Leg pain during pregnancy CaseFile

Maigne's syndrome referral.

Leg pain during pregnancy casefile discusses a typical patient at the clinic; it's particularly problematic for the older woman who has other children to care for, a house to clean, and perhaps even hold down a job.


Leg pain during pregnancy is clearly a common affliction as measured by my own clinic and the amount of mail I get at this contact. 

There are indeed many causes of upper leg pain so a thorough clinical examination is always indicated.

Mrs P, 38-year old woman, was not enjoying her fifth pregnancy. The first four were routine, but now she has had severe upper thigh and groin pain, and some buttock ache for the last six weeks.

The pain was particularly bad at night, and she couldn't sleep. There was no obvious cause except that she is high pregnant, or hoog zwanger as we say in the Netherlands. She is in her 35th week.

The first and most noteworthy observation was that Mrs P was clearly exhausted. She had a haggard look about her that I didn't like. What's more she was very apprehensive, never having consulted a chiropractor before, but she was desperate. Having tried all else, I was her last port of call.

This page was last updated by Dr Barrie Lewis on 31st July, 2019.


Examination of our leg pain during pregnancy casefile

Leg pain during pregnancy casefile is an interesting yet slightly embarrassing consideration from the chiropractic coalface.


Having gone through the usual clinical history, where does it hurt, when did it start, what makes the pain worse, what previous treatment had she had ... we proceeded to the examination.

  • Pain on forward bending in the right buttock.
  • A marked right sacroiliac joint fixation.
  • A less obvious L2 fixation that I could have missed, except that I was expecting it, and thus looking out for it. Why? You'll see ...
  • Extreme pain in the Adductor magnus muscle in the inner thigh.
  •  Exquisite tenderness where the Superficial Femoral Cutaneous nerve exits from the groin under the inguinal ligament.
  • No sensory, reflex or muscle weakness abnormalities.
  • Full and normal range of motion of the hip, albeit with discomfort in the groin.
  • A positive femoral nerve stretch test.

Treatment of Leg pain during pregnancy CaseFile

I always ask that the spouse accompany the patient in this instance. Firstly to reassure them both about the condition and the proposed treatment, secondly because the cross-friction is painful and thirdly because it is in an intimate area; the inner thigh, the pubic bones and the groin.


It's good to take your spouse along. 

The activator technique lends itself well to the pregnant patient. So I used this little instrument to adjust her sacroiliac joint and L1.

The treatment of the groin is awkward and painful for all concerned. I do not like inflicting pain, and chiropractic treatment is not usually so, and she didn't like receiving it.

I gave her the Maigne's syndrome exercises to try; very gently, and recommended massaging bed rest several times each day.

OUTCOME @ Leg pain during pregnancy CaseFile

It was gratifying this morning to see a very different patient. She looked rested and at ease.

Mrs P reported that she had slept normally for the first time in weeks for the last two nights.

All this after only two treatments.

There was not much improvement in the sacroiliac joint pain, so we attempted a gentle general chiropractic adjustment, and a drop toggle on her hip bone whilst lying supine.

Whilst we have a ways to go yet, as she says if it simply remains this much better for the next four weeks she will be more than delighted.


DISCUSSION of our Leg pain during pregnancy CaseFile

Meralgia paresthetica is what we call a double-crush syndrome. There is always an upper lumbar subluxation, from where both the Femoral nerve and the Lateral Femoral Cutaneous nerve originate, and an entrapment in the groin.

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Meralgia paresthetica causes upper leg pain and numbness.


Meralgia Paresthetica

Notice where the Lateral Femoral Cutaneous nerve emerges in the picture above from under the Inguinal ligament. That's exactly where Mrs P was exquisitely painful. It's a condition often related to pregnancy (and obesity, and tight clothing) but certainly not exclusively.

Double crush: Lumbar facet syndrome at L1-2-3 area + impingement under the inguinal ligament.

The condition responds very gratifyingly to both doctor and patient if the correct careful, and I'm sorry to say, not too gentle treatment is applied. I make only three swoops through the area and it hurts. A lot. You may have some bruising. She didn't fortunately, but it does happen.

Maigne's syndrome

Maigne's syndrome and Meralgia Paresthetica have an important common feature - they both originate from the upper lumbar spine. However, Maigne's affects the nerves that emerge and go posteriorally, whilst MP affects the anterior nerves, in particular the Femoral nerve and its little branches like the Lateral Femoral Cutaneous nerve.

Both need to be considered in every leg pain during pregnancy casefile.

Maigne's has a negative Femoral nerve stretch, but both can have a concomitant sacroiliac joint fixation, buttock pain and upper leg and groin pain. Distinguishing between them isn't always easy, though in theory it should be. I call them first cousins.

Maignes syndrome exercises are pertinent to both conditions. The treatment of both conditions has many common features.

Chiropractic

The chiropractic differential diagnosis of conditions like this LEG PAIN DURING PREGNANCY CaseFile is not without difficulty. A sacroiliac joint syndrome is very common in pregnancy, and something like this slipped disc symptoms case file is certainly not uncommon at the chiropractic coalface during pregnancy. A lumbar facet syndrome  whether pregnant or not is probably the most common condition we treat. Maignes syndrome casefile and even hip joint conditions like Femero Acetabular Impingement syndrome come into the equation.There are many causes of lower back and leg pain ...

Purely 'medical' conditions too, like swollen lymph nodes, inguinal hernias, hip arthritis (rare, but does occur in this age group, especially after a poorly managed Perthe's disease or Slipped Capital Femoral Epiphysis).

Your Chiropractor will examine you carefully to make a correct diagnosis and apply the appropriate treatment. X-rays obviously are discouraged during pregnancy except in very exceptional circumstances which makes his/her work more difficult.

Low back exercises for pregnancy

Keeping fit during pregnancy is not easy; weight gain, fatigue and the extra demands of doctor's visits and prenatal classes make it difficult.


Because pregnancy and lower back pain are almost synonymous I recommend that all pregnant women do some simple lumbar exercises; they take only two minutes before getting out of bed in the morning, and the trick is to start them before the trouble begins.

At this page you'll find exercises for the lumbar facets, discs, sacroiliac joints, and more for strengthening the core. If you have no pain, or only mild discomfort then all are suitable.

Just remember, you're not preparing for the Olympic squad. Take them slowly, get to know your own body, because there is no set of exercises that are suitable for every back. If in doubt, get advice from your chiropractor.

Mind you, that big day is not unlike your own personal Olympics. Get into training. This little test will give you an idea of your overall level of fitness.

Nutrition in pregnancy

This is not intended to be an exhaustive page on the subject. It deserves a full page, even a whole site.

Foods with high folate levels are vital for us all because of its necessity to break down toxic homocysteine, but it's especially true in pregnancy when DNA is being rapidly synthesised. Also known as Folic Acid (B9) it is vital in preventing anaemia too.


Folate is also vital in the early weeks of pregnancy when the neural tube is forming. Spina bifida is not to be messed with. Prevention with foods rich in folate.

Two vital fats are omega-3 and oleic acid making up a large proportion of the brain and the covering the nerves and growing foetus.

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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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