Pain and stiffness in the upper buttock

by Marco
(New YorK)

I am a 46-year old healthy male, 5-10, 190 lb, a phd in physics, and a college professor. I have been quite athletic in my life. I have been dealing with a chronic and long term lower-back/buttock pain since my early 20's. At that time, the pain was only attacking me when I did some heavy duty tasks like moving furniture, yard work, etc. The pain always disappeared after resting and some massage.

In particular, if I did regular exercise and stretch, the pain would be minimal. However, the condition has worsened throughout the years. The most recent severe pain episode was about 5 years ago when I foolishly went to get a special Asian massage with someone walking on your back. The pain that attacked me the next day was quite severe and I thought I had incurred an injury. I did X-ray and MRI and nothing significant was found.

Starting about a year ago the background pain had increased. In particular, sitting and standing in the same place (such as when I work at my desk or teach in class) bothers me severely. My sleep is also affected. I have to change position continuously and I wake up with a very stiff lower back.

Unfortunately I have not been able to keep my regular exercise activities and that had added to the issue. I started jogging about 8 months ago and only after about a week I noticed that the pain is getting really bad. I thought I need to address the issue much more seriously. The first diagnosis was SI joint problems, which I highly doubt to be the case. The exact pain location is lower that the SI joint area. It is actually concentrated about 8 cm lower, on two points on both sides of the mid line on my upper buttock. I was instructed to take a couple of steroid injection into my SI join, which dis not help that much. I completed a course of physical therapy. That helped to some extent but now I am back to square one with lots of pain. Bending to any direction causes pain.

A few days ago I took an x-ray and MRI. I am uploading a few of the results. I have not received the reports yet. Meanwhile after educating myself I suspect that I am probably suffering from Cluneal Nerve Entrapment. The exact location of the tender points are about 8-9 cm to each side of the mid-line on the upper part of my buttocks. When I do a heavy duty task, the pain spreads around, my muscles become very stiff, and sometime I feel a nerve is being pinched.

By the way, I can easily move the bones in that area to make a cracking noise. I definitely feel too much movement is happening there. Massage helps a lot. In particular, an electric vibrating massage machine relives a lot of the pain immediately. Perhaps, this could be another indication of an entrapped nerve.

And finally, I must add that due to a sport injury which incurred when I was about 14 years old, I twisted my left foot. As a result my left foot is almost flat and perhaps my left leg is a bit shorter. I never addressed that injury. So my feet are not symmetrical now. This could explain the abnormal curve you see in the x-ray from my spine. I can provide much more details but allow me to await your response first.
Thanks for your invaluable input.

Hello Marco,
Let's start with the x-rays. There are three significant findings. Firstly on the lateral lumbar (is an extension view?) there a sharp posterior angulation of L2 on L3 which is indeed where the superior cluneal nerves emanate from.

Secondly, on the lateral lumbar MRI there appears to be a disc bulge at L3-L4 which may contribute.

Thirdly, you clearly have several "Schmorl's nodes" which are indicative of either old trauma, or possible a condition call Scheuermanns. I favour the latter, especially as all this started when you were a young man. Do you have a siffness in the midback, and round shouldered?

So the question is, is the pain down in the sacral area referred from the upper lumbar spine, or a separate condition? Only a careful thorough exam will make the distinction. The radiating sort is called Maigne's syndrome.

Don't deliberately crack your back; it's already hypermobile and it would worsen it.

Your foot injury, particularly if it's left you with a short leg, or a slight limp may be very significant. Have someone stand behind you, place the hands on the iliac crests, and see if one side is definitely lower than the other. And when you bend forwards, do you develop an obviously scoliosis? A simple inexpensive heel lift may be a big part of the solution.

What's good is that you don't seem to have significant leg pain.

You state plainly that it's been worse since not exercising. How about starting with a simple set of very basic lumbar exercises. Using the search function at Chiropractic Help type in "Maignes syndrome exercises".

You also make no mention of ever having consulted a chiropractor. Isn't it time?

I hope this contributes.

Dr B

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