Chronic Denervation and Its Impact on Calf Discomfort

Discomfort in the calf, abnormal electromyography (EMG) findings?

Hello Doctor, since mid-June, I have been feeling tightness in the back of my right calf.
It feels fine when I first get up, but the tightness increases the longer I stand, although it is not painful.
As my anxiety about this issue grew, I started experiencing numbness in my right foot.
Initially, I consulted a neurologist who performed electromyography (EMG) and nerve conduction studies.
The doctor said the nerve conduction was normal, but the EMG showed chronic denervation changes in the right tibialis anterior and paravertebral muscles at the L5 level.
Given that I mentioned experiencing foot numbness, I was diagnosed with an L5 herniated disc.
After taking Gabapentin, I found that the numbness in my foot resolved, which was a relief, but the tightness in my calf persists.
I researched self-assessment for herniated discs and found that I can bend forward, touch my toes, and raise my legs while lying down without discomfort.
I would like to ask the doctor: 1.
Does chronic denervation necessarily indicate nerve compression? Is it caused by the herniated disc? 2.
After being diagnosed with a herniated disc, I went to a rehabilitation specialist for heat therapy, electrical stimulation, and lumbar traction, but my calf still tightens after prolonged standing.
Should I return to rehabilitation for further treatment? Thank you, Doctor.

nnc, 20~29 year old female. Ask Date: 2023/08/19

Dr. Peng Shiwei reply Neurology

Hello, it is more appropriate for the physician who is treating you to answer your questions.
Thank you.

Reply Date: 2023/08/19

More Info

Chronic denervation, particularly in the context of your symptoms, can be a complex issue that often intertwines with various underlying conditions, including lumbar disc herniation. Based on your description, it seems you are experiencing tightness in your right calf, which worsens with prolonged standing, and occasional numbness in your foot. The diagnosis of chronic denervation changes in the context of your electromyography (EMG) results suggests that there may be some nerve involvement, potentially linked to your L5 disc herniation.

1. Understanding Chronic Denervation and Nerve Compression: Chronic denervation changes typically indicate that the nerve fibers are not receiving adequate signals from the nerve cell bodies, which can occur due to various reasons, including nerve compression. In your case, the L5 disc herniation could be contributing to this compression, leading to the symptoms you are experiencing. However, it is essential to note that not all chronic denervation is due to direct compression; it can also result from other factors such as inflammation, vascular issues, or even metabolic conditions. Therefore, while your herniated disc may be a contributing factor, it is not the sole determinant of chronic denervation.

2. Rehabilitation and Management: Given that you have already started physical therapy with modalities like heat therapy and electrical stimulation, it is crucial to continue this rehabilitation process. Physical therapy can help improve muscle strength, flexibility, and overall function, which may alleviate some of the tightness you are experiencing in your calf. If you find that your symptoms persist or worsen, it would be advisable to return to your rehabilitation specialist. They can reassess your condition and potentially adjust your treatment plan, which may include more targeted exercises, manual therapy, or even a re-evaluation of your pain management strategies.

In addition to physical therapy, consider incorporating some self-care strategies into your routine. Stretching exercises for the calf muscles and lower back can be beneficial, especially if you are standing for long periods. Regular breaks to sit down and elevate your legs can also help reduce tightness and discomfort.

Furthermore, managing anxiety related to your symptoms is equally important. Chronic pain and discomfort can lead to increased anxiety, which may exacerbate your physical symptoms. Techniques such as mindfulness, relaxation exercises, or cognitive-behavioral strategies can be helpful in managing anxiety and improving your overall well-being.

In summary, while chronic denervation may indicate nerve involvement, it does not always mean there is direct compression. Your L5 disc herniation could be a contributing factor, but it is essential to consider a comprehensive approach to your treatment. Continuing physical therapy, engaging in self-care practices, and addressing any anxiety related to your symptoms will be crucial steps in managing your condition effectively. Always consult with your healthcare provider before making any changes to your treatment plan.

Similar Q&A

Understanding Sudden Calf Nerve Pain: Causes and Relief Strategies

Hello, Dr. Jiang. I have had a condition since childhood where my calves suddenly experience nerve pain and a bit of weakness. The location of the pain varies, but the discomfort does not extend to my thighs. I have undergone examinations, and most doctors at the time assessed it...

Dr. Jiang Junyi reply Neurology
Dear Miss Hsiao-Hsing, You mentioned that "most occurrences happen during seasonal transitions (when temperature changes are significant) and in winter (when it is too cold), and applying heat can slightly alleviate the pain at that moment." The symptoms you described ...

Understanding Calf Discomfort: Causes, Treatments, and When to See a Doctor

Hello, doctor. For the past two to three weeks, I've occasionally experienced a tingling sensation in my calves (sometimes in the left leg, sometimes in the right) when I move my feet in the morning. This sensation lasts for about 2 to 5 minutes, and my muscles also feel tig...

Dr. Chen Wayda reply Rehabilitation
Please see the rehabilitation department for an on-site evaluation by the physician.

Understanding Muscle Pain in the Legs: A Neurological Perspective

Dear Dr. Yeh, I am a glaucoma patient who was diagnosed and began treatment four years ago, and I am still undergoing treatment. Over these four years, I have rarely gone out, sometimes only once a month, and I mostly stay in my room. As the weather gets cooler, I experience pai...

Dr. Ye Boshou reply Neurology
Based on your description, with a height of 175 cm and a weight of 88 kg, along with a sedentary lifestyle, it is likely that you are experiencing tendon fatigue and strains. It is probably not a vascular blockage, as that would cause severe pain that persists over time. I recomm...

Understanding Numbness and Pain in Limbs: A Neurological Perspective

Since I woke up last Friday morning (I usually sleep on my left side and mostly sit during work hours), it has been four days. When I walk, I feel pain in my legs, particularly behind my knees, which worsens with bending my legs. The pain is more pronounced in my calves (includin...

Dr. Jiang Junyi reply Neurology
Hello: Based on your description, it may be necessary to consider spinal-related diseases. Excessive force during neck rotation and other external factors may lead to cervical instability, dislocation, and cervical disc herniation. Typical symptoms of lumbar nerve root pathology ...