Case Report 5-hip, lower leg pain, pins & needles

What is Pins & Needles?

The Intricacies of Pins and Needles: A Comprehensive Analysis of Lower Back Pain and Associated Paresthesia

A case study of Dr. George Hardas’ approach to managing lower back pain and associated paresthesia

Introduction to Pins and Needles and Lower Back Pain

Lower back pain, a prevalent affliction that disrupts the lumbar region of the spine, frequently manifests as a consequence of strains or sprains in the muscles or ligaments. Situated beneath the ribcage, the lumbar area is susceptible to exacerbated pain from fractures, poor posture, ruptured discs, improper lifting, or a lack of regular exercise. Arthritis, autoimmune diseases, infections, or tumours may also precipitate more severe complications. In addition to pain in the lower back, individuals may experience symptoms such as muscle or bone pain, discomfort in the legs or hips, and sensations of pins and needles or numbness in the legs. Furthermore, muscle spasms and joint dysfunction are typical indicators of lower back pain.

A Thorough Assessment Process

At Dr. George Hardas’ clinic, each patient undergoes an exhaustive initial history examination to ascertain the cause of their pain. Once chiropractic treatment suitability is confirmed, a comprehensive examination is conducted. In this particular case study, the patient presented with right-sided leg pain, referred pain to the right hip and right lower leg. The lumbar range of motion was painful at 15° of flexion, right lateral flexion, and right Kemp’s/Quadrant test. The palpation of the right L4 paravertebral muscles, right piriformis, and right biceps femoris revealed pain, and a slight limp was detected. An MRI revealed a cam lesion of the right femoral head and a mild right posterolateral disc protrusion at L4/5, causing mild canal stenosis and displacement of the right L5 nerve root in the lateral recess.

Understanding Cam Impingement

Cam impingement, an impairment involving the ball of the femoral head, occurs when the ball is not spherical but rather elongated. Consequently, the deformed section of the ball may become wedged within the socket during hip movement.

Diagnosis, Treatment, and Outcomes Based on Clinical Research

Dr. Hardas’ patient outcome was determined by a combination of assessment, diagnosis, and treatment informed by clinical research from the Royal North Shore Hospital (RNSH), Pain Management Research Institute (PMRI), Orthopaedic Research Institute – St George Hospital (ORI), and presentations to the American Academy of Orthopaedic Surgeons (AAOS), Sports Medicine Australia (SMA), and Chiropractic and Osteopathic College Australia (COCA).

The patient underwent treatment focused on the restoration of specific joint biomechanics. Utilizing Cognitive Behavioural Therapy, coping strategies from the Pain Management Research Institute at Royal North Shore Hospital were employed. The outcome showed significant improvement, with the initial numerical pain rating score decreasing from 7/10 to 1/10. Additionally, there was a considerable reduction in paresthesia (abnormal skin sensations, such as tingling) in the right lower limb.


In conclusion, the phenomenon of pins and needles, or paresthesia, is a noteworthy aspect of lower back pain. A detailed assessment, diagnosis, and evidence-based treatment approach, as demonstrated by Dr. George Hardas, can yield significant improvements in pain management and reduction of associated symptoms. This case study exemplifies the importance of employing comprehensive strategies to address lower back pain and the accompanying sensations of pins and needles.

Lower back pain is a common painful matter which disturbs the lowest segment of the spine. The lower back is the region that begins beneath the ribcage and is generally referred to as the lumbar region. It is most often a result of impairment to the muscles or ligaments, either known as strains or sprains. Pain that occurs here tends to be more intense and is usually caused by fractures, poor posture, ruptured discs, incorrect lifting, and an absence of consistent exercise or arthritis can also be more serious such as autoimmune disease, infection or tumour. In regards to symptoms associated with lower back pain, pain in the lower back is the natural indication of the pain, however, some people may experience other symptoms which include; pain in their muscles and bones, their legs, or hips, as well as pins/needles and numbing sensations in their legs. Muscle spasms and joint dysfunction are also additional common signs of lower back pain.

At our clinic, Dr George Hardas individually and thoroughly assesses each patient with an initial history examination in order to determine the reasoning behind a patient’s pain, with a full examination being employed once confirmation for chiropractic treatment suitability has been determined.

This patient presented with (R) sided leg pain with referred pain to the (R) hip and (R) lower leg. The lumbar range of motion was painful in flexion at 15°, (R) lateral flexion, and (R) Kemp’s/Quadrant. The palpation of the (R) L4 paravertebral muscles were painful as well as soft tissue palpation in (R) piriformis and (R) biceps femoris. There was a slight limp detected. There was a cam lesion of the (R) femoral head shown in an MRI. Another MRI of the lumbar spine showed a mild right posterolateral disc protrusion at L4/5 causing mild canal stenosis and displacement of the (R) L5 nerve root in the lateral recess.

Cam impingement is also referred to as an impairment of the ball situated at the head of the femur. This impingement refers to – when the ball is not a sphere, it is more elongated, and the deformed section of the ball may become wedged in the socket as the hip is moved.

The patient’s outcome was based on the assessment and subsequent diagnosis and treatment based on clinical research by Dr. Hardas, retained from RNSH (Royal North Shore Hospital),  PMRI (Pain Management Research Institute), ORI (Orthopaedic Research Institute – St George Hospital) and presentations to AAOS (American Academy of Orthopaedic Surgeons), SMA (Sports Medicine Australia) and COCA (Chiropractic and Osteopathic College Australia).

The patient was treated for specific joint biomechanics restoration. Treatment was using ‘Cognitive Behavioural Therapy’ using the coping strategies as taught at the ‘Pain Management Research Institute’ – Royal North Shore Hospital. The outcome was marked an improvement from an initial numerical pain rating score of 7/10 down to 1/10. Also, a major reduction in the Paresthesia (abnormal feeling of the skin – tingling) of the (R) lower limb.