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are these pains back related?



  • Here is a dermatome map indicating what areas are affected by our spinal nerves. Hope this is helpful.


    Best wishes to you,

  • When muscles are weakened by disc problems, do they get sore, as if you havent exersised in a long time then done too much?Also when it becomes hard to stand on your toes,and heals what stops you? Is weakness (where?) or pain (where)?I cant stand on my heals, but nothing hurts when I try, I just cant do it!I have an appointment with my neurosurgeon in October and I dont know whether to mention these painsor not.The pain along the soles of my feet is there even when I'm lying down.
  • Yes do mention these pains to your NS and also your inability to walk on your heels or toes, which is usually a part of their exam. My pain is exactly as you describe, as if I have been exercising for days. The muscles ache so bad when it flares up.


  • This is going to sound incredibly picky, but I was interested to see the dermatome chart that you linked to. I wasn't familiar with that link so clicked on it, and was surprised to see that it is different from the typical chart that is used in the US. I did a little research and found that this one is commonly used in Europe, and is on the website of Dr. Bertagnoli (one of the foremost leaders in artificial disc replacement, located in Straubing, Germany).

    The main difference seems to be that in the US pain in the front of the thigh is assumed to be coming from L2, L3 and L4, while the "European" dermatome chart does not include L4. It also has L2 and L3 not going below the knee, whereas in the US this delineation is not made.

    It is my understanding (explained in my very unscientific way!!) that when muscles are weakened from back problems, it is due to issues with the spinal nerves that innervate the muscles. For example, if you have a ruptured disc at L5-S1, in most cases it will be the S1 nerve exiting this segment that is most likely affected.

    The nerves are organized into 31 pairs of nerves that emerge from the spinal cord. Each nerve emerges in two short "branches" called roots; the ones at the front or anterior are the ones that control MOTION. The one that emerges at the back or posterior is called the sensory root and it controls what we recognize as PAIN and all those associated feelings we describe as sharp, stabbing, aching, hot, cold, etc. The motor roots carry commands from the brain and the spinal cord to other parts of the body, like the muscles. The sensory roots carry information to the brain from other parts of the body.

    In addition to affecting the legs and feet, the lumbar nerves (L1-L5) also control the large intestines, appendix, abdomen, bladder, reproductive organs, and lower back. The sacral nerves affect the hip bones, tail bone, buttocks, rectum, anus, etc.

    When a nerve is affected by a problem disc, for example, either root can be effected. If the anterior root is affected, it will result in problems moving the muscle. Depending on how badly "damaged" the root is, it could result in weakness or inability to move the muscle. (In the case of paralysis, the nerve connection is completely severed and no signal is getting through to the brain). It can account for the loss of a reflex, foot drop, etc.

    You could experience a feeling of weakness or there could be achiness and a feeling that the muscle is taxed to the limit and cannot perform any longer. There are a variety of ways your muscles might feel.

    When you cannot walk on your heels or toes, it usually means that there is some sort of disruption of the signal between the nerve and the brain. You're trying to send the signal "walk on your toes" but the brain is not receiving that message and therefore, the muscles cannot respond.

    I hope this laywoman's interpretation helps you to understand how the spinal nerves affect movement and sensation and how the signals can be interrupted.

    I would tell your surgeon about any problems you have with nerve pain or movement when you see him.

    xx Gwennie
  • It sounds like your leg and foot pains are probably related to your spinal surgery. You may have reherniated the disc or developed another problem. What were you told when you went to the hospital?
  • the hospital I've been in is a very small hospital with no specialist consultants. My consultant is 200 miles away and visits another hospital which is 83 miles away, every 2 months.This is where I have my appointment.The doctors at the small hospital can only treat me for the pain and keep an eye on me.They have tried writing and calling my surgeon many times so I can been seen sooner (my appointment is oct. 26th), but he is alaways too busy to speak to them, so they are very frustrated with him.All they say is I need an MRI and that severe nerve pain I am having.My neurosurgeon is quite abrupt and a combination of this and him being Indian with not fantastic english, I dont want to appear stupid and ask stupid questions (II'm quite shy and he makes me nervous).
    I cant walk on my heels because it just wont happen- I lift my toes but thats as far as I get.I can go up on my toes, but this hurts the soles of my feet a bit.For the last couple of weeks the muscles just above my knees ache when I go to sit down and go to stand up.My butt aches and I'm noticing more pain down parts of my right leg.
    I suppose if I can just hold it together I should just tell him that list, but know I'll crumble and just want to get out of there (the surgeon gives you the feeling that he doesnt want you there in the first place), so its for this reason I only want to tell him 'essential' pains.
    Sorry for the long posting x
    One more thing- is it usual that people cant walk on both their heels and toes, or one or other?
  • it looks like your operation has not been a success i was the same ofter my last operation and nearly 2 years on i am looking at even more surgery due to the pain .i hope that i am wrong for your benifit .but it dose sound like you are going to have pain problems my friend ..sorry
  • Obviously we are not doctors, just experienced patients! However, that little fact never stops me from offering an opinion... @) From what you describe, it sounds like you have reherniated the disc. Sometimes it is a matter of not seeing all the pieces and leaving one behind at the time of the surgery. Or, the disc just never heals properly and there is inflammation, etc. that causes the nerve to be compressed (pinched). Another possibility is the formation of scar tissue that is impacting the nerve root.

    Often the doctor will prescribe a course of oral steroids for ten-14 days to see if the swelling will go down...to see if that is even the issue. Or, they will suggest an epidural steroid injection, which will get the steroid right up against the nerve root without having going through your entire system. That is often done prior to ordering an MRI, as it so often resolves the issue for the patient.

    I would suggest that you sit down and write up a list with short bullet points describing your pain, so you can tell the surgeon, in a concise way, what you outlined above. That way if you are nervous, you won't forget anything. It is difficult when there is a language barrier. My pain management doc is Vietnamese. When he gets excited, he starts to talk really fast and it is so hard to understand him...so I know what you mean.

    I think all the pain in your leg and foot is caused by a nerve problem from the surgery. The pains can come and go...there can be weakness at times, but not at others...in effect, things do not have to follow a predictable pattern or course. You can have the toe effected, or the heel, or both...the muscle can become weak and just "not work." It doesn't mean that it will stay this way permanently...but it is important to see the doctor as soon as you can.
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