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

by Vicki
(Exeter UK)

Starting at the ASIS using a little oil run your thumb down through the groin and inner thigh. Compare with the left leg.

Starting at the ASIS using a little oil run your thumb down through the groin and inner thigh. Compare with the left leg.

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.

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

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Jun 11, 2018
by: Vicki

Hi and thanks so far :)
In reply to your questions, Yes there is a lot of back and leg pain in my family, my Mum and Dad both suffer, though Mum believes it’s from LT exercising and Dad believes it’s due to the physical job he had for years. My younger sister suffered a prolapsed disc at 26 yrs and had to have an operation to remove the damage.
I most definitely do get pain in my groin area after raising, circling and then dropping my right leg into the lotus position, and also hear a definite click when moving it to the lotus position.
When it comes to getting into the car, it’s the pretty much the entire moment that causes LB pain, but especially when I begin to bend & then when lifting & swinging the right leg into the car. Then I have residual pain in my LB until Iv been driving a good few minutes, wiggled about and I get the upper leg nerve pain eases if I drop my right knee (&this thigh) outwards & that’s how I have to drive.
The NHS system in the UK/my GP & NHS physio usually day they wont refer into the spinal team at the local hospital until I've attended 6 physio sessions without it getting better. Then that team will send me for x-rays or MRIs. Other than that I’d have to pay privately which I can’t afford sadly. Thought if the medication Iv started doesn’t help reduce the pain in a few more weeks my Mum had kindly offered to pay for me to go private.

Thanks again.

Hello Vicki,
My thoughts are that this is probably a hip issue. Ask for an x-ray of your whole pelvis and, if you can get a copy, send it to me, or at least a copy of the report.

This can be hip, hip muscles or a sacroiliac issue.

When there's a strong family history, then I'd strongly recommend daily lower back and hip exercises; before getting out of bed EVERY morning is best. Ask your physio for help, or you can find some at Chiropractic-Help.

The six physio sessions is not a bad idea. Do the conservative thing first.

Wish I was nearer; you've prompted my curiosity. Let me know how you get on.

Dr B

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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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