WHERE IS MY PAIN COMING FROM? WHY IS IT PERSISTING?

Hip Pain, Knee Pain, Heel Pain - Is it because of your spine?

The FUNDAMENTAL question of WHERE IS THE PAIN COMING FROM AND WHY IS IT PERSISTING is answered in each and every stage in GORE PHILOSOPHY. Intervertebral Disc related changes can give rise to various symptoms in the Lower Limb
  • at the hip
  • at the knee
  • at the ankle, heel or foot
There is a basic dictum that if the pain in the Lower Limb
  • is not because of injury
  • is not because of infection and
  • is not because of ischemia, that is, reduction in the blood supply
then it has to be because of Neuralgia, that is, nerve mediated. Earlier there was no sign to objectively identify the pain coming from the nerve, however for the first time GORE SIGN can identify the pain in the Lower Limb as Neuralgia or Sciatic Pain. Symptoms may be present because of chemical inflammation of the nerve tissue or the dorsal root ganglion in the intervertebral foramen giving rise to
  • pain around hip joint behind the tip, or what sometimes maybe called as trochanteric bursitis;
  • pain can also be behind the knee or the outer aspect of the knee, where it may be called as biceps femoris tendonitis or popliteal pain
  • one may also feel pain at the heel where it is sometimes erroneously called as plantar fasciitis.
We need to understand this pain one by one.

PAIN AROUND THE HIP

This pain is commonly felt as a stabbing pain. Very commonly, the patient points at the area which is normally covered by the hip pocket of the trousers or to a spot which may be behind the bones of the hip.

Pain normally increases when the patient sits with his/her legs crossed and this pain becomes so unbearable that the patient has to get up or change the position of his/her legs while sitting.

The pain may be associated with numbness; it may be associated with pain going down the leg; it may be associated with tingling, numbness, heaviness in the leg.

PAIN AROUND THE KNEE

You may feel pain around the knee, on the back side of the knee or on the outer side of the knee – which is extremely common. You may also feel pain on the inner side of the knee. People generally refer to all types of pain as pain in the knee. However, we need to distinguish this pain from the pain which originates from the knee. Hence, which part of the knee is in pain is important and this has to be communicated to the Doctor correctly as otherwise it may lead to wrong diagnosis. The distinguishing features are:
  • The pain coming from the knee is on the medial, that is, the inner aspect of the knee and this pain reduces when you walk for some time. There is increase stiffness of the joint but as you walk and become mobile the pain reduces as the time passes. This type of pain originates from the knee.
  • Whereas the pain around the knee, on the back side of the knee or the outer side of knee normally increases after walking and it may radiate up and down the leg. This pain on the outer side of the back side of the knee also increases on sitting cross-legged or sitting on the floor with the legs crossed as we Indians do. This pain then becomes so severe after sitting cross-legged that the pain can be relieved only by making the knees straight and moving the leg in order to reduce the stretch on the nerve. This can be called as a moderate degree of affection of the mobility of the nerve. Sometimes when you sit cross-legged, what can happen is that a nerve can become more stretched and can give rise to tingling and numbness going down the leg and the numbness may become so very severe that the whole leg becomes totally numb and the patient is unable to stand on that limb.
Download PDF and Read publication by Dr. Gore on Knee Pain

PAIN AROUND THE HEEL

The pain in the heel commonly is observed on the inside of the heel below the heel bone. Sometimes it is along the outer border of the heel and sometimes it is at the back side of the heel over the tendo achillis. The pain in the heel also is known to be more the first thing in the morning and a patient may experience very severe difficulty in walking after getting up from bed in the morning. This difficulty  reduces after walking a few steps and then the patient becomes more comfortable .

Pain in the heel has erroneously been called as plantar fasciitis without any evidence of anything in the plantar fascia by any means – there is no evidence to support that contention .

We must remember that many times the pain in the heel, pain in the knee, all the pain around the hip maybe the earliest indications of the stretchability of the nerve, which has reduced and the changes which are occurring around the intervertebral disks L4-L5 and L5-S1.

There is one more pain which is very commonly seen called as coccygodynia.  This pain is seen around the tip of the tailbone – it is commonly seen after a minor injury where there may be a sudden twisting of the back and then the pain comes up at the tip of the coccyx, that is, the tailbone or it may come up over the tailbone. The patient is unable to sit on the buttocks on the tailbone and the pain increases if the patient sits in a slouching position. If the patient sits upright and erect the back pain normally reduces. This pain also reduces and centralizes towards L5-S1 on extension of the back and this is a test which can distinguish between the local cause of tailbone pain and a pain which comes off from the disc.

detect, confirm and monitor pain by Gore Sign

In most of these pains the important sign which can be used to detect, confirm and monitor this pain is Gore Sign, where we detect the inflammation of the nerve and we can also treat this pain at least temporarily – if it is very severe we treat it by giving a block of local anaesthetic at the ankle or just behind the ankle.

This information will highlight a simple point that instead of spending time, energy, money and efforts among uncertain people who don’t even know about the existence of these entities – it is better to find out from your doctor where is the pain coming from and why is it persisting, since we now have stitch-less solutions under local anesthesia for all these pains. We need not worry about the cause of the pain and we should be reassured that it can be relieved in a very very simple way by improving the flexibility of the back, the strength of the back, and taking  medication to reduce the inflammation around the nerve.

To Consult Dr. Satishchandra Gore please Contact Us.

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