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What Causes Pain In The Thighs, Knees And Lower Back?
Question: Sure let's try. Painful thighs, sometimes knees and lower back. have been to PT for stretching and exercise but it is getting worse despite regular stretching. Pain causes me to limp, and I can not squat properly to lift, most likely further exacerbating the problem. I see a chiropractor once a week. What options should I look into next?
Brief Answer:
Consult a spinal surgeon
Detailed Answer:
Hi XXXXX,
Thanks for asking.I understand your concern.
You seem to have bulging of the intervertebral disc between L4-5. It presses on the nerve that emerges through spinal canal at the site .. & affects the supplied by the nerve.In your case it is back, thigh, leg .
Actually in such cases patient needs rest till the pain is resolved .. by rest, avoiding bending.-, weight lifting ,excessive stress to spine . NSAIDs do help in the process.Physiotherapy with back extension is applied after acute pain is gone.
I feel the PT exercises created excessive stress to increase the pain in your case. Please consult a spinal surgeon for further medications & a specific physiotherapy to get proper relief & avoid further deterioration
I feel that helps you. any follow up query is welcome.
Thanks..
Consult a spinal surgeon
Detailed Answer:
Hi XXXXX,
Thanks for asking.I understand your concern.
You seem to have bulging of the intervertebral disc between L4-5. It presses on the nerve that emerges through spinal canal at the site .. & affects the supplied by the nerve.In your case it is back, thigh, leg .
Actually in such cases patient needs rest till the pain is resolved .. by rest, avoiding bending.-, weight lifting ,excessive stress to spine . NSAIDs do help in the process.Physiotherapy with back extension is applied after acute pain is gone.
I feel the PT exercises created excessive stress to increase the pain in your case. Please consult a spinal surgeon for further medications & a specific physiotherapy to get proper relief & avoid further deterioration
I feel that helps you. any follow up query is welcome.
Thanks..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Athavale.
Perhaps spinal surgery is not your field of expertise. Can you however, outline the types of options a spinal surgeon might suggest, and provide your insight as to the general effectiveness and disadvantages to those options? Your opinion is appreciated, and will be used along with that of my primary care physician and chiropractor when I consult a spinal specialist.
Best Regards,
XXXXX
Perhaps spinal surgery is not your field of expertise. Can you however, outline the types of options a spinal surgeon might suggest, and provide your insight as to the general effectiveness and disadvantages to those options? Your opinion is appreciated, and will be used along with that of my primary care physician and chiropractor when I consult a spinal specialist.
Best Regards,
XXXXX
Brief Answer:
A list given below for your information.
Detailed Answer:
Hi XXXXXX,
Thanks for the query...
Being a general & family physician I had an opportunity to observe spinal problems being treated in several patients & also observe the results ... in that way, yes I can opine on several spinal surgeries conducted for nerve pinching.. within my limits I must thank you for showing confidence in me.
* First of all, let me be clear that surgical treatment for disc / spinal problems causing nerve pinching are considered as last resort, when all other nonsurgical means( medicines, physiotherapy, physical therapy) fail to relieve the problem after a fair trial for 6 months ,as per spinal surgeon's advise.
* Indication for surgery include-
-No improvement with non surgical measures after 6 months trial./ aggravation of symptoms in spite of advised treatment.
-Weakness & wasting of muscles with progressive symptoms.Difficulty in movements to affect day to day life.
-Emergency complaints like bowel or bladder incontinence
* Spinal surgery in nerve pinching symptoms is aimed at decompression of the pinched nerve & remove the root cause of problem.There are various surgeries used for the purpose including -
1. -Spinal fusion Where affected vertebrae causing nerve irritation while movement are fused together.. so as to prevent movement & pain.
Here there is restriction of spinal movement & repeat surgery may be needed for deficient healing.
2. -Foramenectomy- here the spinal foramen from which the nerve emerges out from spinal cord is stenosed to cause nerve pressure- the foramen is widened by surgery
It can make spine less stable so it is combined with Fusion.
3. -Laminectomy- Lamina is a part of vertebra ( the spinal bone.. which covers spinal cord. cutting of lamina is cut to reach the spinal cord & the site of exact pinch.
4. - Discectomy- This is the method used for the problems of intervertebral disc( a cushion like disc which lies in between two vertebrae to protect spinal cord from jerks.) It can be a bulged disc, slipped disc or herniated & broken disc. Here part of or complete disc is removed to relieve pinch/ pressure on nerve .
This is the method preferred for cases like yours.
It can be done by two methods -
- Traditional or open method- when a large incision is given & all the procedure is done under direct vision.
-Minimal invasive method -here a small incision is given on skin, spinal muscles separated to insert a tubular retractor near the point of trouble & pressing part of disc is removed.
Some times same procedure is done with help of a surgical microscope & small instruments( micro discectemy ) so that the incision is still smaller with least handling of the delicate part.
This method has an advantage of small incision & scar with early
healing.
* In both the methods implants/ filling material are used to stabilize the
spine
* In patients >55 years( where bones are already weak) a total artificial disc replacement is done to give stability to spine .. if doctor thinks so.
Results of discectomy are encouraging with immediate relief in some patients , while others take up to 3 months for gradual relief.
-5. Facet thermal ablation - is used to deaden the nerve endings causing pain & thus pain is relieved
Dis-advantages of spinal surgery - it has common complications like allergy, anaesthetia complications , blood clotting problems ,sepsis along with possibility of trauma to delicate spinal cord/ nerves ( which is negligible at hands of an expert surgeon & his experience,
** In all the decision of the type of operation used depends on the surgeon's decision & patients understanding & co operation . So do believe your doctor in case he advises operation for you.
I hope that suffices. Any follow up query is welcome.
Thanks.
A list given below for your information.
Detailed Answer:
Hi XXXXXX,
Thanks for the query...
Being a general & family physician I had an opportunity to observe spinal problems being treated in several patients & also observe the results ... in that way, yes I can opine on several spinal surgeries conducted for nerve pinching.. within my limits I must thank you for showing confidence in me.
* First of all, let me be clear that surgical treatment for disc / spinal problems causing nerve pinching are considered as last resort, when all other nonsurgical means( medicines, physiotherapy, physical therapy) fail to relieve the problem after a fair trial for 6 months ,as per spinal surgeon's advise.
* Indication for surgery include-
-No improvement with non surgical measures after 6 months trial./ aggravation of symptoms in spite of advised treatment.
-Weakness & wasting of muscles with progressive symptoms.Difficulty in movements to affect day to day life.
-Emergency complaints like bowel or bladder incontinence
* Spinal surgery in nerve pinching symptoms is aimed at decompression of the pinched nerve & remove the root cause of problem.There are various surgeries used for the purpose including -
1. -Spinal fusion Where affected vertebrae causing nerve irritation while movement are fused together.. so as to prevent movement & pain.
Here there is restriction of spinal movement & repeat surgery may be needed for deficient healing.
2. -Foramenectomy- here the spinal foramen from which the nerve emerges out from spinal cord is stenosed to cause nerve pressure- the foramen is widened by surgery
It can make spine less stable so it is combined with Fusion.
3. -Laminectomy- Lamina is a part of vertebra ( the spinal bone.. which covers spinal cord. cutting of lamina is cut to reach the spinal cord & the site of exact pinch.
4. - Discectomy- This is the method used for the problems of intervertebral disc( a cushion like disc which lies in between two vertebrae to protect spinal cord from jerks.) It can be a bulged disc, slipped disc or herniated & broken disc. Here part of or complete disc is removed to relieve pinch/ pressure on nerve .
This is the method preferred for cases like yours.
It can be done by two methods -
- Traditional or open method- when a large incision is given & all the procedure is done under direct vision.
-Minimal invasive method -here a small incision is given on skin, spinal muscles separated to insert a tubular retractor near the point of trouble & pressing part of disc is removed.
Some times same procedure is done with help of a surgical microscope & small instruments( micro discectemy ) so that the incision is still smaller with least handling of the delicate part.
This method has an advantage of small incision & scar with early
healing.
* In both the methods implants/ filling material are used to stabilize the
spine
* In patients >55 years( where bones are already weak) a total artificial disc replacement is done to give stability to spine .. if doctor thinks so.
Results of discectomy are encouraging with immediate relief in some patients , while others take up to 3 months for gradual relief.
-5. Facet thermal ablation - is used to deaden the nerve endings causing pain & thus pain is relieved
Dis-advantages of spinal surgery - it has common complications like allergy, anaesthetia complications , blood clotting problems ,sepsis along with possibility of trauma to delicate spinal cord/ nerves ( which is negligible at hands of an expert surgeon & his experience,
** In all the decision of the type of operation used depends on the surgeon's decision & patients understanding & co operation . So do believe your doctor in case he advises operation for you.
I hope that suffices. Any follow up query is welcome.
Thanks.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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