LBP with upper thigh pain from WHAT TYPE OF Femoral Nerve damage?

by Vicki
(Exeter UK)

For the last 5 months I have been in pain, it started with LBP on the right side and then I developed the Upper Thigh Pain (right leg) which is getting worse and not better!

I am 33 and had a baby 3 years ago. I’m sure this pain started after stretching for some toy under the sofa or lifting him. It’s hard to pinpoint though as there wasn’t a specific injury/painful experience that started this.
I’m seeing a physio as well as a chiropractor who both believe it to be femoral nerve issues but I seem to be showing strange symptoms which is proving hard to help....

I find that in certain sitting positions (such as cross legged) the LBP & thigh pain is less and I can bear it (for an hour perhaps), also when in the car and in the driving seat position this seems to be ok, well after about 5 mins and with excruciating pain on actually getting into the car! I am ok in most sitting positions for half hour but there’s pain I can cope with (medicated) and I just move around often, when I’m at work etc.

If I extend my back then the pain increases and shoots more strongly into my upper thigh with a tingling/burning sensation. The upper thigh pain originated at the outer side of my leg but traverses to the lower inner thigh area (kind of following the L2/3 nerve I think). If I also flex my back such as my sitting on a chair and bending forward to hang my arms down between my legs (rag doll type position) the pain is ok as I slowly bend but at around half way down LBP and the thigh pain kicks in. It’s especially bad in the lower back (takes my breath away) but I've been advised to persist as on breathing slowly in & out and relaxing the pain seems to release and ease up. I can often get right bent over and don’t experience the pain any longer in my lower back but there’s some low level upper thigh pain.

I’m taking a lot of ibuprofen and paracetamol everyday but the pain is still felt esp in the leg as pain killers don’t seem to be stopping the tingling/burning/shooting pain.

I’m doing exercises everyday too - bridge exercises to strengthen my buttocks, back extensions (cobra type position push ups), child's pose stretches, rag doll stretch, hamstring stretch (as I've always had tightness here since childhood sports and it’s got worse), very gentle leg extensions (from 90 degree bent leg to straight) while lying on my back, ensuring my back stays flat (this is very hard and I do shake a little!).

I go running twice a week and this seems to not increase the pain and in all honesty when actually running I can’t feel it!

I've been doing these for over 6 weeks now and if anything the pain is getting worse and not better, esp in my thigh. I do also feel some groin pain too on the same side esp at night when trying to sleep which is proving more and more difficult. In particular when I wake in the morning that’s when my pain everywhere is worst, but having a toddler means I just have to deal with the pain. I have to get out of bed by rolling onto my side and then getting to a sitting position, legs dangling off the bed. Though on numerous occasions I get stuck on the floor and have to stretch in child's pose and do deep breathing for a few minutes to then be able to face getting up (as the pain releases a little when I do that).

The physio I see hasn’t actually diagnosed anything specific except chronic back pain which she thinks exercises will help to relieve and I will need to “look after” my back for the rest of my life. She doesn’t think it’s a slipped disc issue as I can bend and sitting isn't excruciating.

The chiro (who I’ve seen once, so far) thinks I have swelling around my L1-3 origin (spine area) as it’s very tender and thinks possibly an issue linked to a facet joint but can’t rule out disc issues though he’s doubtful it is that. He’s planning to do some deep tissue massage and treatment but said if no better after couple sessions would refer me for a MRI.

I am now getting stressed out and grumpy due to the ongoing pain and struggling to get to sleep and wake up in pain in the night & can't get comfy (writing this at 4am!).
Can you shed any light please? And help me?

Thank you.

Hello,
All in all an unhappy story. Thank you taking the time to be explicit.

Have you had no x-rays? That's where I would start; a lot less expensive, though more invasive, and usually the radiologist will insist on x-rays before an MRI. Ask if they could be taken erect, standing, and include a view of the pelvis seeing you are getting groin pain.

Seeing the programme of stretching seems to making matters worse, I'd take it and divide it in two parts; do one for a week, and then other half for the next week, and make careful notes of progress.

Do you have a family history of lower back or hip pain?

That 'take my breath away' pain when bending forwards suggests this is not advisable; it's likely that this is a disc issue. Was there ever pain with coughing, sneezing, laughing, or bearing down on the toilet?

That getting into the car pain. From flexing your head onto your chest, or lifting your knee and swinging the upper thigh across?

Just to be sure, lie on your back, pull your knee to the chest, to the opposite shoulder, make a circle, and then drop the knee into the lotus position; any groin or hip pain?

That leg extension: ask your chiropractor to do it passively; a femoral nerve stretch; how does it compare with the other leg?

A lot of questions, I know, but there's no clear diagnosis from what you've written, and your answers will help. Get an X-ray taken.

Let me have some answers. Ask your chiropractor for help if some of this is unclear.

Dr B