I had heavy legs. It felt a bit like slogging through mud. The spring in my step was gone, and while I would do OK once I got going a bit, no amount of working out or strengthening or stretching would help. Then I had my heavy legs fixed with a simple injection in my back. In ten minutes it was gone, and lots of other things got better as well. What was going on and how could a quick injection fix a problem that had been plaguing me for six months?
My Heavy Legs
While a lot of my patients know what this is like, having heavy legs is sometimes difficult to explain to someone who has never had this issue. It feels a bit like someone has tied weights to your legs. The legs work, but some activities feel like you’re moving through mud. The spring in your step goes away. You can no longer “bound” upstairs; instead, you work a bit with each step.
The other day I had had enough, so I had my clinic draw some blood from my arm and process the platelets in such a way that the healing growth factors were isolated. This is important, as while platelets are normally the little guys in blood that help it clot, they also help in wound healing, so they’re chock-filled with growth factors. Once these were isolated, I had one of my physician partners precisely inject around the S1 spinal nerves in my back (S1 transforaminal epidural). How did I know that I needed the S1 nerves injected? I have a central L5–S1 disc bulge that can irritate the nerves and the chronic tightness in my hamstrings and calves (where the S1 nerves go).
I went to work out with my personal trainer that night about 45 minutes after the injection. He was literally blown away. We were gingerly working around my easily aggravated back and lack of power in my core, which impacted how much I could lift. In fact, I had also been starting to strengthen my back muscles using a Roman Chair, but I needed to use my hands to support my back. This is that piece of equipment where you face down with a pad under your tummy and flex toward the floor and use your back muscles to extend, like a reverse sit-up.
All throughout the workout, my trainer had a hard time with how this injection had so dramatically changed the fragile older guy he had been helping. First, all of my weights were up about 25%. This is because my back and neck were no longer easily getting tweaked handling the heavier weights. In addition, I promptly got on the Roman Chair and ripped off 20 reps without using my hands, which placed the final hand grenade in his brain, as he had never seen me do that before. The next day, I came to work and ran up the stairs (like I used to) for the first time in six months.
How Did This Instant Change Happen?
To understand what happened, you need to learn a bit of basic anatomy first. The nerves in your low back tell your muscles what to do. If the nerves in the back are not happy, you may or may not feel back pain, but you will feel all sorts of issues in the legs. Sometimes this is numbness and tingling, and sometimes it’s just tightness in specific muscles. In addition, because the muscles aren’t efficiently contracting, the legs can feel heavy, and since the same nerves power little muscles deep in your core (multifidus), these muscles can go offline, causing other bigger muscles to have to take up the load. Finally, the spinal discs, joints, and ligaments can become unstable and sloppy. Basically, a core that never works well to support the power in your arms and legs.
When the injection around the S1 nerves calmed them down, suddenly the muscles powered by those nerves in my legs were getting good signals again. In addition, my core muscles were as well. All of this allowed me to handle more weight. Why? Think about trying to lift weights on an unstable boat in a lake. It would be twice as hard without stable support. Now think about lifting weights in the same boat when it’s firmly stable on land—you could lift much more.
How Could Platelet Growth Factors Chill Out Pissed-Off Nerves so Quickly?
The growth factors in platelets and the cytokines in serum are pretty cool. Some of these, like A2M and IRAP, are very anti-inflammatory and work very quickly to reduce swelling. Some are pro-growth and can build things like new blood vessels or even help new nerves sprout over weeks. So the initial effects I saw were likely due to anti-inflammatory cytokines in the serum. Finally, just the volume of fluid injected around the nerves likely diluted some of the inflammatory chemicals that were living there, causing immediately happier nerves.
The upshot? I should have had this injection months ago, but you know the saying: “The cobbler’s son has no shoes”! Sometimes we doctors just get too busy to help ourselves! In the meantime, I don’t miss my heavy legs one bit!