Leg pain (hamstring, calve) and often lower back pain

[superward]

Hi,

I was looking for some advice.

I am currently experiencing a lot of pain in my left leg. Most days it is in my hamstring but can also be in the side of my calf or the full leg. It is brought on my by walking (even if only for 5 mins) and once sitting down goes away. I also experience at some times pain in my lower back on the left side just above my buttock which may be connected. But, the leg pain is the most prevalent and painful

I play football 1/2 times a week and while playing it seems to subside but if I stop and stand it often comes back.

Last summer I hurt my back while at work, literally by standing up out of a chair, and could hardly straighten up/tie shoe laces/bend to get something without being in extreme pain which may be connected?

I also have extremely tight hamstrings...always have.

Does wanyone have any advice on what I can do or the causes for this?

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[alophysio]

Hi,

It sounds like the back is involved. The symptoms are commonly known as Sciatca although this will need to be checked properly.

There are many reasons why you might have pain in the leg. The fact that moving helps your pain may mean you have a sustained position dysfunction and need to learn to control your posture differently to how you currently hold yourself.

Just because your hamstrings are tight, it doesn't mean they are - they might just be overactive in trying to protect you.

If you haven't seen a physio yet, do so. Find a good one. If you have seen a few, then let us know what they have done to see if there are any gaps we can help with... Cheers

[superward]

Hi,

Thanks a lot for your reply.

I was at a physio last week, got an appointment on Monday with a different one for a 2nd opinion.

The physio I seen implied it was from hurting my back last summer and the muscle being over protected and therefore being very tight and impinging the nerve.

She gave me 6 excercises...well describe best I can

A back arch from press up position
A back arch with arms behind back
Sitting striaght, legs out straight, moving feet back an forth to loosen muscle at bottom of spine.
Lying flat on back, knees together and bent, twist to side and arch back
From chair, leaning over touching ankles to stretch back
Hamstring stretch with both legs holding feet and trying to straighten out.

The last one is VERY painful on my left leg - the one affected.

Will update with what happens on Monday...but what do you think of above?

Thanks a lot in advance

[alophysio]

HI,

DIfficult to say withouyt having examined you but i usually dn't prescribe painful exercises or stretches. From the set of exercises given, perhaps the first 2 are McKenzie extension exercises, the 3rd maybe a neural mobilisation exercise, the 4th a general rotation stretch/mobilisation, 5th a back stretch for the muscles at the back of the back (if you know what i mean!) and the last seems like a very intense hamstring stretch.

The above exercises seem ok but i really don't like the sound of the last one. Many better ways to do stretches and mobility exercises than both legs at the same time.

The main questions are...

...do you feel better for your attendance?

...do you have a decent understanding of your problem (a diagnosis)?

...does this diagnosis sound right to you? - in other words, did you sit there and go "yeah, that makes complete sense!"?

Good luck!

[Canuck Physio]

Lot's of work is needed, no one thing normally will get this done...

These are key areas needing work:

- Soft tissue
- Ergonomics (Gravity acts on us 24hrs/day - its your choice whether that is 24 hrs in good alignment or poor alignment -*NASA studies and bed rest studies show that bed rest ain't the solution).
- Muscle recruitment, balance, spasm etc. (based on the onset of injury it says that something was wrong before that point: in that muscles were not recruiting properly, and your muscles had to spasm and become inflamed to protect you).

Indeed referred symptoms will require much of the work around torso etc.

[alophysio]

Hi,

Thanks Canuck Physio, well said.

Superward, you didn't mention what the physio did for treatment...was it the exercise prescription only? Or was there some soft tissue massage? Stretches? Joint mobilisations? machines used?

I think the point perhaps Canuck Physio was trying to make was that exercises alone is not all there is to treatment (?) - indeed, there are many things that you could address in this condition. At least that's what i am thinking...

[superward]

Hi,

Thanks for all your replies...a little update.

Been a couple of times to the 2nd physio.

She prescribed 5 excercises to me...

1. Sittin on chair, straighten knee as far as possible (probably only about 60 degrees at mo) and bring toe towards me and away.
2. Back stretch from chair as above
3. Lying on back with arms in T position, knees bent, roll both legs side to side,
4. Lie on back, left leg at 90 degrees, rotate hip across body by pulling on toe with belt to stretch muscle in me bum (pirifiros?)
5. A back arch stretch from press up position

The 4th excercise gives me a lot of releif and I think by doing this overall I have had some reilief but in general it is still pretty painful.

On my 2nd visit last monday she used some ultrasound on my back and also some massage. She also was doing something down the bottom of my spine which involved a lot of pushing and pain but really seemed to loosen it up.

Her diagnosis is "stiff" lower back joints and possibly anothe impingement in my piriforsi/bum msucle.
What does everyone think?

[alophysio]

HI,

my thoughts are that you have overly compressed joints and that is why you find relief from the stretching and manual therapy and heat.

Peter O'Sullivan calls it "active extension" pattern. Others call it other things.

[sixphysio]

your physio needs to tell you what is causing the problem, rather that what it is. why the "stiff joints" type of thing.

if the physio can tell you why then you need to have those bits pushed and moved around and the other painful bits stabilised.

none of it should hurt or be painful - it'll feel like your being pushed, but that's all.

can't understand machines - or their users!

as alo said if it smells and tastes right to you (ie you understand what's being said and why) then crack on. i'm sure we'd all do different things, but as long as you are getting better (rather than told you are) then all's good.

cheers

sixphysio

[eshuro]

Hi,
If your physio gave you already a lot of exercises to do and some massages too but still you're not feeling well, why don't you take another opinion , 2nd or 3rd opinion if I may say so...try the link below and check it out.....'coz it works on me !!..just sharing..

[angela1]

It may be your sacroiliac joint, which is where the dimples are on your 'hip' bones at the back. In footballers it is generally a problem in the non kicking leg. If it hurts to walk more than sit it is possibly this joint.

[rodneyani]

Regular massages can help. A leg massager can be very relaxing, but use one only if your doctor recommends.

[mavenlive]

If you're not progressing with the exercises and treatment that one physio is providing, I would recommend seeing another therapist. Not everyone is expert at everything. It would be best to find a therapist who specializes in your injury and/or body part.

_____________________________
Mavenlive Community Driven Physical Therapy Software

[Laura Jayne Physiotherapy]

It sounds like referred pain. A second opinion wouldn't hurt as physios practise in different ways. This must be incredible frustrating and i hope you find the solution

Laura Jayne Physiotherapy

[markmiller]

I read through all the posts here, but they do not get to the root of the issue, which I would be willing to bet is in your hips. When I hear someone has back pain, sciatica and tight hamstrings, it almost always means they have some form of kyphosis. Simply put, that means you have a flat lower back. that flat lower back is causing the vertebrae in your lower back to compress and put pressure on the delicate nerves back there which causes pain down the leg. Until you deal with the postural distortion in the hips that is causing the flat low back, you aren't going to get much benefit and start feeling less pain.

Check out your posture in a mirror. Take off your shirt and look at yourself from the side. Do you see your butt tucking under your pelvis? Do you see a pretty flat lower back? If so, that would really help explain all of your symptoms. You will need a good rehab program to help correct the kyphotic posture, which, by the way is extremely common. Some of the major components of it are- tight hamstrings and glutes, weak quads and core, including psoas.

talk to your therapist about it and see if they can design a good rehab program for you. Otherwise, if you are looking for a cheaper alternative you can follow at home, check out the SMS low back program. I have seen that program really help a lot of people recover from low back pain without drugs or surgery.

[alophysio]

Hi Markmiller,

Certainly, you make a good point and a flat back is a common cause of sciatica and back pain and tight hamstrings.

...however, it is not the only reason...

In this case, from 3 years ago, the information given would seem to suggest an increase in lordosis which can also go with the hamstrings feeling tight because they are lengthened and the facet joints compression which can cause referred pain.

It is why I feel we have to be very careful in giving people things to do without an assessment on the internet. Sharing ideas and exercises are great which is why I like to come here but giving someone advice which is not the best for their situation is fraught with danger...

Thanks for the information though - i am sure it is quite useful for the right patients.

[markmiller]

I agree that we do have to be careful about giving advice without an assessment and we are certainly guessing since we cannot see the person in question. I do not intend to give anyone advice that would cause harm... On the contrary, I am not saying his person has kyphosis, but to suggest a hypothesis he probably has not thought of himself and to look into it further. And if he does have lordosis, that would be important to know as well. In either case, it will be helpful not only for this person, but all others who have similar issues and read this thread. Thank you for your comments and please remember that my only intention is to be helpful.

[alophysio]

Thanks Markmiller - fair enough...I have had to be more careful with my own language here on the forum by learning the hard way... I appreciate your sentiments and totally agree that you are only trying to help

I know i personally appreciate your input and hope to see you around here more

Cheers!

[markmiller]

Thanks, I do plan to be a more regular contributor...

[saunaboy]

I'm not a physio but...

I had hamstring pain & tightness after cycling (I was on here a while ago). I was told by a physio to stretch & this set off a whole host of issues. Pain in medial & lateral hamstrings at knee, back pain, calf pain.

Turns out I have mega tight hip flexors that (after training my quads for the bike and a desk job) got worse. Stretching the hamstrings 1) made the tightness & hip imbalance worse and 2) injured them to the point of tendonitis.

It's just now that I'm aggressively stretching/rolling quads, lower back and hip flexors that 3-4 months of intractable hamstring pain is easing off (in the space of about 2 weeks). But now I'm stuck with a difficult adductor/medial hamstring tendon issue that may take months to resolve.

Be very careful & I would echo the advice on here to seek another opinion of the advice of one physio doesn't help.

[alophysio]

Hi Saunaboy,

thanks for the warning in your own story...just wondering...perhaps you acutally irritated the sciatic nerve during your hamstring stretches which is why you have pain in the medial and lateral hamstrings and calf pain, back pain etc?

Do you really have mega tight hip F or just overactive ones? There is a difference...

From the sounds of your story, I would look at your back or thorax more closely...for what it is worth

Cheers!

[saunaboy]

I have no idea if the hip flexors are tight or overactive. All I can go on is the info from my current physio. What I can say is the following if it's any help (and please feel free to suggest anything you think may be of use!!)

1) thomas test is a joke on the right hand side. when I lay back originally, my right leg was actually not able to fall even to the horizontal - it was suspended by about 10 degrees. After basic hip flexor stretches it's gone to about 5 degrees below horizontal. Going any further past that is proving impossible.

2) Quad stretches can be painful (in the knee) & the leg is impossible to keep straight below body during the stretch.

3) Since I have started to release the hip flexors, that is related to the adductor strains. Before the release, cycling caused pain in sartorius & medial knee, after release, I get a chronic pull in the adductors low down into the knee.

4) Rolling IT band has massively increased flexibility in IT band test. Hip pain has stopped.

I do still have some anterior pelvic tilt, but I now have (or at least I feel I have) far less hamstring pull. It may be placebo but my back is easing up as well. I have lost the constant thigh burning that I had but still have a stiffness & vague burning in the inner thigh & top of calves. The area of the inner thighs about 10cm above the medial knee is very irritated.

I do have a very flexible back. Tight low down into the pelvis on right hand side.

Reason I made the point is that all this started with a sore right inner knee !!!!!!

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[NancyWGrace21]

Thanks, I do plan to be a more regular contributor...