Something happened to me whilst horse riding two and a half years ago. I felt something go on the right side but I don't know what. Afterwards I struggled with lower groin pain and couldn't stretch my legs outward (open my legs) on the right side. Then I developed groin pain.

A year ago I had major gynae surgery and since then the pain in my groin, hip/buttock area and L5 has been relentless. I also have tenderness in my psoas muscle. It affects bending, stairs, how far I can walk and when sitting and really gets me down. More recently the burning aching has got worse. In effect, the more I do the worse it gets. When I rest or sleep it improves and kicks off the more I do.

X-Ray was normal
Physio is not curative
Awaiting lower back MRI
Age 52 and slim 9 and a half stone / height 5"7
Possibly hyper mobile

I would truly like your opinion as I don't know where to turn.

I live in the uk

Hello S,
Mm, this is nasty, particularly going on for so long.

My gut feeling is that is not Maignes syndrome which emanates from the high lumbar spine and not the L5 area at all.

Plus it has more the feel of a hip condition; hence the pain in the groin when you pushed your leg outwards. Abduction is the term. Were your hips also xrayed? Could you attach a copy for me, or send to Contact?

A little test for you to do; lying on your back, pull your knee to your chest and then towards the opposite shoulder. Then drop your knee into the lotus position, known as the Fabere position. Compare right and left. What's the difference?

Hypermobile folk are more prone to injury. I would want to be sure you don't have hip dysplasia. Any clicks in the hips? It's difficult to distinguish between hip dysplasia and hypermobility without an xray. Any family history of hip arthritis?

Major gynae surgery is very hard on the back, particularly if you were put in stirrups.

So the question is are there two different conditions? One in your back and the other in the hip. Or are they one and the same syndrome?

To add to the difficulty, the femoral nerve from the high lumbar spine, passes through the psoas muscle, through the groin and into the upper thigh. Is this a high lumbar problem mainly?

I know I'm asking more questions, speculations, than giving you answers.

A hip condition often gives severe tenderness in the groin and down the inner thigh. Try running your thumb down through the groin, using a little oil, and comparing with the other side.

Does bending and twisting provoke back pain? Try to be specific; where in your back? And does it immediately radiate down the leg? Where in the leg?

Try pricking your leg with a needle and comparing it with the other leg. Is there a difference? Where precisely?

Only a careful and thorough examination will answer these questions. An MRI will be useful, but the examination to me is even more important in coming to the correct diagnosis.

Start doing the gentle lower lumbar exercises at C-H every morning before getting out of bed. Do them gently focusing on where the problem seems to be.

I hope this contributes. Do all these tests and give me some answers and perhaps we can get to the root of your pain. Particularly a copy of those xrays of your hip would interest me. You can photograph them and send as a jpeg if they are on plain film. Ask your doctor if you could copy them.

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.

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