Expert: Dr. Victor Dolan, DC, DACBSP - 8/10/2008

Question
QUESTION: Hi, i am 45 y/old, I get this feeling of leg weakness and foot drop with a slight numbness about 10 mins into running. Normal everyday walking is ok & i don,t get back pain just a bit of stiffness now & again & never really had a back problem.
I,ve had an MRI the consultant says i,ve L4 L5 nerve impingement and wants to give me an epidural.
I asked my DR if there was a physio or chiro that could help instead but he said NO.
I read that the epidural is only a short term fix.
Your input would be appreciated

ANSWER: epidural, epidural steroid injection, foot drop, MRI, nerve impingement, nerve irritation, vertebral subluxation complex, sciatica, neuritis, radiculitis,pinched nerve

Hello Adrian,

First, let me say that I am a doctor of Chiropractic.  As a Chiropractor I have four years of college, four years of professional chiropractic school, and now 25+ years in practice.  My education and experience obviously give me a perspective, some may say a bias or a prejudice.

The same for every discipline, profession, career.

I admit my bias.  I try to support my position with as much objective support as I can find.  I look at research within my field, and try to look at research outside my profession.  I hope individuals in other disciplines do the same.

If all you have is a hammer, everything you see is a nail.

Doctors of Chiropractic work on the spine all day, every day.  Chiropractors work on pinched nerves (nerve impingement) all day, every day.  Chiropractors work on healthy spines, degenerative spines, deteriorated spines, herniated discs, healthy discs all day, every day.

I am never hesitant to have my patients see another doctor- regardless of discipline or degree.  I have no problems with second opinions.  I am happy when another pair of eyes looks at my patient's problem(s).  This helps assure that we are looking in the same area for the cause of a problem, and it is not something I am missing.

You have a nerve problem, a spine problem.  To be denied a chiropractic evaluation does not sit well with me.  Have an evaluation by a Doctor of Chiropractic, let him(her) review your films and findings.  Listen to the diagnosis, possible treatment plan, prognosis.  You compare. You evaluate. You make the decision.

Before receiving invasive injections, I may also want to see another pain management doctor or neurologist.  Epidurals are minimally invasive, but they are invasive.  ESI's are controversial.  Use the internet.  The first few pages may be filled with paid articles that are glowing towards ESIs, but eventually you should find some articles that talk about the downside of the procedure.  Steroids are potent anti-inflammatories; since they bring down inflammation, they ultimately bring down pain, but steroids also weaken bone, cartilage and ligaments.  Proper placement of the ESI is critical to it's success, and proper placement can be tricky.

A second opinion should always be welcome.

For instance, your problem of a regularly occurring, predictable pattern of leg weakness, foot drop; could be, I stress- could be vascular in nature.  Sometimes neurological and vascular problems can mimic each other.  In all likelihood this possibility hs been considered and discarded.  But never be afraid to ask questions of your doctor.  You are the boss, you employ the doctor. You are questioning,,, and that is allowed, it is your body.

Weakness and foot drop are indications of a problem.  Without some treatment your nerve symptoms will grow worse.  Some type of treatment is warranted.  To me, the ESI is symptomatic treatment.
To me, chiropractic evaluation, and if appropriate noninvasive decompression, chiropractic adjustment, nutritional supplementation will get to the cause of the problem.

Leg weakness, foot drop: you need appropriate attention. Get other opinions, including a chiropractic opinion by a doctor of chiropractic.

Here is some information I utilize in my Staten Island Chiropractic Office that may be helpful:

Neck  Pain, Low Back Pain(LBP):   Neck  Pain, LBP  can be caused by many different things.  Big, BAD, catastrophic things like a tumor or a cancer can cause neck or back  pain (only a proper exam by a licensed doctor, like your Doctor of Chiropractic, or your family Doctor of Medicine, can evaluate your signs and symptoms, and perhaps refer for testing).  Big, bad things like a Herniated Disc, pinched nerves, possible fracture or dislocation can cause pain (again, best evaluated by your DC or MD, and perhaps referral).  Bad things, like  - Sprains, Strains, contusion, or Vertebral Subluxation Complex (all very efficiently diagnosed and treated by your Doctor Of Chiropractic.  Neck or Back pain can come from a motor vehicle accident, sport injury, slip, trip, fall, arthritis, lifting improperly, or even bad posture in standing, sitting or sleeping.  All of these things often have a Cervical (neck) or Lumbar (Low Back) Vertebral Subluxation involved.  

         Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.

This is a serious condition identified by its five parts:

   Spinal Kinesiopathology:
        This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.

   Neuropathophysiology:
        Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.

   Myopathology:
         Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.

   Histopathology:
        A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.

   Pathophysiology:
        Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.

The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.

        Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
         Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.

++++++++++++++++++++++++++++++++++++++++++++

Given your short description and findings, I do think chiropractic treatment would be appropriate.  At least get a chiropractic evaluation.


Thanks for your question.

Good Luck, and I wish you Good Health Naturally,
your Staten Island Chiropractor,

Dr. Victor Dolan
http://drvictordolan.chiroweb.com        (email newsletter)
http://www.GoodHealthNaturally.info
http://www.DocDolan.net  






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

QUESTION: I seem to have a greater urgency to urinate now i cannot hold on like i used too could this be linked to my nerve problem.

ANSWER: Hello again Adrian,

Yes.

Bowel and bladder control, control of the lower limb is under control of your lumbar spine.

Previously you reported that the weakness/ foot drop came on predictably after 10minutes of running.  Now we have bladder control changes.  Obviously the more signs/ symptoms the more significant the problem.  Do you now have your weakness/ foot drop more often?, more intense?, is the bladder urgency new or increasing?

Increasing symptoms translate to a need for further evaluation and increased need for treatment sooner.

Bowel/ bladder/ leg FUNCTION problems are more important then simple pain or even numbness.  With FUNCTION problems you should be seen this week if possible, with increasing symptoms- you should be seen this week if possible.

Are you doing anything to aggravate your lumbar spine (low back) which in turn causes increase in these symptoms?

I like changes in symptoms when the change is in the right direction (less problems).  I do not like changes in symptoms when they are worsening.  If your symptoms are worsening, you definitely need to see your original doctor (whom, personally, I am not impressed with- preventing a second opinion), or another doctor for a new opinion.

Do you have pain/ numbness/ control loss when you: cough, sneeze, try to take a bowel movement ('strain at the stool')?  These signs point to increasing pressure on your nerves.

Anyway, increasing symptoms warrant increased evaluation and treatment.  Visit your local doctor of chiropractic, or neurologist, or orthopedic that specializes in low backs.  Ask around your community for word of mouth- reputation- recommendation.

Thank you for your question.  Thank you for your kind evaluation.  Good luck with your problem. Bladder AND leg symptom changes, - try to see someone this week.  You do not need to go to an emergency room- your situation is not 'bad', but increasing symptoms should be seen.

Your Staten Island Chiropractic friend,

Dr. Victor Dolan, DC
http://drvictordolan.chiroweb.com     (email newsletter)
http://www.DocDolan.net
http://www.GoodHealthNaturally.info

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

QUESTION: Hi,
My bladder, when i do get the urge to go i have to go pretty much straight away.
Night time in bed i wake up ok but soon as i turn over i get the urge to go when i get there it can be a couple of minutes before i go & the flow is slow.
I have notice a slight change in bowel movement as well when i get the urge i again need to find a toilet quickly.
I have had trouble getting sexual aroused & getting an erection the MD gave me Viagra which works but ejaculating now seems to be hard getting too, i can get there but i get a big tingling all over my body when i do ejaculate like never before.
Now you have made me think all this is linked ? could it be.
My leg/foot problems seem the same not any worse and no back pain. This must seem a lot of problems to you that i have,
Thanks again for any information,
My MD better get ready !

Answer
Hello Adrian,

Yes, all of these lower body changes can be do to nerve impingement.
Think of spinal injury:
If you break your neck,,,, everything below ceases to function properly.
If you break your back,,, from the point of the spinal cord severance and below, things cease to function properly.

Your lower back supplies your legs, intestines, bowel, bladder, sex organs.  With nerve impingement you will have changes wherever those nerves go to.

Viagra treats a symptom, not a cause.

Painkillers, muscle relaxants, anti-inflammatories treat symptoms, not a cause.

http://www.google.com/search?hl=en&q=spinal+nerve+picture

for a chart/ picture of where the nerves originate and where they go to and functions they control.

I recommend you see a Doctor of Chiropractic to evaluate your spine and associated nerve changes.

I hope this helps,  again good luck and I wish you good health naturally!

Dr. Vic Dolan, DC
http://drvictordolan.chiroweb,com     email newsletter
http://www.DocDolan.net
http://www.GoodHealthNaturally.info