UPPER LEG PAIN

MERALGIA PARESTHETICA

Upper leg pain and numbness 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?' 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. 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 the inguinal ligament and and its attachment to the pelvis (called the ASIS). This is the most common site of entrapment of the nerve.

EXAMINATION

CHIROPRACTIC CARE

Lumbar and buttock pain coming from the thoraco-lumbar region, 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.

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.

THE TREATMENT?

Although not in the usual sense a pinched nerve syndrome, he 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. Cross friction of the thigh muscle and in the groin was very painful but helped greatly. He did exercises faithfully at home, and within a month we were both well pleased that the upper leg pain had subsided.

MEDICAL CARE

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. An essential part is working with the muscles in the inner thigh and groin. 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.

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, 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 upper 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.

For more information about sciatica, click here.

PERTHE'S 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. This very serious malady, called Perthe's hip, 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.

INTERMITTENT CLAUDICATION

It took me many years to learn a basic: if a patient complains of 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.

HIP STIFFNESS IN A YOUNG ADULT?

When I studied chiropractic, in the last millenium, the term Femoral Acetabular Impingement Syndrome had yet been coined, but I did notice periodically that young people can get the stiffness of advanced arthritis in the hip. 'Twas a mystery for many years until I was exposed to FAIS in a continuing education lecture by a prominent chiropractic radiologist. For more information, click here.

ILIO-TIBIAL-BAND (ITB) syndrome.

All chiropractors must attend continuing education courses. One of the best that I ever followed were the FICS (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 his problem was an Ilio-tibial band syndrome.

Hippocrates certainly got it right. "THE LIFE SO SHORT, THE CRAFT SO LONG TO LEARN."

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

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