bilateral posterior thigh pain when sitting

by Gery

Dear Dr,

I am a 36 years old man experiencing bilateral posterior thigh pain with sitting for a year. The pain is immediately relieved when I stand or when I walk.

My GP sent me for a MRI (despite the fact that I rarely have back pain) and it turns that I have a bulging disc in L4-L5 which barely hit the left root of the nerve.
Following the MRI, I have had a peridural injection without positive outcome on my pain.

I recently saw a physiotherapist who says that I lack flexibility in my hamstrings. Do you think that this type of bilateral thigh pain can be due to hamstring thightness.
Is that something you often see in your practice?

Thank you in advance for your answer.

Best regards

Dag Gery,
Uw schrijft goed engels!

I'll answer in English for the benefit of other readers of your blog.
Firstly, bilateral leg pain is not common.

And secondly, a bulging disc at L4/L5 is not likely to affect the back of your thighs.

All of which suggests we need to look further for the cause of your pain. It's true that tight hamstrings are not uncommonly the cause of lower back pain, but in the legs? At this stage, I'm unconvinced.

My feeling is that a thorough chiropractic examination is necessary. Which orthopaedic tests provoke the pain in the legs, are the sacroiliac joints locked using the procedure of your own famous Dr Gillet, what of the neurological examination?

Is your prostate in order and do you have coccyx pain? What of the hips? Did your doctor check your reflexes, skin sensation and muscle power in the legs, for example?

If you bend slowly backwards, forwards and to the side does it provoke any pain in the back or legs?

Do you have any night pain?

I'm frankly uncertain as what you describe is not common. You need to be sensitive to other issues that may develop; are you doing any back exercises faithfully on a daily basis? Let me have some answers.

Tot horens,

Dr B

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Mar 03, 2017
additional info to bilateral posterior thigh pain
by: Gery

Dear Dr B.

thank you very much for your quick answer

It's funny you talk about prostate and coccyx. In fact to be totally exact, my pain issues started three years ago with a so called "chronic prostatitis". The pain was constant during the day (the famous feeling of having a golf ball in the rectum) and worse with sitting. Of course, exams didn't reveal any sign of infection. So, I started to search myself for solutions and it turns that "chronic prostatitis" is often due to neuromuscular dysfunction. (for the record I was running a lot at that time)

Then, I went to physiotherapists who worked both internally and externally. They noticed tightness in the rear left part of my pelvic muscles as well as a general lack of flexibility. After months, pain started to decrease and the golf ball started to feel more like a pea.

In the meantime, pain started in my posterior left thigh. A kind of thightness in the hamstring around the ischium. So, I went to an osteopath who noticed my left foot was in pronation, left leg internally rotated and pelvis tilted.

He did some work to put everything back in place and I wear now orthotics to prevent feet pronation. After a few months, the pelvic pain went away and I am almost pain free all the time in the pelvic muscles. The pain around left ischium disappeared also but now all of a sudden pain is bilateral in my posterior thighs when I sit.

I don't have neurological signs except fasciculation from time to time (not limited to legs) but I am must say that I am quite anxious due to this pain.
My reflexes were tested and are ok. Same for skin sensitivity. All tests are fine (lasegue, gillet, no pain in my back, blood tests are fine except lack of vitamin D and folic acid (we didn't test hormones)

Pain is only when sitting, and particularly when I sit at 90 degrees. When in a car, slightly bend backward with less pressure on thighs, it is often better.
I have no pain at night at all.

Concerning exercices, I must admit that I stopped sports three years ago when the "chronic prostatitis started". Of course, I gained weight (10kg = 22lb) and I feel that my back is not as strong as it used to be when I pick up something.

So my theories are:

either another nerve is involved (cluneal, posterior cutaneous nerves?)
either I need to go back to sports to mobilize my back muscles and to improve my flexibility

Thank you in advance for your answers.

Hello Gery,
I have a suspicion that chronic prostatis - inflammation, not infection - may be very significant. Do some reading on beta sitosterol.

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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 have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is 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 is doing well.

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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 is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has 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 stroll 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; he has a short leg.

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. X-rays 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 few months 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 is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year 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 could not 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 should not be treating the elderly most medical sites state but that is so much bunkum.

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