Lower back / Hip pain - probable cause ??

josehernandez

For the last six weeks I've had debilitating lower back and right hip pain.
In the first few weeks it was moderately painful (4/10) then it became incredibly painful (8-9/10)and seriously affected my mobility and quality of life.
I've only been able to take Paracetamol for pain relief as I take aspirin so am unable to take anti-inflammatories.

Walking can be extremely painful. I can't stand fully upright and sleeping at night is difficult as I have only a few positions I can lie in without pain. Although my back is sore my main pain seems to come from my right hip. Sometimes I am unable to put any weight at all on it.
I also get intermittent pins and needles and shooting pains down my right leg as far as my foot, a constant dull ache in my hamstring and numbness in the back of my calf.

My GP thinks it is likely bursitis which I've had a problem with in the past. My wife, a neuro Physio readily admits she's a bit rusty regarding these types of injuries but suspects a sacroiliac joint or hip bursitis problem probably caused by a lower back issue.
She informs me that these kind of injuries usually take a minimum of 6 weeks to heal but the last time I had bursitis it took longer.

Can anyone offer advice :?: :?:

mrwibble

Possibly very tight Psoas, this muscle connects from your lower back to the top of your femur (leg) and it's one of the most common causes of pain. I would say you need to have it released. The muscle gets tighter and tighter over time, effectively it is permanently switch on (in a state of contraction), it needs to be in a relaxed state. Stretching won't help until it is released then you can stretch.

http://www.youtube.com/watch?v=Augt53mAh5g

lots of videos, should get the idea with this, you need a trigger point ball or a tennis ball and a yoga block.
just remember to hit it about an inch to the side of your belly button.

You will know when you have hit it, keep the pressure there, will feel uncomfortable but this should pass after 20 secs or so. That is when it is released.

Twitter: @imassageuk

josehernandez

Thanks for the advice mrw but I think it's something a bit deeper than muscle pain. Feels like it's eminating from deep in my my hip bone or the bursa.
Going to my GP today as paint at night is shocking.

bahzob

I would strongly recommend this book

http://www.amazon.co.uk/Tom-Danielsons-Core-Advantage-Strength/dp/193403097X

The first section is as comprehensive an overview of the muscles/skeleton, how they work and what can go wrong, as you are likely to find anywhere. If you take it with you visit a professional then they should be able to point to specific pages and say "that's your problem"

The second section is a full range of exercises, some of which may well help.

cookiemonster

JoseHernandez wrote:

I also get intermittent pins and needles and shooting pains down my right leg as far as my foot, a constant dull ache in my hamstring and numbness in the back of my calf.

Ouch

Sounds like sciatica - the nerve running down your spine and through your leg rather than a localised muscle problem. A prolapsed disc can give lower back pain, hip pain, shooting pains and referred pain down to your foot as the disc pressing against the nerve.

Not being medical, my opinion is as valid as a google search, but that'd be where I'd be looking. Off to the MRI with you.

jon

mrwibble

a tight psoas would pull down the spine towards the hip and possibly create a bulging disc, this would effectively rotate your pelvic and shorten all muscles on that side. You need someone to see if your psoas is tight and check your piroformis too. if you go to the doctors, they will give you pain killers and refer you for physio that wont even involve any muscle manipulation at all. I have been there on that one. go to a sports massage practitioner and get the lower back tested for tightness. my advice about psoas stretch and I would also add piroformis stretching is a good course to go.

If you have sciatica, piroformis stretching would be a very very big help, I suffered for 2 years with that one

All the above suffering is why I decided to qualify in sports massage


Twitter: @imassageuk

Reading

I have just had trochenteric bursitis which was very similar to what you describe. I couldn't put weight on my left leg for 2 weeks. GP gave me anti inflammatory tablets and I got Physio. Better now after 1 month & cycled again today for the first time. Unfortunately not doing anything is the solution. Good luck!

ctc

I would probably trust what your wife says if she's a neuro physio. Has she checked you over?

Tb2121

Your symptoms are indicative of a disc bulge/prolapse/degeneration, which is causing some irritation of the sciatic nerve. Its not a hip issue, and its worthwhile getting some physio/osteo to assess you. Most acute discs will resolve within 4-6 weeks- if not seek medical attention again.
In regard to sports massage etc- these can help but a diagnosis of tight iliopsoas would be so far down my list of differentials thats its almost a joke. Parasthesia into your leg is not caused by a tight iliopsoas- and in regard to the literature- we don't even know if iliopsoas can tighten up, or even if release work actually effects the psoas or iliacus.

In someone with non-specific back pain, i would recommend looking at the muscle groups around the area for tightness- but yours isn't non-specific- it is dermatomal and specific. See your GP and get reviewed by physio.

pcb24

Tb2121 wrote:

Your symptoms are indicative of a disc bulge/prolapse/degeneration, which is causing some irritation of the sciatic nerve. Its not a hip issue, and its worthwhile getting some physio/osteo to assess you. Most acute discs will resolve within 4-6 weeks- if not seek medical attention again.
In regard to sports massage etc- these can help but a diagnosis of tight iliopsoas would be so far down my list of differentials thats its almost a joke. Parasthesia into your leg is not caused by a tight iliopsoas- and in regard to the literature- we don't even know if iliopsoas can tighten up, or even if release work actually effects the psoas or iliacus.

In someone with non-specific back pain, i would recommend looking at the muscle groups around the area for tightness- but yours isn't non-specific- it is dermatomal and specific. See your GP and get reviewed by physio.

Phew, someone is talking sense. Please, please see a GP and insist on a physiotherapy assessment. They will assess, diagnose and treat, if applicable. Do not follow some of the information in this thread but see medical professional as you are presenting with more than your average low back pain

pcb24

mrwibble wrote:

a tight psoas would pull down the spine towards the hip and possibly create a bulging disc, this would effectively rotate your pelvic and shorten all muscles on that side. You need someone to see if your psoas is tight and check your piroformis too. if you go to the doctors, they will give you pain killers and refer you for physio that wont even involve any muscle manipulation at all. I have been there on that one. go to a sports massage practitioner and get the lower back tested for tightness. my advice about psoas stretch and I would also add piroformis stretching is a good course to go.

If you have sciatica, piroformis stretching would be a very very big help, I suffered for 2 years with that one

All the above suffering is why I decided to qualify in sports massage


Twitter: @imassageuk

A tight Psoas will not pull down on the spine and create a bulging disc!! In theory a tight Psoas will cause anterior tilt of the pelvis and therefore lumbar lordosis. This will mean LESS lumbar flexion and therefore there is possibly less pressure on the disc as you will be in a lordotic position. I am sure you are just trying to help but I would advise that you request the OP to see a health care professional rather than attempt to diagnose something you are not qualified to do. A physio would not manipulate the muscle at all, you are correct, as it is not possible to manipulate a muscle! Manipulation is a term used to mobilise the spine and not the muscle. I am sure the above quote is meant to try to help you and i hope they do not take offence but please see an experienced physio or GP for help

josehernandez

Thanks for advice so far.
I have been prescribed Co-Cocodamol yesterday by GP to assist further with pain control
I have an appointment with a Physio this Monday 4th November and will update thread afterwards.
No idea how appointment with a Physio came through so quickly as my GP seemed to think there was a 6-7 month waiting list but I'm delighted as coping with this long term would be nightmare.

pcb24

Good stuff. Maybe because your pain is acute it went through as an urgent referral. If the physio you are seeing does not seem to be helping ask for a senior physio's opinion/second opinion from one of the other physio's they have. There will be varying experience levels in each department. Good luck with it.

kingrollo

JoseHernandez wrote:

Thanks for advice so far.
I have been prescribed Co-Cocodamol yesterday by GP to assist further with pain control
I have an appointment with a Physio this Monday 4th November and will update thread afterwards.
No idea how appointment with a Physio came through so quickly as my GP seemed to think there was a 6-7 month waiting list but I'm delighted as coping with this long term would be nightmare.

I have had loads of back - and now hamstring problems. An NHS physio will do the obvious stuff - but the quality does vary widely.
IMO (unqualified!) opinion it sounds like sciatica. For what costs I would book yourself into a local Pilates class - if you can't stand that (pain wise) start with swimming this may relax some tight muscles. Let the physio do the diagnosis - but work on core strength and flexibility yourself - provided your sensible it won't make matters worse

josehernandez

kingrollo wrote:

I have had loads of back - and now hamstring problems. An NHS physio will do the obvious stuff - but the quality does vary widely.
IMO (unqualified!) opinion it sounds like sciatica. For what costs I would book yourself into a local Pilates class - if you can't stand that (pain wise) start with swimming this may relax some tight muscles. Let the physio do the diagnosis - but work on core strength and flexibility yourself - provided your sensible it won't make matters worse

Heading off to Physio this morning and will report back on how it went. As it happens kingrollo I started attending Pilates just prior to my back pain getting worse, obviously it was too far gone by that stage but I intend returning once I am able.

josehernandez

Physio seems to think I have a lower back (L2)/Sciatica problem and that the rest of the pain is stemming from this.
She was very professional and extremely thorough and has advised me on exercises to do until my next visit in two weeks time.

The length of time it is taking to get better is a pain in the backside (excuse the pun). I have a bike fit booked for this Friday with Richard at Pedal precision. It's 8 weeks now since it started and I thought the worst would have passed. Looks like I'll have to arrange a bike fit for later in the year and use his rehab skills instead.

kingrollo

JoseHernandez wrote:

Physio seems to think I have a lower back (L2)/Sciatica problem and that the rest of the pain is stemming from this.
She was very professional and extremely thorough and has advised me on exercises to do until my next visit in two weeks time.

The length of time it is taking to get better is a pain in the backside (excuse the pun). I have a bike fit booked for this Friday with Richard at Pedal precision. It's 8 weeks now since it started and I thought the worst would have passed. Looks like I'll have to arrange a bike fit for later in the year and use his rehab skills instead.

8 weeks - I've been grappling this for 2.5 years - Have an MRI with my hips injected with Dye on Weds !

Reasonable starting point - but be wary of working round the problem - the excercises may you more flexible - in which case you will get some results quickly - but not enough to be a serious cyclist.

I hope you progress better than I - but be wary - the physio will (3 or 4 sessions down the line) look to discharge you - they will lean on you to agree to an improvement as a reason to discharge. I got particularly irked by this in one session and said 'look I don't care how many times you re word the question - I still have a problem here' - it was then I got scans \ nerve tests - and referral to a sports injury specialist.

I hope this doesn't happen to you and you back on the bike in a few weeks - but don't be disharged if you're not -..good luck.

josehernandez

I'm listening kingrollo, how do I avoid that happening to me ?

mrwibble

@pcb24, non taken, i described pretty much what happened to me. Doctor gave me painkillers (off my head for 18 months on coco), physiotherapist at the hospital told me I had a bulging disc and my course was to lay on my front and look upward to bend my spine the other way on a daily basis. After 6 appointments he said there was nothing else he could do. About 18 months after I had a MRI scan which confirmed a bulging disc. I discovered by accident that sciatica can be caused by a shorted piroformis, I sit down all day and simple stretches helped me out and I have been free of sciatica for 3 years now. What I have learnt since that helps me is a couple of things, self massage with a foam roller is good and a trigger point ball to release my psoas helps me a hell of a lot. Apologies for an incorrect word of manipulate, I meant to say massage on the muscles around the problem area to loosen up the area which a sports massage therapist would do. You are right about one thing tho, if you have a problem see a GP and not internet doctor. Speedy recovery...

overlord2

Personally - after 10 years of back problems - I find doctors next to useless. Find a really good Physio who knows their stuff and you'll be better. It never goes away, but exercise I've found is the best way of keeping it at bay even though it hurts like hell sometimes. You learn to cope with it.

kingrollo

JoseHernandez wrote:

I'm listening kingrollo, how do I avoid that happening to me ?

Best thing I did was to lay a recovery target - mine was

"to be able to cycle 25 miles pain free" - I know thats not a lot - but it is a measurable target. But basically until I hit that I am not cured. The exercises will help a little bit - pretty quickly. Don't be fobbed off with this though.

BTW if you get to my stage where they pump your hips full of anesthetic + Dye its pretty painless as I found out this morning

Best of luck...keep us posted

mrwibble

In my experience it's difficult to feel tightness when it has built up gradually over time, you only know when you have had a massage and all that tension, tightness is gone. One area can affect adjacent areas and set a bit of a cascade thru the body. I wish I had taken up yoga 20 years ago...

pcb24

kingrollo wrote:

JoseHernandez wrote:

Physio seems to think I have a lower back (L2)/Sciatica problem and that the rest of the pain is stemming from this.
She was very professional and extremely thorough and has advised me on exercises to do until my next visit in two weeks time.

The length of time it is taking to get better is a pain in the backside (excuse the pun). I have a bike fit booked for this Friday with Richard at Pedal precision. It's 8 weeks now since it started and I thought the worst would have passed. Looks like I'll have to arrange a bike fit for later in the year and use his rehab skills instead.

8 weeks - I've been grappling this for 2.5 years - Have an MRI with my hips injected with Dye on Weds !

Reasonable starting point - but be wary of working round the problem - the excercises may you more flexible - in which case you will get some results quickly - but not enough to be a serious cyclist.

I hope you progress better than I - but be wary - the physio will (3 or 4 sessions down the line) look to discharge you - they will lean on you to agree to an improvement as a reason to discharge. I got particularly irked by this in one session and said 'look I don't care how many times you re word the question - I still have a problem here' - it was then I got scans \ nerve tests - and referral to a sports injury specialist.

I hope this doesn't happen to you and you back on the bike in a few weeks - but don't be disharged if you're not -..good luck.

If you have not made any progress at all, after four sessions (you mention that they leaned on you to try to get you to agree to an improvement), then it would surely be wise to discharge you?? I would hope that they discharged you and referred you on to someone else or requested a second opinion.

Remember there is no one size fits all approach here, everyone's body is very different from one another and its very complicated system. Physio may work for some, pilates another and stretches and a foam roller for someone else.

Mr Wibble, I am not sure how you discovered that a tight piriformis can cause Sciatica as this is simply not true.

I wish the OP all the best as he truly is in the right place for treatment, the hands of the professionals. A lot of people have had bad experiences with their treatment which is unfortunate but I wish that they wouldn't try to suggest that they know better.

mrwibble

Piriformis syndrome is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the piriformis muscle causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending down the lower thigh and into the leg. Quote from Wiki...

My understanding is that a shortened Piriformis muscle (bulging in a contracted state) brushes the sciatic nerve, prolonged sitting, lack of flexibility can cause this so if you say it's not true, you must be correct.

pcb24

No, a tight pirifirmis comes SECONDARY to an underlying irritable sciatic nerve. The neural pain (sciatica) will be caused by something spinal e.g disc, inammation around nerve root, osteophyte etc. a tight piriformis will develop later but as I said, it won't cause sciatica. PS wiki is useless!

kingrollo

mrwibble wrote:

Piriformis syndrome is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the piriformis muscle causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending down the lower thigh and into the leg. Quote from Wiki...

My understanding is that a shortened Piriformis muscle (bulging in a contracted state) brushes the sciatic nerve, prolonged sitting, lack of flexibility can cause this so if you say it's not true, you must be correct.

Gotta say thats my understanding - not just from wikki - from numerous web sources

mrwibble

Thank you!

Manc33

I still don't know what caused my back to go. Went to bed perfectly alright, woke up unable to move 1 inch in any direction. It took about 30 minutes just to get out of bed that first day with it. Took about 4 months before I could walk straight. I am sure cycling helped it recover, once I was able to get on a bike again. A few years later I got a bottle of milk out of the fridge and felt something click, it went again, but this time nothing like as painful as the first time. I must have been all contorted in my sleep or something.

Since you say hip as well, get it checked sooner rather than later. My dad had a pain in his leg for years on end and well, I won't even mention what that was but it wasn't good. He ignored it for a long time.

mrwibble

check Tight Psoas on the internet...

josehernandez

Quick update - Have been doing excercises suggested by Physio but situation has not improved. Whilst up in the early hours of this morning the pain in my hip was so bloody horrendous that I had to stand still for 15mins, I couldn't put any weight on it at all. Some of that may have been my own doing as I missed a dose of painkillers but for the first time since this started 9 weeks ago I'm starting to consider the possibility of giving up cycling. The prospect of facing this amount of pain again is frightening to say the least.

My next appointment with the Physio is this Thursday. It can't come soon enough, this feels like human torture!!!

mrwibble

Forget NHS you obviously need some more immediate treatment. I stand my my original advice go see a sports massage/physiotherapy person to have a look at you. I would try seeing a osteopath or chiropractor at the same time. It will cost money but NHS is treatment by numbers and no good.