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severe hip flexor weakness

Sorry this is a long one....I am a 45 year old female.  In January of 2007 I feel and broke my right ankle (avulsion fracture of atl and another ligament with a partial tear of a 3rd.)  I was put into a cam walker and remained in that until mid May.  When the cam walker came off and i went to a brace I experienced considerable pain in my right thigh and weakness.  This slowly continued to worsen.  Over the course of the last (almost) 5 years I have been seen by countless specialists all to no avail.  So far this is what has happened...I was seen by a hip specialist who diagnosed a labral tear in the right hip via an MRI-arthrogram.  I tried steroid injections into the hip first but unfortunately they were unsuccessful.  In order to repair the tear I first had to address my still unhealed ankle.  In Jan of 2008 I underwent an ankle repair which was successful.  In May of 2010 I underwent a labral repair (doctor found a lot of fraying but "no frank tear" and a lot of inflamation ( he ended up performing a synovectomy).    Following months of Physical therapy the was still no improvement to the hip flexors.  I am unable to raise my (bent) leg toward my chest.  Months passed and my Primary care sent me for an MRI of my back...from those visits it was determined that i had a herniation at L4 and L5 and a disc extrusion that was compressing L5 nerve root ( the MRI also caught the lowest T vertebrae and they appear normal) .  My (2) EMG tests have been normal.  I have received 2 epidural injections.  First one did provide some moderate relief and I was walking considerably better with less hip pain and weakness seemed to improve slightly.  Second injection did little.  I have also underwent ultrasounds and mris of the pelvis and abdomen to make sure that there were no lesions, tumors, etc that could be the cause--these found no problems.
Let me say this--this is not in my head! ( I state that because at this point no one seems to be able to offer any answers).  I used to be very active (biking, running, karate) and now I cannot run at all as my right leg is so weak i cannot get it to my chest..Karate..well forget about that..and biking is a challenge.  I am hoping someone here might read this and it will strike a chord..something..anything.  Thanks for the time....sorry this was so long.
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Avatar universal
I fx the distal fibula when sprained my ankle . I was walking the dogs at night, stepped on a big rock, my foot bent back, then rolled over to the lateral side, I felt the fibula stretch by the knee. At the end of the lateral foot roll over after the pop, I felt a fourth thing, a sharp pain than ran under my foot through the arch.  I brushed it off and walked home.  It hurt a lot at the distal fibula and my range of motion in dorsiflexion was greatly enhanced,  but plantarflexion was non existent.   The next day it swelled up and my leg color was dusky.  After hopping for a few days I went to Dr. and got non displaced fx and mild sprain dx, was given a cam boot that went up to my knee, and was told to come back in 4 weeks.  After 2 weeks my medial knee started to hurt, after 3, discontinued boot because had an incident where I picked up my 1yr old cousin an felt sharp daggers radiate to med knee.  Couldn't  extend leg to the back or would get severe nerve pains.  Had to keep torso tilted forward.  It was severe for a week. Finally enough complaining got me a visit to neurologist. I had already figured out it was femoral nerve dysfunction,  and by then my knee and medial ankle were completely numb.  He prescribed Nortriptyline,  that diminished the pain but felt bad in my brain and also caused rapid heartbeat, I stopped taking it and my head starting to feel better, pains there, but not severe.
Physical therapy was not helpful due pain. My knee is weak, medial quad atrophied,  continue to have boring pain in medial ankle.  Awaiting results of MRI of Lumbar and pelvis.  My ankle finally started to feel improvement after 8 weeks, except for the medial side, it's tingly and feels like a thin band getting overstretched when I stand on it, or do the ankle exercises.  
I believe I had a femoral nerve stretch injury because nerve was tethered at knee when I straightened up.  Definitely feels psoas related as fetal position alleviates pain.  I can flex, externally rotate, basically do all ROM at hip, except extension.  Any insights?
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Avatar universal
Holy cow. How can there be so many of us and no one has an answer. I, too, have the same status:  avid snow skier all mountains west is Mississippi, water skied since I was 5, ice skate, roller skate, scuba, swim, softball fo 13 years. I'm now 64 and have gotten progressively weak over past 4 years in spite of twice weekly PT and workouts at gymn. I now walk with a cane. Will undergo CT scan to look for any soft tissue tumers. Have seen orthopedic surgeons, neurologists, pain management doctors.  No relief or diagnosis. And the power of prayer is daily. I need this fixed.
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Avatar universal
greenielk, Try dorsiflexion exercises to strengthen your anterior tibialis muscle. Find it on youtube. They have good vids. Thanks!
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Avatar universal
I do get a tremor...like a fatigued muscle tremor (for lack of a better description).  I described it to a doctor as the kind of  tremor you get when you first wake up and take that first big deep stretch.  Sometimes you shake a little...well I get that in my leg.  Don't know if this is what your friend is experiencing.  

One other thing.  I also have a bit of foot drop.  I do not have a rolling gait on that side.  My foot tends to slap down when walking.  This is not true foot drop...as my two emgs say I have no nerve damage.  This is being attributed to weakness.
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Avatar universal
greenielk, I just want to run something by you. When this woman lays on her back and I raise her more involved leg, when she reaches a certain point on lowering it she feels a kind of vibration that runs down her leg. Do you get anything like that? Thanks!
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Avatar universal
You're definitely not alone. There are tests the chiro probably did to specify if it was indeed psoas. I gave this woman some psoas work and stretching. I sent her a "kneeling lunge" video to stretch her psoas. I haven't heard from her about that yer, but this is her reaction to the neuromuscular massage therapy I did on her:

I felt really good after the treatment. Much less pain that evening and next day. I would even say that the pain on the side of my hip is less even now. Pain / stability upon standing and walking is still the same. Aching pain around the knees is the same evry time I walk.

I will follow up with an email detailing the timeline, tests, etc.
I am looking forward to the session next Thursday morning.

Thanks for the tip on sleeping with the pillow between the knees. I will try it. I appreciate your help.
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Avatar universal
Wow!  I thought I was alone in the world!  I have to move my leg the same way!  I have been seeing a chiropractor-who has diagnosed extreme psoas muscle weakness.  She believes this came about from wearing the boot for so long and developing a gait based on wearing that.  I am not sure i buy into this and have not seen a whole lot of improvement. (she claims I have been walking unnaturally for 5+ years and therefore it will take time to rebuild muscles--again not sure i am buying all that).  

I would love to hear more about your friend and any relief progress she is making.

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Avatar universal
I should ad this woman has had an MRI, nerve conduction tests, PT and saw an ortho. No one knows what's wrong. She has extreme weakness with hip flexion and actually uses her hands to move her leg and has wobbly gait with pain in upper quads/TFL area. She had a fall before all of this, and wore a boot.
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Avatar universal
I know someone else who has a similar condition and I'm looking for answers if anyone can help. Thanks!
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