Herniated Disc w/ Numbness

Background: 28M, very physically active (running, lifting). A little over a month ago after a light workout, I noticed numbness in my left foot, which started radiating up to the back of my calf, upper thigh, and butt. I lost most of the strength in my left calf and it was tough to walk >5 minutes. Two weeks prior, I tweaked my back squatting, which was extremely painful, but I progressively worked through it and returned to normal until the onset of numbness. (I’ve tweaked my back like this 3 times in the last 5 years. Always very painful; always went away after working through it.)

Current state: Went to the doctor right away and started PT. After a week, I regained most of my calf strength (~75% to normal), and my heel was less numb. However, now, a month later, I’m still numb in my upper thigh, the back of my calf, and the top of my foot. (Example: I can’t feel sensations other than pressure when I scratch these areas. If I pinch myself fairly hard, I start to feel it.) I do PT daily (twice a week at a PT office) with mixed results. I find nerve glides and bridges are the most effective movements for relieving the numbness, but the results are inconsistent and temporary. I take diclofenac and gabapentin 1x per day (cutting back from 2x after minimal results). Over the last month, I’ve had almost no pain.

MRI results: Large extruded disk herniation at L5-S1 level causing severe foraminal stenosis as well as left-sided disk herniation at L4-5 level also causing of subforaminal stenosis.

Priorities: Regain sensation in my left leg/foot. Get back to physical activity ASAP while minimizing long-term risks to my back.

Questions: 1. Has anyone else had a similar case where numbness was the primary symptom? Did it go away on its own, or did you get surgery? If so, how did you consider between a microdiscectomy or endoscopic surgery, which seems less proven but is less invasive?
2. If you had spine surgery, how long did you wait? Based on my case, how long would you recommend I wait? My understanding is that having surgery sooner could reduce the risk of permanent nerve damage, but I want to balance that against the chances of regaining sensation with natural healing.
3. Has anyone had success with relieving numbness using an epidural? (I don’t have pain, but I would prefer not to have surgery if I can avoid it.)

CC,

Sorry to hear about your experience so far, though it is encouraging you have seemingly improved over the last month. We cannot advise you on your specific case over a forum, as this is consult territory, A few thoughts in general, however:

  1. Numbness is common and surgery is not necessarily indicated for this symptom in isolation. Would need more information to weigh-in on this along with surgical consultation if pursuing that route
  2. Would recommend additional exercise on top of PT for fitness, recovery, and metal well-being
  3. Gabapentin is something I would discuss with your doctor about need and efficacy
  4. Would not let others’ experiences regarding surgery vs no surgery play a large role in your decision making process. Everyone is different and personal anecdote is given a lot of weight underservingly.

-Jordan

Thanks for your response, Jordan.

Curious to learn more about your point of view on numbness. Does it typically go away for lifters (or is there is risk it persists if not treated)? Numbness is my primary symptom, so want to contextualize it against the broader population.

I also have some strength loss in my left calf, which is more concerning (~75% strength to usual). I’d assume this is a bigger flag to go down the surgical route.

Would appreciate any general thoughts on recovery numbness/weakness in lifters.

It is very common for these symptoms to improve, in general. There will be a fraction of the population who improves quickly, another fraction for whom the process takes longer, and a small fraction for whom symptoms may persist. We cannot predict/identify such things for a given individual in advance. Weighing this against surgical risk is a complex topic that requires individualized discussion; I think you would receive much more useful/actionable advice via a consultation with our rehab team. Dr. Miles, for example, has dealt with the same situation himself, and has worked with a number of patients going through this (both surgically and non-surgically).

A vital point. A very large number of people will give more weight to one or two personal anecdotes than to large scale well designed randomized control trials.

A random example - a relative had a serious medical problem and research showed drug X could help, so I suggested she discuss it with her doctor. She had no interest. A week later she told me a friend with her condition improved on drug Y. She was very excited and was going to call her doctor. Drugs X and Y were the same - Y was the brand name for generic drug X.

Things like this must be very frustrating to doctors.