Lower Back and Leg pain

1. Femoral nerve

Keywords: lower back and leg pain, lumbar disc protrusion, back surgery alternatives, postero lateral disk herniation, postero medial disk herniation, antalgia, leg length inequality aka a short leg


There is a strong association between what you are feeling in the lower limb and what's happening in the lumbar spine, pelvis and hips; very painful radiating nerve pain emanating from the lumbar spine or the pelvis may cause pain, numbness, weakness and tingling in the feet and legs.

From the mid to upper lumbar spine, a pinched femoral nerve may cause lumbago and or buttock and lower limb pain that radiates along the side, front or inner part of your thigh and down the inner lower leg. It can also cause pain in the groin and even the labia and scrotum.

Early in the condition, the leg may become super sensitive to a pin prick, for example. Later it becomes numb. If there is muscle weakness, it  usually affects the quadriceps muscle. The knee will feel like it's going to give on the stairs.

If the femoral nerve is involved then the knee jerk reflex may be disturbed, and weakness of the quadriceps muscle may develop, leading to a marked limp.  You can test the quadriceps muscle by springing on your leg and comparing the strength of the thigh muscle of the naughty leg as compared with the other leg.



If the muscle gives at the knee, allowing the knee to give, then the quadriceps thigh muscle is suspect and you should consider chiropractic help sooner rather than later. Before there are mutterings about lumbar spinal surgery.

Using a needle, lightly price the side and front of the thigh, and inner lower leg, and compare with the other leg.

But once the muscles are affected the lower back and leg pain will usually be severe, often a deep gnawing, inescapable ache in the leg.

The involved muscles, particularly over the lateral thigh may become extremely sensitive to the touch, with a deep aching pain. Gentle massage down the side of the leg helps.

Meralgia paresthetica and Maigne's syndrome are two conditions causing pain and numbness on the side of the thigh, or groin or front of the leg. Both respond to chiropractic help but often the capsule in the groin must also be addressed.

The superior cluneal nerves are supplied by L1 to 3 too and may cause severe buttock pain.

2. Sciatic nerve

From the lower lumbar spine, a pinched sciatic nerve causes lower back and leg pain which extends usually down the back of the leg, reaching into the calf and foot.

If the sciatic nerve (mainly L4, L5 and/or S1 nerve roots) is involved, then the Medial Hamstring reflex, or the Achilles reflex will diminish. Weakness of the lower leg muscles or great toe may occur. Can you stand on your toes? Raise the big toe? Stand on your heel? If not you should seek Chiropractic help immediately. You are on the verge of lumbar surgery.

FEMORAL NERVE : Roots L2, L3 & L4 (front and side of the thigh pain especially)

SCIATIC NERVE : Roots L4, L5 & S1 mainly (lower leg and foot pain especially)


TINGLING IN FEET and LEGS

The disc joint (some authorities report that the L4 LUMBAR SPINE ... is particularly vulnerable), the facet joints, a restricted spinal canal (Lumbar Stenosis) and the Piriformis syndrome can all cause LOWER BACK AND LEG PAIN and tingling in the limbs. So can a host of neurological other conditions. It's best not to jump to conclusions.


Slump Test for sciatica

A relatively simple tests for a pinched sciatic nerve can be done at home. Interpretation of the results of the Slump Test for sciatica can be a lot more difficult though; work for the experienced clinician.


Test the muscles in your leg... in just two minutes with the aid of a kitchen chair only, you will know if you have "paresis" in the leg.

To start with, can  you raise your big toe off the ground?



CHIROPRACTIC HELP

Lower back and leg pain requires first and foremost a careful examination in order to determine precisely where the nerve is being irritated. Is it in the upper lumbar spine? The lower lumbar spine? Which level exactly? Could it be a lumbar facet syndrome perhaps? The sacro iliac joint? In the groin? Could it be something more serious, possibly from the prostate gland or a blocked artery? Or perhaps even hip arthritis?

Firstly the physical exam will enable your chiropractor to determine more or less where the problem is. But to be honest, sometimes it is extremely difficult to be absolutely sure which level of the lumbar spine is involved. Quite often more than one disc or facet joint is playing up, giving a distorted or confusing exam.

That's where an xray, and better still a scan can help your doctor narrow down precisely where the problem is.



That is very important, because if she or he considers only sacroiliac joint treatment when the problem is at the lumbar 4 lumbar 5 level, then you probably won't improve.

Vital are exercises and rehabilitation, or the problem is likely to return within a short period if you have had lower back and leg pain.

Even though the pain may reduce quite quickly with chiropractic care, if you have pain radiating down the leg from a slipped disc, then it is best to assume that it will be about two months before you be sure that all is healed.

Reduced sitting, and avoiding couches, deep comfortable chairs and car seats is important. Sitting increases the pressure in the disc and inhibits healing.

Alternating ice and heat is the best painkiller and simultaneously has an anti inflammatory effect.

For more about the lumbar slipped disk syndrome, and a slipped disc symptoms case file, click on the links below.

Good lumbar surgery can produce wonders with a bad lower back and leg pain sciatica where there is significant weakness and numbness in the leg. Immediate relief of pain in the leg is the rule. But if the surgery doesn't go well, then a lifetime of backpain awaits the patient.

These are not chiropractic scare tactics. Complications of surgery and Failed Back Surgery are phenomenon the medical world has written prolifically about. They are not chiropractic phrases, but those used by medical researchers.

Can you wait? is the question. If you can, then consider the back surgeries alternatives first. The New England Journal of Medicine reports on research in which 281 candidates were randomly referred to surgery or alternative care. The surgical group did indeed have much faster relief of leg pain, 4 weeks vs 12 weeks but, and here is the interesting part, after one year, there was no difference between the two groups, and a blinded investigator could not tell the difference. Can you wait?



You can be sure that after a proper trial period of Chiropractic help your chiropractor will refer you to the appropriate surgeon should s/he not be winning, which is unlikely. We treat sciatica successfully on a daily basis.

One last tidbit. Research shows that if you FIRST consult a chiropractor you are less likely to end up under the knife than if you first consult your medical doctor. LOWER BACK SURGERY ...

COMPLICATIONS OF SURGERY ...

BACK SURGERY ALTERNATIVES ...

LEG LENGTH INEQUALITY

Or in normal jargon, could you have a short leg? Leg length inequality research confirms that it causes not only hip and knee arthritis, but also lower lumbar back pain. It probably untimately is also one of the causes of lumbar stenosis. Leg length inequality and low back pain are now confirmed to be strongly associated. Not responding to Chiropractic? Has your Chiropractor considered a short leg?

Here is a leg length inequality CaseFile that might interest you.



Journal of Neurosurgery - spine.

Although 1.5 million lumbar MRI scans are carried out each year for sciatica, at a cost of $1.5 billion, only about 300 000 or 20 percent reveal a herniated lumbar disk amenable to surgery. About one third of the surgeries fail to relieve the sciatica. As a consequence, about 1.2 million or 80 percent receive no clear diagnosis and 100,000 Americans have lumbar spinal surgery that fails.

Every year.


FROM THE COALFACE

Mr Kort ironically is very long. Over two metres tall. For nine months he had dreadful pain last year in the lower right leg. His doctor was convinced that it was a sacro iliac syndrome, but Gert wasn't getting better. In fact it was getting worse. He was limping badly and had to stop his favourite sport, volleyball.

We hit it off from the first consultation. He noticed my tie which has in very faint letters written across it the words Jesus Christ is Lord. Like me, Gert is a Christian.

Whilst he did have a fixation in the right sacro iliac joint, it was immediately clear that this was no sacroiliac syndrome. All the sacro iliac orthopaedic tests were negative, and the test that gives me the shivers was strongly positive. Raising his left leg, produced pain in the right leg. The crossed sign. Otherwise, this was a typical case of lower back and leg pain that chiropractors see on a daily basis. He had a lumbar disc protrusion.



The long and the short of it is that he responded magnificently, if slowly. I made him take two weeks leave, with absolutely no sitting, and then part time for the next month. Within six weeks he was much improved and at twelve weeks had very little pain. He took a mattress to work, and lay down every half an hour for five minutes, and did the exercises I prescribed. More important the crossed sciatic sign became negative, slowly, and the strength returned to his calf muscle. He is back playing competitive volleyball.

The long summer layoff is a problem in Europe; everybody goes on holiday. Gert played plenty of beach volleyball on his vacation with no trouble. But at the first training camp some exercises, not active volleyball, did his back in. They made him do double leg raises, a definite no no exercise. He came in three weeks ago looking like the leaning tower of Pisa. He's fine again, and we are considering whether it's time at 45 to consider stopping competitive volleyball. Certainly there will be no more training camps!

Is this an unfair case to claim a chiropractic success for Chiropractic care of lower back and leg pain? Was it simply help from above? Probably!


Intermittent claudication 

Lower back and leg pain may also be caused by an artery in the groin blocked with cigarette ash and cholesterol! The leg pain typically gets worse with exercise. Leg pain.

Smoking is the biggest risk factor in lower back surgery, in fact in all surgery. Low back pain and smoking go hand in hand.



The right bed

Just as important as any of the above is the right bed for your back. Memory Foam Mattresses is something you should consider.


USEFUL LINKS @ LOWER BACK AND LEG PAIN


Stones in my Clog

Mostly, folk know very little about what actually goes on in a Chiropractic Clinic. They may have heard... bones get cracked, ribs may be broken, risk of a stroke...

Follow me, Bernard Preston DC, during my seven year sojourn in the Netherlands. A terrifically bumpy and very fulfilling ride! A very tough language is the start; Dutch is reputedly the third most difficult language in the world.

Read this tidbit about a cyclist who got severe pain in the thigh when cycling. Everyone thought it was a Femoral nerve lesion, but no...

Only $2.99 on your smartphone or Kindle...


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Interesting challenges of the day

1. Mr D has very severe midback back. He bent and twisted, feeding his son, and then laughed. Every breath is a nightmare. A sprung rib is every chiropractor's delight. He or she has golden hands. 30 percent better after one treatment.

2. Mrs C has a long history of severe, disabling migraine headaches since having her wisdom teeth removed. She clenches her teeth at night. After six treatments she has no migraines but some jaw joint discomfort remains; a bite plate is in the offing.

3. Mrs U has the trophy for the worst back this year. After major surgery with plates and screws two years later she still had paresis in the lower leg and severe disabling back pain. She's doing far better than expected, in no little part due to a lift in her shoe for a very short leg.

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. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment 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. 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 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.

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.