Lower Back, Hip, and Leg Pain: Causes and Solutions

Q: Lower Back, Hip, and Leg Pain: Causes and Solutions

Hello Ms. <br>Li： Your issue is quite complex and requires a personal consultation and physical examination for further assessment. <br>It is recommended that you visit the Rehabilitation Medicine or Orthopedic outpatient clinic.

Issues related to the lower back, hips, and lower extremities?

Hello Dr.
Zhou! Here is my condition: In October 2009, I fell from a height due to a car accident, impacting my left hip.
Symptoms included soreness, numbness, swelling, and limping.
I had difficulty walking, going up and down stairs, and mounting a motorcycle, requiring assistance for a month.
X-ray examinations showed no skeletal injuries.
Two weeks after the incident, I underwent traditional Chinese medicine treatments, including massage and acupuncture, for three months (2-3 times a week).
Since then, sitting for extended periods (>6 hours), cold and damp weather, and intense exercise (such as sprinting, jogging for over 30 minutes, freestyle swimming, tennis, etc.) have caused significant stiffness, heaviness, and pain in my left hip, lower back, and legs.
Consequently, my physical activity has decreased significantly, and I primarily engage in walking and stretching exercises now.

In December 2015, I noticed that my left hip (the one impacted in the accident) appeared smaller than my right hip.
Could this be due to muscle atrophy from lack of exercise after the injury? How should I address this situation? By mid-December 2015, I experienced soreness, numbness, and heaviness in my right hip, groin, right thigh, and lower back, which has persisted.
On some days, the pain has been severe enough to disrupt my sleep, waking me up at night.
During this period, I have undergone electrical therapy and heat application, but there has been no improvement.
Could this condition be related to the size difference between my hips, poor posture, or uneven exertion during activities? Do I need to undergo any specific examinations, and what tests can be performed to rule out issues and achieve an accurate diagnosis? Should I continue with electrical therapy and other rehabilitation methods?
In recent years, I have experienced various musculoskeletal discomforts, primarily on the left side.
I am unsure if these are related to the impact on my left hip from the accident.
In mid-2014, I had sharp pain in the sole of my left foot, diagnosed as plantar fasciitis at an orthopedic clinic.
After 1-2 months of electrical therapy, heat application, and stretching, I recovered to a point where it no longer affected my walking.
By the end of 2014, I experienced symptoms of soreness, numbness, and pain in my left scapula, lower back, left hip, left arm, and left leg, particularly at night in cold weather.
Additionally, I had pain in my lower back (on the right side) triggered by sneezing, making it difficult to stand straight.
X-rays showed no issues with bones or nerves, but an incidental finding indicated that my lumbar spine was too straight, lacking elastic space.
I did not receive rehabilitation treatment for these two issues but have been following my physician's advice to perform core muscle training and stretching.
Currently, I occasionally feel tightness in my lumbar spine and experience soreness and numbness in my scapula and other areas during cold weather.
Another issue is with the popliteal area of my left knee, which often causes sharp pain and limping after walking for a while.
In February of this year (2015), after hiking for about 1-2 hours at Xitou, I experienced slight sharp pain while going downhill, which resolved the next day.
Subsequently, in June, after a 3-hour hike on the Lala Mountain Trail, I experienced sharp pain again while descending, with limping lasting for a week.
In August, carrying less than 5 kg, I walked for 1-2 hours on flat ground, and upon starting to walk up stairs, I began to feel sharp pain and limping, which eased with stretching but lasted for four days.
In October, I experienced sharp pain after walking for 20 minutes on flat ground without any load, with limping lasting about four days.

Li, 20~29 year old female. Ask Date: 2015/12/31

Dr. Zhou Jianwen reply Rehabilitation

Hello Ms.
Li: Your issue is quite complex and requires a personal consultation and physical examination for further assessment.
It is recommended that you visit the Rehabilitation Medicine or Orthopedic outpatient clinic.

Reply Date: 2015/12/31

More Info

Understanding lower back, hip, and leg pain can be quite complex, especially when there is a history of trauma, such as a car accident. Your symptoms suggest a multifaceted issue that may involve muscle strain, nerve irritation, and possibly joint dysfunction. Given your detailed history, let's break down the potential causes and solutions.

Causes of Pain
1. Post-Traumatic Changes: The car accident you experienced in 2009 could have caused soft tissue injuries that may not have been visible on X-rays. These injuries can lead to chronic pain due to inflammation, scar tissue formation, or muscle imbalances. The symptoms of stiffness, numbness, and pain in the left hip and lower back could be related to these changes.

2. Muscle Atrophy: You mentioned that your left gluteus muscle appears smaller than the right. This could indeed be a result of disuse following the injury. When a muscle is not used regularly, it can atrophy, leading to weakness and imbalance, which can exacerbate pain and dysfunction.

3. Nerve Involvement: The symptoms of tingling and numbness suggest possible nerve involvement, which could stem from the original injury or from postural changes and muscle tightness that may be compressing nerves.

4. Poor Posture and Movement Patterns: If you have developed compensatory movement patterns due to pain or weakness, this can lead to further strain on your muscles and joints, resulting in pain. For example, favoring one side can lead to overuse of certain muscles while underusing others.

5. Degenerative Changes: Over time, the lack of movement and the stress placed on your body from compensatory patterns can lead to degenerative changes in the spine and hips, contributing to chronic pain.

Recommended Solutions
1. Comprehensive Evaluation: It would be beneficial to undergo a thorough evaluation by a healthcare professional, such as a physical therapist or orthopedic specialist. This evaluation should include a physical examination and possibly imaging studies like MRI to assess soft tissue structures and any potential nerve compression.

2. Physical Therapy: Engaging in a structured physical therapy program can help address muscle imbalances, improve strength, and enhance flexibility. A physical therapist can design a program tailored to your specific needs, focusing on strengthening the gluteal muscles, core stability, and improving overall biomechanics.

3. Pain Management: Since you have experienced significant pain, exploring pain management options may be necessary. This could include medications, such as NSAIDs, or alternative therapies like acupuncture or massage therapy to alleviate pain and improve function.

4. Activity Modification: While it’s important to stay active, modifying your activities to avoid exacerbating your symptoms is crucial. Gradually increasing your activity level while incorporating low-impact exercises, such as swimming or cycling, may help.

5. Postural Training: Working on your posture and body mechanics during daily activities can help reduce strain on your back and hips. This includes being mindful of how you sit, stand, and lift objects.

6. Core Strengthening: Strengthening your core muscles can provide better support for your spine and pelvis, potentially alleviating some of the pain you experience.

7. Regular Follow-Up: Given the chronic nature of your symptoms, regular follow-up with your healthcare provider is essential to monitor your progress and make adjustments to your treatment plan as needed.

Conclusion
Your situation is complex, and while the initial injury may have set the stage for your current symptoms, ongoing management is key to improving your quality of life. By addressing muscle imbalances, improving your physical condition, and managing pain effectively, you can work towards reducing your symptoms and enhancing your overall function. Always consult with a healthcare professional before starting any new treatment or exercise program to ensure it is appropriate for your specific condition.

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