Persistent pain from mid back to the toes


Persistent pain from mid back to the toes with no diagnosis is always going to be a challenge; going back to basics like daily gentle exercises is a good place to start.

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 B

» Persistent pain from mid back to the toes

Comments for Persistent pain from mid back to the toes

Average Rating starstarstarstarstar

Click here to add your own comments

Oct 22, 2016
by: Ruzanna

Please try to copy the links within the brackets, should work.

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 B

Oct 18, 2016
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.

Unable to open these again. None of the bony structure?

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? The femoral nerve stretch test is the start, like the sitting one is for the sciatic nerve. It's more difficult to do yourself though. Ask if it's

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. Stretches other structures too; then do it several times a day.

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. This is not unusual with these hip conditions but gives no clear diagnostic help. Try sleeping with a pillow between the knees.

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 B

Oct 16, 2016
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:

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 B

Oct 15, 2016
Answers to persistent pain from back to toes
by: Ruzanna

Thanks a lot for your time.

1. Exercise - doable! Then do them! EVERY MORNING BEFORE ARISING. It takes less than two minutes.

2. Thoraco lumbar junction - not tender, I don't have discomfort anywhere on touch.j Okay, probably not Maigne's syndrome then.

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. Then this is almost certainly in part a hip problem. Have x-rays been taken of your pelvis?

4. Sitting on the chair test - no pain whatsoever. Not sciatica.

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?

Here are the pictures I tried to attach previously: I was unable to open this file. If the pictures are on plain film then photograph them with a camera. If digital you'll need help to send them.

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

Click here to add your own comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Chiropractic help Questions (General).

Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

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.

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.