spine (low back) and pelvis, it may create pressure or irritation to the nerves that exit the spine.  When this occurs, pain, burning, tingling, or numbness can result in the course of the sensory branches of the nerve roots.  The sensory and motor portions of the nerve roots supply the information from the brain to the entirety of the foot and leg.  Consequently information from the foot and leg are sent to the brain via these same nerves. If dysfunction of the muscles begins, then the problem has progressed further and the nerves are directly being affected at that time.

Neurological pain follows precise patterns according to the nerve root or peripheral nerves involved.  In your case, the symptoms follow the L4 and L5 dermatomes (a dermatome is an area of skin supplied by the sensory root of a spinal nerve, which would be the L4 and L5 nerve root).  

Now, it is also possible that structural irritation to those nerve roots could be the cause of the problem.  This is where the anatomy actually causes encroachment of the nerve roots.  The most common causes of structural encroachment are:  disk bulges, osteophytes (bone spurs), facet hypertrophy (joint degeneration/arthritis), and anterior slippage of a vertebra which is called an anterolisthesis or spondylolisthesis.  All of the above causes can be helped with chiropractic care unless they have progresses to a severe state, which I doubt in your case厃ou抮e too young.

Now the aching is most likely due to local irritation and inflammation as well as muscle spasm.  Again this is a common pain presentation according to your descriptions.  Bottom line, with the information you have given me, I agree with your chiropractor that the problem is not severe, and you should see continued improvements with future adjustments.  In cases such as yours, I usually recommend being treated three times a week for two weeks.  You should see 50-75% reduction of pain in that time period.  You should also be taught some exercises for stability of the low back as well as stretching protocols to eliminate cumulative stress that are specific for your condition.

Preventative measures:  Stop sleeping on your stomach!  This creates an un-natural position for the spine and increases shear tension in the low back.  You should be sleeping flat on your back or on your side with a pillow between your legs.  Also you need to improve your posture, especially when seated.  Sitting increases the pressure on the disk, two times more than when standing erect.  A lumbar support while sitting will help to regulate your posture at work.  Ask your chiropractor about getting one, as well as instructing you on proper ergonomics concerning your work space.  Lastly, it is unlikely that your shoulder problem is contributing to the low back and leg pain.

Questions, comments? Feel free to get back to me if needed.

Respectfully,
Dr. J. Shawn Leatherman  

Answer
Dear Jason,

I am assuming that your pain/numbness issues are the same as the woman had described. SO that is what point of reference I am coming from.

As stated in the previous answer,  you are most likely experiencing some form of irritation to the L4 and L5 nerve roots.  When this occurs, you really should schedule an examination to pinpoint what the ultimate cause of the problem is.  However, here are some places to start concerning exercises.

First thing is to maximize your flexibility concerning the hamstrings and calf musculature. If the musculature in the legs are tight, shortened and inflexible, this creates tightness in the lower portions of the spine and can restrict spinal movement.  Start by stretching in the standing position, and focus on the calf musculature.  Then progress to a seated position with the classic sit and reach stretch...hands to the ankle, then the top of the feet, and then progress to the outside of the foot.  This will very effectively stretch the calf muscles, the hamstrings, and the lower lumbar spine erector musculature.  You do not want to stand while reaching for the toes as this position increased stress directly on the disk.  

Second, extension exercises while lying on your stomach are next.  Lie flat and raise the legs one at a time off the floor about 3-4 inches off the ground and repeat 10 times.  Move on to the bird dog exercise which is on your hands and knees.  You will be extending the leg and arm on the opposite sides at the same time while sucking in the belly, then switch to the other side...this constitutes one repetition.  Work up to 50 of these every day.  You can look this exercise up on line to see how to perform it correctly. This works to stabilize the lower lumbar spine...specifically a muscle called the multifidus muscle.

Now, while these basic exercises will effectively help increase flexibility, stability and movement patterns of the lumbar spine, it will not help you if there is a significant nerve root encroachment issue.  This is why I suggest that you have the area examined to pinpoint what structures are the initiating tissues responsible for your symptoms.  Good Luck Jason.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net