1st:
Dear Sir/Madam,

I’ve just read your website (under ‘chiropractor stuff’) and took note of the ‘trapped nerves’ advice – ie. to be quizzical about this diagnosis.

I’ve had 4 years of leg pain (just in one leg – a deep ache from hip to foot, which is much worse when walking uphill or trying to cycle up an incline) and have just been told (by a physio) that the sciatic nerve is ‘irritated’. Since the piriformis muscle aches – and the sciatic notch aches – but only when I am moving – I suspect there might be ‘compression’ of the nerve in that area. I now have foot pronation and pain at the adductor origin/rectus femoris origin in that leg. And the knee aches deeply too (when repeatedly bending)

I’ve had no success with NHS physiotherapy – and no diagnosis has been given. (MRI scans showed inflammation at the adductor muscle and in the butt – but no other damage.)

I’m in danger of being shunted off to NHS ‘Pain Management’ – which I see as a watershed.

Do you think a chiropractor could figure this out? (My pelvis is slightly ‘down’ at that painful side.)

Does it ring any bells with you – as a pain pattern?

Any advice or insight would be welcome!

2nd, my reply:
I think the key feature of what you’ve added here is that your pelvis is ‘down’ at the painful side as this is a huge problem and may be the key underlying cause. See our blog articles here as well as some others:

http://chiropractor.blog.co.uk/2009/11/05/leg-length-inequality-the-whys-7313331/

http://chiropractor.blog.co.uk/2009/10/29/leg-length-inequality-what-s-going-on-and-can-chiropractic-help-7268588/

I’d get along to a local chiro and get then to have a look at this aspect of your problem as it is obvious to me no one has yet bothered to treat this part of the issue (why would you ignore such an important anatomical change as this) and you’ve not been responding to other care, well, perhaps, just perhaps it’s because they’ve been looking in the wrong place (which is incredible common).

Take it to a chiro and emphasis the leg length discrepancy bit and tell me how it works out.

3rd, patient’s response:
Dear Rupert,

Thanks ever so much for your email and advice – I really appreciate it!

Just yesterday, my cousin visited from the States – she’s an experienced physio – so she examined me and believes the underlying cause is a joint dysfunction (she found a noticeable leg length difference when she pulled me up into a ’sitting-up position’ from laying down) -and believes this is causing muscles/tendons to be ’sore’. She said to treat that underlying joint problem (not try to strengthen the muscles with ankle-weights etc, as the NHS physio has been doing)!

So you’re right in your view – and I will go and see a chiropractor asap!

(I have to persuade the NHS that this is the problem. Physio-Cousin was trained in UK and doesn’t understand why they haven’t nailed the problem so far. I must’ve been sent to nearly 75 hospital appointments since 2006…)

Am hoping it’s fully fixable/curable – and I will drop you a line and let you know what happens!

Many thanks.

Regards,

4 years and over 75 appointments and no one has bothered to give a diagnosis or mention the leg lenght discrepancy – incredible!

This great study shows fairly clearly that glucosamine isn’t likely to help people with low back pain that’s caused by arthritis.

This came from an excellent artical in the Guardian and written by the BMJ Group and sets this out perfectly:

“Glucosamine supplements – widely used by people with arthritis or other joint problems – don’t help the pain of a bad back, new research has found.

What do we know already?
Glucosamine is a natural supplement, often made from shellfish, although you can also get synthetic, vegetarian forms. It’s a building block for the chemicals used by the body to make cartilage – the smooth, shock-absorbing material that helps protect your joints. The theory is that taking glucosamine helps prevent the breakdown of cartilage and so reduces joint pain.

Glucosamine supplements are a popular treatment for arthritis, and increasingly for back pain. Despite their popularity, the scientific evidence around glucosamine supplements is fairly limited, with the best quality studies suggesting little benefit.

In a new study, researchers have looked at whether glucosamine supplements can help people with long-term back pain caused by arthritis of the spine.

What did the research say?
For six months, 250 people were given either daily glucosamine supplements or an inactive placebo treatment. The amount of disability people had because of their back pain fell, but this was the same for both groups. There was no difference between glucosamine and a placebo.

The researchers also looked at the amount of back pain people had, both at rest and when active. Glucosamine didn’t make any difference. People taking glucosamine got the same amount of pain as people taking a placebo.

The most common side effects were skin problems and an upset stomach, but overall, people taking glucosamine didn’t get any more problems than the people taking a placebo.

How reliable is the research?
This was a good-quality study looking at 250 people. People were allowed to carry on with any other treatments they were using, such as painkillers, although a similar number of people did this from the placebo and glucosamine groups, so it shouldn’t have affected the results.

By counting the leftover pills, the researchers worked out that people had taken about 80 percent of the recommended dose of glucosamine. This reflects the real world, where it’s easy to forget treatment every so often. Even so, it’s theoretically possible that people would have seen more benefit if they’d taken the full dose.

Where does the study come from?
The study was done in Oslo, Norway. It was published in the Journal of the American Medical Association, which is owned by the American Medical Association.

Funding came from the Norwegian Low Back Pain Association, the Norwegian Chiropractic Associations Research Fund, and the Wilhelmsens Research Fund. The supplements used in the study were provided by a company called Pharma Nord.

What does this mean for me?
The study shows fairly clearly that glucosamine isn’t likely to help people with low back pain that’s caused by arthritis.

What should I do now?
Back pain can be hugely frustrating, as there’s often no one treatment that makes a big difference. People often try lots of things before they find something that works for them. It’s often a case of finding a way to live with back pain, rather than finding a cure.

Your GP can suggest treatments that are worth trying, and some people also find seeing a physiotherapist helpful. Many people do try alternative treatments, but make sure you’re clear about what the benefits and side effects are likely to be.

From:
Effect of Glucosamine on pain-related disability in patients with chronic low back pain and degenerative lumbar osteoarthritis: a randomized controlled trial. Wilkens P, Scheel IB, Grundnes O, et al. Journal of the American Medical Association. 2010; 304(1): 45-52.”