who likes a challange-advice required

[maddyosm]

looking for a bit of advice-heres the story so far 40 year old
keen skier,mountainbiker,climber up until 3 years ago
fractured tibial plateau which required screw
previous long standing back problem which radiated into hip and buttock didnt restrict me in any activities
rehab went ok but started getting pain in quads and posterier thigh and had to rest for some months then got back to doing some serious miles in bike then same thing happened.
advised i had hamstring problem by a physio
given exercices to strengthen hamstring but found i couldnt walk next day after exercices stopped going to physio and thought i would seek medical advice mri negative,nerve conduction study showed stretched l3 at nerve root
my main problem is in my posterier thigh as i walk hamstring tightens and then spasms with shooting pain down to about my knee.i cant sit for long and driving is a nightmare.i cant lie on my hip (mri of hip negative)
i take gabapentin but its not that helpfull ive had to give up all my outdoor activities
my question is is this sciatica and would physio be helpful the only advice i got from doc was dont exercise so much

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[mIrAge]

The information you have had given builds a picture of someone with a trapped nerve or a sensitive nerve which does not like to be stretched. Nerve conduction study does little in picking up sensitised nerve root.

Can you tell us if stretching your hamstring brings on the same shooting pain.

[maddyosm]

hi there thanks for your reply
I stretch my hamstrings a fair bit,doest bring on the pain,relieves it a bit as they tighten up when walking.i can reproduce the pain when lying on my back with knees flexed.Step ups also bring on the pain it gets really bad if i lie prone and do straight leg lifts,this was the original exercise that really highlited the problem(i dont do that exercise anymore)
Sitting and driving also bring on the pain.

any ideas
cheers
maddy

[maddyosm]

Anybody out there-Went to see a pain specialist who thought it was sciatica.Now had epidural no effect ,could this be a trapped nerve in the leg itself.
Could physio help

[Hallamshire Physiotherapy]

Hi Maddy
Just found your thread. First of all there is nothing wrong with your hamstrings so please stop stretching them. Your hamstrings are spasming as a protective response to your back problem. You need to work out what you are doing when you extend your lumbar spine. If you are hinging from a particular level you will compromise the nerve root and this is probably the thing that is referring pain into your leg.
The fracture of the tibial plateau probably altered how you use your leg and this would compound your long standing back problem. You probably have a very good range of movement in your lumbar spine and possibly too much movement. Seek a physio who will analyse how you walk, weight bear through your old fracture side and change how you use your spine in a weight bearing position. Please note this is not 'core stability ' ( most spines are already too stable but thats another story!)as this will only serve to load the problematic spinal level .
Hope this helps
Steve

[Canuck Physio]

Hi there,

I would tend to sway towards the advice of Hallamshire Physio.

Naturally after a fracture much changes occur along the kinetic chain ie. weight bearing ankle, knee, hip, and ultimately spinal levels.

More often than not, we see over isolation of a specific muscle group, or over generalisation of global force coupling or muscular slings (terms that denote the connection of muscle groups in relation to the force they apply across bones and joints).

Although the pain is very localised, and local therapy may help to reduce the pain, it appears a global rehabilitative protocol has been neglected. An exercise only approach, although highly evidence based, neglects the importance of the Artistic aspect of function and form that is discovered through postural analysis.

One should definitely seek a physio for their advice, and in fact for temporary pain relief of nerve issues I would even suggest poorly evidence based modalities (because clinically they provide great relief to patients to enable them to move or exercise, or be manipulated in a manner that allows specific changes to be invoked).

Also, just like taking anti-biotics, one must finish the whole course, the same must be said of Physiotherapy. One aught to continue through the entire course before waving off the therapy. Physio and Rehab are non-invasive, but evidence based fields that provide opportunity for hastened return to activity.

All the best

[maddyosm]

Hi guys thanks for getting back to me.
I will be going to see a physio,i think that was the plan if the epidural didnt work which it hasnt.
Hallamshire Why no hamstring stretches ?
Cannock- I finished with the physio as she was making the problem worse and woundnt listen to what i was telling her-she was focused on hamstring only,Her plan was to discharge me in other few sessions anyway i just preempted this.

maddy

[Laura Jayne Physiotherapy]

Hi Maddy

How is your problem now. The advice of Hallamshire Physio looked good.

www.laurajaynephysiotherapy.com