UKH

(Sorry, this is a longish post.) Since the end of lockdown I have found that I can’t walk uphill for more than 50 yards or so without feeling intense pain and fatigue in my hamstrings. The feeling is as if I’d walked up a fell to the point where my muscles were burning and my legs running out of fuel. There’s also pain and fatigue afterwards, which feels like the classic ‘second day syndrome’ post-exercise pain.

At first I assumed that this was just a consequence of post-lockdown lack of fitness and would naturally improve as my exercise level got back to normal, but it didn’t so a couple of years ago I saw a physio privately. After several consultations they couldn’t find an obvious musculo-skeletal  problem and suspected a medical issue so I consulted my GP. I was referred to NHS physio services, who again couldn’t find anything and sent me to the local integrated musculo-skeletal unit. They couldn’t find anything in their areas of expertise even after a scan so I was referred back to my GP, who arranged a number of tests covering a range of conditions - nutrition-related and various myalgias. These proved negative so I was referred to a vascular consultant to check for possible intermittent claudication. 

I finally saw the consultant yesterday. After an examination and Doppler ultrasound test it seems unlikely that I have intermittent claudication although I have now been referred for a treadmill blood pressure test to confirm this. Instead, the consultant thinks that a spinal problem may involved, so I will likely be referred back to the IMSK unit. Or, to put it another way, back to square one.

I am left disconcerted. On the one hand I now know I haven’t got any of a large number of nasty conditions but on the other I am no nearer to identifying what is going on. Summer approaches and it looks like once again I won’t be doing very much in the way of walking and climbing. I wondered if anyone on UKC might have any insights into what may be happening with my legs, either from professional expertise or from experience?

Do you have any other symptoms of claudication? Does the pain relieve after a few minutes' rest, which seems to be a prominently discussed feature.

My first thought was sciatic pain, so the spinal referral may make sense...

TL-DR - Since you have had various investigations, ask about the possibility of natural or otherwise spinal degeneration causes (and/ or a more extreme possibility spinal stenosis if you have other symptoms). If appropriate ask about more specialised physio.

No formal medical knowledge, just gained understanding from something that started similar to what you mentioned.

Have you ever damaged your spine, or maybe have some loss of movement in the spine through aging?

It can be old injury and or a natural age thing in some folk with age related narrowing of discs, alteration of flexibility, spine alignment, etc. Any narrowing of the nerve exit gaps in spine can cause a nerve problem and if a nerve gets pressure/interference it can cause remote local problems. Therefore, if a nerve to the hamstring is affected it may just affect just the hamstring and not be obvious as the back may not show any obvious signs or symptoms of the cause and can pain free.

I had what started after lockdowns similar but different to you - one leg only and in the calf. After very little walking even on the flat let alone any slope (though I found uphill slightly easier than any down!) pain and muscle tightness (to put it mildly). A bit like intense cramp but wasn’t which stopped knee straightening and bending and the use of foot correctly naturally. No obvious reason to explain as to why back then.

My pain and tightness in the calf muscle lasted many hours/rest of the day after stopping walking though if that is different from you. Next day after rest and sleep, it would feel fine until I walked on it for any length of time which could be as little as 15 mins or less at worst.

On a positive note - physio is the answer to natural age related causes apparently. The only NHS recommended treatment is physio and pain control as far as I know unless it is more extreme (or more rarely becomes a medical emergency) when an operation is considered. Physio has been shown to work, but of course it has to be addressing the actual source of the problem and not just the calf (hamstring in your case if it from the spine). Also, pain control has to be painkillers specifically for nerve pain and not general/muscle pain.

Anyway, something to consider in absence of other possibilities. Mine has progressed more extensively, and now thought to be spinal stenosis, though I did gain benefit from specific physio, and still do up to a point. Still climb albeit less and to a much lower level. Not able to hill walk though or anything to too active.

Thanks for the reply. So far I'm not reporting or showing any characteristic symptoms of claudication. According to my consultant pain with claudication typically affects the calves and quads, not the hamstrings. The Doppler test showed that my arteries in lower leg and feet are in decent nick. The treadmill /blood pressures test should give more information but the consultant reckons that claudication is unlikely to be the problem. 

The pain I'm getting is not like sciatic pain, which I've experienced before. It really is like I've walked up a decent fell and I'm at the point where my legs are empty and hurting. 

Thanks for this, a lot to think about there. My case is rather different in several respects as you say. The pain is not a cramp-like pain - as I've just said to the captain it's more like the kind of pain you get when you're running out steam after a steep section of fell. I've also had a scan which according to the IMSK team didn't show any obvious back issues, and at the time they weren't interested in offering me any physio-related treatment. But as you say the nerves can produce effects in remote parts of the leg not apparently connected to back issues so I'm not ruling anything out.

Your condition sounds pretty hellish, and I hope your treatments keep things at bay and keep you at least a little active. No fun getting older is it?

What sort of physio have you seen? I might be massively oversimplifying and I'm not an expert but have had some similar symptoms in the past.

My issue was to do with the body being inherently lazy and building habits quickly. I had an ankle injury from running and had overcompensated, driving from the other leg. This led to overuse in the 'good' leg and the switching off of hip and glute muscles in the injured leg. I became quite unbalanced. An office job with lots of sitting contributed and my hamstring tightened up such that when running it got tighter, tired and crampy very quickly.

The solution for me was lots of quad and hip flexor stretching and glute and hamstring strengthening. There's a guy called Tom Morrison on YouTube who's a borderline genius for his stuff. For me, the Couch Stretch Reach and the Assisted Split Squats were the keys but he has a mobility programme which really helped overall.

Do you get the same symptoms if you go for it on an exercise bike or rowing machine ?

Hi Bob, sounds sciatic, ask for an MRI of the lumbar spine, persistently!

Hi Bob, as your issue is bilateral (suggesting a central cause) I would have another look at the the possibility the problem is nerve based (likely sciatic and/or compression of a disc in the lower spine).  How you describe the issue is not typical of sciatica but shooting type pain is not the only way nerve pain can present.. it sounds really rough so good luck and don't give up hope of a solution

I did have a scan already and there wasn't any obvious damage, but my vascular consultant reckoned that this wasn't necessarily conclusive.

A couple of years ago I had what I took to be hamstring issues in both legs (ache down the back of the thighs). I am now pretty certain it was sciatic having had other symptoms.

I haven't used a rowing machine in a long time - disagrees with my back. With cycling most of the load comes on my quads, and there isn't much strain on my hamstrings. A bit more if I stand on the pedals but that's no something I do for long.

Thanks for raising the muscle laziness and overcompensating issues. I'm familiar with these from recovering from hip and knee replacements - I managed to rupture my achilles tendon in my 'good' leg after I had my hip replacement when I tried running afterwards. There may well be something in this. I know my glutes are pretty weak, and have some exercises to improve them but I've let that slip recently.

I've seen private and NHS physios. I'll have a look at Tom Morrison's stuff - sounds interesting. 

It's interesting that you say typical sciatic pain isn't always present when nerve pain is involved, and your point about the issue being bilateral is a good one. And thanks for the good wishes.

Thanks. That seems to fit with what maxsmith says above about nerve pain not always being that characteristic shooting pain.

My sciatic pain has taken various forms (though thankfully only rarely debilitating) but I wouldn't describe any of it as shooting.

NHS physios are often pretty inexperienced and there is a tendency to discharge people if a few sessions don't immediately fix things, so I wonder if assessment by a different physio might be helpful? In 2019 a shoulder problem stopped me climbing and the NHS did a bunch of referrals that wasted a year and got nowhere. I was keen to resume the ability to lift my left arm above shoulder height so I asked a private shoulder specialist and they sent me to a physio specialising in complex problems: https://nellmead.com/ . It took a while, but Nell sorted the shoulder and I'm now climbing as well as ever. Nell is a former military physio so she's used to working with people who are fit and motivated, and her background is in working for an organisation that needs to get people fully functional ASAP if it is at all possible. In short, I think Nell is unusually persistent and thorough. Worth a shot, maybe?

Thanks. I know what you mean and have come across this before but my encounters with the NHS physios round here have been pretty positive. The IMSK unit that I'm being referred back to has a team of 'advanced' physios and they seem to have decent expertise.

So if you can work hard on a bike and not have the same issues it rules out a cardio vascular problem…which I guess would point towards it being a back problem.

have you considered an Osteopath?

Another thought on this - you were fine before lockdown and then not fine after it? So...

What did you do during lockdown? Were you very sedentary? Did you put on weight? Did you catch covid and could it be some form of long covid? Did you get injured? Given this problem have you been more or less sedentary for the last couple of years?

You said it's a problem when walking uphill. How's downhill? How are you on the flat?

Could you concentrate on river valley or flat coastal walks to get your overall fitness level up and try again after a few months after you've built more of a base?

Thanks, good questions. I have raised the lockdown and Covid as possible contributory factors with my GP. I was pretty sedentary and did put on a bit of weight but I've been in that situation before as part of the joint replacement processes - grinding to a halt (almost literally!) before and having to recover fitness after. This feels very different. I don't have many of the markers for long Covid.  

I can manage flat walks although my back isn't very cooperative, and downhill is okay. I do try to get out for the kinds of walks you suggest. 

How would you describe it? Just wondering how it might relate to my experience, which is very much like the pain of pushing your legs in steep uphill walking.

Always a dull ache of various intensities wherever it has been. 

Lateral canal stenosis can be difficult to see on an MRI. HDS

A friend recently underwent emergency lumbar decompression surgery for cauda equina syndrome, a form of spinal stenosis.

https://www.nhs.uk/conditions/lumbar-decompression-surgery/why-its-done/

Their symptoms were pain in glutes & hamstrings, then numb toes.

Thanks - that’s interesting and fits with what the vascular consultant said. 

That sounds nasty! I haven’t had any numbness yet so hopefully not this but I’m keeping an open mind. 

I had a brain MRI recently which showed up a minor anomaly. They had me back to do an MRA that gives greater clarity for blood vessels…turns out I still have a minor vein anomaly. I was advised to ignore and forget about it.

That doesn’t sound very nice. I hope they advised you on risks and care etc. 

My take on it was that it was like a varicose vein …. Just happens to be in my brain. The consultant dismissed it and told me not to worry. Doubt they could do much about it.

Its an example of a circumstance where you’re better off not having a scan. Bit like bad backs, everyone has one and all the MRI does is confirm what you know.

I've just received an appointment to go for a treadmill blood pressure test, where they check your blood pressures in various limbs before and after a treadmill workout. That should give some clear indication as to whether or not I have intermittent claudication. 

In the meantime I just wanted to thank everyone who's contributed to this thread. No definitive solution but several interesting possibilities to pursue. And it's also good to get some sense of other people's similar issues and difficulties- it makes you feel a little less isolated.

Cheers, Bob