Upper leg pain

(Keywords: upper leg pain, chiropractic help, maignes syndrome, developmental hip dysplasia, femoro acetabular impingement syndrome )

Leg pain and numbness in general, is a common complaint in the chiropractic clinic. There are many possible causes, so a careful examination is called for.



FROM THE COAL FACE


‘Doctor, I have an awful burning pain on the side of my thigh.’

‘When did it start, Mr Jones?’ The man facing me is in his sixties, handsome and well dressed for a visit to the chiropractor in his Harris tweed and tartan scarf, but in fact Meralgia Paresthetica can occur in any age group.

‘About four months ago. It wakes me at night.’

‘You’ve seen your doctor?’

‘Yes, he prescribed some pills but they don’t help, and they're giving me acidity in my stomach, so I stopped them.’

‘That was wise. Did he examine you? What was his diagnosis?'

'Not really. I asked him about it at the end of my last prostate exam - I thought it might be related - but he said it was a different problem. You see, they're not allowed to examine you for a second condition any more. In and out, ten minutes. Proper treadmill he's got going there.'

I nodded. 'But didn't he do even a little exam?'

'Yes, he pulled my leg about a few times, and just said it wasn't arthritis.

'Okay, so what relieves and aggravates the pain?’

‘Standing and walking are miserable, but I get some relief when I sit. And it keeps waking me at night.’

‘Oh. Did your doctor check the pulses in your legs?'

'No! Nothing like that.

Could a blocked artery be causing it?' LEG PAIN ... Mr Jones was starting to look alarmed.

'It could, especially if you are a smoker ... he shook his head ... we'll check the pulses in a moment to rule out a condition called Intermittent Claudication. No back pain?’

‘Not really. Sometimes a bit of an ache.’

‘Does it hurt in the groin?’

‘Yes, sometimes, and here on the top of my leg too, but it’s mostly on the side of my thigh.’

‘Do you have any difficulties on the stairs?’

‘No.’

‘A few awkward questions. You can urinate normally, and no difficulty getting an erection?’ No diabetes?

‘Well, I’ve been having some trouble with my prostate as I said, it’s regularly tested, but nothing has suddenly changed. I’ve been tested for diabetes.’

‘Okay, we had better examine you. Could you please slip down to your under clothes.’


A bit of science ...


The Lateral Femoral Cutaneous Nerve (LFCN) originates in the low back (roots L2-3), runs down the Psoas muscle deep in the abdoman and through the groin on its way to the side of the thigh. It is a purely sensory nerve, so upper leg pain but not muscle weakness characterises this syndrome.

On this journey it travels through a tunnel in the pelvis under a ligament in the groin where it attaches to a hard bump in the front of the pelvis pelvis (called the ASIS). This is the most common site of entrapment of the nerve.

Read more about MERALGIA PARESTHETICA .

A little test, known as Nobles test is used to differentially diagnose an Ilio-Tibial Band Syndrome. (see lower down this page) For more about Nobles test and chiropractic help click here.


EXAMINATION

If you are complaining of upper leg pain you can expect your chiropractor to do a very thorough examination. (If s/he doesn't, go elsewhere!) S/he will check the range of motion of your hip, and your lower back, all the muscles around the thigh and buttock, a full neurological and orthopaedic examination, the pulses in the lower leg. In the groin itself they will be looking for the possibility of an inguinal hernia and swollen lymph nodes, and perhaps an aneurism. They will do two specific nerve stretch tests to check if the sciatic or femoral nerves are being pinched or irritated anywhere along their path.

In the USA you may be expected to have a further series of tests to rule out the very rare things. A secondary cancer for example can gnaw away at the bone in your upper thigh. In the rest of the world however, if the diagnosis is fairly clear we often treat the condition and, only if it's not responding, order more tests.

Only yesterday, for example, I was consulted by a man for the sixth visit, complaining of upper leg pain. Another DC had missed a very obvious arthritic hip. Working on the range of motion of the hip, deep muscle and capsule work in the groin, and a home exercise program, and he can now sleep through the night without pain. It's not rocket science, just a careful examination, and knowing how to manage such things. We haven't taken X-rays. I KNOW he has arthritis of the hip. However, I have recommended it.


CHIROPRACTIC HELP for MAIGNES SYNDROME Lumbar and buttock pain coming from the thoraco-lumbar region, pain in upper leg, Maignes Syndrome , is a notoriously difficult region to adjust. Thus you should be patient with your doctor. You may not immediately hear loud clicks, and dramatic relief of pain. Common chiropractic adjustment techniques for this low back pain may include a prone straight bilateral transverse adjustment, a hyper extension technique (sitting or standing), a lumbar roll, McManis traction, an activator technique, and others. PAIN IN UPPER LEG Case file ...



If you enjoy reading, the ramblings of this batty chiropractor will keep you chuckling all the way to your sweet dreams. For more information about Bats in my Belfry ,.. click here.


Mr Jones responded quite well to my care of his upper leg pain, though it took nearly four months for the last vestiges of hyperesthesia - sensitivity to touch - in the thigh to recede. Within three weeks he could sleep though the night, and within a month he could walk well enough to take up hunting again. Shooting the pigeons and geese that caused havoc on the farmers’ lands in Holland was his passion. He even took a trip to Scotland to go shooting for grouse on the moors. Not my favourite passtime.

Another short anecdote concerning pain in the upper leg (scroll down to 4-11-08) can be found at SHORT ANECDOTE …


THE TREATMENT of MERALGIA PARESTHETICA (MP)

Although not in the usual sense a pinched spinal nerve syndrome, Mr Jones did have fixations in the mid lumbar region where the LFCN has its origin. Of course as a chiropractor I adjusted them, and cleared those subluxations first. Cross friction of a thigh muscle, and around the inguinal ligament in the groin was very painful but is an important part of the care of MP. He did exercises faithfully at home, and within a month we were both well pleased that the upper leg pain had subsided.


CHIROPRACTIC HELP for Meralgia Paresthetica ...

MEDICAL CARE of Meralgia Paresthetica ...


RESTLESS LEGS SYNDROME


Restless legs is a poorly understood syndrome. In fact I think it covers a whole gamut of conditions. For example, Statins, the drugs used to lower blood cholesterol are known to cause restless legs. So too can a sacro-iliac syndrome, and hip conditions.

True Restless legs syndrome is apparently a condition in the brain affecting the nerve supply to the legs.


Upper leg pain during PREGNANCY.

Upper Leg pain often occurs during pregnancy and may continue long after the birth of your child. There are many causes from a frank slipped disc, but a common finding is pain in the vicinity of the pubic bones and groin, spreading down into the inner thigh. This is a readily treatable syndrome which lends itself to chiropractic care. Having said that, your chiropractor will have to do more than just adjust your back when you are suffering from leg pain during pregnancy. An essential part is working with the muscles in the inner thigh and groin if you are experiencing leg pain during pregnancy ...

The treatment is focussed on an intimate part of the body, and you may want to take a family member with you for the first few consultations.



DEVELOPMENTAL HIP DYSPLASIA

One in a thousand babies have a condition called DDH in which the the socket is not properly formed. In the infant, on examination the hip gives a deep-sounding 'thunk'. In the child, adolescent and young adult one is faced with a HYPER mobile hip. The range of motion is greatly increased, and it hurts in the groin... DEVELOPMENTAL HIP DYSPLASIA ...

Whilst true hip dysplasia is uncommon, mild doses of it are very common. Not having the sloping acetabulum, but nevertheless a shallow acetabulum... hardly a day goes by when your chiropractor will not be confronted by the patient with groin pain, and it's not hip arthritis.

The good news is that it responds well to chiropractic treatment that addresses not only the back and sacroiliac joints but also the hip joint. Read more at Hip dysplasia casefile ...

Strong hip muscles are vital to hold the hip firmly in the socket. Exercises....


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What Other Visitors Have Said

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ARTHRITIS

Of course, arthritis in the hip is another cause of upper leg pain. When it's advanced it's a job for a good surgeon, but the trick is to catch it in it's early stages when flexion and adduction and internal rotation are becoming limited and sore, but before the arthritis is full blown. Start by simply pulling one knee and then the other to your chest. Does it feel limited, sore in the groin? For more information about hip arthritis, click here. Go from UPPER LEG PAIN to HIP ARTHRITIS , another common cause of upper leg pain


SCIATICA

I've kept the best for last. Sciatica is of course the most common cause of upper leg pain. Chiropractors treat hordes of people every day with lower back and leg pain that comes from a pinched nerve in the low back. There are several different causes which need to be considered. This is so common that we have several pages especially for this condition.

Tip: You don't have to rush to the chiropractor with every little pain in the back, but when it starts going down your leg ... don't delay. Lower back and leg pain is serious.

For more information about sciatica, lower back and leg pain ... click here.


PERTHES DISEASE

Children too suffer from upper leg pain. If your child complains of pain in the groin, and especially if they are limping, then please take him IMMEDIATELY to your chiropractor, and don't accept any talk of 'growing pains'. It doens't exist and a Perthes hip certainly does. This very serious malady, Perthes disease effects predominantly boys, but girls too, predominantly around 6-12. Treated promptly the serious sequelae can usually be avoided, but this is a very serious condition which, neglected, results in a nightmare of hip problems, often involving numerous hip replacements starting in the 30's, crutches by 50-odd and a wheelchair by 60.


INTERMITTENT CLAUDICATION

It took me many years to learn a basic: if a patient complains of lower or upper leg pain, particularly whilst walking or cycling, and has a negative Lasegue test, ONE SHOULD ALWAYS TEST THE PULSES IN THE ANKLE AND FOOT.

I could not reproduce the pain in Mr Herveille's leg, no matter how far I made him bend and twist, or raise his legs, or stretch his joints, muscles and nerves. Finally, the penny dropped. INTERMITTENT CLAUDICATION ... (This one gets a red.)

Symptoms of aching legs at night time are discomfort, cramping, burning sensations and tingling feelings. Home remedies and natural cures for legs pain at night.


HIP STIFFNESS IN A YOUNG ADULT?

When I studied chiropractic, in the last millennium, the term Femero Acetabular Impingement Syndrome (or Femoro ..) had not yet been coined, but I did notice periodically that young people can get the apparent stiffness of advanced arthritis in the hip. 'Twas a mystery for many years until I was exposed to FAIS as a cause of upper leg pain in a continuing education lecture by a prominent chiropractic radiologist. For more information about FEMERO ACETABULAR IMPINGEMENT SYNDROME ,.. click here. It's very treatable with chiropractic help. Untreatable it progresses relentlessly to hip arthritis.


ILIOTIBIAL BAND STRETCH (ITB) syndrome.

All chiropractors must attend continuing education courses. One of the best that I ever followed were the FICS online (sports chiropractic) courses. It was there that I learnt from Olympic Games chiropractors how a hip condition called ITB responds so well to chiropractic management. In Chiropractic Coalface you can read about a former marathon star, who hadn't been able to run for a whole year, was told that he must have a meniscus operation (which he duly did, with no relief whatsoever), but the cause of his upper leg pain was an Iliotibial band stretch syndrome.

UPPER THIGH PAIN ... two case histories.



"THE LIFE SO SHORT, THE CRAFT SO LONG TO LEARN."

Hippocrates certainly got it right.


You think your kid has problems! Take a look at this! Stunning, watch to the end, on full screen. This will make your day!! ( watch?v=LU8DDYz68kM )


IMPORTANT CONSIDERATIONS @ UPPER LEG PAIN



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Interesting challenges of the day

1. Mrs D, a 78 year old woman has very severe sacroiliac joint pain, and even more severe cramps in her right leg. There are two problems; she is on two diuretics but no slow K. Taking her temporarily off one diuretic and adjusting the SIJ brought 50 percent relief within four days. 

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

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. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.

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?


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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.

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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.


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