Lower Back Pain and Leg Numbness: When to Seek Further Care

Inflammation of the lower back and hips, with numbness in the lower extremities?

I had been standing for long periods and lifting heavy objects, and about a month and a half ago, I started experiencing lumbar pain that made it difficult to bend.
The symptoms disappeared after resting, but two weeks ago, the condition worsened, and I woke up in the morning with tight pain that made it hard to move.
I consulted orthopedic and neurosurgeons, and they all believed that the condition of my spine on the X-ray was good, with no issues like reduced disc spacing.
Therefore, I was diagnosed with lumbar muscle strain and prescribed pain relievers and muscle relaxants.
(I can lift both legs while lying flat without pain.) Since the medication was not effective, I sought treatment at a traditional Chinese medicine clinic, where the doctor indicated it might be myofascial pain syndrome (or tendonitis? I didn't hear clearly) and prescribed blood-invigorating herbal medicine, advising me to walk to relieve muscle tightness.
The medication did alleviate the tight pain in my lumbar region and both sides of my hips, but I also noticed slight twitching in my left toes.
After other symptoms improved, my left leg has been increasingly numb (this has persisted for two weeks), and recently I've experienced unusual tightness in the front of my lower leg, along with pain in the hip muscles.
Walking and standing are generally fine, but lying flat/side, sitting on the toilet, and sitting on chairs that put pressure on my hips exacerbate the numbness.
I would like to ask the doctor if I should go to a larger hospital for further examination.
Additionally, besides medication, are there any suitable home exercises for relief? I found some information online suggesting that walking backward can alleviate symptoms; would that be appropriate for me? I am filled with uncertainty and hope to receive the doctor's assistance.
Thank you for your patience in reading this!

Nari, 20~29 year old female. Ask Date: 2017/07/20

Dr. Xu Zhenrong reply Rehabilitation

The most common causes of low back pain due to prolonged standing or heavy lifting are intervertebral disc herniation and lumbar muscle strain (especially the quadratus lumborum).
However, lumbar muscle strain rarely causes pain that radiates to the calf, while the piriformis muscle (located in the buttocks) often leads to lower limb pain.
In addition to the aforementioned causes, there are many other etiologies that require differential diagnosis, and the recommended stretching exercises vary depending on the underlying cause.
Walking backward and walking forward engage different primary muscle groups; while occasionally training different muscle groups can be beneficial, it is not recommended for the treatment of low back pain.

Reply Date: 2017/07/20

More Info

Lower back pain, especially when accompanied by leg numbness or tingling, can be a complex issue that requires careful evaluation and management. Given your symptoms and the history of your condition, it’s essential to approach this situation with a comprehensive understanding of potential causes and treatment options.

Understanding Your Symptoms
From your description, it seems that you have experienced a progression of symptoms over the past month and a half, starting with lower back pain that has now escalated to include numbness and tightness in your left leg. The fact that you have already consulted orthopedic and neurosurgical specialists, and they found no significant structural issues on X-rays, suggests that your pain may be related to muscular or soft tissue problems rather than a serious underlying condition like a herniated disc or spinal stenosis.

The diagnosis of muscle strain or "lumbar muscle strain" is common in individuals who engage in prolonged standing or heavy lifting. This condition can lead to muscle spasms, which may explain the tightness and discomfort you are experiencing. Additionally, the mention of "fasciitis" or "tendinitis" by the traditional Chinese medicine practitioner indicates that there may be inflammation in the soft tissues surrounding your muscles, which can contribute to pain and discomfort.

When to Seek Further Care
While your current treatment with pain medication and muscle relaxants has provided some relief, the persistence of your left leg numbness and the new tightness in your calf warrant further investigation. Symptoms such as persistent numbness, tingling, or weakness in the legs can indicate nerve involvement, which may require imaging studies like an MRI to assess for potential nerve compression or other issues that may not be visible on X-rays.

If your symptoms do not improve or worsen, it is advisable to seek further evaluation from a specialist, such as a neurologist or a pain management physician. They can perform a more detailed assessment and may recommend additional diagnostic tests to rule out any serious conditions.

Home Management and Exercises
In terms of managing your symptoms at home, there are several strategies you can employ:
1. Gentle Stretching and Strengthening Exercises: Engaging in gentle stretching exercises can help alleviate muscle tightness. Focus on stretches that target the lower back, hamstrings, and hip flexors. Strengthening exercises for the core and back muscles can also provide support and stability.

2. Heat and Cold Therapy: Applying heat to the affected area can help relax tight muscles, while cold therapy can reduce inflammation. Alternating between the two may provide relief.

3. Walking: As advised by your traditional medicine practitioner, walking can be beneficial. It promotes blood flow and helps maintain mobility without putting excessive strain on your back.

4. Avoid Prolonged Sitting or Standing: If certain positions exacerbate your symptoms, try to change positions frequently. Use supportive seating and consider using a cushion if sitting on hard surfaces aggravates your pain.

5. Mindful Movements: Be cautious with movements that involve bending or twisting. When lifting objects, use your legs rather than your back to avoid further strain.

6. Backward Walking: Some individuals find that walking backward can relieve pressure on the lower back and improve balance. However, ensure you do this in a safe environment to avoid falls.

Conclusion
In summary, while your symptoms may be related to muscular strain or inflammation, the persistence of leg numbness and tightness should not be overlooked. It is crucial to monitor your symptoms closely and seek further evaluation if they do not improve. Meanwhile, incorporating gentle exercises, heat therapy, and mindful movement can help manage your discomfort at home. Always consult with your healthcare provider before starting any new exercise regimen, especially given your history of back pain.

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