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 ...

USEFUL LINKS


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?

Do you have a question about leg pain? Share it!

[ ? ]

Upload 1-4 Pictures or Graphics (optional)[ ? ]

 

Click here to upload more images (optional)

Author Information (optional)

To receive credit as the author, enter your information below.

(first or full name)

(e.g., City, State, Country)

Submit Your Contribution

 submission guidelines.


(You can preview and edit on the next page)

What Other Visitors Have Said

Click below to see contributions from other visitors to this page...

leg pain and at time leg will buckle Not rated yet
My leg just under the butt cheek hurts and it makes it hard if not impossible to walk. The pain will move to where there was none the next time. I …

Pubic symphysis & hip pain help? Not rated yet
I'm 4.5 months post partem. I was diagnosed with pubic symphysis dysfunction after my first pregnancy and it got severe with this most recent pregnancy. …

Buttock groin posterior thigh foot pain Not rated yet
numbness in buttock groin down the back of right leg into foot followed by burning then a lot of pain You need to give me a lot more details for

Click here to write your own.


Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.


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. Mrs T looked like the leaning tower of Pisa; she had a slipped disc at L5 making her lean towards the opposite side. It's called the postero lateral disc hernia; she's much better after two weeks of treatment and will go back to work next week, part time. Lateral discs are more difficult; both take a minimum of six weeks to heal. In my opinion, antalgic patients need what I call exercising bed rest. Sit and it won't get better.

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 groin pain, 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 lower back is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her hip, 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. Hypermobility is more difficult that too stiff in my opinion. Chiropractic 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

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.