Anterior Thigh Pain

Anterior thigh pain can be very severe especially at night.

On arrival at a friend's home on a trip, my host was complaining of severe antero lateral thigh pain, with minimal or no back ache.

Immediately I knew there would be difficulties. Radiating leg pain in the absence of back symptoms is never easy. To make matters worse, on examination there were clear indications of two different nerve roots involved.

Although he wasn't complaining of lower leg pain, on forward bending he had a tightness in the calf, and the Slump test for sciatica was strongly positive at level 4 in the right gastrocnemius muscle; there was no LBP. My thoughts were of a S1 nerve root lesion, perhaps L5.

Lasegue's and Braggard's tests were strongly positive in the posterior calf.

Worse, on extension he immediately had severe pain in the right buttock and the side and front of his thigh; most likely the L4 nerve root.

The first had the appearance of a bulging disc at L4 or L5. The second a degenerative facet at the L3 L4 level affecting the femoral nerve.

Fortunately there were no hard neurological signs.

In the best of situations this wouldn't be easy. Adjusting his spine on a bed was a nightmare.

Old xrays were unclear and I quickly realised possibly misleading; they showed degenerative change to the L5S1 joint but the spinal fixations were at L3 and 4. Anyone trying to make a diagnosis based on the xrays alone would have been at sea.

Luckily after six attempted adjustments on the very soft bed, and two at a local chiropractor's office on a proper chiropractic table, he is eighty percent better.

On handing my host over to the local chiropractor, I was somewhat disturbed to hear that he would be required to pay up front for 30 treatments. Worse, after watching me examine and treat my host, the local chiropractor informed us that he was a straight chiropractor; no examination would be done, or diagnosis made; he only treated subluxations based on new xrays that must be taken.

I was at pain to point out that the new xrays would almost certainly show L5S1 degenerative change but that the pain was responding to the treatment of L3 and L4. The Slump test for sciatica was almost negative by the time I left.

Anterior Thigh Pain

Anterior thigh pain especially if it's also in the groin and side of the leg is a diagnostic nightmare.

It was true that there was some conflict; was the sciatica an L5 or S1 root. My hands were pointing to the former, the xrays to the latter. There was little on the radiographs to point to a femoral nerve lesion, but the examination and fallout certainly did.

Needless to say, I have little time for chiropractors who will not, and do not examine their patients. Xrays can be very misleading; a scan would have told far more.

In short, making a clear diagnosis is often not possible without an MRI scan. At each level of the spine, it's possible for two different nerve roots to be affected; if it's a medial herniation it causes a quite differen level of leg pain as compared to the lateral prolapse, or a facet syndrome.

Nothing short of a very thorough examination enables the clinician with any certainty to correct the subluxation; over the years I have more cases than I care to remember where, after the failure of my chiropractic help, a scan revealed I was treating the wrong level.

Roll on the day when every case of serious anterior thigh pain is first scanned; it would save insurance companies and you the patient a great deal of time and money; and pain.

Femoral nerve

The femoral nerve emerges from the mid lumbar spine, whereas sciatica from lower down. It is often the source of anterior thigh pain, crossing over to the inner lower leg. 

A femoral nerve lesion can be just as painful as sciatica. Weakness at the knee is often a feature. 

Massaging bed rest

Sometimes with severe lower back or leg pain a short period of bed rest is mandatory; prolonged it will only aggravate your problem. Perhaps a few days and, in exceptional cases a week or two.

Whilst on your back make sure you are using alternating ice and heat treatment. Appropriate lower back exercises too are vital.

Then some massaging bed rest is helpful; whilst lying on your side, not on your belly. Has your spouse got the right hands? Perhaps a professional sports masseuse might be a better person.

Every hour, during the day, get up and move about for as long as possible.

Art and science of chiropractic

Good health care is an admix of art and science. To provide a good adjustment is pure art; to know what to adjust, and in what direction to thrust with the right amount of force is all about science. Look for chiropractors who specialise in the art and science.

Meralgia paresthetica

Meralgia paresthetica is caused by a pinched nerve in the groin; and in the back too. Lateral rather than anterior thigh pain is the norm. 

One of the slips from the femoral nerve passes through the groin and to the side of the thigh. It's a pure sensory nerve, and so has no effect on the quadriceps muscle, but the numbness and stinging lateral and anterior thigh pain can be very unpleasant.

However, this lateral femoral cutaneous nerve, as it is known, is quite often involved in a "double-crush" syndrome, affected in the mid to upper lumbar spine, and in the groin.

If you google meralgia paresthetica you'll find that medicine has no effective treatment, and no chiropractic research has been done. Yet, I find that chiropractic help, directed both at the lumbar spine, and the groin is very effective.

Mayo clinic recommends weight loss, looser clothing and analgesics such as aspirin initially and then corticosteroid injections and antiseizure medication.


Chiropractic is a health science based on the premise that frankly pinched and irritated nerves cause in the first instance radiating pain down the limbs, but also may affect the organs supplied. Anterior thigh pain is more common in the older person, posterior in the younger.

Orthopaedic tests such as straight leg raise  and Braggard's test

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

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