paging ACL people....

[Tyrone Shoelaces]

hey...has anyone who's had a hamstring graft done experiend sciatic nerve pain? (I'm just guessing its sciatic). Hollliiiieee crap...this just kinda started gradually over the past 2-3 days, but it's heating up now that I'm attempting to walk normal again w/o crutches.

What happens is when I go to plant my heel down with my right leg (this is the reconstructed leg) and extend my leg I began to feel a "pulling" sensation in my achilles tendon and then as I extend my heel to the ground a quick shot of pain shoots up from the tendon, through my thigh, into my lower back. holy crap it sucks. pain killers seems to help it subside and I can walk normally. But christ is this normal? My PT says maybe its the swelling putting pressure on the nerve, but its (the pain) is getting worse while the swelling seems to be going down. wtf? could the docs have messed anything up with this nerve when they were harvesting tissue?

this is more of a rant...but if any of guys have felt this before, I'd appreciate your input. like how long it lasted etc. I don't see my PT again until Friday.

[Buster Highmen]

I had a lot of stiffness in the hamstring area for about 2 weeks. I don't remember it being as bad as you're saying. Then again, I was heavily medicated.

[basom]

wow, youre off the crutch already? one of the reasons i picked pateller over hammy was my doc wont let hammy's off their crutches for six weeks. where as he wants Pateller's bearing full wieght by the second or third day.

thats cool, if not painfull. hope its not a big deal for a guy. + luck buddeh.

[Tyrone Shoelaces]

wow, youre off the crutch already? .

yuppers...I am surprised at this too (It's been 8 days since surgery). You're doc sais crutches for 6 weeks for hammy? holy crap...When my doc took the stitches out on Monday, he practically yelled at me as I crutched out of his office to stop using them. He said as long as I can take it....don't use 'em as it will help to put an end to the loss of muscle tone.

But this nerve stuff is sucky sucky. It's not with every step that I feel it....but like every 5th step or so..WABAM!...a lightnight bolt shoots up my leg and I want to down my whole bottle of Norco's. good times, good times.

[LAN]

Hi Shoe. Bummer. Sounds different than sciatica. Usually sciatica originates in your lower back/butt area and "zaps" down your leg. If it's starting in your Achilles, it sounds like something different. At first, I was thinking maybe you were positioned poorly on the OR table and are having some subsequent pain from that, but since it's going from the bottom --> up, doesn't sound like that either.

Let me go look in some of my books. Back shortly ...

[descender]

I doubt that the doc did anything to disturb the nerve. You may have messed with it from the awkward leg up all the time and crutch walking positions you have been forced into for the time being. I have a friend that is constantly wrestling with this nerve. Seems that working out and specific stretching is the only thing his doc recommends. Good luck.

[basom]

yuppers...I am surprised at this too (It's been 8 days since surgery). You're doc sais crutches for 6 weeks for hammy? holy crap...When my doc took the stitches out on Monday, he practically yelled at me as I crutched out of his office to stop using them. He said as long as I can take it....don't use 'em as it will help to put an end to the loss of muscle tone.


my guy said it was due to the graft strenght being much stronger in those first weeks for a pateller over hammy. i guess he is weighing the risk of busting the graft in the first few weeks if you happened to fall over a longer rehab schedual. He may have jus tbeen trying to convince me to go with Pateller in a sneaky way, as thats what he does to all the patriots, and is his prefered technique.

after the initial trama healed most of my pain has been in the lest few months as i've been ramping up my activity, and nothing nerve related (although for the pateller graft they slice a nerve in half when they go in for your pateller, which leaves a huge area of skin fully numb. it grows back one milileter a day. i've been having a lot of wierd pins and needles as its starting to come back)

[Tyrone Shoelaces]

Hi Shoe. Bummer. Sounds different than sciatica. Usually sciatica originates in your lower back/butt area and "zaps" down your leg. If it's starting in your Achilles, it sounds like something different. At first, I was thinking maybe you were positioned poorly on the OR table and are having some subsequent pain from that, but since it's going from the bottom --> up, doesn't sound like that either.

Let me go look in some of my books. Back shortly ...

Thanks LAN. that's kinda what I heard too....but the sciatic nerve is the only nerve name that I know, so of course I zeroed in on it :D. thanks for any insight you have. All the best to Scoober too...hope he's doing ok after his surgery. found this abstract online just now:

Sciatic nerve injury following hamstring harvest.

Vardi G.

Droitwich Knee Clinic, St Andrews Road, Droitwich Spa, Worcs WR9 8DS, UK. glen@vardi.freeserve.co.uk

Injury to the sciatic nerve following harvesting of the medial hamstring tendons is a complication that has not been described. I report a unique case of sciatic nerve injury above the level of its bifurcation into its terminal branches following hamstring graft harvest for use in ACL reconstruction. The sciatic nerve anatomy and technique of graft harvest is briefly described.

Publication Types:
Case Reports

I also feel the pain sometimes when I try to extend my leg to zero degrees. Like I'll extend to zero, then dorsi-flex with my foot for an added calf stretch, and ZAMMO! there's that nerve pain in my lower back.

Descender --- yeah I doubt anything happened during surgery, I'm just hoping its pressure on it from swelling.

[LAN]

Shoe-

Couple of questions:

Did you have a femoral nerve block?

Are you having a lot of swelling/bruising in your ankle (yet)?

Are you having any numbness/tingling in your toes/foot?

Could be an aggravation of your tibial nerve, shooting up to your sciatic nerve? Or like your PT suggested, maybe from the swelling?

Make sure you're keeping your leg elevated and iced. Have any Neurontin lying around? That might do the trick.

[basom]

I also feel the pain sometimes when I try to extend my leg to zero degrees. Like I'll extend to zero, then dorsi-flex with my foot for an added calf stretch, and ZAMMO! there's that nerve pain in my lower back.



maybe your hammy's are just uber uber tight. are you having a difficult time getting full extension? keeping those hammy's loose is a big key, streatch em up!

[Tyrone Shoelaces]

Shoe-

Couple of questions:

Did you have a femoral nerve block?

Are you having a lot of swelling/bruising in your ankle (yet)?

Are you having any numbness/tingling in your toes/foot?

Could be an aggravation of your tibial nerve, shooting up to your sciatic nerve? Or like your PT suggested, maybe from the swelling?

Make sure you're keeping your leg elevated and iced. Have any Neurontin lying around? That might do the trick.

Yes to the femoral nerve block. No to the ankle swelling (seems to moving down to my shin now), no to numbness or tinglines in toes/foot. No neurontin laying around.

I'mma just gonna keep stretching as much as I can, elevate and what not and see what happens.

Basom -- yeah the ham's are pretty tight. I was pretty loosey goosey going into surgery, but now....uh-uh. I can get to about 4 or 5 degrees extension, then have to force my knee down to zero. when I force it down, my hamstring screams. it's tolerable, but it's a damn good stretch (especially just behind the knee)

[LAN]

So when you're fully extended and in dorsi-flexion, is the pain going all the way up your leg from toes to your back, or you just feel that "bwamo" right smack in your lower back/butt?

I occasionally get the zaps over my butt and down my leg, which I'm convinced is a slightly slipped disc from lifting 600+ lb patients. The best thing that I would suggest is to stretch your glutes, hammies and gastrocs. I know that's especially hard for you now, but work on your stretches a couple times a day.

If you're still having the pain on Friday, I would call your MD. Best of luck! Thanks for the well wishes by the way - Scoob's doing great. We're off to the gym after he gets home. Our PT cleared him for stationary bike and walking on the treadmill. :D

[Tyrone Shoelaces]

So when you're fully extended and in dorsi-flexion, is the pain going all the way up your leg from toes to your back, or you just feel that "bwamo" right smack in your lower back/butt?


It goes from achilles tendon all the way up leg to lower back.

funny I don't notice it so much after I took a handful of Norco's :D

edit: and thanks for looking into this stuff nurse-LAN. much appreciated.

[el_jefe]

i had a hamstring graft and my doc also told me to ditch the crutches and walk normally asap. he also recommended a "cpm" (constant passive motion) machine to get the knee moving immediately after i got home.

didn't have any shooting pains like you're describing, but note that the area where they harvested the graft may require concentrated PT later on. it seemed like it took forever for my harvested hamstring to regain the same strength as the other one - even after a month or more of specifically targeted weights/excercise.

hang in there. its amazing how fast you start recovering after a couple of weeks go by.

[Vinman]

Ty, couple possibilities here

1. muscle tightness, tightness of your glutes and hams could put some tension one the sciatic nerve. Any history of previous low back pain similar to this? bulging disc or SI joint pain?

2. swelling placing pressure on the nerve

3. Pain when extending the knee and dorsiplexing the ankle from stressing the graft site

4. injury to the Saphrenous nerve. The saphrenous nerve bracnes off hte sciatic and runs on the medial side of the knee and leg. But your pain doesn't exactly fit this. You probably would have noticed this right away after surgery. you would have felt, numb,tingly, burning, weakness etc if they had injured the nerve during surgery.


This is kind of tough to tell from behind a puter screeen. My suggestion is to call your ortho and see what he says.

[maddog]

I had some similar pain after my hamstring graft, but not all the way into my back. It ended in my upper butt area. I found gentle and frequent stretching to relieve the pain in time. Also, when you start strength training, keep your reps high and the weight low (even a little lower than you think you should at first). Work hard on gently increasing your range of motion, and let your hamstring heal for a few weeks before you work too much on increasing strength. Do you have bruising up and down the back of you leg? It sounds like you may have pulled your hamstring. I pulled my hamstring several times in the weeks following surgury because I was trying to increase strengh too soon, and found the pain very similar to your description. I'm betting this problem will decrease with the swelling. Keep it elevated and on ice when you're not stretching... and good luck.

[Tyrone Shoelaces]

Ty, couple possibilities here

1. muscle tightness, tightness of your glutes and hams could put some tension one the sciatic nerve. Any history of previous low back pain similar to this? bulging disc or SI joint pain?

nope, no history of any pain like this. But my hams, glutes, etc are probably pretty tight. Mrs. Shoe (who just passed her personal trainer exam wohoo!) has been stretching me daily since I got my stitches out.



2. swelling placing pressure on the nerve

yeah there's still quite a bit of swelling. a lot of it seems to have move down from knee into my calf.



3. Pain when extending the knee and dorsiplexing the ankle from stressing the graft site

that's exactly when I feel the pain...knee extension as far as I can go + dorsiflex of ankle = OOOOWWWWWW!!!



4. injury to the Saphrenous nerve. The saphrenous nerve bracnes off hte sciatic and runs on the medial side of the knee and leg. But your pain doesn't exactly fit this. You probably would have noticed this right away after surgery. you would have felt, numb,tingly, burning, weakness etc if they had injured the nerve during surgery.


yeah, don't think its this....no numbness, burning, weakness or anything.



This is kind of tough to tell from behind a puter screeen. My suggestion is to call your ortho and see what he says.

absolutely....the episodes of this nerve-ish pain has gone down today from yesterday, so I'm going to see if it keeps improving like this. If not, will call the docortho

[Tyrone Shoelaces]

I had some similar pain after my hamstring graft, but not all the way into my back. It ended in my upper butt area. I found gentle and frequent stretching to relieve the pain in time. Also, when you start strength training, keep your reps high and the weight low (even a little lower than you think you should at first). Work hard on gently increasing your range of motion, and let your hamstring heal for a few weeks before you work too much on increasing strength. Do you have bruising up and down the back of you leg? It sounds like you may have pulled your hamstring. I pulled my hamstring several times in the weeks following surgury because I was trying to increase strengh too soon, and found the pain very similar to your description. I'm betting this problem will decrease with the swelling. Keep it elevated and on ice when you're not stretching... and good luck.

yeah, Mrs. Shoe is helping me with the stretching when I'm not in PT....and yep, there's a bunch of bruising up and down the back of my leg. Hamstring feels super tight behind my knee. Just gonna keep icin, stretchin, elevating.....

thanks for the info everyone.

[Arnold Babar]

Wierd stuff, Ty. I haven't had this problem, but my doc also told me not to ditch the crutches yet, wtf! I don't get my stitches out till tuesday, and I'm a gonna talk to him then, but he's been telling be the same thing basom said, "don't get off crutches too early hammy grafts are initially fragile." I must say that I FEEL ready to ditch the crutches: hammy is tight but not bad, swelling is way down, rom is pretty damn good. I initially had back pain when I wasn't moving around too much, but now it's gone. Hope yours goes away.

[altagirl]

I was zero weight bearing and on crutches for six weeks after my hammy graft because of a meniscus repair. So I didn't experience that, but I wasn't walking on it either.

My guess is that because you're trying so hard to walk early that you're doing some wierd things limping and it's aggravating your back. I know my hip will start getting odd pains when I'm limping too much and stretching my hamstring and hip helps get rid of it. Yours sounds a little more severe but my doc made me use crutches this time at the slightest hint of pain and wanted to see me still using them for long stretches of walking until 4 weeks.

And after the first week I did go through bouts of muscle pain/ache/etc. You've probably been laying around in odd positions to keep it elevated, moving in odd ways to favor it every time you get up or lay down, etc. Hell, my shoulders started to hurt from the weird way I was getting in and out of the car. (our driveway is on an angle...) Keep stretching, make sure you keep your PT informed about what's going on and I'm sure it will get better soon.

[Arnold Babar]

Maybe Yogachick could tip us to some stretching positions that might alleviate the discomfort associated with our injury compensating activities. What say you YC, or anyone else in the know of such topics?

[Zeedashbo]

shoulda gotten a piece of a dead person put in yer knee. but then you'd have to deal with the urges to kill.

[xboat]

that's what i'm doing for my surgery in two months. second one on the same knee, so patella has already been hacked. not too interested in the hammy deal, that shit scares me.

does anyone else around here have a cadaver ligament? anything i should know?

will i have the urge to kill? :FIREdevil

[altagirl]

that's what i'm doing for my surgery in two months. second one on the same knee, so patella has already been hacked. not too interested in the hammy deal, that shit scares me.

does anyone else around here have a cadaver ligament? anything i should know?

will i have the urge to kill? :FIREdevil

Me. I haven't killed anyone yet. I'll keep you updated though...

[xboat]

that's good to know, AG. i'm sure i'll have some more questions soon enough.

hope things are going well for ya, have a good weekend!

[Zeedashbo]

i am a mass murderer. but i'm pretty sure i was before i had a dead persons achilles in my knee. the only problem i've heard from the cadaver graft is that it takes time for the graft to tighten up, and become a living part of your body. sometimes they have to go in and shrink it up after the surgery. worked well for me though. and if all this doesn't make sense, i'm taking a ton of pain pills right now and i can't form a comprehensible sentence. i think i broke my sternum.

[basom]

the only problem i've heard from the cadaver graft is that it takes time for the graft to tighten up, and become a living part of your body.

cadaver graft never becomes a living part of your body, as i understand it.

[altagirl]

that's good to know, AG. i'm sure i'll have some more questions soon enough.

hope things are going well for ya, have a good weekend!

Ask away. Here's my whole surgery/rehab story to date, if you haven't seen it: http://tetongravity.com/forums/showthread.php?t=18388&highlight=knee+update