Femoral nerve impingement or hip and knee problem?


I had a lumbar fusion L5/S1 and hemilaminectomy about six years ago to stabilize a retrolythesis and to correct a L5 herniation which led to a foot drop.

I began having issues this fall enough to push me to seek a follow-up reevaluation of the lumbar spine. I now have spinal stenosis both central/lateral at L4/L3. Also, a far right lateral herniation exists at L4. I did manage to get through that flare.

However, recently,after some strenuous activities I have developed severe lower back pain, right sciatic glute pain, that crosses over into the groin causing groin pain; front quad pain that extends to the knee.

The knee is sore to the touch as well as parts of quad. This is exceptionally painful and is interfering with my ability to walk, climb the stairs (both painful), and painful to rise from sitting position to standing after having sat for awhile.

After doing some web research came across your Chiropractic Help site and strongly believe what I am dealing with is worsening of the far right lateral herniation which is now impinging on the femoral nerve.

I'm fairly certain that this is coming from my lower back as I can push on the spinal level and it feels pinched and is painful to push on that area and creates painful symptoms.

I am almost a month out on this and currently working with a PT who has I think entirely missed the boat on his diagnosis. I am seeking a reevaluation with a neurosurgeon as I can not live with or endure the level of pain I am presently enduring.

Hello JCK,
Your letter raises many interesting issues. The first is that it's most unusual for a L5/S1 lesion to cause a foot drop; anyway the surgery obviously helped.

There is alas no long term cure for low back pain, whether you go to surgeons or chiropractors; after a serious herniation a life time of daily back exercise and common sense with lifting, and sitting, is necessary.

Your story is not unusual; after surgery the joints above the fusion have to work hard, and often give.

When you say the right glute pain 'crosses over' do you mean to the left groin and knee?

My initial thoughts on reading your story were that this is either a knee or hip problem.

Of course, it can be both a localised problem in the limb and separate but connected issues in the lower back.

It does seem that further evaluation, and a second opinion, are necessary. Make sure that your hip and knee are properly examined too.

Start doing some lower back exercises EVERY morning now for the rest of your days; before getting out of bed is best, in my book. Otherwise, even if this is exceptionally well treated, the pain will progress to yet another level.

And the days of strenuous activities like lifting grand pianos and moving the deep freeze are clearly over; that's just inviting trouble.

Having said that, if you are able to get over this problem properly without setbacks, and do daily exercises, there's a good chance you can again lead a normal life.

Good luck, I hope this contributes to the conundrum.

Dr B

» Femoral nerve impingement or hip and knee problem?

Click here to post comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Femoral nerve.

Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

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.

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 pain-free. 

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.

Do you have a problem that is not getting better?

Are you looking for a different slant on your pain?

Do you want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.

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.

Your own unresolved problem. Pose a question

Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is 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.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what a DC does.

The quickest and most interesting way is to read one of my eBooks of anecdotes. Described by a reader as gems, both funny and healthful from the life and work of a chiropractor, you will love them. Priced right at $2.99, though Kindle fiddles the amount without telling me.