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Persistant leg pain

Discussion in 'Biomechanics, Sports and Foot orthoses' started by David Smith, Dec 18, 2008.

  1. David Smith

    David Smith Well-Known Member

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    Hi all

    I'm asking for some advise or thoughts on a hip and leg pain that I get.

    It started to come on about a year and and has slowly got worse. It only comes on when walking more than about 100meters or standing for about 5 minutes. Its starts mainly over the right greater trochanter and to a lesser extent at the at the superior aspect of the right sacro iliac joint. Then the medio- anterior thigh then the lateral aspect of the anterior tibialis and finally into the MLA. Over the GT and pelvis the pain could be described as a deep ache to digging with a screw driver type thing. The thigh and lower leg is a biting ache going to burning and the foot like standing on a large pebble. Recently the pain has progressed to coming on when lying supine, just enough to keep waking me up. Another symptom is I keep straining hamstrings and muscles in both legs. Yesterday it was the medial vastus insertion. There is also a feeling of numbness, weakness and losss of motor control although no actual numbness, weakness or loss of motor control has been noted. Sometimes a feel like I am standing in a bucket of very cold water with my right foot. There are no left side problems except for straining and continuous bursitis of the origin of the abductors (i think) at the isheal tuberosity. There is no lower back pain on movement thru any full RoM and no SLR test(straight leg raise) pain, either leg.

    I have had a plethora of investigations, including x ray, MRI (hips, pelvis and all spine), physio assessment, musculo-skeletal specialist evaluation. No amount of stretching, bending, RoM contorsions can reproduce the pain on the couch and there is nothing remarkable in the reports except for slight insignificant age related degeneration of lumbar spine and a very small L4 disc bulge (not really a prolapse). I have also looked closely at the imaging with the specialists and there are no apparent or significant problems to be seen.

    Nobody knows what to do and so I have been signed off with the proviso to return to GP for further referral if it gets worse, which it has but so what.

    I go to a private physio who mobilises, manipulates and streches every joint he can and this can can relieve the symptoms for a few days but, post treatment, this is preceded by a few days of being much worse.

    Any ideas - the pain is getting beyond a joke and worse I can't walk from the Red Cow to the Jolly Frenchman without stopping at the Black Bull in between and the beer there is always warm and watery.

    Sincerely Desperate of Folkestone UK

    Luv Dave

    Ps Oh yeah recently I find that I have to walk with a hip twisting rolling side to side action, I'm not sure if its antalgic or a muscle weakness / firing sequence problem.
  2. David Wedemeyer

    David Wedemeyer Well-Known Member


    Despite valid objective evidence this sounds like discogenic low back pain and mild radiculopathy (L5 disc), possibly pseudo-sciatica from quadratus muscular involvement and myofasciitis. I would also suspect degenerative sacrolilac changes and its sequela, sacroilliitis.

    We often see evidence of disc involvement without frank neurologic involvement or confirmatory orthopedic findings, MRI etc. The objective picture does not always match the subjective symptoms in my experience with sub or para-rhizal discs. Did they locate any free fragments of the annulus? Might be worth having the films read by an outside radiologist.

  3. David Smith

    David Smith Well-Known Member


    Mild MILD!! a mild case of intense pain and debilitation. :boxing:

    Just joking David - Thanks for your thoughts, I'm sure your right and I get the feeling that its sacro illiac involvement and Myoneuropathy (is that a word?) I mean referred nerve pain and paraesthesia due to muscular involvement.


    You might be right - In UK radiologists generally only comment on the area of interest of the GP referral ( which was mainly 'query spinal stenosis', there was no narrowing noted) and don't tend to go into much detail.

    Cheers Dave
  4. Stanley

    Stanley Well-Known Member


    Without a thorough evaluation it is hard to say what is going on. However, the fact that it hurts when walking or standing rules out a primary disc. This is what is usually seen as an anterior innominate secondary to pronation.
    Usually in this pattern, the ASIS is low on the painful side, and there is an associated equinus on the same side. Instead of treating the innominate dysfunction by manipulation, you have to look at the lateral cuneiform of the foot. Have the lateral cuneiform manipulated, have the ligaments massaged under it, and support it with an orthosis.
    That should get you started. Then you have to figure out why the tone of the ligaments and fascia is deficient to allow this to occur. This gets a lot more complicated, and can be caused by anything.


  5. David Smith

    David Smith Well-Known Member


    Thanks for the reply.

    Its difficult to evaluate my self but I do appear to have a low right hip and equinus ankle right foot. A heel lift didn't help and tended to make the pain worse. So you may be on the right course.

    Now here's the strange thing, just before Christmas*** the pain started to ease IE i could walk further before pain onset. Now it hardly becomes painful at all just a mild ache. However the paraesthesia seems worse but this might be because I can walk further. A few days ago I tried a long walk (about 2 miles) and there was not much pain but the paraesthesia meant I had to concentrate on walking on my right leg. Sometimes I would stumble if i did not notice a small change in topography in the pavement. Also my foot was freezing cold and felt as if it was very wet. I did 1 hour of boxing training today with no pain and no real paraesthesia, perhaps its self resolving??? Very odd.

    *** Also just before christmas I put a full length 10mm -> 3mm tapered heel lift in my right shoe and tried it for a few days until I couldn't stand it any more. ( I went on a shopping and drinking day out in London, which really killed my leg) I thought it might kill or cure. Perhaps it changed something and started a cure, who knows???

    All the best for the new year Dave
  6. Wendy

    Wendy Active Member

    Having read the thread with interest and the subsequent self resolusion (almost). This thought could be a bit left of centre but just wondered if there could have been a viral element to the problem - has there been any flu like syptoms since the leg started to recover? Only asking as many years ago OH had a viral problem with muscles in shoulder and after approx 2 months he had flu type cold and shoulder resolved (after many visits to physio).......
    Wendy :drinks
  7. David Smith

    David Smith Well-Known Member

    Can't say I have had any flu symptoms during the resolution although I did have a cold the first week of December.

    My thoughts now go back to David W's thread where he mentioned discogenic involvement. I read up about this and proteins released from the pulp of the damaged disc have a high tendency to start inflammatory response's. This can effect nerves and connective tissue in the area but as the source of the protein runs out the inflammatory reactions reduce and pain subsides. This however, does not explain why it/was is only painful and paraesthetic on walking. Or perhaps it does, If you thought of a pathological nerve as a space occupying lesion then the inflamed nerve affected was compressed by forces due to the kinematic changes of walking but now cannot be compressed when it is not inflamed since it does not take up so much space in a void??

    Cheers Dave

    Thanks for all your interest, I'll let you know how things progress.
  8. drsarbes

    drsarbes Well-Known Member

    Hi David:
    I agree, Radiculopathy sounds like a safe bet, sensory symptoms are more common than obvious muscle weakness. What to do about it is another question.
    Sounds as though it may be more than one level, perhaps L3 -L5.
    How are your DTRs?
    I don't see that you had an EMG or NCS.
    The MRI was clean?
    Any sympathetic NS signs or symptoms besides the "feeling" of cold?
  9. David Wedemeyer

    David Wedemeyer Well-Known Member


    Discogenic low back pain is often relieved by walking but this is not always so. Often with disc wedging, LLD, scoliosis etc. the whole clinical picture is obscured and can be be brought on by axial loading of the spine such as sitting and standing. In fact most low back pain is exacerbated by sitting.

    Disc pain and the resultant sciatic symptoms are often relieved by laying prone and propping up on the elbows and this is a good test (look for localization of low back symptoms to the midline and a decrease in leg pain), but of course these patients usually have a primary low back complaint and you do not.

    I would suggest degenerative arthritis lumbosacral (because you do get relief from therapy, albeit short-lived) with possible disc involvement, rule out radiculopathy) and LLD/altered gait unless more objective findings can be documented.

    As Steve stated this is sensory so I am finding some difficulty with a clean MRI. What did the report say? Any foraminal stenosis, degenerative changes, foreign beer mugs;)?

    I like your explanation above. Hope you're feeling better David, all those secondary stops to lesser pubs must be frustrating :empathy:

  10. David Smith

    David Smith Well-Known Member

    Dear Steve

    Yes feeling of numbness (but not actually numb to touch loss of proprioception ie I had to think about using the right leg ie I walked like I had foot drop by lifting the knee high and feeling and observing the ground topography as I put my foot down.

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