Dr. Wise. A moment of your time

[rob4974]

First and foremost Hope your holiday was well. I've been reading your site since I've found it a week ago and yes you have answered my many questions but I need to drill ya bit more. One common complaint i have everyday is the tightness of my hamstrings or the feeling of them being so tight that i can't walk or when i walk for prolong times they get so tight. One suggested on here that i have Spacitiy? Is there a test to prove that? I read online the definition of it and it seems i do have alot of the symptoms. So my question would be this. Knowing some of my history here. Multi level lumbar fusion with hardware. Waking up unable to move my legs, Being bedridden for a month unable to move my legs..than finally after 3 months the first movement of my muscles in my quad jumping with the FES. Coming home in a wheelchair, standing, walking with a walker, than a brace and cane, than a brace, and now nothing but still my left leg is very weak. At therapy i can leg press 190 on the right but only 90 on the left. Severe atrophy i would say. But than as i said when i got cellulities from vascular surgery all the symptoms of tightness and pulled hamstrings and tingling and numbess were gone, so that makes me feel like spaciity is not what i have, but perhaps it is a nerve problem, yet my EMG showed no damage. I read that there is some nerve drugs that I may benifit from..however my ortho doctor will not give me or prescribe any to me as he says i should not block out what i am feeling but problem with that is i am not feeling anything. My legs are still numb....How long does it take nerves to come back, he says a year, well jan is a year for me. Don't feel much different to be honest. Is there anything, experimental that i can do to help my situation. I know you said cycling, walking and swimmming to help the atrophied muscle...Do you know of anyplace i can go for swimming since its not like i can get in and out of a pool that easy? Is there any supplements that i should be taking to help increase my muscle tone or definition...i mean does steroids help ? Makes muslces bigger and stronger right? People around me don't understand how hard it is to move and walk when i am so tight. It is making my life a living hell...I know i am not alone...but I do know enough people in this state to make a difference or to have them hear me or others if we need help or awareness. Please anything u can tell me here to help me would be greatly appreciated.

[Wise Young]

Originally Posted by rob4974

First and foremost Hope your holiday was well. I've been reading your site since I've found it a week ago and yes you have answered my many questions but I need to drill ya bit more. One common complaint i have everyday is the tightness of my hamstrings or the feeling of them being so tight that i can't walk or when i walk for prolong times they get so tight. One suggested on here that i have Spacitiy? Is there a test to prove that? I read online the definition of it and it seems i do have alot of the symptoms. So my question would be this. Knowing some of my history here. Multi level lumbar fusion with hardware. Waking up unable to move my legs, Being bedridden for a month unable to move my legs..than finally after 3 months the first movement of my muscles in my quad jumping with the FES. Coming home in a wheelchair, standing, walking with a walker, than a brace and cane, than a brace, and now nothing but still my left leg is very weak. At therapy i can leg press 190 on the right but only 90 on the left. Severe atrophy i would say. But than as i said when i got cellulities from vascular surgery all the symptoms of tightness and pulled hamstrings and tingling and numbess were gone, so that makes me feel like spaciity is not what i have, but perhaps it is a nerve problem, yet my EMG showed no damage. I read that there is some nerve drugs that I may benifit from..however my ortho doctor will not give me or prescribe any to me as he says i should not block out what i am feeling but problem with that is i am not feeling anything. My legs are still numb....How long does it take nerves to come back, he says a year, well jan is a year for me. Don't feel much different to be honest. Is there anything, experimental that i can do to help my situation. I know you said cycling, walking and swimmming to help the atrophied muscle...Do you know of anyplace i can go for swimming since its not like i can get in and out of a pool that easy? Is there any supplements that i should be taking to help increase my muscle tone or definition...i mean does steroids help ? Makes muslces bigger and stronger right? People around me don't understand how hard it is to move and walk when i am so tight. It is making my life a living hell...I know i am not alone...but I do know enough people in this state to make a difference or to have them hear me or others if we need help or awareness. Please anything u can tell me here to help me would be greatly appreciated.

A lot of questions at one time. Let me take the first one first and then, if I don't answer the question that you want, you can ask again.

Spasticity is increased muscle tone and reflexes resulting from reduced inhibition of reflexes and excessive gamma motoneuronal activity in the spinal cord. Increased muscle tone and reflexes need not necessarily mean spasticity. So, how can you tell whether you have spasticity?

Your spinal cord detects muscle tension are through muscle sensors called spindles. The tension on the spindles are set by gamma motoneurons. When spindles are stretched, they cause the motoneurons to the muscles (called alpha motoneurons) to activate and contract the muscle. So, when gamma motoneurons are hyperexcitable, they contract the muscles in the spindle, increasing their excitability of spindles, causing spasticity. There may also be increased excitability of the reflex arc that sets muscle tension.

Let me start by describing one circumstance where you can have increased muscle tone and reflexes without spasticity. You can increase the spindle activity simply by stretching the muscle beyond its normal resting length. For example, as I suspect is the case for you, you may not have gotten enough physical therapy when you were paralyzed and your muscles (particularly your hamstrings) have shortened.

Sometimes called contracture, this is a natural phenomenon that is associated with all exercise. Athletes get contracture also and they get around it by stretching their muscles whenever they exercise it. By stretching the muscle when it is at rest, one can reset the tension of the muscle so that it no longer activates the spindles.

However, if a person has spasticity, reversing contracture is often hard. That is because the spasticity will oppose the stretching. Many people, particularly those who have been paralyzed since childhood and have not been undergoing standing and stretching exercises, their leg muscles go into a long-standing flexion state, called flexion contracture, it is very difficult to stretch the muscles out.

In such situations, orthopedic surgeons often will do tendon lengthening. The surgeon cuts the tendons in a Z-shape cut, slide the tendons to increase their length, and sew the tendons together so that they will heal in the lengthened position. It takes a couple weeks for the tendon to heal and the spasticity is reduced.

This releases the tension on the muscle and allows people with spasticity towalk. For example, tendon lengthening or "release" is commonly used in children who have cerebral palsy and longstanding spasticity. These children commonly walk on tiptoes because of very tight gastrocnemius muscles. Physical therapy is often unable to relax the muscle due to the spasticity.

The hamstring muscle is a huge muscle. It frequently undergoes contractures when a person becomes paralyzed and does not walk. Because it is so big, it is difficult for a physical therapist to stretch this muscle. By the way, one must be very careful with such big muscles because it is easy to tear the muscle or tendon during the stretching.

Wise.

[rob4974]

How does one know if it is spaciity or not? Is there a test? I take it that you are right about what my case was due to the inactivity during the time that i was prone to being bedridden. So with that being said and knowing how hard it is to stretch this muscle what can i do or not do? Is there medication since more than likely i don't know the tendon cut and stretched? Like for instance today its not as much as my hamstring as it is from my knees down. My knees feels swollen and huge but looking at them they are not. Let me say I do have a Torn MCL as well in the left knee. Also can you make sense as to why when i Had cellulities that all my pain and pulled hamstring feeling and tightness and what have you disappeared but the moment the infection cleared up..it was back?? Is this spaciity as well? In your opinion do you think I need a Spinal Cord Stimulator? Listen I am willing to try and do whatever I can to make my world a world of difference, but I need some new and real help. Your the guy to me. Is there a way for you to review my records and my medical reports and maybe you can make heads or tails about what has happened. I will even pay you money to do so. I just need to knwo what is the truth and what i need to do and make sense of all this. Thank you very much.

[Wise Young]

Originally Posted by rob4974

How does one know if it is spaciity or not? Is there a test? I take it that you are right about what my case was due to the inactivity during the time that i was prone to being bedridden. So with that being said and knowing how hard it is to stretch this muscle what can i do or not do? Is there medication since more than likely i don't know the tendon cut and stretched? Like for instance today its not as much as my hamstring as it is from my knees down. My knees feels swollen and huge but looking at them they are not. Let me say I do have a Torn MCL as well in the left knee. Also can you make sense as to why when i Had cellulities that all my pain and pulled hamstring feeling and tightness and what have you disappeared but the moment the infection cleared up..it was back?? Is this spaciity as well? In your opinion do you think I need a Spinal Cord Stimulator? Listen I am willing to try and do whatever I can to make my world a world of difference, but I need some new and real help. Your the guy to me. Is there a way for you to review my records and my medical reports and maybe you can make heads or tails about what has happened. I will even pay you money to do so. I just need to knwo what is the truth and what i need to do and make sense of all this. Thank you very much.

What I don't understand is why your physical therapist and doctors are not explaining spasicity to you. Spasticity is straightforward Physiology 101. An experienced physical therapist or physiatrist should be able to tell after about 5 minutes of examining you whether what you have is spasticity or not. They should be able to explain to you the various therapies that are available and whether they would help or not.

What you describe sounds like spasticity but it is impossible to tell because your description is confused and confusing. Some of what you describe does not make sense. Are you sure that all the spasticity went away when you had cellulitis? Cellulitis usually aggravates spasticity. When did you tear your MCL? Was this during the rehabilitation, before or after your cellulitis? What was the cause of your cellulitis? What was happening to your spinal cord and cauda equina at during this time?

Please don't assume that everybody has memorized your complicated story. For example, I can't get your story straight. I get emails and stories from dozens of people every week. Based on what I can remember, you had an injury to your cauda equina affecting your left leg more than your right. You apparently recovered substantially but you had/have spasticity that is interfering with your walking. I don't have a good idea of what your current status is.

So, please, retell the story but do it in an organized and clear way. Start from the beginning. State the facts in temporal order. Describe your current status, what you are able to do now. Then ask your questions.

Wise.

[skeaman]

when you are on the subject of spasms i have a lot of spasticity i know it helps my tone i am on 120ml per day of baclofen but still no good the doctors would like me to put in a pump to help me i know it can be turn up and down i am afraid it might waste away any tone that i have i do all the standing and stretching this controls it for awhile why i would not like my tone to go away much if something was to come out of your trials i would have a head start would this be right? and do you know if any thing would help us with spasms from your trials if so would this come early in the trials for i don't think i could keep up the stretching and standing going all the time for it just wears you down it is the not knowing

[TAM63]

Rob, I sent you a private message.