Peristent posterior innominate rotation

[Lac ham]

Hi I'm a physical therapist in the US, practicing for 3 years now. Unfortunately cannot figure out my own source of pain.

March 2013 I was doing a workout- heavy on the legs/hips with focus on endurance/power. Next morning my right side felt like it was hit by a bus. Since then I've been experiencing a variety of right sided pain- never left.

Started with lateral hip and pelvic floor pain. First tried dealing w/ it myself with some rest and basic stabilization (TrA pelvic tilts, bridge, SL hip abduction, CLAM). The pelvic floor stuff got worse, and for several months it was ONLY pelvic floor- no pain elsewhere. I began complete rest.

About October 2013 I began seeing a women's health specialist. Had a lot of manual therapy and dry needling, really no relief. In fact I began having weird right abdominal pain, anterior right hip pain, posterior/lateral hip pain, increased low back pain and increased cervical pain. I felt like I always wanted to stretch: hamstrings, hip flexors, quads, adductors, posterior/lateral hip, etc but never found relief. (Good hamstring length, no discrepancies with thomas test, better quadriceps flexibility on the right than left which was the side of an ACL reconstruction 10 years prior) There was one small episode of improvement when I began doing closed chain hip stabilization on the right. During that time saw an OB/GYN and a urogynecologist who called it a obturator inturnus spasm. They put me on a suppository muscle relaxant which helped for like a week and then I found my lumbar/thoracic pain (again right sided only) getting worse. Had a ultrasound of my lower right quadrant to clear any ovarian cyst/etc. All (-). The general belief was that the abdominal pain was my psoas. Did a general screen to find that my left hip was considerably hypomobile in respect to my right and that I had very poor thoracic mobility (left rotation worse than right). Had some co-workers work heavily on my left side (mobilizations of all sorts) and thoracic spine with improvement in my lumbar/thoracic pain but no change in my pelvic floor/anterior/posterolateral hip pain.

Early Spring 2014 began seeing another PT. She worked on pelvic floor and suggested I have some sacral torsion. Found my left ASLR to be positive in that I couldn't stabilize the right side of my pelvis when lifting. She suggested pilates. I began finding that whenever cued to stabilize my core (TrA or glute max) I would have pain (felt like overworking) in my right lumbar spine or right anterior hip. The best I could do to relieve this feeling was perform most exercise with a bit of an anterior pelvic tilt.

Saw a physiatrist who first suggested a lumbar MRI, my pain diagram looked kinda like L1 distribution with the random pelvic floor stuff too. The MRI was (-). Then he suggested it was all coming from my SIJ. All SIJ cluster tests were negative during the testing, but within a few minutes later sitting there talking to the doctor my right SIJ began hurting. He said that he thought my left SIJ was hypo, my right SIJ was hyper and had a persistent posterior innominate rotation on my right side. I began having my co-workers perform some muscle energy to correct the rotation but it would only hold for a few hours/day max. I had a SIJ injection into the R, numbing agent and corticosteriod. No immediate change, and within 2 weeks it made my pain worse. Had a lot of pain along my right sacral border. Felt good to dig along there and my sacrotuberous ligament/etc, but short term.

I started just getting back into some stabilization exercise. It felt really good to do rotational core stuff versus straight plane. I was doing OKC and CKC hip from all directions and felt good/productive activation of all the correct musculature. Tried to get as much mobility throughout my thoracic spine as possible, working the foam roller and self mobilization. Still felt the right lumbar spine and right anterior hip pain whenever I worked too much glute max or TrA. Felt better when I actually did hip flexion exercise or lumbar extension exercise because it felt like it was pulling my posteriorly rotated pelvis out of that rotation. It is a perpetual tug-o-war contest it feels like. I feel like I got about 85% better with some exercise and tried running for a short bout. Did about 5' of walk/jog and things fell apart again. I regressed back to 50% or so.

Began having my co-workers work on my regularly. Testing my innominate rotation daily, if I was off we did MET. It always felt better when I was in "alignment". When my low back hurt I could tell that I was "off" and asked to be checked. Now if my pelvic floor or anterior hip hurts I think it's "off" too. Have been wearing a heel lift religiously on the right side. Feel that I shouldn't rotate out of "equal" so easily. I am in persistent posterior rotation and one co-worker things I have an inflare on the right (ASIS inward in supine).

Always feel better standing. Sitting on soft surfaces is worst (driving in the car or sitting on a soft couch). I cannot lay on my right side without lateral hip pain (no pelvic floor, back, or anterior hip). I mentioned before that I've been having more cervical pain, part of me wonders if that's just because I'm less active and less stable (in the scapulothoracic region) than before the injury or because we have gone to EMR and I spend more time in front of the computer. Movement feels good, best thing I can do is get out and walk (usually do about 2.5 miles and feel good at the end).

Strangest thing. Went on vacation for 3 days and while there- almost no pain at all. Could sit, stand, sleep in any position without pain. I thought I was cured, or distracted? I know that stress can be a major pain producer and I've done everything I can to de-stress (baths, hot tub, relax, etc, etc, etc). Never thought I was too stressed to begin with, but we all are blind to certain things I have a prolactinoma (have had for 8 years or so) and when visiting my endocrinologist put me on lexapro just to be sure of any anxiety. She also tested vit D which was normal.

Would love any suggestions/insights as possible because it's so very frustrating. I'm 28 and shouldn't have chronic pain. Happy to provide any other information/special tests/etc. Any help or direction is appreciated.

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