Persistent pain from mid back to the toes


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I am struggling with chronic lumbar ischialgia, as German doctors call it with no pathological cause. There has been no real diagnosis and no real medical help for me so far.

1. One year ago I lifted about 35 kilos in a forward bended position. Next morning I could not move my legs. I was hardly walking, but just sliding my both feet. The back was feeling like broken in mid area and I could not feel my legs whatsoever. I was prescribed ibuprofen, muscle relaxants, strong painkillers, had dexametazon injections and underwent physiotherapy sessions, a lot of them.

2. This lasted about 3 months with unbearable pain with not much success. And here I stopped taking medications, started mild exercise routine and swimming. I had an Xray and nerve conduction test, usual blood test, all three were fine. MRI revealed a small protrusion between L4/L5 with no impact on the nerve.

3. At around month 4 was able to go to the gym, with significant amount of constant pain though. Started doing yoga at the same time with great pleasure and almost no pain during or after the class. I was also subscribed a TENs device, which did not help at all.

4. Around month 6 I received acupuncture treatment, which after the 4th treatment let the left side of my body go. The pain disappeared and did not return so far. After this, the doctors started to focus on the disk, because earlier, it was on both sides and not typical for a disk. But now, all they can see is one side affected and a bulged disk and do not look any further.

5. Other treatments received after this point included chiropractic, fascia treatment, ultrasound, manual therapy, muscle relaxation. And another follow up MRI, which showed no change to the disks and one more for muscles, again all OK. I also had injections of muscle relaxants directly into my back, 32 needles at a time.

6. Somewhere after month 7 the situation is more or less stable with very slight improvement in symptoms month on month, but no full relief. The pain is there, always.

Usually, the entire right side from mid back until the toes hurts, including groin area and side of the waist. Mornings are relatively OK, a bit sore, but throughout the day the pain increases gradually. It fluctuates, say one day the calf hurts more, the other day the knee, or the groin, literally the entire leg hurts. But the areas I highlighted with red are the ones that are always in pain no matter what. The pain feels like dull and pulling force, sometimes like short bites here and there.

I am 34, 174cm tall, with 58kg weight, regularly doing yoga and going to a gym. I work at a standing desk mostly, sit only at most 30 minutes at a time and only about 4/5 times a day. Do not have any health issues other than a stubborn pain. Please see if you can shed some light on my condition.

Thank you very much in advance.





Hello Ruzanna, and thank you for a very comprehensive account. First lesson to be learnt is that a 58kg lady shouldn't be lifting 35 kilos, but that I'm sure I don't need to emphasise.

The second lesson is the virtue of two minutes of lower back exercises EVERY morning before arising from bed; better still at night also. You can find them in the navigation bar at Chiropractic Help; start slowly and gently, listening to your body; you're not preparing for the Olympics!

The waist and groin pain is what sticks out for me; using the search function at Chiropractic Help, look up Maigne's syndrome. Ask someone to prod at the thoraco lumbar junction. Is it very tender?

The other common cause of groin pain is a hip condition; lying on your back, pull your knee to the chest and then towards the opposite shoulder. Now make a circle of the hip, using then knee as a lever, and then drop it into the lotus position. Any pain or stiffness compared to the other hip?

Sitting in a kitchen chair, flex your head onto your chest, and then straighten the good leg parallel to the ground; repeat with the naughty right leg. Is there any difference?

If you bend slowly forwards, then backwards and to the side; do you have pain? Where?

I wish I could be of more help, but this may help.

Dr Barrie Lewis



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Jun 13, 2017
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by: Ruzanna

Hi, I upload the photos to Google drive and share the http link with you.

I have been to a chiropractor around 8 times. His comment was that the SIJ is blocked on the left side. He was working on unblocking that, but it did not bring any relief.





Many thanks, just signed up; something new for me.

It's not enough to work on the SIJ, though it is often indeed blocked; in my opinion one of the signs of a hip condition, but because it's not the underlying cause, it's not enough to work on SIJ alone. He's got to get into the muscles around the hip, the capsule and mobilise the hip.

Sorry, it's complex; you've got to start hunting for a someone who works on the hip proper, and not just the SIJ.

Dr Barrie Lewis
May 31, 2017
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starstarstarstarstar 		xray
by: Ruzanna

After several months of ridiculous pain, I finally had my pelvic area xrayed. Please find a picture here:

https://drive.google.com/open?id=0B7N1GH0J9U9rTzBKYmw2b0s3VWM

The symptoms are pretty much the same as described earlier. There has been no progress so far; some days are bad, some others are very bad. Painkillers don't help.





Hello Ruzanna,
The hip joint spaces are good bilaterally; this is not arthritis. But there are small pincer and CAM deformities in both hip which fits with what I'm thinking: femoro acetabular impingement syndrome. This usually has a knock on effect in the sacroiliac joint, and sometimes causes a piriformis syndrome and trochanteric bursitis.

And you appear to have a transitional vertebra at S1, though this can only be confirmed by a lateral view of the lumbar spine.

I can't remember, Ruzanna; have you seen a chiropractor? It's time to start hunting for someone with a particular interest in the hip joint as I have; I'm afraid I can't help you there. Start talking to friends, neighbours, your GP and the state association.

How do you put that graphic into the https format so that I can see it so easily?

Dr Barrie Lewis
Oct 31, 2016
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starstarstarstarstar 		answers
by: Ruzanna

Unfortunately, there are no other images of the pelvic area. But now I am informed and at the next appointment (end of next week) I will insist on looking into the hip. Out of all articles that I read here, FAI symptoms describe my case.

I will keep you posted.
Oct 22, 2016
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starstarstarstarstar 		answers
by: Ruzanna

Please try to copy the links within the brackets, should work.
[https://drive.google.com/open?id=0B7N1GH0J9U9rbUR2ZWx4akdQbGs]
[https://drive.google.com/open?id=0B7N1GH0J9U9rZ2cta1hnQjNrdUk]
[https://drive.google.com/open?id=0B7N1GH0J9U9rOE1leXFOaEtRWWs]

Yes, I do stretch throughout the day, but it doesn't give the quality of the yoga class (1.5 hours).

Leg length issues were checked by the doctors I visited, no problems on that end. Curvature or scoliosis where not mentioned, no.

I tried femoral nerve stretch test with help of course, seems to be negative. Blood supply to the foot is fine. Asked for help to check.





Hello again Ruzanna. I could open the graphics but mainly of the soft tissues of the pelvis; the one that shows the hips partially suggests the presence of pincers in which case an impingement syndrome may be a large part of the problem; is there no pelvic x-ray?

If both the sciatic and femoral nerve stretch tests are negative then I'm thinking hip; that comes up consistently. And often affects the gait and sacroiliac joints.

Ask one of your professionals to confirm that both the femoral and sciatic stretches are negative, and all reflexes intact.

Dr Barrie Lewis
Oct 18, 2016
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starstarstarstarstar 		answers to entire leg aches
by: Ruzanna

My computer skills are to blame for disk problems!

Here are a few snippets from muscle MRI showing hip region.
https://drive.google.com/open?id=0B7N1GH0J9U9rbUR2ZWx4akdQbGs
https://drive.google.com/open?id=0B7N1GH0J9U9rZ2cta1hnQjNrdUk
https://drive.google.com/open?id=0B7N1GH0J9U9rOE1leXFOaEtRWWs


Femoral nerve trajectory very well describes my pain areas. I just do not know how to check if it's really the cause of my problems. If it doesn't shop up on MRI, what else can check it out, perhaps nerve conduction study?

Two observations from my daily routine:

At the yoga class, particularly difficult are the poses that stretch the psoas. I can clearly feel that the right side is much more stiff and difficult to stretch. Plus after the stretch it feels oh so pleasant. Nice sensation lasts quite a few hours.

I can not sleep on the left side. When I lay down even for 5 minutes on the left, and my right (problematic) side is up, this nasty pulling sensation gradually runs through the hip, groin, butt, mid back, pretty much along femoral nerve, but does not go down the thigh, perhaps because I change the position.

The big toe does not bother me much. Back in February I stretched it backwards in the gym and it is possible that the pain is still coming from that injury. In general, the leg entirely is in dull pain, the toe being in more pain. But still, the calf, the knee, etc is pretty painful by the end of a working day. Also could be caused by standing too much. In any case, to every doctor I went to, excluded sciatica by doing similar tests as the sitting one. And the neurosurgeon also confirmed several times, that the nerve is intact.





Yes, prolonged sitting and standing often a problem; leg length discrepancy also needs to be considered. Has anyone mentioned the words curvature or scoliosis?

Ask if anyone has tested the posterior tibial and dorsalis pedis pulses. A smoker?

I wish we were closer; you've got my curiosity up!

Dr Barrie Lewis
Oct 16, 2016
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starstarstarstarstar 		answers to groin pain questions
by: Ruzanna

For pelvic area we have an MRI looking into muscles and it came back OK. I have no other hip imaging, but I can insist on getting one. Should I ask for X ray or something else?

Yes, inner thigh is significantly more painful on the right side. I tried pressure on the painful spot and the pain gradually decreased.

I tried uploading the pictures again, they are in PNG format, please see if you can access them. Also emailed them. Hopefully they arrive at your mailbox:

https://drive.google.com/open?id=0B7N1GH0J9U9rMU9xZXMyYmx2WXc
https://drive.google.com/open?id=0B7N1GH0J9U9rV09lbzVCMWhPb00

Again, thank you very much for your time.





Hello Ruzanna,
I'm impressed with your computer skills; one day you give me a lesson on getting your photos into that format.

The MRI must surely also have shown the bony structure of the hip; if you can extract a few pertinent ones and send them in the above format it would be a great help. There's something going on in your hip; that fits too with the anterior thigh, groin and buttock pain.

The big toe corresponds with the L5 dermatome, but with a negative chair test, actually known as Slump test, it doesn't sound like sciatica. Is there local tenderness around the great toe? Redness and swelling? It could be gout then.

The mid to upper lumbar spine supplies the femoral nerve to the anterior thigh and groin area; there's a two way relationship; sometimes a hip condition refers up the femoral nerve, or up the psoas muscle to the lumbar spine.

With groin pain on pulling your knee to the chest, and inner thigh tenderness with pressure, my money right now is on a hip condition; there may be other things going on.

The darkness of the L4-5 disc could also be the cause of the great toe pain. L5 dermatome.

I need a pic of your hip. Read the many pages at Chiropractic Help on upper thigh, upper leg, groin pain. It's complex.

Ovaries okay?

Dr Barrie Lewis
Oct 15, 2016
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starstarstarstarstar 		Answers to persistent pain from back to toes
by: Ruzanna

Thanks a lot for your time.

1. Exercise - doable!

2. Thoraco lumbar junction - not tender, I don't have discomfort anywhere on touch.j

3. Hip rotation and lotus - as soon as I pull the knee towards me, there is a dull pain in the groin. It is more on the front side. I am not sure if it's already the hip or something between the groin and the hip. Range of motion is the same on both sides. Lotus position is super comfortable. Very often throughout the day I will pull my leg up and do a standing lotus of the right / bad leg.



4. Sitting on the chair test - no pain whatsoever.

5. Bending - forwards, backwards, to the right/ bad side are fine. But when I bend to the left, the right side has this pulling pain from mid back until the groin. If's more on the side of my body, just on the side line of the waist. I gently stretch this side very often throughout the day. It helps relieve unpleasant pulling.




Then your back is almost certainly involved also.

One of the rules of health care is to remember that the patient can have two different conditions. I strongly suspect that a part of your problem is in the hip, and a part in your lumbar spine; the overlap is what makes diagnosis difficult.

Find the ASIS in the pelvis. Use Google to locate this anatomical structure on the ilium. With a little oil on your thumb, run it down from the ASIS through the groin and down the inner thigh. Lighten up in the centre as you pass over the femoral nerve and artery. Is it distinctly more painful on the naughty hip?

We're getting places, Ruzanna. I need to see those x-rays. Send them to Contact.

Dr Barrie Lewis

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