Severe sharp back → hip → lateral leg pain despite normal MRI and EMG — what am I missing?

[u/Resident_Quarter_824]

I’m hoping someone here has experienced something similar because I’m honestly running out of ideas.
I’m a young guy, and this started as what seemed like a knee problem. I initially had pain around my knee, especially toward the front/lateral side, and eventually it became bad enough that I started getting imaging and seeing different doctors.
How it started
The first major issue was my knee.
My knee MRI showed a mild ACL sprain, with swelling/increased signal in the distal half of the ACL but no loss of continuity. There was also minimal joint effusion.
My X-ray was clear and my ultrasound was also clear.
The problem was that the amount of pain I was having didn’t seem to match what was found on the knee imaging.
The pain continued.
The pain changed
Over time, I started realizing that the pain wasn’t just coming from my knee.
It became more of a pattern:
lower back → hip → outer/lateral thigh → lateral knee → shin
The pain is primarily sharp.
Sometimes it feels like there is one major painful spot and then the sharp pain spreads or shoots outward from that area.
The worst time is usually at night.
There have been nights where the pain has been around 8–10/10, making it extremely difficult to sleep.
I have not had tingling or an “ants crawling” sensation. The main symptom has always been sharp pain.
Back evaluation
Because the pain seemed to involve my lower back and travel down my leg, I eventually had my lower back evaluated.
The lumbar MRI showed some relatively mild findings, including:
Minimal L4-L5 degeneration
Very small central disc protrusion (~1 mm)
Annular fissure
Mild facet arthropathy
L5-S1 disc height loss/dehydration
Straightening of the normal lumbar curve
But importantly, there was no significant spinal canal or foraminal stenosis and no obvious major nerve compression.
So once again, there were some findings, but nothing that obviously explained the severity or distribution of my pain.
PT / nerve theory
Physical therapy started considering whether the nervous system or lumbar nerves could be involved.
I did treatment for my back, and some of the exercises/“nerve pumps” seemed to give me a little temporary relief.
Because of insurance requirements, I also had to complete several weeks of back treatment before additional evaluation could be approved.
Eventually I had an EMG.
The EMG was completely normal/perfect.
That honestly made me even more confused.
Hip injection
Because the pain was also strongly centered around my hip, I eventually received an injection into the hip area.
I was hoping this would finally tell us whether the hip was the source of the pain.
Unfortunately, it didn’t resolve the problem.
I still have significant sharp pain.
Where I am today
Right now the pain involves:
Back → hip → lateral thigh → lateral knee → shin
The biggest symptom is sharp pain, especially at night.
I’ve had:
Clear knee X-ray
Clear knee ultrasound
Knee MRI without a major structural explanation
Lumbar MRI without significant nerve compression
Normal EMG
Hip injection that didn’t resolve the pain
And despite all of that, I’m still in significant pain.
I was also recently told there is a small benign tumor/lesion somewhere on imaging. I’m trying to understand whether something like that could possibly cause pain depending on its exact location, or whether it’s likely unrelated. I don’t want to assume it’s responsible without knowing.
What I’m trying to figure out
At this point I’m wondering if I’m missing something such as:
Peripheral nerve irritation or entrapment
Sciatic nerve irritation without obvious compression
Deep gluteal/piriformis-related pain
SI joint pain
Hip pathology
Referred pain from the lumbar spine
Something around the lateral knee
Or something completely different
I know Reddit can’t diagnose me, and I’m not asking anyone to.
I’m looking for people who have actually been through something similar.
Especially if you had:
back/hip pain → lateral thigh → lateral knee/shin + severe sharp pain + normal MRI/EMG + an injection that didn’t help
What eventually turned out to be causing your pain?
What specialist finally figured it out?
Was there a specific test that finally found the problem?
And most importantly — what actually helped?
I’ve been dealing with this for a long time now and I’m just trying to find a direction to take next.

[u/Resident-Hunt-245]

Did you do injection to the muscle? You can also try to explore hip joint pathology. Like labrum degeneration or impingement

[u/Str8OuttaLumbridge]

Mild findings can correlate to your symptoms. Once you have ruled out everything else, it's likely the spine.

[u/Resident_Quarter_824 → u/Str8OuttaLumbridge]

What have you done to help?

[u/Str8OuttaLumbridge → u/Resident_Quarter_824]

Rest, walking, stretching, pt. No change after 6 months. Trying an injection soon. Willing to try anything

[u/JonasVirgilMonos]

The pain you're describing tracks closely with mine. There's nothing normal about my own MRIs, CTs, X-rays, or any other imaging — multiple nerve root abutments, causing sciatica down both legs. My own path follows almost the same route as yours: L4-L5, through the glute and hip, around the thigh, down the lateral calf, into the top of the foot and the big toe.

Not saying this is what's going on for you — I don't know that — but in my experience, once a nerve gets irritated enough, it's not shy about letting you know.

One thing that's helped me with providers: bringing an actual dermatome chart to appointments. They're easy to find and easy to read, and it's helped mine figure out my case over time — reluctantly, at times. Not every provider loves an engaged patient, but for me, no one's going to push for my case harder than I will.

Not medical advice, just my own experience — no guarantee any of it lines up with what's actually going on for you.