Expert: Dr. J. Shawn Leatherman - 5/16/2007

Question
Hello,
I have been dealing with sciatica now for about 4 years or so, off and on. Each time it was related to a sports type activity and my chiropracter is pretty used to seeing me and dealing with my problems...and each time we've been successful in getting me back up to speed, 100%. Last weekend I revisited my sciatic problems once again, and I'm pretty sure it was from the moderately heavy squats I was doing. Nonetheless, the pain was alittle different this time. More persistent (no position except standing would relieve the pain), yet not near as strong as last time. More alarming was foot numbness on the outside blade of my foot and toes. This was also accompanied by a very sore calf muscle and an inability to stand on my left toes (I couldn't do a one-footed calf raise, essentially, with my left foot).
I'm into week 2 now of dealing with this. The pain in my back is getting better and really only bothers me in the morning, but it's nothing bad. My calf/ability to do calf raises is what worries me most. Last week I went to the gym and could only do 35 pounds with my left foot (calf raises) with some difficulty, and compared to say, the 85 pounds I can work out with easily on the right foot. This week I can do 50 pounds with the left, with some difficulty. The numbness seems to be going away slowly, I'm walking better, and my stregnth seems to be slowly returning. Slowly.
My question is, do I need to be concerned with permanent nerve damage or nerve death if things seem to be progressing in a positive direction (albeit, slowly)?
I talked to some people who've herniated mutiple discs and have had the numbness/weakness, and some have had surgery others not. One in particular herniated 3 disks, could barely walk, and with 6 mos or so of physical therapy came back 100%. Just wondering if I should still be concerned even though I'm making progress?

Thanks!
Beau

Answer
Dear Beau,

The problems you have described are common in chiropractic practice.  The inability to initially do a toe raise on the left foot as well as the pain that radiated to the outside of the left foot correlates perfectly with the known patterns of nerve root involvement called dermatomes. Your pattern is S1 and some S2.

There are also areas of pain sensation on the leg that have been determined to be specific for a particular nerve root without crossover from other nerve roots.  These are called Autonomous Sensory Zones, and there is one on the lateral aspect of the calf muscle. The specific nerve is the S1 nerve root. Below you will find a link to visualize the dermatomes in the leg.

http://www.regionalabc.org/lower/anatomy/dermatomes.php

Now, I don't think you have anything to worry about because of the fact that you are making consistent progress in strength gains as well as the reductions in symptoms.  Progress/improvement is always the best sign of clinical efficacy.  Stick with the doctor you are seeing and follow through with the treatment rendered as it is working.  IF you hit a snag in progress, it may be appropriate to have an MRI of the lumbar spine to more appropriately visualize the disks and nerve roots.

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