Spine/lumber region severe back pain radiating to the outer and front of the thigh..

by John
(Gold Coast, Australia)

Spine/lumbar region back pain extending to the bony area left about 3" and radiating to outer left thigh and front left thigh. Pain often mirrored on right side however with less pain intensity. I have no abdominal or groin pain.

The pain is severe after 5-15 minutes walking/standing. Morning pain level 8-9/10. The function of sitting from the standing position is very painful but after a few minutes the pain eases dramatically. The most comfortable position is sitting with lumber support; pain level 0-1/10. Lying can be a little uncomfortable and relieved by on side moderate foetal position and or on back legs bent.

Symptoms have presented ongoing for four weeks, beginning two days after attending intense exercise circuit with a trainer involving cardio repetition Inc. sit-ups, back presses, light weights etc.

I attended my Chiropractor who after an examination concluded that my spine, hips and legs all appeared in good condition. He ordered an x-ray. Following the results (as below and accompanying) he performed moderate stretching and gentle manipulation. Given my continued pain after 10 days he suggested I get a CT scan. This I needed to do through my GP. In the 3rd week I attended my GP who referred me for the CT scan following his own examination. He could not determine any issue and suggested that should the CT scan not show anything conclusive I should put up with it until it abated and or return to my Chiropractor. The CT report apparently indicated no area of concern.

I am yet to return to my Chiropractor however I plan to make an appointment upon receiving the CT results myself.

Radiographer X-ray Findings:
As requested, a spot lateral and a lateral view have been performed.
There appears to be a very minor anterolisthesis of L5 relative to S1 in the order of only 2-3mm and degenerative.
There is no other malalignment.
There is no fracture.
There is no destructive pathology.
There is good preservation of intervertebral disc heights.

Good day John,
Firstly, would you please ask a specific question addressed to the radiologist about the status of your abdominal aorta.

Secondly, an MRI would be more useful than a CT, with no ionising radiation. If you haven't yet had.

The pain brought on with walking; is it in your leg too? Is it relieved almost immediately by sitting? Smoker? Ask your doctor to test the posterior tibial and dorsalis pedis pulses. Any question of 'intermittent claudication' needs to be ruled out.

If this is nerve problem, and it probably is, then the Slump test for sciatica and the femoral nerve stretch should be done; one of them will be positive.

If you bend slowly forwards, backwards, to the side, do you get back and leg pain?

There certainly is a mild anterolysthesis at L5 but this is unlikely to cause front of the thigh pain. Is your knee feeling weak on stairs? Has the quadriceps reflex been tested? Normal? With pinprick is there any difference right and left?

There are a lot of unanswered questions here, John. I'm being the Devil's advocate, suggesting your doctors look further than the obvious.

Read the riot act to your trainer; he pushed you far too hard.

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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