Hip, hamstring pain - PLEASE HELP ME

[snomys]

Hi

I have had a problem for about 6 months now, Im currently seeing a physio with Bupa, but after 3 sessions and regularly following the routine they have set, I am not seeing any changes. The injury just came out of the blue, there was no particular moment I can say, oh, it happened this day, or that time, it just slowly came on.

Left side, which is my weaker side.

Im 37 year old male, quite fit as I run alot, lift weights, practice karate(even though I have stopped for the last few months).

The issue is strange, it kind of moves around, but the most noticeable symptoms, are:

1. When bending over at the waist, I get a real aching pain down the back of my upper leg, hamstring area,
2. When I walk uphill or steps, it feels like the hip is weak and it aches a little
3. When sitting down, I get a really sore ache under the left buttock

My GP and Bupa ran through the hip motions to isolate if it could be a hip issue, but as I have movement as expected, this has since been discounted.

I went to see the pilates instructor at my gym yesterday and have a session tomorrow, immediately she suggested "Sciatica", but then seemed a little perplexed and suggested an impingement, I guess she wont know exactly, and the conclusion of the consultant and physio at Bupa are suggesting its related to a weakened gluteals, and I have been given a variety of strengthening exercises to perform.

Ive googled and there obviously is a whole host of things this could be, so self diagnosis has drawn a blank, but Im hoping posting on this forum someone might be able to offer me some advice.

When I bend over with my legs out wide, I do not get any pain in the hamstring, but when standing straight I do.

Usually any injuries I have had, the body over time, sometimes stubbornly, repaired itself, but this problem, just is not going away.

If I could describe the pain in adjectives, I would "achey, sinewy, deep, nervy, bone pain".

Really any help, ideas, advice, absolutely anything would be so well gratefully accepted.

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[Stargazer]

Please test:
Does the pain occur when bending your left knee against some resistance
(possible way: lay down on a flat surface - belly facing the floor - have someone hold down your lower leg with a reasonable amount of strength (i.e. you are barely able to perform the full motion) - check if this causes your typical pain)

please test:
Do this again to make sure it is causing your typical pain "1. When bending over at the waist, I get a real aching pain down the back of my upper leg, hamstring area,"
if yes now redo the same test with your left knee bent (about90degree) without your muscles having to maintain the bent state
(possible way: do 1st part standing up bending forward - do 2nd part standing up with your left (bent!) knee and lower leg resting on a chair - bend over your waist/torso/hip in the same way in both cases)

do not repeat tests unnecessairly - stop the test once your typical pain occurs, do not try to see how much it can hurt if you continue doing it

post results

[snomys]

Hi

Thank you for taking the time to read through my original post, and also for asking for the results to your exercise suggestions, so here are my findings:

1. Lying belly flat, with resistance and trying to bring to foot up to bend the knee, I did'nt really feel the ache, just a mild soreness on the outer hip area.
2. Standing straight with the left foot resting on chair, and knee bent, I could bend forward at the hip and not feel at pain whatsoever.

Are there any other diagnostics you would like me to try? Just let me know, I'll do anything!

Again, thank you for posting and querying this with me.

Look forward to your response.

[Stargazer]

result of the first test suggests that there is no strong involvment of any knee flexor (i.e. exclude hamstrings)
result of the second test suggests its either a problem with a knee flexor or a nerve problem which is not located directly at the nerve exit at the vertebral column

One of the gluteal or transversal pelvic muscles (such as piriformis) may be involved and/or may slightly compress nerves which are in between these muscles. Gluteus maximus pars inferior might cause the typical pain in the "hamstring area" then again nerves may cause this as well.



Personally i`d approach the issue with soft tissue techniques such as deep friction on gluteal/pelvic muscle insertions and "tender/trigger" points (or whichever terminology is typical for points which are very painful during palpation).
If i wouldn`t be able to find any tender points during palpation of the gluteal area, I`d have to try a different approach

^This should be done by a professional but pretty much any physiotherapist should be able to work with the terminology deep friction

You can also try applying heat to your gluteal region with a heat pillow or something like that - this increases local blood flow and should reduce most nerve derived pain and improve healing in damaged muscle tissue. However, heat by itself is unlikely to solve your problem.
I`d advise against stretching exercise for the gluteal/pelvic region while the issue is still present especially if they increase pain afterwards/during the stretch
I`d advise to strengthen the muscles which are affected the most after the pain has reduced.

Also try to check your daily life for situations which cause excess stress on the aforementioned muscles and avoid those - excess stress means permanent stretch/permanent (even if weak) contraction. 3*50 squats every three days are not excess stress.



Not much more i can do via online forum. I find the conclusion of your physio reasonable though nothing is ever 100% certain.
Make sure that you dont do anything on your own which increases your typical pain.

Hope you get well soon , cheers

[snomys]

Hi

Again, thanks for your posting, last night I went to my first ever pilates session, and the lady there suggested I have torn hamstring. She said I need to stretch hip flexors, piriformis and have alot of hot baths with magnesium salts.

I will have session with her, every week, for 30 mins.

My job is IT, so I spend alot of time sitting each day, over many hours the pain in the left buttock comes, so I bought a memory foam cushion for my chair, but it doesnt really help much.

But for the last 6 months, I continued running in the gym, and lifting weights, I think for the next month, I will stop completely, just attend pilates, and try to stretch piriformis and hip flexors.

You are in Cyprus right? Do you ever visit London?

If after a few more months, there is no change in my condition, would it be possible to meet you, I'll pay you for your time, or even pay for you to visit London, as you can tell Im quite desperate to fix this problem.

The pilates lady suggested it can take years to overcome a hamsting injury like this, do you have any treatments I can try, or stretches?

Maybe I can come to Cyprus in a few months, I want to find a good physio, even Im using my private healthcare here in London, he suggested I just have weakened gluteals. I dont think its correct.

Should I ask for a CT or MRI scan? Will this help?

Thanks again

[Stargazer]

EDIT: I had to remove all the links due to forum rules I`ll try to pm them if that doesnt work just use picture google for "ischial tuberosity" and "hamstring insertion" and look around a bit.
EDIT2: pm sent - seems to work

Again, thanks for your posting, last night I went to my first ever pilates session, and the lady there suggested I have torn hamstring.
Should I ask for a CT or MRI scan? Will this help?

Did she do any tests to come to this conclusion? If so which ones?

Personally i find it unlikely that your hamstrings are torn off. When a muscle tears you`d expect a sudden strong pain and a strong visual haematoma. You on the other hand described your problem has developed gradually over time. And if theres only a partial tear or a strain of the hamstrings then bending your knee vs resistance should have caused your typical pain.

The only other option for Hamstring might be tendinose/tenidnitis of the upper hamstring insertion. This MIGHT not have shown when bending your knee vs resistance (although it should)
LINK

^a link showing the location of the ischial tuberosity - this is a massive bone structure which is pretty easy to find when you poke into your cheek meat from below while standing (or any other position as shown on picture) google ischial tuberosity to learn more about it

Ischial tuberosity is the point of insertion for the hamstrings(link: ) and in case of a tendinose/tendinitis it should be pretty painful when you rub the ischial tuberosity with a finger (do it on both sides! the left side should be very painful while the right side should be pain free)
^actually this really should be done by a professional - in fact id expect anyone who diagnoses hamstring issues to check the insertions for pain when pressured

I`m not an expert on medical imaging. I`m reasonably sure that with an imaging technique you should be able to rule out a tear 100% - ask a doctor/other expert on medical imaging for more information on this topic.

^the treatment i would apply in case of tendinose/tendinitis would still be the same - deep friction in gluteal area (in this case ischiadic tuberosity in specific)

She said I need to stretch hip flexors, piriformis and have alot of hot baths with magnesium salts.

I wrote this one post earlier - i`m not a big fan of stretching strained muscles - i`m even less of a fan of stretching short muscles such as piriformis
Then again many ways of treatment can lead to a good result

I`d advise you to try the treatment your physio suggests if you feel like she/he ran a decent diagnosis to come to her/his conclusion.
I`d heavily advise you to stop the stretching exercise altogether if your typical pain increases during or after any of the streching exercises. Make sure to tell your physio that her/his exercise increase your typical pain if this is the case.

But for the last 6 months, I continued running in the gym, and lifting weights, I think for the next month, I will stop completely, just attend pilates, and try to stretch piriformis and hip flexors.

Same thing as said above applies here as well. I would avoid exercises/stretches which increase your typical pain during or after the exercise

My job is IT, so I spend alot of time sitting each day, over many hours the pain in the left buttock comes, so I bought a memory foam cushion for my chair, but it doesnt really help much.
(my physio) he suggested I just have weakened gluteals. I dont think its correct.

Personally i find the idea of problems with muscles in the gluteal region to be reasonable. This doesnt necessairy have to mean your muscles are weak. (I assume you think he`s wrong because you work out a lot?)

Long sitting is a constant strain (stretch! in this case - so stretching even more seems counterproductive) on some small pelvic muscles especially if you tend to bend forward towards the PC. Plus the pressure of your body weight - this may cause these muscle to cause a variety of problems. Also The smaller gluteals arent trained very well with typical exercise such as squats.

I like the idea of a foam cushion - ideally you want to change your position around a lot while you work - for your specific problem i`d suggest trying to "lay back" in your chair so you`re almost in a "sleeping on your back" position.
^Aforementined position is not ideal for working and is horrible for your neck because your neck needs to bend forward heavily to compensate in order to look at the screen. So as mentioned before - try to change your position as much as possible and use positions which feel comfortable for you.
You should also try to change around the position of your feet because this has a big influence on the rotation of your upper leg and with that influences strain on pelvic muscles. crossing your feet under the table while your knees are bent 90degree makes the upper side of your upper leg point outward - doing the opposite which is putting your left and right foot further apart from each other each on their corresponding side makes the upper side of your upper leg point inward.

^try playing around with these positions they both reduce strain on different pelvic muscles - find the one which is most comfortable at a certain moment in time and switch around every now and then.

You are in Cyprus right? Do you ever visit London?
If after a few more months, there is no change in my condition, would it be possible to meet you, I'll pay you for your time, or even pay for you to visit London, as you can tell Im quite desperate to fix this problem.

I dont give out any real information on myself online and im not going to meet anyone i met online - sorry for that.

Please remember that i`m just a guy who just happens to be here at this point in time. Online diagnosis is A LOT worse than hands on face to face diagnosis - you should put more trust into the physio who performed an extended hands on diagnosis. I`m sure that you have a lot of Physios in the UK who know their stuff equally as well or better.

I`m happy to see that you understand that Physiotherapy is not something that helps you from one day to the next. Try to find a physio who you can trust and who runs a decent diagnosis - let him explain his thoughts to you if you want (i like doing that as you have probably noticed) and then stick with his treatment give him some feedback every few weeks and see where it takes you(If you want you can ask him to check for trigger points in your gluteal area and request a deep friction treatment if he finds any which is as i said what i`d do).

Myofascial taping in the gluteal region might also be beneficial for your problem if you can find a physio who does this (shouldnt be too hard in London i guess).


Hope you get well soon.

[snomys]

Hi



OK thanks again for your information, I will read into this literature you have sent in the PM, and also into myofascial taping, actually I want to inform you of a development I have tried over the last two days.

As you know the pilates instructor mentioned a few different body parts which she said needed stretching, so a few nights back I googled and came across this post, on youtube.
(had to PM it again, sorry)

So as I had said, when sitting for a prolonged period at the office, very gradually I would get a very dull aching pain in the left buttock, kind of in the bone just under the meat of the cheek itself, so I thought, ok Im going to get up, go into a toilet cubicle and perform this stretch.

Surprisingly when I done it, and returned to my desk the ache had gone, and before under the desk when the ache was there, whilst sitting I just tried to raise my left leg up under the desk, and could feel the usual strain pain all the way down the back of the leg hamstrings area, so I just returned it back to its normal position. But after the piriformis stretch, the ache in the buttock had gone, and also, I could now extend my leg under the table with no ache at all, just a very slight tingle in the inner groin of the left leg.

I read on wikipedia, about piriformis syndrome, and it kind of sounds so similar to everything I have been through, and it says to perform the stretch every 2-3 hours, so I woke up today, done it very gently, as usual, and I just walked outside my home as I have the day off, and walked up the hill, which usually immediately gives me a bit of insecurity in movement and lets me know the problem is still there, but it was different today, it felt alot stronger, free-er, more flexible.

Whats your thoughts on this? Right now Im sitting down, have a hot water bottle under my buttock, and Im going to perform the piriformis stretch every 2-3 hours, and do as you suggested, 3x50 squats every 3 days, I done my first set last night.

I dont want to get my hopes up, but there is definitely some relief happening when performing the stretch in the video.

Are there any other things I could try?

Sad we couldnt meet, but I understand and respect your choices, but again, thank you very much for your time and consideration.

[Stargazer]

I read on wikipedia, about piriformis syndrome, and it kind of sounds so similar to everything I have been through

Yea this is pretty much what i expected the problem to be after you did the first 2 tests - doesnt necessairily have to be piriformis, it can be any transversal pelvic muscle/small or medium gluteal muscle as they are all very close to nerves. And they can all be affected in similar ways.

I`m glad to hear that stretching helps you and you should continue doing it if it continues reducing your symptoms! Watched the pm you sent me,it is definitely a good way to stretch your transversal pelvic muscles.



As for the 3*50 squats - please dont take things i say out of context. I didnt suggest you do this (although i would suggest doing squats to everyone who wants to exercise for a healthy lifestyle in general - just make sure you have decent technique) i wanted to clarify that doing a big set of squats isnt bad for your muscles as opposed to putting constant stretch or constant weak contraction on a muscle.
Here`s the exact quote concerning the 3*50 squats:

Also try to check your daily life for situations which cause excess stress on the aforementioned muscles and avoid those - excess stress means permanent stretch/permanent (even if weak) contraction. 3*50 squats every three days are not excess stress.

Are there any other things I could try?

Nothing else comes to mind that i havent said before in previous posts

thank you very much for your time and consideration

Glad if i could help you - hope you get well soon.