Persistent femoral nerve pain

by Alex
(London, England)

Hello. I have a long history of lower back problems, with 3 bulging discs in the lower region. I had gone several years without a bad spasm and was being fairly good about my core strength exercies.

In mid-March I suddenly developed severe pain in the right thigh, running down to the knee.
An MRI showed a 'right paracentral L3/4 disc prolapse' causing a 'stenosis of the traversing L4 nerve root as well as the exiting L3 nerve root'. (Quotes from my consultant's letter.) Another letter mentioned a sequestrated disc.

The cause has been put down to routine 49-year-old wear and tear, not helped by sitting at a desk in the office for up to 11 hours a day for a couple of years.

On March 20 I was given epidural anti-inflammatories, tranformaninal and facet joint injections, which cleared up 60% of the pain. Five weeks later however the pain was returning though not nearly to the same degree. The consultant surgeon recommended a second round of injections, which did little to help. In fact gradually the pain worsened in the weeks afterwards.

On May 22 the pain had increased to the point that I went home from work with strong pain in the groin and bad ache in the thigh.
I have been off work since. I have been doing physio to strengthen the quads and core muscles, and floss the nerve. I take two half-hour walks each day.

But it's now ten weeks off work and I still can't sit for more than 20 mintues wihtout needing to get up. I can't be on my feet for more than 2 hours without needing to lie down to relieve the pain or ache in the groin.

What do to next? I've got to get on with my life and can't stay off work forever. I would love not to miss a holiday to Greece booked for Aug 17.
The surgeon has left it up to me to choose between doing nothing, a third set of injections, or decompression surgery. He is not pushing surgery.

I am inclined to try a third injection ASAP, and make sure to resume physio right away afterwards, which I didn't do after the first two injections. Your thoughts would be much appreciated.

Hello Alex,
I seem to remember answering this, but let's have another go. I know exactly where you are, because last year I was in precisely the same position, with almost identical MRI findings. You can read about it at femoral nerve damage using the site search function at C-H.

Who ever called this "routine" is nuts; you have an extremely painful condition; I know!

In my case, two things were different; first I'm a chiropractor and knew exactly what was happening. And secondly my daughter is a chiropractor; this is a very serious condition, often ends up in surgery, but because two educated and committed minds were working together I recovered.

Yours is going to be more difficult now, because so long has passed. What we worked out was that the usual "lumbar roll" treatment increased the pain, but a side posture technique lying on one side only, with a gentle thrust on L3, specifically NOT trying to get a release is what fixed it.

But I did stop completely for about 2-3 weeks and was then extremely careful for several months. Within two weeks the pain in my leg was virtually gone, but the numbness and weakness around the knee took nearly six months to recover. We are now at one year, and I'm absolutely fine.

Could you recover completely like this after all these months? I'm not sure. Gather up your scans and x-rays, and start hunting for an experienced and thorough chiropractor close by. Perhaps print this out for him or her; they are welcome to contact me.

Let me know how you get on.

Dr B

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May 23, 2016
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starstarstarstarstar 		Numbness in outer thigh following lunge exercise
by: Brian

Having recently lost over 100 lbs in weight and with no other medical issues I have started training with a personal trainer and whilst doing a lunge move where my left knee was close to the floor whist the right foot was extended in front of my body a shooting pain went through my outer left thigh and went as quickly as it happened with soreness and a little after pain. Now my outer left leg around the quad is numb. Any suggestions on how to aid recovery would be gratefully accepted.

Hello Brian, congratulations on the weight loss; I take you've done it deliberately with dieting of some sort. There will be enormous benefits down the road.

Take your exercise routine slowly; you ain't gonna make the Rio Olympics! It seems you trainer may have pushed you a little too hard.

The first thing to watch for is whether the knee starts to give; that's serious as it means an injured femoral nerve most likely.

If it's only sensory, then we suspect a problem with the Lateral Femoral cutaneous nerve; it has no motor component and when irritated affects the outer thigh.

The condition is called meralgia paresthetica; it's a double crush syndrome with the nerve being irritated in the mid lumbar spine AND the groin; both have to be addressed for a successful outcome.

I would recommend stopping everything for a couple weeks and just doing a few gentle home exercises; mostly likely it will resolve on its own. Do some walking and perhaps swimming and cycling for a month.

If it doesn't then a professional examination is called for to determine the cause of your problem.

I hope this contributes; let me know how you get on.

Dr B


» » Numbness in outer thigh following lunge exercise
Aug 21, 2014
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starstarstarstarstar 		what type of swimming?
by: Anonymous

Dr B,
thanks for your previous comment. I encouraged my physio to try and manipulate gently and it has been helpful. Neural flossing, she called it. A couple of days on and the groin pain has reduced and my sitting down time has extended to half an hour or so.
Could I ask another question? Which swimming styles/exercises were helpful to you with this problem? I know to avoid breast stroke.

best regards,
Alex

Hello Alex,
I would suggest butterfly. Only kidding!

Start by just lying on your back and kicking gently; use your arms if you want. Do that for a week or two. Then you might tentatively try some crawl.

Dr B
Aug 11, 2014
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starstarstarstarstar 		Inversion Table - Lie on Back
by: Garry Anderson

The Inversion Tables are designed to lie on the back, with the spine straight along the top of the padded table.

Here is a link to the ATIS-4000 on Amazon.com:

http://www.amazon.com/Ironman-ATIS-4000-Inversion-Table/dp/B000VSQ9A6/ref=sr_1_1?ie=UTF8&qid=1407813256&sr=8-1&keywords=atis+4000

Thanks Garry, appreciate your contribution.

Dr B
Aug 11, 2014
Rating
starstarstarstarstar 		response to Dr B
by: Alex in London

Many thanks for your comments. I did visit one of the best osteopaths in London but he was wary of aggravating the nerve pain, and did little.
I will show him the manipulation your daughter found successful.
But if I cannot find an osteo or chiropracter here to deal with this, my dilemma is going to be choosing between an operation or letting it run its course with exercises, careful lifestyle etc... The physio estimates a 5-11 month recovery period but I don't know if I can face that much longer living this semi-life and dealing with constant niggles or pain. Any thoughts you have on that choice would be much appreciated.
As for sleeping, I am on my back or side.

regards,
Alex

Hello Alex,
There is risk with all treatment, including chiropractic; but my questions is, can it actually be made worse? You're headed for an operation anyway to remove the fragment pressing on the nerve.

There's a big difference between medical and chiropractic treatment; they consider this an inflammation, we consider it something physical pressing on the nerve. Like we wouldn't treat a broken arm with anti inflammatories.

The question is whether the offending disc fragment can be displaced with skillful, artful manipulation? I believe it can; as I said I personally had this exact problem.

That traction device is worth a consideration; it has merit but I've only used it once on a condition like yours and it made it worse, but that's simply an anecdote. I decided not to use it myself; the manipulation was sufficiently effective that I didn't need to risk it.

There are various decompression tables, using traction that have merit too.

It takes quite a lot of courage for a chiropractor to wade into a back like yours. I do it pretty confidently now, but I've been in this business for 34 years. Artfully done, there's much to be gained; brutally done there's much to be lost! But you're heading for an op anyway.

Look for a chiro in your area who is experienced; and courageous!

Dr B
Aug 10, 2014
Rating
starstarstarstarstar 		Try Inversion Table for Lower Back
by: Anonymous

Hi Alex:

The most effective treatment I have found, for what you are describing, is to slowly reverse the 49 years of standing and sitting by hanging upside down on an inversion table, to reverse the effects of gravity. I do my Inversion Table for 10 minutes in the morning, and again in the evening. Doing so, gives me mobility for the whole 12 hours, and it is a drug free do-it-yourself treatment.

The table I recommend is the Iron Man ATIS-4000, which sells for about $300 in WalMart in Canada and America. Check it out on the web, look at the specs (like locking lever for the inversion angle, and secure foot clamps), then see if you can find something similar in the UK.

I think it might be worth a try in your situation, because it has really helped me. The instructions will recommend you slowly invert over a two minute period in order to allow the blood pressure to equalize as you go upside down. Same thing coming right way up again. Unless you have a severe heart condition, there does not appear to be any danger for 10 minutes of inversion.

Best wishes.
Garry Anderson.

Thanks for this Garry.

Do you lie on your back or stomach?

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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