Member Case Study: Sore Leg Muscle or Nerve?

author : AMSSM

comments : 0

I have a sore muscle or nerve on the front of my right leg, from above my knee to waist area, with most of the pain in the middle of my leg. After a run or long walk it starts getting sore.

Member Question from Dwayne:

I have a sore muscle or nerve. I am not sure which. It is on the front of my right leg, from above my knee to waist area, with most of the pain in the middle of my leg. I can swim or bike pain-free. After a run or long walk it starts getting sore. After I sit or lay down, the pain comes, and it usually lasts for 3- 5 days, especially if I don't do any running or long walks. Once the pain starts and I stand up, I have to balance myself before taking the first step. I would just like to know what it is and what is the best way to rehab it.

Answer from Kenneth Cayce, IV, MD
Member AMSSM

Research has demonstrated that injury rates in triathletes range from 37 to 90% annually, with overuse injuries accounting for 68 to 78% of injuries. Running injuries include illiotibial band syndrome, patellofemoral pain syndrome, and patellar and Achillies tendonosis. Cycling injuries include patellofemoral pain syndrome and quadriceps and calf strains.

If the pain is on the outside of the thigh, then it would most likely be illiotibial band syndrome. If the pain is on the front of the thigh, then it would be most likely to be a quadriceps muscle strain. Let us discuss both, but I feel that your injury is more likely a quadriceps strain based on your symptoms.

Illiotibial (IT) band syndrome is the most common cause of pain on the outside of the knee and hip. It often increases with downhill running then ceases with rest. It is caused by friction between the IT band and the bone on the outside of the knee (lateral epicondyle). This can be associated with tibial torsion, and tightness of the abductors, adductors, external rotators, and hip extensors. The treatment is ice, a dual action strap, foam roller exercises for soft tissue work, and flexibility and strengthening exercises for the hip abductors, adductors, rotators, flexors, and extensors. If symptoms continue despite physical therapy (PT), then a sports physician can inject the IT band with a steroid. If all fails, surgical options can be discussed.

Muscle strains are the most common injury in sports, ranging from delayed muscle soreness and muscle strain to complete disruption. Delayed muscle soreness is defined as muscle pain 24-72 hours after physical activity. The pain can last for 5-7 days and can range from mild soreness to severe discomfort. Athletes usually report loss of muscle strength, decreased range of motion, and tenderness. The treatment for delayed muscle soreness is exercise. The soreness will diminish with repetitive exercise. The research behind this is unclear, but the thought is that with increased endorphins or other alterations in neural pathways, the pain decreases.

NSAIDS can decrease pain in the short term, but it does not show benefit in the long term. Muscle strains occur commonly during exercise in muscles that cross two joints (hip and knee). The treatment for strains is rest, ice, and PT. NSAIDS should be avoided because these medications can delay muscle healing. Physical therapy incorporates muscle stretching and strengthening. Most studies have stated that stretching and warming up prior to exercise and stretching after exercise have prevented muscle injury. Recent studies have noted that stretching prior to exercise may increase injury, but there need to be more studies before definitive conclusions can be made.

Other diagnoses can include nerve injury or entrapment, compartment syndrome, and hip pathology (i.e. hip osteoarthritis). I would recommend seeing a sports medicine physician for a complete evaluation. The physician may obtain some x-rays, an EMG/NCV study to evaluate the nerves, or compartment testing. Then the physician can prescribe an appropriate treatment based on evidence-based medicine.

Kenneth Cayce, IV, M.D., is a Primary Care/Sports Medicine Physician at MAX Sports Medicine and Family Health. Dr. Cayce is currently accepting new patients by calling (614) 828-4241 for an appointment.

Rating

Click on star to vote

21579 Total Views  |  50 Views last 30 days  |  14 Views last 7 days

date: November 12, 2008