Lower back and upper leg pain

(keywords: Lower Back and Upper Leg pain, tingling in feet and legs, Chiropractic Help, Meralgia Paresthetica )

Lower back and upper leg pain are common complaints at the Chiropractic Coalface. They may be connected, for example as in an irritated Femoral nerve in the lower back causing pain, or tightness, or tingling, or numbness on the side or front of the thigh, and/or groin.

Or they may be quite unconnected, or seemly unconnected. For example, kneecap arthritis and lower back pain.

Traditionally, in Chiropractic, the cause is in the spine (a pinched or irritated nerve) and the effect in the limb, for example, upper leg pain, numbness and/or weakness, or perhaps in an organ. The latter are far more difficult to document, but ask any chiropractor and s/he will tell you of unusual and oft unexpected results in general health. Less menstrual cramps, lower blood pressure, fewer ear infections in a child, less constipation...

Motor Muscle Inhibition

This has been very adequately theorised and demonstrated. For example, Le Pera has shown that an irritated nerve is unable to stimulate the muscles it serves, altering the biomechanics of the entire region. For example, a frankly pinched Femoral nerve may cause profound weakness in the quadriceps muscle. Can you hop on one leg without the knee tending to give?

However, can a knee or hip condition cause changes within the spine?

Certainly a short leg ( leg length inequality, in the jargon ) can cause a scoliosis, and consequent arthritic changes within the spine. Since a short leg also causes an increased incidence of knee and hip arthritis, leg length is an important focus of Chiropractic practice.

The short leg alters the biomechanics of the lumbar spine, pelvis and knee resulting in an increased degree of pain and disability. What constitutes a short leg remains controversial.

In medical practice there needs to be at least a 10mm difference, but in my experience even a 3-5mm insert in the shoe can make an enormous difference to the health of the lower back and pelvis.

However, could a knee condition such as Patello Femoral Pain Syndrome (pain under the kneecap) or Femoro Acetabular Impingement Syndrome be the cause of arthritic changes within the spine?

Interesting Lower back and
upper leg pain case

A 63-year old woman developed pain in the right groin some four months prior to the first consultation. Then, three months later, pain began in the right upper lower back and flank, progressing to the right lower quadrant of the abdomen.

She had pain all day, a deep ache, and pain at night too. Having a history of malignant cancer, the worst was presumed, but all tests proved negative.

On examination of the hip, internal rotation and adduction of the right hip was markedly painful in the groin, with limited range of motion: early hip arthritis OR Femoro Acetabular Impingement syndrome? Or both.

The X-ray revealed all: Both. Untreated FAIS becomes arthritic in many cases.  First and foremost, a daily set of range-of-motion exercises is what is required. Simple. One minute, twice a day.

Radiologist's report: A prominent bony bump (known as a CAM deformity) is noted at the head neck junction of the femur. The appearance on the x-ray is that of acetabulum femoral neck impingement.

Examination of the lumbar spine.

Range of motion of the lumbar spine was full, but extension and right lateral flexion caused mild pain in the right mid/upper lumbar spine. Femoral and sciatic nerve stretch tests were negative.

Reflexes and muscle strength were normal, but there was very significant numbness (90%) on the right lateral thigh. Where the Lateral Femoral Cutaneous nerve exits under the inguinal ligament was exquisitely painful.

There was a right sacroiliac joint fixation. Likewise at L2 on the right.

I could add more clinical detail, but it contributes little. What is interesting is the x-ray of her lumbar spine.

Two important features:

  • Severe loss of the L5/S1 disc but at this point in time not relevant. She has no pain at this segment and no radiation in the course of the sciatic nerve. An incidental finding.
  • L2-L3 and L3-L4 instability with large osteophytes that the body has built to stabilise the joints.

These are not hereditary features, there is no scoliosis, but are the result possibly of old injury, but none is recalled, or...

My point?

This lady has a congenital hip condition called a CAM deformity in her hip. (In fact in both hips, but only the right is symptomatic)

She also has acquired? lumbar spine changes in that part of the lumbar spine that supplies the capsule of the hip. This could not have caused the congenital hip condition. But could the hip condition have caused the changes in the lumbar spine?

Nociception and Neurogenic inflammation

Numerous physiologists have now shown that irritated receptors (such as mechanoreceptors) in dysfunctional joints cause inflammation in the nerves that supply them. This inflammation is transmitted to both local muscles, and also back to the spinal cord with the potential to cause weakness both at the local area of injury, and at remote sites supplied by the nerve should it have a motor component.

Could such an irritated nerve from the hip capsule cause weakness in the lumbar spine muscles? Yes, certainly. Then the body would build those large spurs to stabilise the spinal joints.

All this confirms the age-old chiropractic claims that subluxated spinal joints can have far reaching effects on joints, muscles, and even organs.

This is the area of the spine supplying the side of the leg where she is no numb, sometimes causing a condition called Meralgia Paresthethetica.

Meralgia Paresthetica is a stubborn "double-crush" syndrome where the Lateral Femoral Cutaneous nerve is irritated both in the mid/upper lumbar spine and as it exits from the pelvis under the inguinal ligament in the groin causing numbness and sometimes severe pain in the side of the thigh and/or the groin.

Medical sites report that MP is particularly resistant to treatment, but by addressing both and the upper lumbar spine, chiropractic in my experience can claim to successfully treat this knotty condition. I know of no research confirming this opinion.

Lower back and leg pain go hand-in-hand.

Notice the three features of this difficult case:

  • The primary: a congenital hip condition (a CAM deformity) causing limitation of movement of the hip and ultimately, untreated, hip arthritis. Femoro Acetabular Impingement Syndrome ...
  • A secondary? mid/upper lumbar spine instability.
  • A further irritation of the LFCN causing numbness on the side of the leg. 

Chiropractic Help

As a patient, perhaps, you are not particularly interested in the ins and outs of your condition, be it diabetes, high blood pressure, lower back and upper leg pain ... just fix it, doc.

However in these difficult syndromes, full patient participation in the treatment and after care are vital. The diabetic who won't exercise and watch his weight and diet, the hypertensive patient who won't stop smoking, the lower back and upper leg pain patient... there's big trouble coming.

This particular case had a very promising start. Chiropractic Help directed at:

  • Mobilising the hip
  • Painful crossfriction of the hip capsule and the exit of the LFCN from the groin
  • Chiropractic sacroiliac joint treatment ...
  • Lumbar spine McManus traction
  • A vigorous rehab programme addressing both the hip, the lumbar spine and the deep core muscles of the lower back and deep pelvic muscles. Lower back exercises ...

Within a month she was much improved and had six months of almost no pain. Then the exercises began to wane... most chronic chiropractic conditions are not cured and need on-going monitoring and maintenance care of every lower back and upper leg pain case ...


Lower back and upper leg pain case file

Every chiropractor can write umpteen case files like this one. What makes this degenerative lumbar disc disease case file is that this elderly lady would have been red carded on two counts for consulting a chiropractor. She has osteoporosis and had severe upper leg pain.

Groin and/or thigh pain?

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Interesting challenges of the day

1. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks she was 75 percent improved; no longer vomiting or falling. She's not enjoying the Brandt Daroff home exercises.

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

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. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

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

CLS writes:

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.

Your own unresolved problem. Pose a question

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.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.