back went out leading to severe butt pain

[wkriski]

I just had a repeat of what could be called 'my back going out', or a twinge, something slipping, etc in the center of my lower back. For a few days I am bent over not able to stand upright, and in the past I had to crawl around in my hands and knees. I've had no traumatic falls.

But after a few days that central issue clears up and I end up with severe pain in my left buttock, a pinching feeling that hurts when I lie on my stomach or lean backwards. For those of you thinking piriformis let me say that I have had botox injections, IMS, active release therapy, prolotherapy in those are other gluteal muscles. We've found many sore spots in these muscles but haven't been able to stop the pain.

During this acute phase, which sometimes results in brutal butt spasms that come on in the wee hours of the morning, I had an s1 nerve root block and it instantly reduced the pinching/stabbing pain considerably.

My back pain started in 2002 and I had an MRI which showed 2 bulging discs at S1 and L5, with more bulging on the left side and a partially lumbarized sacrum. A surgeon looked at it and didn't think it was significant enough to warrant surgery.

I have had some sore spots in my butt and hip that I worked out with a dog ball and my IT band was really sore but that has been much better, but the pain remains. Once the acute phase calms down I am left with constant nagging pain that never ends now, ie. there is no relief, it never gets better. I recently found that taking voltaren and tylenol together helps with the nagging pain, however during this acute phase it doesn't help at all.

I recently returned to physio and she is trying to get me to squeeze/strengthen my glutes and keep a better posture. During these treatments over the holidays I experienced my back going out which has escalated the pain.

Any help with diagnosing the actual issue would be most helpful along with suggested treatments other than the usual core strengthening/posture. For example, treating the possible nerve inflammation, takeing the pressure off, etc. I have an inversion table but it's never seemed to help and I'm afraid to inflame it during this acute period.

If I were to guess I'd say the disc is inflaming the nerve which is referring pain to my glutes, but since no one wants to operate on the disc I'm not sure what to do as the pain is constant and currently acute as mentioned.

Thanks in advance!

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[physiobob]

During this acute phase, which sometimes results in brutal butt spasms that come on in the wee hours of the morning, I had an s1 nerve root block and it instantly reduced the pinching/stabbing pain considerably.

I think that gave you your answer. Maybe if this is not being alleviated for any useful period of time a microdiscectomy might be in order. Sounds like something is physically pressing on that nerve and you need it to stop doing so.

That said time is a good healer as many in the non-western world live full normal lives without surgical intervention. There can be some interesting postural changes though

[wkriski]

Thanks Bob,

Unfortunately 'they' won't do surgery based on the mri I had and also many people seem to develop scarring so it still touches the nerve. I read about laser surgery but have seen some horror stories from some of the places in the US but it seems that slicing away some of the disc would make sense.

I wish time would fix this problem, over the past few years it's been pretty constant.

[bhalla.ravneet]

Yes he is right,

check these sites out should help you

Causes of Buttock pain - WrongDiagnosis.com

Reasons for Pain in Buttocks - Pain in Buttocks

If it is a confirmed fact that you have Disc Bulge/herniation or posterior bulge and is compressing your nerve roots you could ask your physio to teach you Extension exercises or Mckenzie exercises along with MWM .

check this out dr Mike
YouTube - McKenzie Exercise

Wish you a speedy recovery

God Bless
tc

[wkriski]

Thanks for all the info. Hopefully I don't have anal fissures!

During this painful phase it's hard to lie on my stomach and when I lean back or do mckenzie exercises, it pinches so bad that I can't do it. but hopefully after the nerve root block today I'll be able to do these. I have done them in the past as well as inversion table/traction with no relief.

When the pain is not as bad I've noticed that as I lean back it starts to increase pain and pinch, then it relaxes as I go further back...not sure what that means!

[bhalla.ravneet]

Do these exercises under supervision,

I have treated some patients with Movement WITH Mobilization- Mulligan.
The Results have been quite satisfactory.

i suggest you meet a Physio who is specialized in Manipulation and Mobilization.
You should feel better in jiffy

Get well soon, ll Pray for you

God Bless

[wkriski]

Thanks for your help!

I was strapped into one of those devices a few times and it hurt pretty bad, seems like the compression pressure of the belts would irritate the disc/nerves.

[bhalla.ravneet]

I dont know which device are you talking about,
What i have adapted is while doing mckenzie on elbows you turn your back to one side while the therapist applies pressure over the spinous process and gives a Pa glide
then A lateral glide on the transverse process in the direction of the movement,
ask your physio he i ll be well versed with this..

[wkriski]

Just had an S1 nerve root block last tuesday after the painful butt pain/pinching. After immediate relief for less than a day, it wore off and I'm back to butt pain again, so that makes me wonder if the relief came from the initial anaesthetic not the nerve root block.

Any ideas what these clues might indicate? It hurts when I stand, lie on my stomach or lean back - when the pain in the butt increases. I can sit without much discomfort.

I've put an ice bag on it for a long time and there's no relief from that.

[physiobob]

Maybe it's time for a repeat investigation. You might have an unstable spondylolithesis or perhaps the pain is coming as a referral from the bony vertebrae themselves. The fact that the block gave immediate relief suggest the buttock referral is in fact a referred pain - as you say maybe not from the nerve itself but perhaps from surrounding structures e.g. joint/bone. Now you need someone expert is working with you on restoring that lumbosacral area.

[wkriski]

Thanks for your input! How do I go about doing that? - how to investigate, what the treatment would be, etc. I've been putting ice on it during the day and it doesn't seem to be helping. I thought maybe the initial numbing agent did something but it wore off quickly. Walking and standing is brutal but luckily I can sit for work purposes, which wasn't always the case.

I did chiro at one point consistently with proper alignment and still had issues...

It's amazingly difficult to get a proper diagnosis of the cause of the pain and then how to treat it.

[maldo1]

Try this as this may help - i would be interested if it does.

Have a physio or massage therapist trigger/release (call it what you like) your left TFL/iliacus/psoas - try 1 at a time and reassess your extension based pain and see if 1 or a combination helps relieve your extension pain. Im not sure if this will clear the buttock pain though. Try it and let us know how you went.

[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!

[pauljackson]

Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system These newer correction methods are even safer, more comfortable and more effective than ever before.
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[pudding_bowl]

With the McKenzie exercises how often did you do them and were they helping?
You managed 6 months releif and it came back with lots of sitting and flexion (possibly) Maybe that you need to dig into the extensions again. Have you done much in terms of core control work? Any physio guidance as to swiss ball or pilates input? Might be a nice adjunct to your current self treatment.