lower back/right groin/right thigh-inner/outer/front/back

Displaced fat in the foramen points to a large disc prolapse.

Displaced fat in the foramen points to a large disc prolapse.

I broke my left ankle 28 years old, 4 years ago it was surgically fused to alleviate the pain caused by a lack of cartilage causing the bones to grind. The surgeon fused the ankle with a 1&1/2 inch lift because of this I can't walk barefooted without hyper extending my left knee leaving me no alternative but the wear only shoes with a 1&1/2 heal all the time.

In retrospect I had noticed a pronounced weakness in the front of my right thigh while climbing stairs for about 6 months prior to recent injury.

6 weeks ago after a prolonged period of yard raking and general yard cleanup (nothing heavy lifted) I felt that I had overdone it by the end of the day.

Week 1 - the next day I was in extreme pain(stairs and walking are almost impossible and achieved only with cane and slowly and small steps) due to what presented itself as a groin strain to my Chiropractor, he suggested icing 6 times a day, sitting/standing no longer than 20 minutes at a time and would not start treatment till the pain subsided to 20%. Before injury he had been stretching my back-face down,lower body strapped to table and progressively pulled back and down.

Week 2 - Chiropractor works on upper back only

Groin pain has not subsided indeed I started to get crippling pain on the outside of the right hip to knee not extending past, buttock and back of thigh and front middle of thigh to knee as well which would ease after painfully lowering myself into chair, my lower back was extremely tight/painful but after a minute or so thigh/back pain would ease and I can again bend over from sitting or stand/walk till the next episode, no relief for groin pain while walking

Week 3 - Chiropractor works on upper back suggests I see a physio therapist for pain relief

Week 3 - PT suggests L1 L2 is involved not a groin strain applies heat to back/upper thigh then intramuscular stimulation (outside thigh/groin area) & acupuncture (outside thigh only) She gives me gentle movements and stretches to do twice a day
Relief tentatively achieved to the outside/front/back of thigh the groin still painful sometimes seizing so badly I am unable to find relief by posture changes and still aggravated by walking

Week 4 - Chiropractor - disagrees with PTs diagnosis still maintains it's groin strain works on upper back
PT - heat, intramuscular stimulation (outside thigh/groin area) & acupuncture (outside thigh only)
Outside thigh relief continues, front and back thigh relief spotty no relief for groin pain

Week 5 - Using crutches now only to keep back straight when pain is to back
Chiropractor, face down releases my upper back and drops table to release hips, says all moved well
Next day PT - uses acupuncture on groin area and outside thigh suggests massage for groin tightness
Next day massage therapist works small of back, outside/front/back thigh, buttock and groin area all very tight, relief increasing for the rest of day into night

Today, groin pain is as bad as ever and I'm confused as what treatment I should be persuing.

The difficulty is whether this one or two separate conditions. One in the back, and a separate one in the hip and groin.

Then the weakness in your thigh prior to this new injury. Is it what is known as "disuse atrophy" after the ankle surgery, or the lurking femoral nerve problem?

Ask the various people treating you, did any of them test the knee jerk reflex prior to this recent injury? What was the result?

Now a quick check on your groin pain. Lie on your back and gently pull your knee to the chest and then to the opposite shoulder. Compare with the other leg. Is there a marked difference in stiffness and pain in the groin? If so, we are looking at a hip condition probably unrelated to your back. Are there xrays of your hip?

Secondly, sitting, first straighten your knee, and then secondly raise your bent knee. Pain in the groin?

Then go to C-H and type "slump test for sciatica" into the Search function in the navigation bar. Do the test. What's the result?

Does bending forwards, sideways or backwards reproduce the pain in your leg and groin?

Thirdly, ask your physio and chiropractor to do a femoral nerve stretch test. If it's positive then that certainly points to your back.

However, if there's pain in the groin, back of the leg, side and front of the leg, and lower leg you are likely to have a very large prolapse in your back.

I would think a scan of your lower back is the next step. An expensive step, but important.

Let me know.

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 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?

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Interesting questions from visitors

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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.

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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.

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