Sports Injuries: When to See a Neurologist or Orthopedist?

Doctor, please help me?

Hello, doctor.
Back in August, I strained my lower back and hips while exercising.
I felt a warm, painful sensation in my lower back and hips, and my legs would tingle and feel numb when walking.
I had an X-ray done, and the doctor said there was damage to the lumbar vertebrae and injuries near both hip bones, which were classified as sports injuries.
I was advised not to engage in intense activities, but I continued exercising happily.
Last week, during colder weather, I started experiencing tingling and numbness in my left foot, which later spread to both feet.
My lower back also feels slightly warm, and I'm worried that my old injuries might be flaring up.
I would like to observe for a while longer.
Should I see a neurologist or an orthopedic specialist? Thank you.

A-Ming, 30~39 year old female. Ask Date: 2023/12/27

Dr. Jiang Junyi reply Neurology

Hello Mr.
Ah-Ming,
You mentioned that "your back, waist, and hips feel hot and painful, and your legs feel tingling and numb while walking." Your symptoms may suggest possible sciatic nerve compression.
A common cause is a herniated disc leading to localized inflammatory responses that result in lower back pain, which may extend to one or both sides of the buttocks or hips.
If a herniated disc compresses a nerve root, it can lead to neuropathic pain (sciatica), with symptoms typically located in the posterior thigh, lateral calf, and sole of the foot.
Peripheral neuropathy may present with the following characteristics:
1.
Pain with a burning or electric shock-like quality.
2.
Symptoms with a specific dermatomal distribution, which can be triggered by touch or pressure.
3.
Accompanied by muscle soreness and weakness.
Examinations for peripheral nerve issues typically involve electrophysiological studies to assist in diagnosis.
Nerve conduction studies assess the conduction velocity and waveform of large fiber nerves.
Electromyography evaluates muscle responses in the areas supplied by the affected nerves.

I recommend that you visit a neurology or rehabilitation clinic for examinations (such as nerve conduction studies and electromyography) and treatment.
The physician will prescribe medications based on your condition.
For rehabilitation, it is advisable to supplement with B vitamins and remind yourself to stand up and stretch every half hour to avoid nerve compression and muscle tightness that could exacerbate your symptoms.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Jun-Yi,
Department of Neurology, Taoyuan Hospital

Reply Date: 2023/12/27

More Info

When dealing with sports injuries, especially those involving the back, hips, and legs, it’s crucial to understand the signs and symptoms that may indicate the need for specialized medical attention. Based on your description, it sounds like you have experienced a series of injuries that could potentially involve both neurological and orthopedic issues.

From your account, you initially sustained injuries to your lower back and hips, which were diagnosed as sports-related injuries. The fact that you felt a "hot" pain in your lower back and hips, along with numbness or tingling in your feet, suggests that there may be nerve involvement. This is particularly concerning because nerve issues can lead to more significant complications if not addressed promptly.

The symptoms you describe—specifically the tingling or numbness in your feet—could indicate that the nerves in your lower back are being compressed or irritated. This could be due to a herniated disc, spinal stenosis, or other conditions affecting the lumbar spine. The fact that these symptoms have progressed to both feet being affected raises the possibility of a more systemic issue or a progression of your original injury.

In terms of whether to see a neurologist or an orthopedist, both specialists can provide valuable insights, but they focus on different aspects of your condition:
1. Orthopedic Evaluation: An orthopedist specializes in the musculoskeletal system, which includes bones, joints, ligaments, tendons, and muscles. Given that you have a history of injuries to your back and hips, an orthopedist can assess any structural damage, such as fractures, ligament tears, or joint issues. They may recommend imaging studies like MRI or CT scans to get a clearer picture of your spine and hips.

2. Neurological Evaluation: A neurologist, on the other hand, focuses on the nervous system, including the brain, spinal cord, and peripheral nerves. Since you are experiencing symptoms like tingling and numbness, a neurologist can evaluate whether there is nerve damage or compression that needs to be addressed. They may perform nerve conduction studies or electromyography (EMG) to assess the function of your nerves and muscles.

Given your symptoms of pain, tingling, and the history of injuries, it would be prudent to consult both specialists. Start with an orthopedist to rule out any structural issues in your spine and hips. If they find that your musculoskeletal system is intact but your symptoms persist, then a referral to a neurologist would be the next logical step to investigate any potential nerve-related issues.

In the meantime, it’s essential to manage your symptoms carefully. Avoid activities that exacerbate your pain or numbness, and consider physical therapy, which can help strengthen the muscles around your spine and improve flexibility. This can alleviate some pressure on your nerves and promote healing.

Lastly, it’s important to listen to your body. If you notice any worsening of your symptoms, such as increased pain, weakness in your legs, or loss of bladder or bowel control, seek immediate medical attention. These could be signs of a more serious condition that requires urgent care.

In summary, your situation warrants a thorough evaluation by both an orthopedist and a neurologist to ensure that both the musculoskeletal and neurological aspects of your injuries are addressed appropriately. Early intervention can significantly improve your recovery and help you return to your desired level of activity safely.

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