Right lower back pain and anterior leg pain

by Jack B.
(Encino, CA, USA)

Lumbar facet arthropathy

Lumbar facet arthropathy

Right lower back pain and anterior leg pain




I have suffered with back problems for about 12 years now (I'm now 49y/o). In the past I have had relief from a period rest and staying in the supine position with legs raised, then gradually increasing my activity and wearing a brace.

However I re-injured by back 2 days ago and this time the supine position causes more pain. The only partial relief I can get is either standing bent over holding onto my legs just above the knees or lying down on my right side. However if stay in this position for too long the pain when I get up is worse than ever.

I went to urgent care today and was given naprosyn and flexiril but so far these drugs haven't made any difference.

Any advise would be greatly appreciated.
Jack B.

Hello Jack,
Firstly, accept that with twelve years of intermittent back pain that some of these Lower Back exercises done EVERY MORNING for the rest of life in bed, before arising are your lot. They will save you a lot of pain and dollars.

You have all the signs of upper lumbar facet arthropathy, the joints are worn and you get relief by bending forwards.

The front of the leg is supplied by the
Femoral nerve so the chances are that the problem lies in the mid to upper lumbar spine.

If it's going into your leg, I'd get some X-rays unless you have some less than three years old, and if you have the money an MRI SCAN. Expensive, but give us a load of information.

Shop around and find find a good chiropractor ...


Let us know how you are getting on in a month.

I hope this has contributed.

Dr B




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Oct 09, 2013
Rating
starstarstarstarstar 		Empathy
by: Anonymous

Dr B,
sorry to hear you have also had the dreaded L3-4 issue and femoral nerve entrapment. At least you don't have to look far to find a good chiro!
Good luck with your rehab.
Jack

[Hello Jack,
Thanks, I too have recovered at the end of week 6. A little tinling and numbness in the leg in L4 nerve root distribution. I'm lucky actually, extrusions are supposed to be medical emergencies, and shouldn't respond to manipulation. Mine did. Probably because I was able to get treatment immediately from my daughter.

Keep well, and keep exercising. If it goes down your leg again, get an MRI scan.

B
Oct 02, 2013
Rating
starstarstarstarstar 		Update
by: Jack B

Hi Dr B,
I am now coming up on 20 weeks since injury so thought this might be a good time to update you on my status. I continue to be pain free and have been exercising regularly and even started playing a little soccer again. I would like to thank you for the advise you have given that helped me get through the tough times in the beginning. You are also the only one who suggested I might not get 100% strength back and I appreciate your honesty as this has been the case. I seem to be stuck on about 60% strength in my right leg and I am starting to believe that I wont get to that 90% but I'm hoping I can maybe get to 75%.
Thanks again for your help.

Jack

[Hello Jack,
You won't believe it, but I'm typing from my bed of woe, with EXACTLY what you had. Disc extrusion into the IVF at L3-L4!

I lifted a heavy patient, and then silly didn't follow my own advice, got too busy too soon. Now paying for it! Still, I too am getting better with good chiropractic care from my daughter. Femoral nerve damage ...

You can be very well pleased with your progress. Compliments to your chiropractor! This is one of the more difficult conditions we face at the coalface.

Choose your chairs carefully. And remember, before football, all players, and especially those who've had injuries, must go through warm up, and warm down.

The quad is a very important muscle on stairs. Don't play ring-a-ring-a-roses...

Thanks for the update, Jack. Buy your chiro a bottle of red wine! Better still, buy him a Bernard Preston book.

Dr B
Jul 04, 2013
Rating
starstarstarstarstar 		Lower back and leg pain update
by: Jack B

Hello Dr B,
Thought I'd post my update and maybe get some of your great insight. I am 5 1/2 weeks since injury now. Pain in the back is virtually gone and pain in the right leg is minimal.

However i do have constant pins and needles in the leg and have about a 50-60% loss of strength in my hip flexors and quads. My chiropractor is treating me on the drx decompression machine twice weekly. I started at 40 lbs and I am now up to 102lbs.

My concern is whether my leg weakness could become permanent and no one seems to be able to give me an answer on how long it takes before this can become permanent damage.

As always any advise or suggestions you can give are greatly appreciated.
Thanks,
Jack

Hello Jack,
My rule of thumb is: if the pain goes away, then the strength in the muscle will return. Perhaps not 100%, but if it's 90%, I think you'll be satisfied.

Frankly, this is great news. You're in good hands. I'd be interested to know what the Femoral stretch test is like. If it's still very painful in the thigh, then beware, you're a long way from healing. But if it's nearly the same as the other leg, then you can relax.

Time for rehab and lots of exercises. And some common sense. No grand pianos!

Keep in touch.

Dr B
Jun 05, 2013
Rating
starstarstarstarstar 		update-MRI
by: Anonymous

Hi Dr B,
Got my MRI results today, still need to discuss with my doc which I will do tomorrow but figured I'd give you the heads up:-

L1-2, L2-3 normal
L3-4 - 7mm right intraforaminal disc herniation. L3 nerve root compressed, distorted, disfigured and impinged
L4-5 - 2-3mm broad based posterior disc bulge which indents the anterior thecal sac
T2 hyperintensity in right paraspinous muscles consistent with hemorrage &/or edema &/or muscle tearing

As always, any insight you can give would be greatly appreciated.

Thanks

Jack B

Hello Jack,
You're at a difficult place, between the proverbial rock...

It really depends on how much you want to avoid surgery. Personally I would advise a month's trial with manipulation, but you have have to be assiduous in following the rules. Taking great care, sitting less, not bending, stop smoking if you're a smoker and being very sensible.

With good surgery the pain in your leg will probably stop almost immediately and even at the best of times there are risks with surgery and anaesthetics, which is why I recommend a conservative treatment trial.

Which ever way you go you're into a lifetime of back exercises and acceptance that there are somethings you cannot do in the future... lifting grandpianos!

Talk to all those around you, then follow your own sense of what's right. Good luck, not easy. Keep us updated.

Dr B
May 30, 2013
Rating
starstarstarstarstar 		Status Update
by: Jack B

Dr B,
Thank you for your prompt response. I took your advise and saw a Chiropractor in my area (cancelled my orthopedic appointment). He had me also see his DO colleague. X-rays showed a Class IIb transitional vertebrae and they agreed there was femoral nerve involvement at L3 and possibly L4. They have ordered an MRI and put me on a Prednisone taper which I just started and is finally starting to give me some relief. I havent started your exercises yet. I'm waiting for the pain to subside a little more first.

Thanks Again,

Jack B.

Pleasure Jack, glad there's some progress.

Prednisone is strong stuff, don't be misled by reduction of pain.

The exercises are deliberately simple and light. Talk to your chiro about which might be suitable for your case.

The rule: feeling some discomfort is okay, but as soon as you reach the pain treshhold, back off.

Let me know what the scan shows.k

Dr B

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