Severe knee pain following L4 injury

by Kay
(Ireland)

Buttock injection causing sciatica

Buttock injection causing sciatica

Buttock injection causing sciatica
Where around the knee is the pain?

Hello,
I have been attending a chiropractor for over 6 years following a previous disc injury. I remained on a maintenance programme once a month since that time.

I recently suffered another injury (caused by lifting) and went to my chiropractor with severe back pain and leaning to my right side.

I had daily adjustments for one week, then 3 adjustments in the second week. After a simple movement at home I went into a severely painful spasm and called my GP (doctor) as I couldn't move.

He injected me in the left buttock with a painkiller and prescribed anti inflammatories, tramadol and lyrica and diazepam. The injection caused me to sleep for some time and on waking I had severe hip and knee pain.

Whilst my back pain has eased, the leg weakness and knee pain remains.

I'm worried about taking so many pills but can't last long without them as the pain is so bad. I am waiting for an MRI (still one week away) and reluctant to be adjusted by the chiropractor until I know exactly what the problem is.

Is there anything you could recommend that might help me.
Thank you.

Hello Kay,
There are two possibilities, and neither frankly are particularly palatable.

Do I understand it correctly that you had no leg pain until the injection? It shouldn't ever happen, but it does, fortunately not very often, but if the injection was not administered in the upper outer quadrant it may have penetrated the sciatic nerve.

It's not often that a doctor will make such a serious mistake, and it's thus unlikely, but needs to be considered.

The telling distinguishing factor is where in the knee does it hurt? Back of, side, front of or inner knee? If it's the front of the knee, or the inner side going down the inner lower leg, then it involves the femoral nerve and has nothing to do with the injection.

That leaning to the right is called an antalgia; it's is a serious sign of a slipped disc. Seeing you had the injection in the left buttock, I'm presuming the pain was more on the left side.

That's what's called the postero lateral herniation; at the L4-L5 level would most likely affect the L4 nerve root. To complicate matters it has slips in both the femoral and sciatic nerves.

Sitting in a kitchen chair, with your head flexed on the chest, ask Hubby to GENTLY raise the lower leg parallel to the floor. If it reproduces the pain in the back and leg, then it's most likely the sciatic nerve.

All this I know is theoretical and disturbing. What are you to do? Firstly, put yourself to bed. Do not sit, don't bend and try not to cough or sneeze.

Go to our lower back exercises page, and find those for a slipped disc; do them gently several times an hour; they take less than a minute.

Below you'll find our slipped disc rules page; follow them to the T.

One of the problems with a disc herniation is that the pain goes away faster than it heals; your story is not unusual. For that reason I've written the 50 percent less pain rule page. You might find it useful; use the search function at Chiropractic Help.

The MRI is probably going to show a bulge; that doesn't mean you're down for surgery the next day, but it lurks.

I'd talk frankly both to your chiropractor and GP about where you are and what's happening. It's difficult, I know. Be careful, use ice for pain relief and continue with intermittent bed rest at least until you're up straight. That's controversial by the way, and is not supported by the literature, but when in such pain and you're not allowed to sit, staying on your back is the only other option. Roll regularly onto one side or the other. Every hour get up and walk about for as long as you can.

Look out for weakness developing in the quadriceps muscle; it'll give on the stairs and cause a limp.

Good luck, let us know how you get on.

Dr B



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Oct 28, 2016
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Thank you
by: Anonymous

Dr. B
I am so grateful for your help and advice. From the diagram I think L4 would be correct, and the injection was given in the correct location, so that's comforting to know. If a disc bulge the doctor mentioned an epidural - a steroid I assume.
I will follow your advise and exercise plan, and return to my chiropractor when able.
Many, many thanks

Kay

Pleasure Kay, remember the MRI is likely to show a big hole in the disc; the steroid will kill some of the pain, but the damage is still there and needs to heal. In fact the steroid actually impedes the healing.

So for at least a month you need to be very careful, or the bulge will turn into a prolapse.

Good luck, let us know when you have the MRI results.

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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