Pain in the bum

by Zoe

Pain in the bum.

Dear Sir. I have pain in the buttocks which radiates at back from waist over hips and into the back of thighs and also into feet; sometimes on both sides sometimes just one.

It's very painful at night when lying in bed, but also after sitting, and feels very uncomfortable and stiff to walk. Feel like my back/pelvis needs the bones clicked. Physio says it is a piriformis syndrome. Why does it migrate from one side to the other though?

I like to run, but this seems to make it worse, as does being inactive. Have tried ice after exercise, hot Epsom salt baths, foam rolling, glute-strengthening exercises and yoga. Nothing seems to work for very long. Any advice you can offer?

Hello Zoe,
Apologies for the late reply. I've been on leave.

Please do two tests for me, and send me your response keeping to this thread.

After no painkillers for 24 hours,

1. Bend slowly forwards, then backwards and then to the side. Tell me exactly what you feel.

2. Sitting in a kitchen chair, raise one leg parallel to the ground, lower it and then with the other leg. Tell me EXACTLY what you feel with each. If it causes no real pain or discomfort, repeat with the head flexed on your chest.

Have you been given a piriformis stretch?

Are you doing some gentle back exercises every morning before getting out of bed? If not, start there.

Ask your physio if there is tension at the T12 area, and whether you have a short leg. A condition called Maigne's syndrome refers to the buttocks too, but not to the feet.

Let me know.

Dr B

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Jul 24, 2016
Response to questions
by: Zoe - Scotland

Pain has abated somewhat recently. Leaning forward feel pinch in buttocks, same back leaning but not really painful at present. Side to side feel stiffness around spine lower back. No pain doing seated leg raise.
Have been told left hand side is tighter. Also saw podiatrist a while back and was given insoles to correct fallen arches which they thought may be causing piriformis.
Been given piriformis stretches plus exercises to strengthen gluteals - clam shells and wall squats.
Not been doing back exercises.
Physio discharged me - thinks it should heal by itself with rest and may just be overworked tender piriformis muscles.
Pain seems to have subsided greatly since I stopped running but flares whenever I exercise.

Hello Zoe,
Then start those lower back exercises every morning; they take less than two minutes. I do them myself, and never miss.

When you feel up to it, start a walk jog routine, if need be just a stroll initially for five minutes; gradually introduce gentle running.

It's important that it settles down; give it a few more weeks and if still unable to run see a local chiropractor. When the sacroiliac joint is fixated you simply can't run because the ilium must rock on the sacrum to enable you to raise your knee. It's usually not difficult to fix, unless your lumbar spine is also involved.

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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