Post-op leg cramps

[2cool4U]

OK. I know I haven't started a thread in the Surgical Outcome area, but I have a post-op question. I am day 22 post-op ADR at L5-S1 Charite. The entire experience went about as well as I could have hoped for. I essentially have no back pain, have decreased medication use by 75%, X-rays look good, have no incision pain, etc.

I have read these forums extensively over the last several months to prepare for the surgery, and I believe that these resources are partially responsible for my positive experience so far. However, I have searched multiple times for an answer to the following question, and I have yet to find help.

I am having fairly severe leg cramping and aching bilaterally, mostly below the knees. I expected this, as the literature and numerous threads on here indicate that this is a common occurrence. However, I've tried all of the treatments that I can find in any of my resources. These include walking 6-8 times a day at a leisurely pace for a total of around 4 miles/day, gently but persistently stretching several times per day, slowly pedaling an exercise bike, gatorade, heat, ice, elevation, massage, self trigger point, icy hot patches, aspirin, ibuprofen, aleve, vicodin, kadian (which I didn't expect to work, as it is a sustained-release med that needs to be taken regularly, but I had a few left from pre-op and I was desperate), flexoril, TENS/muscle stimulator on my back and on my calf muscles, valium, potassium supplements, B-vitamins (which I also don't really believe will help since I prob. get adequate amts. in my daily diet, once again desperation) and probably something else I'm forgetting.

Does anybody have any other suggestions for treatment? Any ideas or personal experience on how long these will last? I'm neither surprised nor worried about the leg cramping, but I am surprised at the lack of response to treatment.

Thanks in advance for any help.

[Harrison]

Tim,

Of course, we can’t say what will help – but here are a few comments that I hope will help:

- You seem to walking a lot! Perhaps you can walk far less (maybe ½ the distance) and see what happens.
- Try taking daily baths with Epsom salts with very hot water…as hot as you can stand it.
- Massage as many leg muscles as you can you. Have you noticed if other muscles are also tight, like your ham strings or IT bands? When you say below the knees, are talking about your shins?

If you can, spring the $ for a few deep tissue massages – focusing on your legs and trunk. It may also help you figure out which specific muscles are problematic.

It took me a long time for my hamstrings to get back into “normal” condition; perhaps six or seven months….that really surprised me too! Slow, gentle and regular stretching in the legs performed daily really can help!

[2cool4U]

Thanks, those are helpful suggestions. My hamstrings are very tight, much more so than pre-op, but there's no real pain from them. I have an achy or crampy pain originating from lateral and posterior calf muscles. They are diffusely tender, but no real focal trigger points. A portion of my pain is due to shin splints, which surprises me as I really didn't have this problem before when I was regularly running 25 miles/week of steep hills at 8:30 min/mile pace. Now I'm walking on a cushioned treadmill at 2.4 miles per hour using the same running shoes and I get shin splints? I'm icing them down after walking and trying different shoes.

I actually already tried to decrease the walking. I cut down by about 30%, and the next day my legs were much worse. I tried this once per week over the last 2 wks. with the same results both times. I was just cleared for bathing, so I'll give that a try over the next few days.

My main problem occurs at night after about 6 hrs. sleep. The calf cramping wakes me up, and until today the only solution was to get up and walk on the treadmill. Of course, it's then impossible to go back to sleep. I think I might have found my own answer last night. Icy Hot ankle/leg wraps along with Valium at bedtime. The wraps cover most of my calf and have 16% menthol. I was much better last night and this morning. Of course, it could just be coincidence or just the Valium, but I'll take it either way!

I suspect that of all the things I'm trying, time will end up being the only fix.

I'm going to hijack my own thread to ask another question. I was not cautioned about NSAID use after surgery. I've been using them liberally as I decrease my opioid use, both for pain relief as well as to decrease any inflammation. However, two unrelated situations yesterday made me aware of the fact that they inhibit bone growth. Does anyone know if NSAID use will adversely affect the endplate ingrowth of bone after ADR? Has anyone been told to NOT take NSAIDs (aleve, ibuprofen, flector, bunch of others)?

Thanks.

[kimmers]

Tconnor,

Aren't those 4-5 am leg cramps lovely? I had them after surgery and I spoke to others that did too. I have been told they are from distraction of the vertebrae as things are now changed and things need to sort out.
I jumped out of bed on a regular basis. They are like the charley horses of the calves. They came on whether I walked or not.
I had them for quite a while and then I didn't have them. They also came back but now they have been gone for weeks.

As for the NSAIDs, I went off of them for the most part after surgery. NSAIDs inhibit bone growth and the bone in my vertebrae needed to grow into the artificial disc so I didn't take them. After a period of time, I went back on them. I just recently in the last month or so restarted Celebrex and my surgeon reminded me not to take Celebrex and another NSAID also. So I haven't taken Ibuphrophen and take Tylenol instead.

Hope this helps.

Kimmers

[2cool4U]

Thanks. I knew from all of my research to expect distraction issues, it was just the lack of a successful treatment that surprised me. I'm staying the course with walking, icy hot and valium for a few days to see if that works.

The 2nd issue is somewhat embarrassing to me, what with being a doctor and all. I bumped into a friend who broke her arm skiing a few days ago. She was told not to take NSAIDs for the pain as they inhibit bone growth. She was asking my opinion on that and my advice. I professed my ignorance. I stumbled on something similar a few hrs. later by accident while checking on the leg cramp issue.

What a dilemma. Mild pain doesn't warrant taking anything strong, but taking the most common OTC pain meds is bad for bony ingrowth. Here I've been patting myself on the back for tapering opioids and converting to ibuprofen. Now what? Aspirin to go ahead and finish the ulcer that I've probably already started working on from all of the other meds?

I guess I need to research exactly what the importance is of bony seating of the Charite endplates. I probably should also ask, you know, my real doctor rather than trying to be my own doctor. That almost never works out well.