Pain from Lower Back to Outer Thigh: Causes and Solutions

Right lower back to the outer thigh?

Hello Doctor, I started jogging on December 1, 2015, and everything was going well until April of this year.
At the end of April, I ran for an hour continuously, and the next day I felt pain in the upper right side of my lower back (possibly the lower back area).
The pain has persisted and radiated to the outer side of my right thigh, which feels sore (and occasionally numb at certain angles).
There is no pain when pressing on the surface.
In the first few days after the initial pain, even walking was painful, but I returned to normal after getting up in the morning.
The pain became more noticeable as the day progressed, and the symptoms resolved on their own after about a week (I consulted a doctor during this time, but did not undergo rehabilitation; the doctor mentioned that I had tendonitis in my lower back).
Then, at the beginning of June, it recurred, and it has flared up again in the last couple of days.
I am unable to stand and lean back, and I can't determine if it's muscle pain or spinal pain.
I want to seek medical advice actively.
Should I insist on having an X-ray, or should I stop exercising and self-monitor for a month or two?

Rongrong, 20~29 year old female. Ask Date: 2016/07/01

Dr. Cai Shanglin reply Orthopedics

Tendinitis is possible, and this condition may not be visible on X-rays.
Diagnosis primarily relies on medical history and physical examination.
Based on your description, it seems to resolve on its own without any treatment, but it recurs.
It is still advisable to undergo further evaluation, such as X-rays or specific physical examinations of the spine, to rule out any spinal issues.

Reply Date: 2016/07/01

More Info

Understanding pain from the lower back to the outer thigh can be quite complex, as it may involve various anatomical structures, including muscles, ligaments, nerves, and joints. Based on your description, it seems that you have experienced recurrent pain in your lower back and outer thigh, particularly after engaging in running activities. This pain has been characterized by a sensation of tightness and occasional numbness, which can be indicative of several underlying issues.

Possible Causes of Your Pain
1. Muscle Strain or Tendonitis: Given that your pain began after a prolonged running session, it is possible that you have strained the muscles or tendons in your lower back or hip region. Tendonitis, which is inflammation of the tendons, can occur due to overuse, especially in activities like running.

2. Lumbar Radiculopathy: The pain radiating from your lower back to your thigh could suggest nerve involvement. Lumbar radiculopathy occurs when a nerve root in the lower back is compressed or irritated, often due to a herniated disc or spinal stenosis. This can lead to pain, numbness, or weakness along the path of the affected nerve.

3. Piriformis Syndrome: The piriformis muscle, located in the buttock region, can sometimes irritate the sciatic nerve, leading to pain that radiates down the leg. This condition can be exacerbated by activities that involve repetitive hip movements, such as running.

4. Iliotibial Band Syndrome (ITBS): This condition is characterized by pain on the outer side of the knee or thigh and can occur due to overuse, particularly in runners. The iliotibial band can become tight and inflamed, leading to discomfort during activities.

5. Facet Joint Dysfunction: The facet joints in the lumbar spine can become irritated due to repetitive motion or poor biomechanics during running, leading to localized pain that may radiate to the thigh.

Recommendations for Management
1. Rest and Activity Modification: It is crucial to allow your body to recover. If running exacerbates your symptoms, consider taking a break from high-impact activities. You might switch to low-impact exercises, such as swimming or cycling, to maintain fitness without aggravating your pain.

2. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can assess your movement patterns, strengthen the muscles around your lower back and hips, and provide you with specific exercises to improve flexibility and stability.

3. Pain Management: Over-the-counter anti-inflammatory medications, such as ibuprofen or naproxen, can help manage pain and inflammation. However, consult with a healthcare provider before starting any medication.

4. Diagnostic Imaging: If your symptoms persist or worsen, it may be prudent to pursue imaging studies, such as X-rays or MRI, to rule out structural issues like herniated discs or other spinal abnormalities. This can provide valuable information for your healthcare provider to tailor an appropriate treatment plan.

5. Gradual Return to Activity: Once your symptoms improve, gradually reintroduce running into your routine. Start with shorter distances and lower intensity, and pay attention to your body’s signals. If pain recurs, it may be necessary to reassess your running form or footwear.

6. Consultation with Specialists: If your symptoms continue despite conservative management, consider seeking a second opinion from a specialist, such as an orthopedic surgeon or a sports medicine physician. They can provide further evaluation and treatment options.

Conclusion
In summary, the pain you are experiencing from your lower back to your outer thigh may stem from various causes, including muscle strain, nerve irritation, or overuse syndromes. It is essential to listen to your body, modify your activities, and seek appropriate medical evaluation and treatment. By taking a proactive approach, you can work towards alleviating your symptoms and returning to your running routine safely.

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