Health: Why walkers can experience this type of back and hip pain
Eric R. writes:
Late last November one weekend, my right hip felt a bit sore as I went to bed on my right side, the next day after I walked my normal 40 minutes to work, my right leg hurt. I stopped walking and used public transport from then on until my leg came right.
During the first few weeks, it did not matter where I put my right leg in bed it hurt, if I coughed or sneezed the right leg would tingle, if I sat down even for a few seconds my right leg would hurt so much it would slow my walking down to very slow walk for the first 50 meters (the doctor (GP) said 10 minutes) but even if I stood up after sitting down and waited 10 minutes before walking I would still have to walk about 50 meters or so before my leg came right.
After doing leg stretching exercise when I raised one leg at a time on the third step up a stairwell, that came right after a week.
At one stage at both side my lower rearside back would hurt, but after doing “Cat stretching” exercise, I could feel the same muscles that normal hurt. And once again after about a week these muscles did not give any more trouble. During the injury time I used ice packs and heat cream on my leg which I think was a waste of time, I think the most effective is muscle stretching exercise.
My doctor (GP) sent me off for a number of X-rays and found a problem with L2, L3, L4 (I take it L stands for lumber, the lower part of the spine) had deteriorated with age and I was told that part of the lumber was pinching on a nerve that runs down the right leg. He also told me to take up swimming or learn Thai Chi.
Now to make the plot a bit thicker I had a very similar problem at the same time of year, a year ago. That went away after a month or two. And never had any trouble for most of the year, and I kept the leg raising exercise. What lead to cure it, I missed the bus to take me to the physiotherapist and had to walk a couple of kilometers in bit of a rush to make it to the appointment on time. It occurred to me I was nursing it too long.
Which leads me to ask, how long should I
nurse it for before I ease back into walking as normal and what would be the best muscle stretching exercise all year round.
By the way I am about 60 years of age, The physiotherapist said it (L2,L3,L4) is no different, from anybody else my age, but how people who do not have this trouble get xrays just to find their spine is 100%
Gary Moller replies:
You are a good case study for an article for Walking Magazine, so thank you for writing. The kind of back and hip pain that you are describing would be one of the most common ailments that walkers contact me about. Why this kind of ailment? I think it is to do with the aches and pains and other health risks associated with getting older and it is “older” active people who most often contact me. Walking is not really the culprit. There are a number of possible causes of your discomfort:
Let’s get this one out of the way first. Some big blood vessels are located in the back and groin areas, carrying blood to and from the legs.
In about 80% of New Zealanders we can expect some degree of clogging and calcification of these blood vessels (arteriosclerosis) as the years tick by. For more information, do a Google search: “Gary Moller
arteriosclerosis”. As the flow through these blood vessels is progressively restricted, there will come a time when there may be cramping of the legs, or back/groin pain upon exertion and/or during deep sleep when blood flow is at its lowest.
A blood clot may be another possibility, forming either in the back of the knee or in the groin. A clot may be felt as a “pulled” muscle in the calf or groin, from unknown causes and which gets worse upon exertion or while sleeping. The term for this is “Deep Vein Thrombosis” (DVT) and the trigger may be stress and/or long periods of sitting, such as during air travel.
I have had one case of severe back pain which turned out to be due to the blockage of a large blood vessel in the groin. Not surprisingly, this case of back pain caused by DVT happened at Christmas time - Christmas is traditionally the most stressful time of year (For more information about DVT, do a Google search “Gary Moller DVT”).
Hints of the gradual clogging that occurs with age are: Increasing blood pressure that responds poorly, or only temporarily, to medication; taking increasingly long to “warm up” when exercising; and night cramps.
Of course, any of these warrant a visit to your doctor, or emergency service, without delay, especially if there is a sudden loss of exercise capacity, difficulty with breathing and the appearance of purple lips and cheeks. In your case, Eric, I will assume that your doctor has eliminated this possibility.
Wear and tear of joints is more likely than not as we get older and it is of no surprise that your doctor has detected some wear and tear of the lumbar vertebrae. There may also be some arthritis of the hip and knee joints.
Interestingly, though, there is a poor correlation between back pain, sciatica and Xray images showing lumbar degeneration: There may be as many asymptomatic people out there with similar “arthritic” X-ray images of their lumbar spines as there are people suffering back pain.
An X-ray for back pain is a poor diagnostic tool that is best avoided in most cases (Fact: X-rays do cause cancer; especially those of the head, chest and abdomen). To learn more about the controversy surrounding X-rays, Google: “Gary Moller mamogram myth” and for an excellent e-book on the topic, please Google: “Gary Moller Rolf Hefti”.
X-rays are warranted when there has been a violent injury and/or loss of function of muscles, bowel and bladder. For anything less, I would be inclined to give the X-rays of the pelvic regions, or anywhere else, a miss. While you may have X-ray evidence of degeneration, this may be a “red herring” as to the real cause of your pain which I suspect is mostly of muscular origin.
The most common cause of low back, groin and leg pain, commonly described as “sciatica”, is muscle spasm.
Spasm that may have been triggered or aggravated by degeneration of the low back and pinching of a nerve. The key to relief is
to focus on relieving any muscle spasm, rather than fruitlessly focusing on degeneration of joints. You can’t do much about arthritic joints while you can do a lot about sore, twitchy muscles.
When you describe your pain and the exercises that give you some relief, we can be quite certain that the muscles affected will be the iliacus, psoas, piriformis, the big gluteal muscles and the iliotibial band. Please study each of these using Google Images to search for them on line and you will see how these muscles wrap around the hips, pelvis and even attach to the lumbar spine and extend down the side of the leg.
And, it just so happens, that the nerves and blood vessels that supply the legs pass through, alongside and under these big muscles and through the narrow channels of the groin. They are prone to being squeezed if any of these muscles are hard and bunched up in spasm.
Of course, arthritis can make these muscles and nerves more irritable; but relief comes from focusing on what you can influence. It is easy to see how sciatica and back pain can arise from muscle spasm and/ or be perpetuated by it.
At least 80% of the people I test for vitamins and minerals have significant imbalances between calcium and magnesium; usually far too much calcium and too little magnesium. Calcium and magnesium must be in balance for optimum nerve and muscle function. Calcium settles the central nervous system while magnesium excites it; calcium excites muscles while magnesium relaxes them. So, an excess of calcium relative to magnesium will express as feeling tired all of the time, brain fog, fibromyalgia, cramps, migraines and even an irregular pulse (All common symptoms in exhausted athletes, by the way).
It just so happens that this calcium to magnesium imbalance is also the pattern that drives non-traumatic arthritis (Excess calcium deposits in soft tissues, including the joints - and even the blood vessels).
It’s not all about age - Your nutrition is a huge driver of health and illness. We are a calcium-soaked country with not much of anything else, thus causing the health issues we are discussing here (Arthritis, muscle pain and possibly arteriosclerosis).
How to get lasting relief
Exercise, including walking daily is most important. Walking is a wonderful exercise but it can make matters worse if not combined with daily stretching of the kind you described in your letter Eric. In my book, “Back Pain”, which you can purchase off my website ( www.garymoller.com), you will find the perfect set of exercises to stretch and mobilise the muscles about the hips and low back. Whether you have back pain or not, all walkers would benefit from doing some of these exercises daily.
Deep tissue massage, once a week, of the buttock, hamstring and outer thigh regions of the leg. Including the good side. This can give dramatic relief from about 3-6 weeks; but it has to be done right by a trained therapist (This is available at my clinic in Wellington).
Nutrition by way of restricting calcium intake while taking supplementary magnesium. However this is simplistic nutritional advice that may be only partially effective. Human physiology is incredibly complex and there can be confounding factors such as exposure to toxins like lead and arsenic (Disturbingly common).
A person’s nutritional status can be partially unraveled and understood with various remarkable tests nowadays. Contact me if you want to learn more about testing and to determine if it may be beneficial for you.
How long should I nurse my injury before getting back into walking?
Good question, Eric. I never tell a person to stop a low impact activity, like walking, for longer than about five days. Unless there has been a fracture or rupture, nothing is to be gained from resting up for longer.
Resting for longer than several days does nothing of benefit and the consequent loss of condition from too much time off can cause a whole lot of new problems with trying to get started and back to fitness again. This is especially the case as you get older - lost physical condition is harder to restore the older you are, so don’t lose it in the first place!
Eric, please rest up for only 3-5 days from the activity that causes increasing pain, while getting stuck into the nutrition, stretches from my book on back pain and weekly deep tissue massage, then resume the activity (in this case: Walking) with “baby steps”. You may need to do one day on - one day off for the first few weeks.
Aqua-jogging, swimming and Tai Chi are excellent alternatives, if walking is too uncomfortable and ideal activities for your “rest” days.
If you continue to suffer too much pain and dysfunction, despite this advice, then please go back to your doctor, or consult another experienced therapist, because there may be something else going on that has yet to be detected.
Please let us know how you get on with this advice, Eric - whether it helps you get back to walking freely - and thank you for allowing us to share this with other readers of Walking Magazine.
From left to right: Gary Moller, Tinara Kosena, Sui Kosena, Alama Moller and Alofa Kosena. Tongariro Crossing February 2014.