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.