Back injury, mild foot drop

[Joe Cavazos]

Male, 30

Three days ago I injured my back doing Romanian Deadlifts. At the bottom of a rep, sudden popping/shifting feeling in the left side of the L5 area, followed immediately by a weird sensation running down my left leg. Over the next 8 hours the back pain became very bad, and my left leg experienced some numbness down to my big toe.

The next morning my back pain was mostly gone, but my left leg still felt tingly, weak, and clumsy. Further inspection showed I have particular trouble with dorsiflexion. I can flex/extend my whole foot pretty well, and walk on my heels with some difficulty, but when I stand up straight I can barely move my left toes at all. After three days I can't detect any improvement here. Seems like a moderate case of foot drop caused by a disc bulge or herniation.

I went to a sports/spine doctor the morning after the injury. She noticed the back muscles around the injury were extremely tight, as expected. She's taking a "wait and see" approach to see if my foot weakness improves, but after calling her this morning she shares my concern which is that my back pain/mobility is improving but my nerve function is not. She shares Rip's feelings that MRIs can be more trouble than they're worth since everyone past a certain age has spinal pathologies and the results of an MRI can lead to misdiagnoses, but she's said I should have imaging done if things do not improve by next week.

I found this video both worrying and reassuring: Back Injuries | Starting Strength Podcast

Worrying because as Ward notes, foot drop is very serious and probably permanent. Reassuring because it seems it can be improved somewhat.

Questions:
1. Assuming light, correct squats and deadlifts are useful for recovery, how long should I wait before starting with them?
2. Can the nerve damage associated with this injury heal on its own? If so, how long should I wait for things to improve before deciding to get an MRI?

[John Weaver]

Not sure if you've read this: Back Rehab: A Case Study | Mac Ward

Covers some of the same stuff as the podcast.

I had some questions about Mac's case in this thread that I hoped Will would answer. But perhaps his lack of answer was the answer. I dunno.

Podcast #44: Back Pain with Will Morris DPT

You've got something serious here. Good luck in your recovery.

[Joe Cavazos]

For no particular reason I remembered I made this thread and decided to post a (very) delayed update. The injury healed and was almost completely gone about 3 months afterwards.

The week after the injury I began training squats and deadlifts at a very light weight (3 sets of 5 at 135 lbs) and slowly worked up from there, 5-10 pounds per workout. During this time I still had neurological symptoms (weakness in left leg, numbness from the front of the shin to the top of my foot, and an inability to dorsiflex that foot or curl the toes upwards) but it did not prevent me from doing the movements. I also did the McGill "Big 3" three times a day.

I began wearing a belt while handling any weight at 225 lbs or heavier, and stopped doing heavy deadlifts with an eccentric contraction. My injury occurred at the eccentric phase of a heavy-for-me (325 lbs) beltless Romanian Deadlift, and I had read that many back injuries occur when combining an eccentric contraction and a rotational element. My guess as to what happened was, due to some asymmetry in my form, I introduced a rotational element at the bottom of the movement and that caused something to break. Going forward I had no problem doing Deadlifts, Deficit Deadlifts, Stiff Leg Deadlifts, Rows, etc, as long as each rep was started from a dead stop.

Strength and symptoms improved to normal, although the symptoms improved so gradually I didn't really notice until sometime in August. In late October I competed in the 2017 USSF Fall Classic with no problems and hit numbers that are typical for me at that bodyweight. The month after the injury was scary and anxiety-inducing, since much of the online literature around foot drop caused by acute back injuries suggest it may be permanent and symptoms were so slow to improve. But this may be another case of barbell training magically causing fucked things to un-fuck themselves, provided you don't do anything stupid.