Pain in back of leg and buttock.

by Jim
(La Crosse, Kansas, USA)

I have had several bouts of moderate to severe pain in the buttocks and the back of the thigh of my left leg. The current manifestation differs somewhat from earlier bouts, but is largely the same.

This one often, especially at the beginning, prevents me from sitting due to intense, fiery pain in my left buttock and the back of my left thigh. I can stand and walk for many hours, and I have been able to lie down and sleep. Sitting, whether to relax, have meals, or visit with friends, has been mostly impossible.

When standing, especially after long hours, the pain seems muscular, and tension like. It can be distracting, but is not usually intense, such as occurs when I try to sit.

The pain of sitting is intense, and sometimes feels close to the skin surface, rather than seated in the muscle. At these times it is definitely on the under side of the thigh, with the sensation of fiery heat pain sometimes extending to the skin on the inside and outside of the posterior thigh.

Though this period of pain started only about three weeks ago, rather suddenly at the end of March, 2014, I have had recurrent leg and buttock pain for almost a year now.

The immediate preceding period began in mid September of 2013, and extended through mid January, 2014. During that entire period I could not sleep more than 4 hours at a time. The pain would awaken me, and I had to walk it off, for roughly an hour, before I could sleep again. That period began with a time - a week or so long - during which my muscles were cramping often.

This included my feet and my hands, where my thumbs would lock into my palms while typing on the computer and have to be pried out and my hands massaged briefly before I could continue typing.

Toward the end of that previous bout I noticed that my left buttock seemed shrunken and flaccid, except for what felt like knotted cords under the loosened skin. When the pain finally passed, rather suddenly after doing some floor exercises, it did not take long for my left buttock to return to a more normal shape and condition. On that basis I have speculated that, at least that time, I was suffering from "piriformis sciatica".

I have associated the beginning of this period of recurring buttock and leg pain with a sudden, severe, but short illness I suffered in November, 2012. That manifested as extreme weakness, high fever, and disorientation lasting about 60 hours. During part of that time the strength of my lower abdomen and back reduced to the point I could not sit up in bed or control my bladder effectively. Afterwards, my strength returned, but I felt achy, sore, and like I had little or no resilience or endurance.

At this point I am considering an appointment with a rheumatologist, in hopes of establishing a cause of and treatment for these incidents, including the possibility that surgery may be necessary. I wonder what you think of all this, and what other treatments may be useful?

Hello Jim,
These may be related, but I'm of the opinion - seen from a distance, and thus speculative, of course - that you have two different problems.

1. A fairly typical sciatica, but that would need to be confirmed by a positive Slump test for sciatica. Take the test and confirm it. The gluteus muscle in the buttock, the shrunken one, is supplied by the same nerve as the back of the thigh pain.

2. The locking thumbs sounds more neurological to me, and I would recommend a consult with a neurologist. The high fever may or may not have been related.

I would presume you have had some xrays taken of your lower back. What do they show? If not, get some, with the anterior posterior view taken standing.

Sitting increases the pressure in the disc reportedly up to twelve times; sit much less and choose your chairs carefully. Perching is better.

If you aren't doing any exercises, start these lower back exercises and do them faithfully every morning before getting out of bed; several times a day would be better.

It's your choice whether to go for surgery, or see a chiropractor. Neither can guarantee a cure and a lifetime of good back care is ahead of you. Accepting you can no longer lift the grand piano and lots of bending and twisting, and that you must exercise daily.

This is a condition that we treat on a daily basis and generally the results are good and the risks are low. The worst that might happen is that it simply doesn't get better.

Good surgery would probably fix the problem in the short term, but you're still in for good back care for life and the risks are much higher; the cost too.

I hope this contributes.

Dr B