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 have been feeling a warm, painful sensation in my lower back and hips, and my legs have been experiencing tingling and numbness when I walk.
I had an X-ray done, and the doctor mentioned that there is damage to the lumbar vertebrae and also injuries near both hip bones, which are classified as sports injuries.
The doctor advised me to avoid intense activities.
However, I continued exercising happily, and last week, during colder weather, I started experiencing tingling and numbness in my left foot.
Eventually, both feet began to feel this way, and my lower back has also felt slightly warm.
I'm concerned that my old injury might be recurring, so I want to observe it for a while.
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.
Amin,
You mentioned experiencing "heat and pain in your back, waist, and hips, along with tingling and numbness in your legs while walking." Your symptoms may suggest possible sciatic nerve compression.
A common cause is a herniated disc, which can lead to localized inflammatory responses resulting in lower back pain, potentially radiating to one or both sides of the buttocks or hips.
If a herniated disc compresses the nerve roots, 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 that is burning or electric in nature.
2.
Symptoms that follow a specific dermatomal distribution, which can be triggered by touch or pressure.
3.
Accompanied by muscle weakness or fatigue.
Examinations for peripheral nerve issues often utilize electrophysiological studies for diagnosis.
Nerve conduction studies assess the conduction velocity and waveform of large fiber nerves.
Electromyography evaluates the muscle response in the areas supplied by the affected nerves.
I recommend visiting a neurologist or a rehabilitation specialist for examinations (such as nerve conduction studies and electromyography) and treatment.
The physician will prescribe medications and rehabilitation therapy based on your condition.
Thank you for your inquiry.
If you have further questions, feel free to discuss them!
Wishing you good health, peace, and joy.
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2023/12/27

More Info

When it comes to sports injuries, particularly those involving the back and hips, it is crucial to understand the nature of the injury and the appropriate specialists to consult for effective treatment. Based on your description, it sounds like you have experienced a significant injury that has led to ongoing symptoms, including pain and tingling in your feet.
Given that you have already undergone X-rays which indicated some damage to your lumbar vertebrae and hip areas, it is essential to consider the implications of these findings. The symptoms you are experiencing, such as the tingling and "hot" sensations in your lower back and hips, could be indicative of nerve involvement, especially if they are accompanied by pain radiating down your legs. This is often referred to as radiculopathy, which occurs when a nerve root is compressed or irritated, leading to pain, numbness, or tingling in the areas served by that nerve.

In your case, since you have a history of lumbar spine injury and are experiencing new symptoms, it would be prudent to consult with both a neurologist and an orthopedist. Here’s why:
1. Orthopedic Evaluation: An orthopedist specializes in the musculoskeletal system, which includes bones, joints, ligaments, tendons, and muscles. They can assess the structural integrity of your spine and hips, evaluate the extent of your injuries, and determine if there are any mechanical issues contributing to your pain and symptoms. They may recommend imaging studies such as an MRI, which can provide more detailed information about soft tissue injuries, including those affecting nerves.

2. Neurological Assessment: A neurologist focuses on the nervous system, including the brain, spinal cord, and peripheral nerves. Given your symptoms of tingling and numbness, a neurologist can help determine if there is any 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.

In terms of treatment, both specialists can offer valuable insights. The orthopedist may suggest physical therapy, medications for pain management, or even surgical options if there is significant structural damage. The neurologist can provide guidance on managing nerve-related symptoms and may recommend treatments such as nerve blocks or medications to alleviate neuropathic pain.

As for your concern about whether your symptoms indicate a recurrence of your previous injury, it is possible that the initial injury has led to changes in your biomechanics or nerve function, which could explain the new symptoms. It is crucial to take these signs seriously and not to push through the pain, as this could exacerbate the underlying issues.

In summary, given your history of injury and the new symptoms you are experiencing, it is advisable to seek evaluations from both an orthopedist and a neurologist. This dual approach will ensure that both the structural and neurological aspects of your condition are thoroughly assessed and treated. Additionally, it is important to follow your doctor's advice regarding activity levels and rehabilitation to facilitate recovery and prevent further injury. Remember, early intervention can often lead to better outcomes, so do not hesitate to seek the necessary care.

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