(Keywords: lower back and leg pain, sacroiliac joint, tingling in feet and legs, causes of osteoporosis, lumbar disc protrusion, back surgery alternatives, POSTERO LATERAL DISK HERNIATION, POSTERO MEDIAL DISK HERNIATION, antalgia, leg length inequality - a short leg)
Lower back and leg pain are strongly associated, of course, with radiating nerve pain emanating from the lumbar spine or the pelvis causing pain and tingling in the feet and legs.
From the mid to upper lumbar spine, a pinched femoral nerve may cause lower back and/or leg pain that radiates along the side, front or inner part of your thigh. It can also cause pain in the groin and even the labia and scrotum.
Early in the condition the leg may become super senstive to a pin prick, for example. Later it becomes numb. If there is muscle weakness, it usually affects the quadriceps muscle.
If the Femoral nerve is involved then the knee reflex may be disturbed, and weakness of the quadriceps muscle may develop, leading to a marked limp. The leg will then 'give' particularly on stairs. You can test the muscle by springing on your leg and comparing it with the other leg.
If it gives at the knee, 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!
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.
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.
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? A Lumbar Facet syndrome ? The sacro-iliac joint? In the groin? Could it be something more serious, possibly from the prostate gland?
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 X-ray, and better still a scan can help your doctor narrow down precisely where the problem is.
That is very important, because if s/he considers only sacroiliac joint treatment when the problem is at L4-5, 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.
LOWER BACK SURGERY
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.
'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.
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 (20%) 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 (80%) receive no clear diagnosis and 100,000 have lumbar spinal surgery that fails."
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 SI syndrome. All the SI 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. This was a typical case of lower back and leg pain that chiropractors see on a daily basis. Gert had a lumbar disc protrusion.
The long and the short of it is that Gert 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 mattrass 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 - when everybody goes on holiday. Gert played plenty of beach volleyball on his vacation with no trouble. But the first training camp - 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!
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 ....
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
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...
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Bernie's May 2013 blog:
Whilst shopping in Maastricht, I was accosted... read on for some light fun. The importance of being ernest ... not by Oscar Wilde!
Just one cigarette per day ...
"Even brief exposure to tobacco smoke causes immediate harm to the body."
"Lying to ourselves is more deeply ingrained than lying to others."
$193 billion per year
Health care costs + lost productivity
"Occasional smoking or just second-hand smoke damages DNA causing cancer."
"Most smokers are already well aware of their increased risk of acquiring lung cancer. Fewer people know about the patients I see every day, those with cancer of the lips, mouth, nose, throat, sinuses or larynx (where the voice box is located).
These cancers account for about 6 percent of all cancer diagnosed annually in the U.S. Ninety percent of these cancer victims can blame their illness directly on tobacco use."
Paul Donald, M.D.
Over 1,000 Americans per day die directly from smoking.
- worse than cancer
"Tobacco smoke damages every organ in your body - not just your lungs"
Obesity + smoking = disaster
Chiropractic manipulation + smoking?
Will Tweety have a stroke?