SIJ problem - Any help would be appreciated

[April RN]

I am new to this forum and want to start by saying hi. My name is April and I would love some advice/opinions. To start, I had a D&E on 8/25, for which I was under general anesthesia. I was discharged that evening, still full of narcotics, and literally walked inside my home and to my bed. I awoke at 6 AM the following day unable to walk on my own. I saw an ortho who diagnosed an SIJ problem, gave me a Medrol dose pack and sent me home. 4 days after beginning the steroids I was in so much pain I thought I was dying, called his office and Robaxin was called in....which was no help at all. I had excruciating pain for 2 weeks, and after taking Robaxin for a couple of days I then sought out a physiatrist. He also said SIJ dysfunction with a ligament tear, injected muscles, the SI joint, and the trochanter with Depo-Medrol, and gave me pain meds....both of which helped, but I am still unable to walk without crutches. I have been in therapy now receiving ultrasound and light pelvic strengthening exercises, but am having intermittent bouts of moderate to severe pain in the upper SIJ area and at the L trochanter. I had a MRI of the lumbar spine which showed two annular tears, but no herniation. It sounds crazy, but I was hoping for a herniation, surgery, and then to recover in 6 weeks. I have no clue what has actually happened to me, and since this has been going on for over a month now, I am wondering if it seems like the diagnosis is correct of a ligament tear and SIJ dysfunction. I am wearing the SI belt religiously...only taking it off to shower, and am still having quite a bit of pain...primarily at the trochanter and the inner portion of the iliac crest/upper SIJ if my anatomy is correct. Can anyone tell me what might have happened and I am on the right track with the therapy and just waiting this out to improve???? I really want to get back to walking again without crutches, to go back to work, be able to care for my young son, and get on with my life! Please help!!

Similar Threads:

• Any help would be appreciated
• Hi advice re NZ appreciated
• any advice appreciated!!
• Any Help Appreciated!! Pain in Butt/Groin!!
• Quadraceps injury - Any help appreciated

[Dr Damien]

Hello April

If two different professionals have had a look then perhaps it is what has been diagnosed.
From the information given very little reasoning can be made and as you cannot be assessed it is even more difficult. SIJ problems are very easy to diagnose so perhaps these professionals cannot have made a mistake with the diagnosis

Help us out with the following information to see what advice can be given

1) what happens when you stand on that leg?
2) bringing ur knee to your chest? what happens? what about bending foreward like you wanna touch your toes?
3)can you lie down on your left hip without pain?
4)is this pain constant or only there when you are walking?
5) does it disturb your sleep?
6) the SI pain and left tronchateric pain, do they occur at the same time?
7) any lowerlimb symptoms?
measure from ur belly button to the anterior superior iliac spine on both sides? anydifference in length?

The anatomy youv mapped out correlates also with the anatomy of the small rotators of the hip
7) what happens when u turn ur foot in and out against resistance in standing respectively (like against a wall)?

SI problems most often have a traumatic onset and there are different types (inflares, outflares, upslips and downslips), the often respond well to manipulation/mobilization to reset and specific exercises to reset and maintain.
some laxity may have been present in ur ligaments prior to ur D&E and the surgical procedure could have traumatized that...

hope to hear from you soon

[April RN]

Dr. Daminen,

Thanks so much for your response. I really appreciate you taking the time to write me. Below are answers to your questions....

1. When I bear weight on the affected leg, which I have started doing only in the past few days since it has been too painful in the last few weeks, I have pain primarily at the pirifiormis insertion site, but occasionally also have pain at the iliac crest.
2. Bending forward doesn't cause pain....just a slight pulling sensation like my muscles are tight, which I am sure is the case since I have been unable to do much stretching in the past couple of months.
3. I can not lie on the left hip. This makes the pain greatly increase. I only attempted this last night after reading your message, and it was quite uncomfortable.
4. The pain occurs when I am walking or moving the affected area. Presently, sitting doesn't cause pain.
5. The pain has greatly affected my sleep. I rarely slept for any length of time initially, but have slept some better the last few weeks. I sleep on a soft couch with a thick soft blanket folded beneath me since this has happened. I slept in a bed with a memory foam mattress before, and have tried to since, but wake in the middle of the night hurting and sore, and then make my way back to the couch.
6. The SIJ pain seems to have greatly diminished, and now the primary point of pain is at the trochanter/piriformis insertion. Intermittently I will have pain at the SIJ area, but only if I move my leg in a certain way, like out to side, or just walking if I move my leg too quickly.
7. I have not experienced lower limb symptoms.
9. Currently there are no discrepancies in leg length, though there was for 2 to 3 weeks after this happened. My therapist stated my left leg was longer than the right, but I think they have "gotten the SIJ back in place", so to speak.
Thanks again for your help. I have been stunned over all that has taken place since my surgery. I certainly never expected it, and was afraid I may not have been pursuing the proper treatment avenues.

Sincerely,
April

[Dr Damien]

Dear April

My apologies for replying you late.

based on you reply here are my thoughts of your problem

Your site of pain is mainly at the hip, you cannot lie down on it; usually we find that people who have this problem either have a pelvic fracture, a hip replacement or a greater tronchanter syndrome (bursitis, abductor tear etc) or an SIJ problem (wherein closure/jamming of the SIJ causes pain as would happen lying on the affected side). In your case the above two can be ruled out leaving the latter two
You pain is mostly on weight bearing: this would suggest either a back problem, SIJ or hip problem
Sitting does not affect it...so we can technically rule the back disc problem out
YOu say the pain used to disturb your sleep but now you find you can sleep well; the inflammation you get from this problem is getting better...perhaps due to natural healing or the treatment you have been getting
you say you sleep better with a rolled blanket beneath you..this is puzzlying? (beneath you where?) if its your back...then it suggests that your back might be an area to assess again....
you are not experiencing any lower leg symptoms so I would not think you have you have a neurodynamic component (what people describe as sciatica)
You do not have pain when you bend forward but everything feels tight...Lumbar and SIJ seem unlikely, however what happens when you been backwards?

You have not provided me with any details with regard the test i suggested above, pushing your foot against the wall or what happens when you bring your knee to your chest

However here are my thoughts on your problem

while it is still vague what the primary issue might be..I would think from what you have said you have a possibly a hip abductor strain/ small hip rotator strain...an SIJ in/outflare could also be a possibility...

I think this because you say bringing your leg out is an aggravator, and lying on your side is also an aggravator....

I would suggest a few more tests that you could do by yourself or with someone assisting

Test 1
to check if you have an abductor strain
Stand next to a wall with your bad side to the wall, keep your feet pointed forward
now push against the wall with the side of the foot (stand straight and do not let you leg go out to the side)
what happens?

If you cannot do this easily from lack of understanding of my ridiculous description...
lie on you back, keep legs straight, ask someone to put their hands on your side of your thighs or knees, they should resist while you try to open your legs...there should be no movement of your legs apart with the resistance

Test 2
To check if small rotators have been strain
standing against the wall again...turn your foot out and push against the wall
repeat the other way....trying to push against the wall with your foot turned in...

there are other tests to for your SIJ but if this is the problem we do not want to aggravate it....

let me knkow how you get on...

cheers