Pain in upper leg

Area of pain

Area of pain

Area of pain

For over a year now, a have a pain in my right thigh. It is around the hip flexor, to the inside of the leg.

There was no specific injury. One day I started to feel a sensation like a there was a tear in the muscle. It is not very painful. Over the past year, it has worsened, whenever I start working out. It is not very painful but is an ongoing discomfort. I only feel it in certain positions: e.g. lunges or if I stand and bend my leg pulling my foot to my butt.

- I work out about 30 minutes 3 times a week. I do various activities, spinning, group classes, elliptical machine.
- I work in an office, walk 25 minutes two times a day.

I have been to months of treatment – physio, chiro, osteo, massage therapy. Nothing has resolved my issue. I have seen two different doctors more than once. Here are some things that my treatment providers have told me:

- I naturally hold myself in anterior pelvic tilt. I now make a big effort every time I am walking to be in a neutral position.
- One doctor said I had hip bursitis and gave me a cortisone shot which did nothing.
- Scar tissue from an injury (although I don’t know of an injury I have had). I need to keep moving so that the scar tissue comes apart and heals.
- I also have very hard knots in my quads all the time. I do regular rolling. At one point as part of my physio treatment, I was also getting dry needling to release the knots. It did not provide any sort of lasting solution.
- My toe muscles are weak on this leg – in the abductor hallucis area.
- My glute muscles are weak.

Thank you for any advice you have.

Best regards.

Firstly, congratulations for taking the time to spell things out clearly.

Let's start with five tests. Please respond as accurately as possible; only then can I possibily help.

1. Sitting in a kitchen chair with your head flexed on your chest, ask someone to left your left leg parallel to the ground. Now repeat with the naughty leg. Is there a significant difference? Where?

2. Standing raise your left big toe and ask your friend to press down on the toe. Remember how strong it feels. Now repeat with your right big toe. Is there a significant difference. In other words is it actually weak, or only feel weak?

3. With a little oil on your thumb run it down from the ASIS through the groin and down the inner thigh. Are both sides about the same?

4. Let's add a fourth; bend slowly forwards, then backwards, then to the side. Any pain in the back and in particular any radiation or pain in the upper leg?

5. Lying on your back with your hip and knee at 90*, ask your helper to push hard on your knee towards your toes, and you pull your upper leg equally hard towards your chest. Pain? Weak?

Please write down what you feel after each test and reply in detail what you are experiencing.

I take it you've had an x-ray of the pelvis; if not get one, preferably taking standing.

Ask your various doctors if the femoral stretch test and quad reflexes were normal.

Let me know.

Dr B

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Feb 27, 2018
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by: Cynthia

Hi Dr. B, thank you for your help and all the details. Here are my responses

1.No difference

2. No difference. But if I try to lift my big toe without lifting my other toes on this same foot, it is much more difficult on my bad leg.

3.For my bad leg, there is tenderness when pressed on the groin area.

4. None at at all.

5. Nothing.


No doctor has accepted to send me for an x-ray, said it was not needed but I will ask again.

I will ask about the femoral stretch and quad reflexes tests

Thanks,
Cynthia

Hello Cynthia,
It's certainly not clearcut but I'd hesitate a guess this is not from your back; unless the femoral stretch, quad or medial hamstring reflexes are diminished, or there is real weakness in the big toe.

Your answer in regard to the big toe is not really clear; is it weak, or isn't it. Your doctors should test it; it goes along with the medial hamstring reflex. Prick the area on top of your foot, and the great toe with a needle; any difference right and left?

What this leads us to is that tenderness in the groin; there are muscles there, the pubic bones, the large femoral artery, inguinal hernia and enlarged lymph nodes.

It's not sounding like hip arthritis, but are you very flexible, especially in those hips? Is there any family history of hip dysplasia? That x-ray is important; send me a digital copy to contact.

Let me know when you've had the x-ray, with the report, and the tests I've asked for. Right now nothing is clearcut.

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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