Asleep in the Lotus Position?

Question

Kyle is a college freshman and marathon runner. He recently was at a party and passed out asleep, sitting on a hard wood floor in the lotus position. After about at least an hour, he awoke and his legs felt numb, heavy, and he couldn’t move them. His friends carried him to their car and took him to the local ER. The doctors examined his legs. Kyle is asking what happened to his legs and how long will it take to move them?

Answer 1

The learning objectives in this case include:

1. Sciatic nerve anatomy

2. Wallerian anterograde degeneration/retrograde degeneration

3. PNS regeneration

Kyle falling asleep in the lotus position resulted in compression at points along the course of the sciatic nerve, including the buttocks, greater sciatic notch, knee, and ankle. The sciatic is a mixed motor and sensory nerve beginning in the lumbar spinal cord and extending down the length of the leg and foot.

Wallerian degeneration is the anterograde result of injury to an axon, separating its metabolic support from the cell body. Retrograde degeneration follows as a consequence of the axon being removed from its postsynaptic target. This process occurs distal to proximal.

In Kyle’s case, there are multiple sites of sciatic injury because of the lotus position. Numbness, heaviness, loss of reflexes and motor function are commonly the expected sequelae of such a sciatic injury. The key question to be asked and answered is what Kyle wants to know, what happened and how long will it take to recover?

A full successful recovery outcome necessitates many neural components all coming together correctly, including PNS regeneration of the axons, myelin, supportive tissue, and connections to their specific postsynaptic targets. It is important to understand that the regenerative process occurs proximal to distal vs the degenerative process occurs distal to proximal. If optimal requirements are met, PNS regeneration in a cut nerve occurs approximately 1 mm/day vs 10 mm/day in a severely injured nerve. The length of Kyle’s legs is 32” which is approximately 800 mm. Kyle is most likely looking at a long recovery...

-jq