Femoral nerve impingement

by Jeanne

Femoral nerve impingement

On Oct. 26 I bent over to move some small tree branches out of the way; after I did that I leaned my trunk over my right leg and stood up. Piercing pain shot a short way up my right side of back and down my leg so much so that I almost fell down. I couldn't move or walk.

Went to a Chiropractor initially and he saw me every day (except Tues.) for 5 visits and I changed Chiropractors because the first one was not addressing the problem. The pain is constant and incredible - brings me to tears. I can't sleep, can't get comfortable no matter what position I am in.

I have numbness of the right anterior thigh both medially and laterally. Pain down the right groin. I am being treated by a different Chiropractor who adjusts the lower back on my side with my one knee up and twists the area. I am 46 and I have a history of degenerative bone disease in my family, and I have osteoarthritis, scoliosis and 2 herniated discs from a car accident in 1998 (1 is at c5 and the other at L5), and the x-rays from this injury showed some compression between L5 and S1.

The current Chiropractor is saying that it is most likely the rotation of the discs at L1 and L3 which both of mine have been out and continue to slip out (so I assume the impingement is continual which is why the pain and numbness is lasting so long). This Chiropractor is also tractioning the legs as he discovered my pelvis was also rotated and likely causing an impingement...that is dong better.

The pain still persists and is driving me crazy! I am taking tramadol for pain and ibuprofen for inflammation every 6 hrs. and I usually can't wait for the 6 hrs. to be up. Does this sound like the issue is being corrected and I just need to stick with it and grin and bear the pain until it calms down?

Or has the issue not been addressed properly, which is what I fear and further nerve damage is occurring?? What can I do to make the pain stop??? I use ice and it helps, temporarily, I use a TENS unit and it helps somewhat and temporarily, I mentioned the meds and they take the edge off the pain, I find myself flat on my back in bed most of the time for the most comfort I can get, but I cannot live life like this!!! I am even resorting at times to punching the groin area and the thigh to relieve the pain temporarily, at this point I really don't care I just want the pain to stop!!!

If I stay absolutely as still as possible in bed, it relieves it some, but the minute I make any movement the pain is back. Please, any suggestions would be greatly appreciated.

Hello Jeanne,
Yes, incredible pain, I've been there myself, so I know you aren't exaggerating. Femoral nerve damage ... It hurts.

Do you have more leg pain than back pain? If so you may have an extruded, or sequestered disc which is a very serious condition.

The thing to look out for is whether the quadriceps muscle is getting weak. Stand on your left leg, and gently bounce on the knee. Now repeat on the right leg. Does it feel like the knee is going to give? Feeling weak on the stairs?

Then, prick your legs and as accurately as possible try and find out where it's numb. It helps determine the level.

Is the knee jerk reflex diminished? Hopefully it's been tested, and should continue to be tested.

It's now three weeks. Are you any better at all? It sounds to me like it's time for an MR scan. It's the only way to determine exactly the level to treat. Depending on whether the extrusion is far lateral into the foramen, or more central, pinching different nerves, it's very difficult to be absolutely sure one is treating the right level. Yes, it's expensive.

In my first twenty years in practice, I wouldn't treat patients with severe leg pain, and minimal back pain, particularly if there was weakness developing in the leg. As it was highly likely that one was dealing with a Grade IV rupture. Slipped disc symptomes ...

However, of late, I have had success with sequestered discs, provided you the patient are prepared to be patient and very careful. But not always. In fact my own sequestered disc is healing nicely, but it's now 10 weeks, which is a long time to be patient. I really wanted to escape surgery, and if you really want... Slipped disc rules ...

My own daughter is a chiropractor, so I had optimum care. A little tip that you might like to share with your chiropractor. We have been using a "drop-roll" technique, lying in the side-posture you describe, but with no true cracking sounds. A gentle drop in the side-posture. That's what worked best for me. She did it bilaterally, L3 on the right, and L5 Left, but yours of course will be/ may be quite different.

What also really helped was lying on my side and doing soft tissue therapy down the leg. The leg itself becomes extremely tender following the Femoral nerve path, and massage down the leg, ice too as you are doing, really helped.

In short, Jeanne, you have a serious condition. Take it seriously, and do your part. Be careful, don't sit, don't garden, nothing silly, try not to sneeze.

I would recommend an MR but your chiropractor will advise you about that. It helps make the diagnosis. Adjusting the correct level is vital.

If it's in the groin then one also has to consider other hip conditions,

Maignes syndrome and even a pinched nerve in the groin: Meralgia paresthetica ...

Good luck. I hope this contributes, a difficult condition, especially when it hurts at night. I know...! Let us know in a couple weeks how you are getting on. Perhaps print this out and take to your chiro if you think he might appreciate it.

Dr B

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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.

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