Expert: Dr. J. Shawn Leatherman - 8/7/2008

Question
QUESTION: Hi, I am in the 8th week of backpacking south america for 6 months. Before leaving to travel i often got a very restless left leg when going to bed only alleviated by getting up and moving around. Since travelling (i think due to carrying the back pack and sitting on many bumpy busses) i reguarly wake up with a compleatly numb upper thigh on the left leg. I understand from your previous answer to another sufferer that it could be a irritated nerve. As i am 4 months away from home and seeing a doctor is there any advice you can give me to stop this getting worse. Any excerises i can do? Or how to lay / sit please?
I have lightened my load of my backpack already, is there anything that will make it worse? I am very worried and would really appreciate a reply if possible.
Many thanks Helen.

ANSWER: Dear Helen,

The first thing to consider is the weight in your backpack.  I know that you have already reduced this.  However, you should realize that it is never indicated to carry more than 15% of your body weight in a backpack and that includes the weight of the pack (Backpack Safety America).  So try to make sure that you fall within that guideline.

When you are lying down at night, place a pillow, clothing or whatever you have to get the legs up so that you are creating a seated position while flat on your back.  This will reduce overall low back stress and relax tension on the nerve roots and peripheral nerves that go to your legs.

Overall flexibility of the low back, pelvis and legs is key to allow for proper motion in the spine which will further allow for reduced stress on the nerves and disk.  Simple toe reaches will accomplish good flexibility in those areas.  This should always be performed in the seated position rather than standing. While seated with the legs in-front of you, rotational twists of the torso will help as well, but do not force the stretch...it should be fairly gentle. Lastly, lying flat on your back, bring your legs up to the chest to make a ball...and pull with the arms. Try for three sessions a day.

This should help alleviate muscular and fascial restriction on the pelvic and low back spinal structures.  If the numbness gets any worse, I would suggest that you cut your trip short and get to the doctor for an examination.  Good Luck Helen.

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







---------- FOLLOW-UP ----------

QUESTION: Dear Dr Leatherman,
Many thanks for your reply. I have started a stretching regime now, also i read that gentel core strengthening excerises would help so am doing those, do you think that is the right thing to do? i will lighten my backpack even more too. If it gets worse i will try and see a Dr here if not then try to go home. Afterall Ive only one back - and there are plenty more trips when its better!!
Is it ok to contact again if i get any other weird symptoms?
Best Wishes
Helen.

Answer
Dear Helen,

The core strengthening exercise are fine, just make sure that you form is good, and that you are tightening the abdomen while performing them.  Really good core exercises are called the PlANK, SIDE PLANK, and BIRDDOG exercise, otherwise known as quadriped extensions.  It emphasizes core strength and support concerning the multifidus muscle in the low back.

To do the plank exercise, lie on your stomach. Raise your body up in a straight line and support your bodyweight on your forearms and toes so that your body hovers over the ground. Keep your back straight and your hips up. Hold your abs tight (as though you were bracing against a punch to the stomach), but breath normally. Hold this position for 20 seconds, and try to hold it a little longer each workout.

To do the side plank, lie on your side, then raise your body in a straight line so that your body hovers over the ground. You will be supporting your bodyweight on one forearm and the side of one foot. Keep your back straight and your hips up. Hold your abs tight. Contract them as if someone was about to punch you in the stomach, but breath normally. Hold this position for 10 seconds for each side, and try to hold it a little longer each workout.

Finally, to do the Bird Dog exercise, kneel on a mat and place your hands on the mat under your shoulders. You should be on “all fours”. Brace your abs. Raise your right hand and left leg simultaneously while keeping your abs braced. Point your right arm straight out from your shoulder and your left leg straight out from your hip. Your pelvis SHOULD NOT ROTATE (if someone placed a ball in the small of your back, it shouldn’t have fallen off). Your back should be flat like a table, and you'll look like a "Bird Dog" pointing. Hold for 3-5 seconds and then slowly lower without rotating your pelvis. Alternate sides, and do 5-50 reps per side.

Do not rest between exercises, but rest 1 minute before repeating this mini-circuit 1-2 more times. You can do this everyday if you wish.  Check out the link below I found while doing and Internet search for Birddog, and watch some of the videos.  This site is actually pretty good in illustrating the exercises with good form.

http://www.orthop.washington.edu/uw/backpain/tabID__3347/ItemID__265/Articles/De

Hope this helps Helen.

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