(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...
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.
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:
These are not hereditary features, there is no scoliosis, but are the result possibly of old injury, but none is recalled, or...
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?
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:
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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:
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 ...
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Interesting challenges of the day
1. Mr B has the trophy for the most acute neck in February. He has quite advanced lower neck arthritis for a forty year old, thanks to a severe fall on the head from a trampoline. But this is upper cervical pain. Right rotation is simply impossible. Luckily he is improving rapidly, eighty percent better he says after three treatments. See cervical facet syndrome.
2. Mrs C is a new patient with a long history of lower back pain, hip pain and pain in both feet. We'll see how we get on, Rome wasn't built in a day.
3. Miss U sprained her ankle two months ago, wearing high heels. She still has severe mid foot pain. Xrays and perhaps a CT scan.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of foot. It started after a long drive in the car. Update, she's forty percent less painful after four treatments, but the leg is still numb. Update two; she 60% better, but it's slow and is going to take the full 6 weeks to heal. Further update; a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. Mrs Y, a 70 year old woman is on maintenance care fo a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection in the shoulder. After 4 operations he is incapacitated and going rapidly down hill.
8. Mrs Z, an 78 year old woman is doing remarkably well with a bad sciatica. But at over 200 lbs she is not losing weight, in fact gaining despite my suggestions. She's high risk for a stroke. Referral to a dietician to crack the whip.
9. Mr A, a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. Reassured him it's not hip arthritis.
10. Mrs B, a 64 year old woman has had Scheuermanns disease; it's left with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment, provides she come every six weeks or so for treatment.
11. Mr C, a young engineer fell off his mountain bike injuring his cervical spine and pelvis. Luckily both responded very quickly to a few chiropractic adjustments. Update: his neck is sore again. It all goes back to a whiplash injury ten years ago when he was rammed by a fully laden truck carrying a load of stone. Time for Xrays.
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. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes. Chiropractors shouldn't be treating the elderly? Bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
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.