L5 Weakness: Waiting to see improvement

by Mary on November 13, 2016

I wanted to show you the leg and foot weakness I’m hoping to recover from so I can skate. It was caused by disc problems damaging the L5 spinal nerve at two different levels of the spine. I had surgery a week and a half ago to decompress the nerve and give it a chance to heal.

The most obvious problem, but not the only one, is the damaged tibialis anterior muscle causing weak dorsiflexion of the left foot. My PT and neurosurgeon both consider it to have a strength of 4+ out of 5. It can move against gravity and has some resistance when you push on it, but less than normal strength.

Some people would love to get a strength of 4+ back after a nerve injury and would be satisfied with that. A true foot drop is a strength of 3 or less on the 5 point scale and is much more disabling. It causes the toes to drag on the ground with ordinary walking. I had a taste of that when I was first injured, when I would trip over my foot several times a day. It did improve and the stumbling with walking stopped after a couple of months, but then my improvement seemed to plateau.

Certainly I had advice from multiple quarters that I should wait longer or avoid surgery altogether. But others could see that because I’m athletic, this was a functionally disabling injury for me, and encouraged me to get surgery while it still had a chance to make a difference.

Ordinarily the tibialis anterior muscle should be quite strong on a figure skater: skating works it very hard. My sports medicine doctor Dr A. said that in his population of athletes weaknesses can be subtle and not show up on the standard strength testing. My primary doctor had only pressed down on my foot and found no weakness at all though it was quite obvious to me. Dr. A had me try to heel walk to bring out the weakness. I can’t walk on my heels and keep the front of the left foot off the ground.

In the video, taken today, I walk up a corridor twice. On the second pass I try my hardest to keep the left foot up and it stays a bit better.

There’s a whole lot in skating that depends on being able to rock strongly onto the heel: carving edges, doing back three turns, and skating backward without toe scratching. I need more strength in that leg to be able to do those things.

We’ll see how much recovery I get. Two days after my surgery my surgeon Dr. C. called to see how I was doing. He asked whether I had noticed any improvement in my left-sided strength. After his call I tested it and it was exactly the same.

Some people get immediate improvement after surgery if their weakness is due to the least severe type of nerve injury. If compression of the nerve is impeding its electrical conductivity, as soon as the pressure is off, the nerve can work well again. If the motor neurons are damaged, though, that takes time to heal and healing is incomplete and not guaranteed.

I was disappointed and a bit freaked out to get no improvement at all so far. I read that I should start to see improvement within 2 to 4 weeks of the surgery if I’m going to get it. My surgeon’s PA told me that I would have 80% of the improvement I was going to have by three months after the surgery.

I’ve been cleared to start PT for the weakness, though it’s not time yet to exercise my back. I haven’t gotten any appointments yet but I just started working on my feet with PT bands on my own.

Fingers crossed that I start to see a difference soon.

{ 12 comments… read them below or add one }

Eva at Eva Bakes November 13, 2016 at 12:04 pm

My fingers are also crossed for you, Mary. Hoping your body recovers quickly and that you see some improvement soon!
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Mary November 13, 2016 at 4:28 pm

Thanks, Eva, I’ll take all the luck I can get!

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Marcia November 13, 2016 at 9:30 pm

Your video looks pretty darn good to me but then again, I know nothing about this and what to expect. Nevertheless I’m glad the surgery is behind you and I’m keeping everything crossed that you see signs of improvement very soon.
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Mary November 14, 2016 at 1:38 am

Thanks Marcia. Yes if all I wanted to do was walk– and lots of people with back injuries would like to be able to do just that– I’d be doing great. Try heel walking yourself and you’ll see the difference. You’ll easily be able to walk on your heels keeping the front part of your foot up through the entire gait cycle. That said, maybe I’m doing better than I think! I do keep the foot up on the last two steps on that last pass (with 100% effort), and that’s more than I could do at the beginning of this injury. The other problem is that I have hip instability on the left. The TFL (tensor fascia lata) is objectively damaged and other things aren’t behaving right, like the glute etc.

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Melissa November 14, 2016 at 3:37 pm

Hi, glad to see you’re up and walking already. I can definitely see the improvement in the second attempt. My sports med doctor used the same metric, 80% improvement at 3 months for my platelet rich plasma injections for torn hamstring. So you’re very early into that timeframe. Saying prayers for a complete recovery and that you’re back on the ice soon!

Hugs,
Melissa

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Mary November 15, 2016 at 4:55 pm

Thanks so much Melissa, I appreciate your support and reminder that it’s still very early. I didn’t know you had done PRP for your hamstring. It’s good that we have these new options to try these days, and that you have been able to come back and compete after that injury.

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George A. November 14, 2016 at 4:55 pm

Mary: Foot drop is a miserable thing. I had a bout of that after hitting my head on the ice last year. In my case the foot drop was immediately reversed after I had a crainiotomy to evacuate the subdural hematoma. My case was much different than yours since it involved an acute head injury. None the less I wish you a full recovery.

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Mary November 15, 2016 at 5:01 pm

Yes your saga was very scary, thank God for modern medicine right? I’m so glad yours was recognized while it was just compression and not permanent damage and addressed in time for a full recovery. Thanks for the good wishes toward full recovery, I appreciate it and will let you know how I do.

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Hannah November 14, 2016 at 6:44 pm

You are such a trooper. My goodness, I have nothing but respect and admiration for the way you’re facing such adversity head-on. There’s no doubt in my mind that at this rate, you’ll be back at 100% in no time. You can do it!
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Mary November 15, 2016 at 5:01 pm

Thanks Hannah! I’m definitely going to give it my best shot.

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Jo November 15, 2016 at 3:05 am

Thanks for posting the video, Mary. This will be encouraging as you make progress. The walking (especially the second pass) actually was quite impressive, considering what you’ve been through. I hope you feel better overall as the nerve recovers. I can imagine that the hip imbalance is also affecting what you can do with that foot. It does take some time to get the other muscles more functional again, which helps with balance and confidence. Hang in there!
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Mary November 15, 2016 at 5:04 pm

Thanks Jo. It’s so helpful to have your support when I know you’ve had to work with related issues. I hope I can show you all a better video soon!

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