Pain in back of leg and buttock.

by Jim
(La Crosse, Kansas, USA)


I have had several bouts of moderate to severe pain in the buttocks and the back of the thigh of my left leg. The current manifestation differs somewhat from earlier bouts, but is largely the same.

This one often, especially at the beginning, prevents me from sitting due to intense, fiery pain in my left buttock and the back of my left thigh. I can stand and walk for many hours, and I have been able to lie down and sleep. Sitting, whether to relax, have meals, or visit with friends, has been mostly impossible.

When standing, especially after long hours, the pain seems muscular, and tension like. It can be distracting, but is not usually intense, such as occurs when I try to sit.

The pain of sitting is intense, and sometimes feels close to the skin surface, rather than seated in the muscle. At these times it is definitely on the under side of the thigh, with the sensation of fiery heat pain sometimes extending to the skin on the inside and outside of the posterior thigh.

Though this period of pain started only about three weeks ago, rather suddenly at the end of March, 2014, I have had recurrent leg and buttock pain for almost a year now.

The immediate preceding period began in mid September of 2013, and extended through mid January, 2014. During that entire period I could not sleep more than 4 hours at a time. The pain would awaken me, and I had to walk it off, for roughly an hour, before I could sleep again. That period began with a time - a week or so long - during which my muscles were cramping often.

This included my feet and my hands, where my thumbs would lock into my palms while typing on the computer and have to be pried out and my hands massaged briefly before I could continue typing.

Toward the end of that previous bout I noticed that my left buttock seemed shrunken and flaccid, except for what felt like knotted cords under the loosened skin. When the pain finally passed, rather suddenly after doing some floor exercises, it did not take long for my left buttock to return to a more normal shape and condition. On that basis I have speculated that, at least that time, I was suffering from "piriformis sciatica".

I have associated the beginning of this period of recurring buttock and leg pain with a sudden, severe, but short illness I suffered in November, 2012. That manifested as extreme weakness, high fever, and disorientation lasting about 60 hours. During part of that time the strength of my lower abdomen and back reduced to the point I could not sit up in bed or control my bladder effectively. Afterwards, my strength returned, but I felt achy, sore, and like I had little or no resilience or endurance.

At this point I am considering an appointment with a rheumatologist, in hopes of establishing a cause of and treatment for these incidents, including the possibility that surgery may be necessary. I wonder what you think of all this, and what other treatments may be useful?

Hello Jim,
These may be related, but I'm of the opinion - seen from a distance, and thus speculative, of course - that you have two different problems.

1. A fairly typical sciatica, but that would need to be confirmed by a positive Slump test for sciatica. Take the test and confirm it. The gluteus muscle in the buttock, the shrunken one, is supplied by the same nerve as the back of the thigh pain.

2. The locking thumbs sounds more neurological to me, and I would recommend a consult with a neurologist. The high fever may or may not have been related.

I would presume you have had some xrays taken of your lower back. What do they show? If not, get some, with the anterior posterior view taken standing.

Sitting increases the pressure in the disc reportedly up to twelve times; sit much less and choose your chairs carefully. Perching is better.

If you aren't doing any exercises, start these lower back exercises and do them faithfully every morning before getting out of bed; several times a day would be better.

It's your choice whether to go for surgery, or see a chiropractor. Neither can guarantee a cure and a lifetime of good back care is ahead of you. Accepting you can no longer lift the grand piano and lots of bending and twisting, and that you must exercise daily.

This is a condition that we treat on a daily basis and generally the results are good and the risks are low. The worst that might happen is that it simply doesn't get better.

Good surgery would probably fix the problem in the short term, but you're still in for good back care for life and the risks are much higher; the cost too.

I hope this contributes.

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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