back went out leading to severe butt pain

[gaf1986]

Hi, just thought I would chuck in my two cents worth!

Just out of curiosity have you had/know the results of the straight leg raise test and slump tests? I'm pretty certain this would have been done? Also is there any weakness, numbness, pins and needles in the left leg compared to the right? If there is a true nerve impingement on the nerve root you would expect some neural symtpoms and reduced reflexes.

From my experience with chronic disc bulges like yours, I find many patients have developed adaptive posture into a overly anteriorly tilted pelvis as this would have been a position of comfort initially, as such patients lose the ability to posteriorly tilt their pelvis which is needed during normal lumbosacral movements i.e bending forwards and backwards. Also due to this constant anterior pelvic tilt more pressure is put on Z-joints in the lumber spine so they can become irritated and also this explains when you bend backwards the pain is increased or 'pinching' as the joints are already near the end of their range and you are just really shutting them down on further extension. This theory would also explains why sitting is a position of comfort for you and standing/walking is worse, which doesnt really fit the picture of a disc problem anymore!!

In terms of treatment I agree with guy below in getting a release on the hip flexor muscles as well as the quadratus lumborum as these are the muscles that would become tight in a chronic anteriorly tilted pelvis, once released (and continuing with stretchs) work a lot on regaining your posterior pelvic tilt in lying, sitting and standing so that you adapt back into a 'normal' position for your back and pelvis to work better together.

As physiobob said, time is a great healer and after two years I would expect the disc to be in a stable state so infact you would want to promote opening up of the joint (lumber flexion) over closing them down further and compressing the nerves with more extensions!

Hopefully this makes sense, you seem quite in the know so should do! Hope its of benefit! If not and in view of your new actue episode, maybe a new MRI is in order to see if something has changed causing the new onset!

Glenn

[wkriski]

Thanks Glenn, physiobob and everyone who has posted here. I'm so happy to see your new responses! And that's some very detailed analysis which is awesome. From what I gather from the exams/treatments my reflexes and other neurogical issues have been fine. I agree that I have probably compensated by leaning more on my right side and other things. And the pelvic tilt hasn't been happening I don't think because when I have done that I get the pinching in the butt.

Just thought I would give you an update:

I returned for recently for about 6 active release therapy (which I had in the past causing butt spasms) and 2 massages and during the ART/massage I've had the psoas muscle worked on as well. The doc pushes on it while the other person pulls my leg back for a great stretch. The severe pain has pretty much gone away! I've also been taking calcium citrate and glucosamine. Someone had mentioned that the calcium can help repair tendon injuries.

I've also been self-massaging a muscle in the upper glute just below that bone with my thumb, since I noticed some sensitivity there.

Now I have a lot of numbness in my outer left foot when I sit. And an overall achiness/stiffness in my low back. So the doc is also doing some chiro adjustments. When I had a massage there was lots of achiness on my right side lower back when she would massage me in that direction (to my right). But I'm really happy to be making some progress.

What kind of stretches do you recommend? I've been doing the piriformis stretch (one leg crossed over, etc) and the cat stretches, mckenzie exercises and using a foam roller for IT band, quads, etc.

I am actually completely surprised that anything has worked after 7+ years of grief, especially since I've done ART before. Not out of the woods yet and this has recurred again and again but thanks to you all for your input!

[wkriski]

Hi it's me, Will, again. I thought I would give an update. The butt pain came back within the last month, so I had a good 6 months or so of relief. The pain coincided with me working a full time IT contract again and the accompanying stress, so I'm not sure what happened, as I normally sit quite a bit even when not working.

I started up massage and physio again although it's not the same as the ART I had. Since I can't figure out exactly what helped I'm trying to replicate everything. I may have to try the calcium citrate again. With massage there are so many areas and the psoas is hard to access. If I could figure out exactly what was done to help and why it came back (eventual tightening of muscles again,etc) I'd be a happy camper!