left buttock pain radiating to mid back

[Driver-Jowitt]

Thank you. I am afrad that many of the terms and concepts presented in you letter which are unfamiliar to me, and I cannot usefully comment.

hi
is there any neurodynamic tests positive on left side
i feel the gluteal pain and radiation to mid thigh may be due to reduced mechanosensitivity of sciatic branches.development of ectopic impulse generation site
the back pain as is occuring with primary combination of left lateral flexion and left rotation.
i would like to know the effect on pain if flexion/extension is superadded to the above mentioned primary combination
how is the quality of movement while he is doing spinal flexion/extension

any pain reproduction with passive accessory movements
AP
TRANSVERSE/ROTATIONAL

[linbin]

hi friend
i feel i used terms which are quite familiar
neurodynamics - based on shacklock
combined movement - edwards
passive accessory movements -maitland
if you need any clarification regarding any concepts feel free to ask
cheers

[msk101]

HI,

I'd also be curious to know what the SIJ is doing (simple test like the stork test might help), and a slump or SLR for neuro things, or PKB if it's front of thigh radiating as well.

I definitely agree with a more thorough assessment of the lower lumbar spine as well, and find a "quick test" that easily and reliably reproduces the pain (eg the action of kicking a football), then analyse that.

Msk101

[Driver-Jowitt]

HI,

I'd also be curious to know what the SIJ is doing (simple test like the stork test might help), and a slump or SLR for neuro things, or PKB if it's front of thigh radiating as well.

I definitely agree with a more thorough assessment of the lower lumbar spine as well, and find a "quick test" that easily and reliably reproduces the pain (eg the action of kicking a football), then analyse that.

Msk101

SI pain is always a possibility, and as a precaution pain in the joint, perhaps caused by an incidental pathology which is made symptomatic by a relatively minor incident (such as ankylosing spondylitis) could be considered. Purely traumatic SI pain is rare, as this is an extaordinarily stable joint, certainly in a young male like this. Driver-Jowitt

[jacinta]

hi all,

sorry for the late reply.
this gentleman came yesterday.

dear linbin & msk101,

-since his 1st treatment, neurodynamic tests [ SLR, PKB, Slump's] all -ve
-accesorry movement tested in all directions did not produce symptom.
only P-A on Lt. L3 - L5 facets produced pain. [ muscle spasm was thr]
-combine mvt do not elicit pain.

dear jowitt,

i have to agree with u as he has no symptom at all on both SIJ.
mobility is good.
but his blood test n x-ray ruled out A.S. and spond.

jacinta

[Physio Dace]

Have you considered an intra-articular hip pathology or possible iliopsoas strain? Labral tears have been known to refer superiorly into the lumbar spine - or associated with maladaptive gait patterns with subsequent NSLBP. Beyond that from the MOI I would be thinking Lx first (more likely facet) and SIJ second. If its purely an acute muscular injury (i.e. strain) I would have expected considerable improvement in 1/12.

[jacinta]

hello dace,

thanks for the reply.
it was found that thr is NAD in his gait.
this gentleman was not sure had he injured his hip previously,
but claimed numerous falls on buttock.
No x-ray was done.

It's a good news to me that his left thigh adn mid back pain are resolved.
Rt. hamstrings tightness reduced.
Lt. hip pain reduces in VAS: 3-4 /10 (previously 7/10)

new finding: Lt. iliopsoas tighness (again, thanks for your suggestion)
stretches are taught.
will wait & see how next week.


jacinta