Expert: Dr. J. Shawn Leatherman - 10/11/2006

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…you’re 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