Butt pain of two years duration

by Rachael
(Leicestershire, UK)

Maign'es referral pattern

Maign'es referral pattern

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Hi,
X Ray's showed bilateral pars defect 20 plus years ago. Regular issue with lower back pain over the years. Pain on walking somewhat improved with orthotics.

Over the last two years I have hip pain that can be deep in the glute, around the top edge of the hip, along the side and or at the front (hip flexor area); a very clear aggravating factor is cycling, particular when I have to pedal against resistance such as going uphill. The discomfort may be for the entire ride, then stop or persist for the remainder of the day.

Soft tissue massage has not improved it. Foam rolling is very painful and does not seem to alter the issue. New chiropractor initially suspected a tight psoas as the cause but is now considering Maigne's syndrome. If so, is it usual to have a particular movement, for example pedaling, as an aggravating factor? Is the underlying abnormality with the pars likely to be related to this issue?

Any advice gratefully received,

Thank you.





Hello Rachael,
Oddly, as I was reading your history, Maigne's syndrome crossed my mind; but then you would certainly have some discomfort at the dorsolumbar junction.

The spondylolysis is probably part of the problem; you don't mention if there's a forward slip of L5, known as a spondylolysthesis; is a grade mentioned in the report?

Also thoughts are of a complicating hip condition; if you pull your hip to your chest, towards the opposite shoulder, or dropping into the lotus position does it cause any groin or obvious hip pain? How does that compare with the other hip?

Ask your chiropractor if your hip is particularly hypermobile; increased range of motion. Do internal and external rotation cause discomfort in the hip?

Do you have a family history of hip disease? Has your hip been xrayed?

Do any movements of your back provoke any of this hip pain? Ask your chiro again if the sacroiliac joint is fixated when you raise your knee. Are any of the SIJ orthopaedic tests positive?

There really are a lot of possibilities, Rachael. Unable to examine you, I'm simply throwing out a few ideas. Perhaps print this out and give it to your chiro for comment; I expect most of this has gone though his mind.

Let me know if this rings any bells.

Dr Barrie Lewis



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