Health: Why walk­ers can ex­pe­ri­ence this type of back and hip pain

Walking New Zealand - - Contents - by by Gary Gary Moller Moller Dip Dip Ph Ph Ed Ed PG PG Dip Re­hab PG Dip Sport Med (Otago) FCE Cer­ti­fied

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:

Car­dio­vas­cu­lar

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.

Arthri­tis

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.

Mus­cu­lar

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.

Nu­tri­tion

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.

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