Question
I have LBP and pain i right gluteus area. Ocasionally have pain in posterior thigh, lateral calf and top of the foot. Pain is mild and intermittent. Pain is increased by hyperexension and during prolonged sitting. My NMRI shows no pathology,EMG shows no pathology (n. peroneus n. tibialis). I also done neurological exam and there is no signs of disc related condition. What could be source of pain in back and leg? I hear something about referred pain from some other sturctures except discs. Could it be something like that and could it be serious?

Answer
Disclaimer: please do not take any of my advice without at least consulting with your doctor(s) first.  If necessary, print this email in its entirety for your doctor(s) to read.  In addition, please do not attempt to use this website or my advice as a substitute for your healthcare needs or as a substitute for the advice of your doctor.  There is no way a thorough health evaluation or assessment of any medical condition can be properly made via email.  Please only use the contents discussed as a guide or tool to address your health matters with your doctor(s).  If any of the information I provide conflicts in anyway with the information your doctor(s) provide, it is always best to default to the information provided by your consulting doctor(s) or to seek additional opinions from qualified, licensed healthcare providers as needed.

Hello M.,

First off, it is important to remember that you are doing the right job by checking your pain out with your doctors.  There is no way I could do a better job at guiding you or providing you with some direction via an email than your doctors can do in person.  So if you still have pain after all of the exams you have been through, keep investigating.  Pain is a symptom that indicates something is not normal.  

With that said, again, keep in mind any direction I give may be way off the chart since I can't evaluate you myself and I'm only going off of what you've written.  Unfortunately, patient management is more involved than this letter.  But one thing that can cause leg pain is  vascular pathologies.  I'm assuming your doctors have already ruled this out since they cannot find a musculoskeletal cause (ie-disc, joint, nerve) for your pain.  But you didn't mention this scenario, so I thought I would.  Vascular pathologies can occur in patients with high blood pressure, fatty diets, sedintary lifestyles, diabetics, and smokers.  If you have multiple of these conditions, then you are at a greater risk.  When I refer to vascular pathologies, I'm implying some sort of narrowing of the arteries preventing adequate blood supply to your legs.

Since all of your tests are normal, there is a possibility you are suffering from referred pain, like you asked about.  Referred pain is pain that is felt in a certain area of the body because of a problem located somewhere other than where the pain is.  For example, a heart attack can cause shoulder pain, even though there is no problem with the shoulder.  Muscular trigger points could cause referred pain.  Also, piriformis syndrome could cause a sciatic pain down your leg while your tests remain normal.  Here is some more information on piriformis syndrome: http://en.wikipedia.org/wiki/Piriformis_syndrome

Again, anything is possible and your arteries may be perfectly fine.  But unfortunately, I cannot provide you with better information than what your doctors can provide.  I would strongly suggest that if you don't have any luck with your doctors to seek the advice of a KNOWLEDGEABLE chiropractor, physical therapist, or acupuncturist to help you out.  Just because one type of doctor may not know how to help you out does not mean there is not an answer for you.  Sometimes when things appear normal after extensive testing, it can take a very long time trying to find a practitioner who can correctly diagnose, and thus, treat your condition.  I hope this helps guide you a little bit.

Best of luck!
Dr. J.R. Strecker, D.C.