By Bernard Preston

L3 far lateral entrapment with severe thigh pain on walking and quad weakness

by Lisa

I had a herniation down the L3 nerve root 3 months ago with quads weakness and severe thigh pain on walking.

Motor function nearly normal but my back up to the thorax is still stiff and sore and when I flex the knee and bend forward on a stool I get the thigh nerve pain a bit. My walking is now much slower and I can’t really get up hills.

Do you think I still have a chance of full recovery at 6 months?

I’m 52 and previously active fit and well I’m having physio every 2 weeks.

Ps I followed all your advice and found it very helpful - I see you have had the same injury.

Good morning, Lisa,
I'm sorry to hear about your troubles and, yes, I have the T-shirt. It was extremely painful, and I was very lucky to escape the knife.

It's very difficult to compare two cases, yours and mine, especially when the treatment is so different. The big question always for me, is it still improving? Are you better than two weeks ago?

It's very good that the strength of the quad - you say quads, did it affect both legs? - has returned. And the reflex?

Bending with the knee bent is presumably stretching the femoral nerve, hence the nerve pain. Ask the PT to do the standard stretch test with you lying on your tum, knee bent, and then lift the the whole thigh, hand under the knee. Is it very painful still in the front of the thigh? Compare with the other leg.

I very strongly recommend some gentle exercises EVERY morning, before getting out of bed. Just a couple minutes.

If you are confident that your condition is still improving, especially pain in the leg, and knee not conking on the stairs, then I would stay with your FT, but exercise every day and be very careful with bending and twisting. No vacuum cleaner.

My daughter is also a chiropractor which was my salvation, and I recovered completely; took about 6 months before I could really trust my back, but now do everything, but still need a treatment periodically.

Good luck; let me know how you are getting on in a few weeks.

Dr B

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Oct 10, 2018
Follow up
by: Lisa

Hi I just wanted to give a update. I hope it helps others to know I am pretty much recovered.It took me nearly 8 months.
A few other things that helped were stopping twisting exercises with lateral leg rolls ( physio gave me that one)
Arnica gel and heat pads on the stiff back areas and a tennis ball to help relax the muscles on the side of the thoracic spine.
I still have mild twinges but can walk normally are normal speed.
It's been very frightening with the nerve damage but time and patience has helped.
Thank you for your advice and your excellent website you really know your stuff!

Hello Lisa, thank you for the compliment. I have indeed been around the block. And have the T-shirt myself. If at Chiropractic Help you look up Femoral Nerve Damage you'll see what I mean.

The key now is to accept that like a diabetic patient you must for your back for life. That means doing the exercises every single day before arising, walking regularly and wisdom when it comes to lifting. It's okay to say NO rather than go through this again.

Think about joining a Pilates class, but start SLOWLY, at YOUR pace. You already know the danger of twisting type exercises. Note there are good Pilates teachers, and those not so experienced. Choose your class with care.

I find if the pain goes away, there's a very good chance the nerve damage will heal. My quadriceps strength returned to normal and I've just a 40 mile difficult terrain hike along the South African Whale trail without any problem.

And always choose chairs and beds with care. Good luck, keep well.

Please make a comment on my Facebook page, "Chiropractic Help Website".

Dr B

May 29, 2018
by: Lisa

Thank you for your reply.
My weakness was on the side of the lesion but at one point I had bad bilateral pain after an osteopath session on my front - fortunately that settled. I haven’t dared to lie on my front since (6 weeks ago) and was too terrified to go back to the osteopath so swapped to a physio.

I think I am still gradually showing improvement so thank you for your advice, I really appreciate it.

Hello Lisa,
For that very reason I learned many years ago not to lie an acute patient on their tum for any length of time; always treat lying on their side until the acute phase is over.

Remember that the pain diminishes faster than everything heals; you're in the dangerous phase now when you might be tempted to sit too much, and start getting on with life. Beware, a set back now would be disastrous.

Do the exercises faithfully every morning, without fail.

Let me know in a few weeks how you are getting on.

Oh, and don't underestimate the influence of what you eat; if you're consuming a lot of inflammatory refined carbs and oils it will certainly delay healing.

Dr B

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