Help with piriformis, and possibly more

by SB
(Illinois)

Hi,

Came across your site and have the following for the last 6 months or so. Have visited two physio's with the following condition. This has all started after I pulled a hamstring playing softball. Active runner (<10m/wk) and cycler (50-100m/wk)

1. buttock pain, stabbing, then radiating down leg after sitting for extended period of time, usually greater than 30-60n min
2, back of thigh pain
3. occasionall leg tingle (depending which way I strect

first doc said hip injury(weakness on left leg), looked at me, had me walk 10 steps and gave me a prescription for pain killers, orthotics, stretching and PT. Also wanted to use a specific set of shoes, pusrchsed at specific store, and only use his recommended PT. Didnt buy the story, got a seocnd opinion.

second doc said hip injury (weakness left leg) to go with PT, increase strength training more along back and core as well as left side. did that for almost 6 months.

With both docs flexibility was there, no pain during tests, just weakness. Both saw an MRI of lower back, nothing out of the ordinary. I feel better since this started, yes. But I have plataued and still get pain while sitting. Getting up makes it go away within 30 sec or less. both docs said piriformis syndrome.

Current state
I can still bicycle for 1-2 hours and usually no pain during ride, but get the burning, stabbing pain in buttock afterwards (2-4 hours later after exercising) Power is still there, but usually can feel tightness during hard applications. running is a little worse, probably because of the impact, but still can get 2-3 miles on occasions. i have stepped it down and run a mile, walk, run, etc to break it up. During workouts I feel very good doing most exercises, though some the buttock and hamstring area is tight(good mornings, lunges). Still, nothing that stops me from working out as the pain is low and usually only the 1st rep or two. I've stopped stretching and increased meassage, primarly into trigger points which has helped. Can definitely tell I have been holding onto some tension and have alwasy had that issue. The weird thing lately that is again when sitting for extended periods of time and when I pull my head down, I feel a tingle, like an electric shock near my sacrum? (just where the buttock spilts), inside of thigh, and then down to arch of my foot. Never painful, just a tingle. If I try to do it agian right away, doesnt happen. 30 minutes later, i can recreate it. Just weird.

Thoughts on this? I really would liketo get my activity back to where it was before injury in terms of distance, but i am not pushing myself. I still workout 5X a week to staty active, but am having difficulty on what the next step is. Am considering seeing a chiro as well.

thanks

SB

Hello SB,
This mistake was not to see a chiro first! This is now chronic and likely to be difficult. My rule of thumb: if any condition is not responding well, within 3-4 weeks, I would recommend a second opinion. I have no beef with you seeing medics first but you waited too long, but anyway that's history, and sealed in concrete.

I say this not by way of reprimand, but for the next time you have this or another condition. Once you know you are not getting better, move on...

Two interesting features:
That tingle and pain in the leg when you flex your head and neck is called Lindner's sign. It's a classic nerve impingement sign.

The question is which nerve. Initially it seems your symptoms were Sciatic nerve related, but that tingle in the inner thigh suggests a Femoral nerve problem now. You can have both.

The test for the sciatic nerve is routine, and you can do it yourself. Go to the Search this site feature at C-H and type in Slump test. Let me know what the result is.

The test for the Femoral nerve is more difficult and you can't do it yourself, plus it's a difficult test to interpret. Ask one of the physicians treating you to do it if they haven't already.

One more simple test for you: if you bend forwards, is the one leg much tighter than the other? And if you bend backwards? Sideways? Do any of these movements produce back pain, tightness, tingling in the leg?

One other condition to be considered is Maigne's syndrome (see C-H). It's an impingement high in the lumbar spine affecting the superior cluneal nerves that supply the skin over the buttock. It often goes with a leg length inequality that may be the underlying problem.

The long and the short of it? You need a good thorough chiropractic exam to decide where the underlying problem is. There are plenty of chiros in Illinois, I know, I did my training some thirty plus years ago in Lombard.

Do your homework: don't go to the chiro with the biggest sign. Talk to friends and family, your doc.

I hope this contributes.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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