Pain in the bum

by Zoe
(Scotland)

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
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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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