LEG PAIN DURING PREGNANCY CaseFile(keywords: LEG PAIN DURING PREGNANCY CaseFile, upper leg pain, lower back and leg pain, meralgia paresthetica)
My TWITTER. MERALGIA PARESTHETICAMrs P, 38 years old, was not enjoying her fifth pregnancy. The first four were routine, but now she has severe upper thigh and groin pain, and some buttock pain for the last six weeks. The pain was particularly bad at night, and she couldn't sleep. There was no obvious cause except that she is 'high pregnant' (hoog zwanger) as we say in the Netherlands. She's in her 35th week.
The first and most noteworthy observation was that Mrs P was clearly exhausted. She had a haggard look about her that I didn't like. What's more she was very apprehensive never having consulted a chiropractor before, but she was desperate. Having tried all else, I was her last port of call ... Having gone through the usual clinical history, where does it hurt, when did it start, what makes the pain worse, what previous treatment had she had ... we proceeded to the examination.
TREATMENTI always ask that the spouse accompany the patient in this instance. Firstly to reassure them both about the condition and the proposed treatment, secondly because the treatment is painful and thirdly because it is in an intimate area: the inner thigh, the pubic bones and the groin.IT'S GOOD TO TAKE YOUR SPOUSE ALONG. The activator technique lends itself well to the pregnant patient. So I used this little instrument to adjust her sacroiliac joint and L1. The treatment of the groin is awkward and painful for all concerned. I don't like inflicting pain, and chiropractic treatment isn't usually painful, and she didn't like receiving it. I gave her the Maignes syndrome exercises to try (very gently).
MAIGNES SYNDROME EXERCISES ... OUTCOMEIt was gratifying this morning to see a very different patient. She looked rested and at ease.Mrs P reported that she had slept normally for the first time in weeks for the last two nights. All this after only two treatments. There was not much improvement in the sacroiliac joint pain, so we attempted a gentle general chiropractic adjustment, and a drop toggle on her hip bone whilst lying supine. Whilst we have a ways to go yet, as she says if it simply remains this much better for the next four weeks she will be more than delighted.
DISCUSSION of our LEG PAIN DURING PREGNANCY CaseFileMeralgia paresthetica is what we call a double-crush syndrome. There is always an upper lumbar subluxation, from where both the Femoral nerve and the Lateral Femoral Cutaneous nerve originate, and an entrapment in the groin.
Notice where the Lateral Femoral Cutaneous nerve emerges in the picture above from under the Inguinal ligament. That's exactly where Mrs P was exquisitely painful. It's a condition often related to pregnancy (and obesity, and tight clothing) but certainly not exclusively. Double crush: Lumbar facet syndrome at L1-2-3 area + impingement under the inguinal ligament. The condition responds very gratifyingly to both doctor and patient if the correct careful, and I'm sorry to say, not too gentle treatment is applied. I make only three swoops through the area and it hurts. A lot. You may have some bruising. She didn't fortunately, but it does happen.
LOWER BACK AND LEG PAINThe differential diagnosis of conditions like this LEG PAIN DURING PREGNANCY CaseFile is not without difficulty. A sacroiliac joint syndrome, slipped disc symptoms case file, a lumbar facet syndrome, Maignes syndrome casefile and even hip joint conditions like Femero Acetabular Impingement syndrome come into the equation.Purely 'medical' conditions too, like swollen lymph nodes, inguinal hernias, hip arthritis (rare, but does occur in this age group, especially after a poorly managed Perthes disease or Slipped Capital Femoral Epiphysis). Your Chiropractor will examine you carefully to make a correct diagnosis and apply the appropriate treatment. X-rays obviously are discouraged during pregnancy except in very exceptional circumstances which makes his/her work more difficult.
IMPORTANT CONSIDERATIONS
|
