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
Comments for Persistent femoral nerve pain
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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.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
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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.
Your own unresolved problem. Pose a question
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