Monday, July 27, 2009

Sciatica: A Real Pain in the Butt

THE MANY FACES AND CAUSES OF SCIATICA
Sciatica merely describes a path of pain and is not a specific diagnosis. The use of the term "sciatica" does not specify a cause.

Defined, "sciatica" is a description of a particular path of pain following the sciatic nerve as it traverses the buttock (hip) and/or continues down the back of the thigh, outside of the leg and perhaps the foot. As our article title denotes, sciatica can be a real pain in the buttocks.

Generally, the worse the condition, the further down the leg the pain travels and may even affect the foot. However, there are certain cases that although severe, only affect the hip area or buttock. It suffices to say that the symptom picture can be quite varied from one individual to another. Although most commonly associated with nerve compression from a low back disc condition, there are many causes of sciatica, some of which are not back related. Interestingly enough even those cases originating from a low back condition may not exhibit any back pain.

Some authorities would argue that if the origin of pain is not compression of a nerve root in the lower back, the result is not a "true sciatica", but a pseudo-sciatica. Synonyms for sciatica would be sciatic neuralgia or sciatic neuritis.

ANATOMY OF THE SCIATIC NERVE

The sciatic nerve is about 1/2 inch in diameter and is known to be the longest and largest nerve in the human body. The nerve originates in the lower spine as nerve roots exit the spinal cord (between the vertebrae in the spine), and combine to extend all the way down the back of the leg to the toes.

It is thus composed from a combination of 5 nerve roots exiting holes known as foraminal openings between vertebrae in the lower lumbar and sacral region. These include the following nerve roots: L4, L5, S1, S2, and S3. Nerve roots in the lumbo-sacral area of the spine are named by the vertebrae above. Thus if the nerve root exits between L5 and S1 it would be considered the L5 nerve root. By understanding this one can correlate the area of symptoms with a specific spinal level.

The five nerves combine anterior to (in front of) the piriformis muscle to become the sciatic nerve. This nerve then travels down the back of each leg, branching out to innervate specific regions of the leg and foot. It should be mentioned here that a spasm of this piriformis muscle where the nerve crosses the sciatic notch can cause sciatic neuralgia and often mimic symptoms of a herniated lumbar disc.
Just above the back of the knee, the sciatic nerve divides into two nerves, known as the peroneal and tibial nerves, going to various parts of the lower leg:
  • The peroneal nerve innervates the shin and outer aspect of the leg down to the upper foot.
  • The tibial nerves innervates the posterior portion of the leg and traverses all the way to the feet to innervate both the heel and sole of the foot.
The sciatic nerve supplies both motor input (eliciting muscle movement and reflexes) as well as sensory innervation.

SYMPTOM PICTURE OF SCIATICA

Pain: searing , stabbing, usually intermittent pain is generally the overwhelming symptom. The pain can be felt in the low back, buttock, posterior and outer side of the thigh or leg and possibly all the way to the toes. The pain is most often felt in certain positions, while walking or while straightening the leg. It may occur on both sides (bilaterally), but it is more often one-sided (unilateral). Pain is sometimes exacerbated by sneezing, coughing, laughing or pushing during a bowel movement (Valsalva's Maneuver).

Numbness/tingling: sometimes the pain is either accompanied by or replaced by numbness and tingling known as paresthesia or radiculopathy.

Weakness: in the most severe cases of sciatica there is actually impairment of the motor nerve functions causing weakness in the leg and/or foot. The most common sign of such would be foot drop or the inability to pull the big toe up toward your knee (aka: lack of dorsiflexion).


CATEGORIES OF CAUSES

Mechanical Spinal Nerve Compression: most often from a herniated, ruptured or extruded disc but can be from severe misalignment or vertebral subluxation.
Compression by Muscle Spasm:
most commonly known as a "Piriformis Syndrome" whereby the muscle underlying the gluteus maximus (buttock) is spasmed applying pressure to the sciatic nerve underneath. This is known to clued physicians as an "entrapment neuropathy" and is often misdiagnosed as a low back disk herniation because it mimics many of the symptoms of such. This can prudently be differentially diagnosed from a disc herniation by either MRI studies, CT scan or just a good old fashion history and exam including questions regarding pain during coughing, sneezing and bowel movements.
Trauma to the Sciatic Nerve:
bruising, puncture wounds, or over-stretching injuries to the nerve itself can produce the symptoms of sciatica.
Spondylolisthesis:
this is a slippage of one vertebral body on top of another and may be a result of fracture or a genetic defect in the pars interarticularis. If in the L4 to S1 region, sciatic neuritis symptoms can occur. Although many authors seem to describe a compression of nerve roots resulting from a spondylo-listhesis, it has been my experience both clinically and in my review of the literature that the most accepted authorities believe the nerve root irritation to be a result of traction or stretch of the nerves vs. an actual compression.
Spinal Tumors:
space occupying lesions, of the spinal vertebrae, spinal cord, cauda equina, or surrounding muscles or sciatic nerve itself can cause sciatic symptoms.
Sacro-iliac Joint Sprain or Subluxation:
this is actually one of the least understood or recognized conditions causing sciatica, but in this clinician's experience is one of the most common causes of sciatica not resulting in pain extending below the knee. Coughing and sneezing does not increase the symptoms in this case and often Kemp's sign will NOT be positive. Subluxation or sprain of the sacro-iliac joint leads to a referred sciatica in this case. This is generally best treated by a chiropractic physician.
Chemical Irritation:
although not even known or considered by most practicing physicians, chemical radiculalgia is one of the physical results of back dysfunction and can be the primary cause of sciatica. This is an actual irritation to nerve roots caused by the swelling pressure of inflammation against the nerve. It is a major factor in what is called the "cycle of pain". It may be interesting to note that it has been this practitioner's experience that this is often the factor that is most concerning when dealing with the sequela of a disc herniation or injury. It is the overwhelming reason that Lumbar Epidural Steroid Injections have been so effective in relieving the symptoms of herniated or ruptured disc conditions. It leads some researchers to believe that inflammation may play an even greater roll in symptomatology than the mechanical pressure of displaced disc material.
Viscerally Referred Pain:
although not as common as some of the other causes of sciatic symptoms, paresthesias, pain and odd sensations may be felt along the sciatic nerve distribution as a result of problems with internal organs. For example, problems with the prostate gland or female organs can refer sensations along the sciatic nerve. This can easily be ruled out by a thorough examination.

TREATMENT OF SCIATICA

Certainly the best treatment practices for sciatica would include addressing the cause in addition to alleviating the symptoms. Thus the approach may be different dependent on the cause. Sitting, driving and arising from the sitting position is usually a problem for all sciatica sufferers and thus one of the most recommended items would be a pressure relieving seat cushion. One type is known as a memory foam seat wedge. The 2nd type is a gel seat cushion that is wedged for ultra comfort.  Make sure that the cushion you select has a cut-out for the coccyx or tailbone and that it is solid, fairly dense memory foam or a solid type of gel. Ice is nice in the case of sciatica and heat should generally be avoided in acute cases.

Other treatment protocol is more causal specific and usually requires a battery of prescribed and self-care. Some of these are listed below:

DON'TS
Avoid irritation and stretching of the nerve during the healing process. This would eliminate toe touching with the leg straight.

Avoid running, fast walking or other physical activities that increase pain.

Avoid heavy lifting, stooping, squats or prolonged bending.

Avoid sitting on soft overstuffed chairs or couches or desk chairs that fall away when leaned against.

Avoid fast movements.

Avoid arising out of bed w/o first turning on your side

Avoid stomach sleeping or sleeping on your back with both legs straight out.

Avoid straightening the involved leg when sitting.

DO'SDo see a physician or chiropractor for a proper diagnosis and treatment. Depending on findings your doctor of choice may suggest: spinal adjustments or manipulation, deep tissue massage of the buttocks, core muscle strengthening and stretching, repair of a disc herniation, oral anti-inflammatories, lumbar corset or lumbar epidural cortisone injections. Lumbar traction and/or gravity inversion may be advisable in some cases. For less common causes like tumors or referred pain from internal organs, your doctor will likely refer you to a specialist for further investigation.
When sleeping on your back, keep at least the involved leg slightly bent with an orthopedic bed wedge or soft fluffy pillow.

When side sleeping, place a soft pillow between your legs starting at the knee and positioned downward from there.

Do utilize a memory foam seat wedge to keep good posture and remove pressure from the sciatic nerve when seated or driving. For chronic sciatica seated workers should consider the purchase of a nimble ergonomic chair like the Bodybilt task chair.

138 comments :

  1. My one of the best friend has a problem of Sciatica! He is very close to my heart. I am not able to see his pain. So I am searching a good article for him Because we are not aware about Sciatica in deep. So thank god I got a very nice article here. I am going to give this article to him. Thank you very much.

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  2. Nearly 20 years ago, received injury to the S1, S2, L4, L5 nerves at a hospital, during or after obturator hernia surgery. Crawled for the first few months. Thankful I could walk again, but never without some degree of pain. A nerve block did nothing. Tired of being told by friends "go to a chiropractor". Question if a chiropractor can help if a nerve block could not.

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  3. This is in response to Anonymous post regarding nerve block vs. chiropractic care.

    You posed the question as to whether chiropractic care could help if a nerve block did not. The answer to such is rather a tough one because the answer is highly variable and best based on a complete clinical history and examination. Certainly the lack of response to a "nerve block" does not rule out the possibility of chiropractic care being valuable. On the contrary, facts gathered by the insurance industry support the premise that back related complaints respond to chiropractic care more often than they do to any other form of care. Sciatica is often related to irritation of nerve roots exiting the spine. I think it is important to realize, that the fact that the symptoms began as a result of your obturator hernia surgery doesn't delineate why. There are many things that could have happened during such surgery that led to the sequela of sciatic symptoms.

    The best advise I have to offer is to visit a chiropractic physician that has is well respected in the medical community and comes with high recommendations from a patient. After 20 years, I think you at least owe yourself a complete examination from a chiropractic perspective. You do not have to follow through with the care, but will at least have something other than hearsay to base your decision upon.

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  4. I have scoliosis. I am 42. Kidney and vascular disease diog. at 37. Have extreme pain and burning on top of right foot and on right side of very lower leg (close to ankle). Spine is twisting towards the right and starting to compress lung. During last pregnancy at 38, legs swollen and now legs are heavy discolored. Could this be sciatic or more likely from damaged nerves in foot/leg from swelling? What can I do? Thank you so much!

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  5. Dear Anonymous with scoliosis and burning right lower extremity pain. It certainly is a shame that you've had to suffer from severe pain for 5 years now. Although one certainly cannot make a diagnosis about such a complex condition from a distance, it is certainly possible that a chronic sciatica could play a part in your burning leg pain. However more concerning and perhaps more typically, the quality of "burning pain" is often associated with either a referred pain from an underlying organic condition or inflammation of the vascular system. From your description it would seem plausible that your leg swelling and vascular condition may be responsible. I'm concerned that you are suffering with such for a prolonged period and do not yet know the exact cause. It is very important that you follow up with perhaps both a vascular specialist and/or a neurologist to arrive at the origin. Regardless of the underlying cause a lifestyle changes seem rather prudent: (1) if you are overweight, it is important that you change your diet behavior and get yourself to a good weight. (2) A diet that is low in sodium (less than 1800 mg per day) is crucial because of your kidney condition and swelling in the leg. (3)Do not smoke or drink excessive caffeine because they both impede circulation. (4)Eat a balanced diet and take a good natural vitamin supplement. (5) Have some blood work that tests for inflammation like C-Reactive protein. (6)Regardless of your condition I think a very good quality fish oil supplement would be in order. My preference is the following one from Life Extension: http://www.lef.org/Vitamins-Supplements/Item01484/Super-Omega-3-EPA-DHA-with-Sesame-Lignans-Olive-Fruit-Extract.html

    I wish you well on your quest to be pain free!

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  6. i have a ruptured disc L1 S5 with severe sciatia pain i haven't been able to work out in about 5 yrs now faithfully. my musles hurt in my both legs and my muscles in butt and glutes are now like sponge the pain is so bad everday i don't know what to do as far as, is there a possibility i can get those parts to tighted up again? i am 50yrs young and in good shape at 100 pnds. i'm scared on what excersises i am able to do and will it work ?
    signed scared and helpless !!!

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  7. Regarding Rayna.rayna:
    I'm sure you mean that you have an L5/S1 disc rupture vs. L1 S5 (probably just a typo). First of all, let me just say that things are never hopeless and there are always multiple ways to approach such issues in hopes of ultimately achieving a pain free status with good likelihood of better function. As you say, you are only 50 and weigh 100 lbs. For some reason, you apparently have not found the right type of care to bring you back to a healthy state. I no longer practice as a chiropractor, but you would be just the kind of case I would have wanted when I was in practice. I would suggest that you get a recommendation for a good chiropractor in your area; one that believes it is important for you to do your part in the rehab process. Ask that chiropractor when you would be ready to work with a personal trainer that specializes in developing the core and rehabilitation of back problems. You might also need the services of a deep tissue massage therapist to work on possible muscle adhesions. Your chiropractor should take the lead in deciding all these things. You could also seek the advice of a good medical doctor who specializes in physical medicine and rehab if you prefer that to chiropractic care. I can't really get more specific for your needs, because there is no way to diagnose someone's condition from afar.

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  8. I had a fall at work and now I have heat and pain in the left buttox and no one believes me. I lost my job as a result of the injury but I still have the pain and heat.

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  9. Sorry to hear about your fall at work. Not sure why no one believes you. Certainly pain and heat type symptoms are relative to sciatica and a fall. Why don't you find a good chiropractor in your area to do a good diagnostic evaluation. That would be the first step...

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  10. Hey Great post. Really a very nice piece of information. sciatica treatment

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  11. I have pain in my left butt cheek, it comes and goes but is here more than not. If i cough or sneeze or bend it is severe, not so much coming out of a sitting position or going into one, sometimes when i walk, I almost have to baby the left leg. There seems to be no lower back pain, although before this butt pain came about, I did have a pinched nerve in my lower back. I have recently began to feel my muscle tighten up in my neck almost like a crick. Have any ideas of what might be going on? Been dealing with this for a couple of months now, some days are worse that others. From Alab

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  12. Hi Alab,

    Classically, the symptoms picture you describe is very suggestive of a herniated lumbar disk. As far as the crick in your neck, it is not uncommon to have the neck become dysfunctional when the lower spine has some problems. This is because the lower spine is the foundation for the upper spine. When it is out of whack, the neck responds accordingly. It would be prudent for you to see either a chiropractor, neurosurgeon or orthopedist to further delineate your condition.

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  13. I am having prolotherapy for as my pelvic bone isn't aligned properly, my right side is lower than my left and there is movement where there shouldn't be any, as I have lax ligaments.

    I have been like this for a very long time and pain comes and goes from my sciatic nerve. I am now having massage to help with this along with continue prolotherapy. I have had 6 treatments so far and my doc thinks possibly 8 should fix it, if not 10.

    Just wondering if the prolotherapy would be an idea for some of the people on here to stablised joints before going down the operation route. Its not new and it does work for the majority of people.

    Just thought I'd share as I'm having some good positive results. It's not a quick fix though, but think it's worth it to have the rest of my life painfree.

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  14. Prolotherapy is a non-invasive technique that involves injecting an irritating substance into loose ligaments. The purpose of such irritant is to elicit an inflammatory response that causes shortening of the lax ligament(s), in hopes of improving joint stability. I think it can be a very effective technique, but it should be noted that this is for a very specific problem and not a cure all, end all technique. The previous post is from a prolotherapy patient that apparently has a hyper-mobile sacro-iliac joint which is the joint between the upper pelvis (ilium) and base of the spine (sacrum). Sacro-iliac joint conditions are a frequent cause of low back pain and sciatica due to the fact that there are sensitive spinal nerves that pass close to the joint. I personally have seen more inflexible sacro-iliac joints than hyper-mobile ones, but hyper-mobile ones certainly can occur. There are three methods of stabilizing hyper-mobile joints: 1) prolotherapy, 2) good nutrition and cartilage supporting supplements, combined with core strengthening exercises that provide dynamic stability to the sacro-iliac joints. 3) Surgical intervention. I agree with the last post that prolotherapy is a good try before surgery.

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  15. I had bilateral knee surgery 11 mo. ago and now have pain in the back of the thigh and some in the knee when I sit or when I bend the knee and do a side leg lift. My doctor thinks it may be sciatica, but my back does not hurt nor my buttocks.

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  16. HI I have been a vegan for four years and recently began experiencing incapacitating pain in my buttocks and all over the bottoms of both feet. I began eating fish and dairy about 3 months ago and within 24 hours the pain in my feet was 80% reduced and in one week the pain in my buttocks was gone altogether. AS i said, it has been 2 months since i began the new diet (fish and dairy) but i still experience constant pain in both feet, my buttocks is fine. What do you think is going on? if there were nerve and or tissue damage perhaps it will take much longer for my feet to return to normal?? how important do you think it is to stay off my feet (in order to give them property to heal)? any information you could provide would be appreciated thanks.

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  17. Hi anonymous with bilateral knee surgery. Sorry, I somehow missed your comments before and failed to reply. Hopefully, you are now feeling better. Having pain in the thigh and knee following knee surgery would not be terribly uncommon, especially if you did not have deep tissue massage and lots of physical therapy, and stretching and a strengthening routine following the surgery. One possibility to evaluate after hearing your description would be ITB or ilio-tibial band syndrome. It is often a culprit after trauma to the knee of thigh and surgery can certainly be considered somewhat traumatic.

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  18. Regarding the post about acquiring incapacitating pain in the buttocks and bottoms of the feet after 4 years as a vegan is interesting and somewhat puzzling. I have hunch the vegan diet is not directly related to the issue. However, malnutrition certainly could be. To be a successful vegan it takes a pretty thorough knowledge of what you need to eat to get all the nutrients that you might miss from an omnivore diet. You could have been missing your B complex vitamins and perhaps a complete protein sources. Overall, the symptoms you describe make me wonder whether your foot issue may be related to a blood sugar problem. I would suggest that you seek a differential diagnosis to see if you have evidence of diabetes or nerve root irritation from a problem in the lower spine. It would be prudent to first rule these out and then certainly read up on things you need to be aware of when living the vegan lifestyle if that is what you desire to do. B12 omega 3 fatty acids, calcium, vitamin D3 and complete proteins are often missed by vegans. Interestingly enough, fish and dairy may be supplying all of the above and if you were missing out on them during your vegan lifestyle, you could have suffered inflammation and/or nerve damage. Most vegans need to take a supplement of B12, but there are some vegan sources: red nutritional yeast, vitamin B12 fortified soy milk, vitamin B12 fortified meat analogues (food made from wheat gluten or soybeans to resemble meat, poultry, or fish), and vitamin B12 supplements. Your omega 3 can be converted from flaxseed oil if you are not consuming fish related sources.

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  19. Hi. I've been having really bad butt cramps. Mostly left side,but sometimes both. The pain begins when I put pressure by attempting to walk. It shoots up my leg up to my buttocks literally causing my leg to give out from sharp pain. I have to drag myself or be carried when it gets that bad. It all began during pregnancy about two years ago. It stopped on and off. I maintain a really active lifestyle, running and playing soccer. However, I'm afraid I will be doomed and become an invalid when the pain gets really bad. Please help, any feedback will be greatly appreciated!

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  20. To: Luzadris,
    First of all if you are ever able to be active in activities like soccer and running, it is almost assuredly true that the problem is not yet a severe one. Otherwise, it wouldn't be occurring so intermittently. There are several possibilities, and determining the origin or problems from a distance is very difficult, it not impossible. However, the "gut feeling" I get when reading your description is that you are suffering from an "SI" or "sacro-iliac" joint problem. The reason I say that is because this often begins during pregnancy because the hormone cause ligamentous laxity, in an attempt to allow pelvic expansion for childbirth. At such time, the SI joint or joint between the pelvic and base of the spine often slips or becomes mal-aligned. This may often present with symptoms like you described. If you are a side sleeper, it is important to sleep with a pillow between your knees to remove stress from the SI joint. Ultimately, your best resource to diagnose and likely resolve this issue would be a competent chiropractic physician.

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  21. I have a pretty severe pain in the upper part of my left hamstring right under by butt cheeks. It hurts to straighten my leg if I were to stretch. It also hurts when I run but the pain seems to extend to the middle of my butt and go to my hip joint. Not sure what's up. Feels as if the left side is swollen. I do go to a Chiro went this week and he made adjustments. I also go to pt and they have helped with my si joint. Am getting frustrated as I don't know why it the pain won't go away. Do I need to quit working out?

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  22. Regarding the severe pain in the upper left hamstring just below the buttocks...

    Although such pain can commonly result from either a hamstring strain or a sciatic nerve problem, one could likely rule out the hamstring strain because of extension of pain into the buttocks and hip joint. Without actually seeing the problem first hand it would seem like you are suffering from sciatic neuritis. Now, that being said, there are multiple causes of sciatic neuritis (inflammation and irritation to the sciatic nerve). The most common would be be referred from problems with the SI or sacro-iliac joint. This is the joint between the pelvic bone and the base of the spine. Displacement, subluxation or strain of this joint will most often send a pain into the buttock and down the back of the hamstrings on the side of involvement. This does not usually send pain below the knee and does not seem to increase during coughing, sneezing or bowel movements. If pain is felt below the knee, into the calf or foot and/or coughing or sneezing exacerbates the problem, it is more likely the result of sciatic nerve impingement (most often from a lumbar disk herniation).

    I can not really say whether you need to stop working out. However, I can tell you that you need to stop doing anything that irritates the problem or increase the pain. Sometimes this means you can simply modify your workout. Then again, if severe enough, you may need to put the workout on hold until you improve. This question is really better answered by the chiropractor you are visiting.

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  23. I have had sciatic nerve issues a few times in the past couple years towards the end of golf season. I have been able to have the issue quickly remedied by a couple of visits to the Chiropractor. This year as it set in around mid August I just let it go until about mid Sept. when I noticed it getting worse than I've ever experienced. So as usual I went to my chiropractor. So here I am 5 or 6 weeks later still dealing with the pain. I've had some relief off and on, my regular doc prescribed Naproxen and Flexeral about 10 days ago because I was having muscle spasms really bad. That has really helped. Monday I woke up pretty pain free, but got worse in the evening after a bowel movement, went to the Chiropractor Tuesday because it was so bad. I felt better Tuesday night and this morning felt really good again, until after 2 more bowel movements (each very painful) I am hurting again like fire down the back of my let to my ankle. I have no pain while sitting, standing still, no problem laying down or sleeping. I have been icing it continually. I don't have a dropping of the food or reduced strength in my leg or foot. Most of the pain is located in my right lower butt cheek but at its worst shoots down the back of the upper thigh. The Chiropractor keeps mentioning an MRI, but I respond to the treatment he gives, it just doesn't hold. What do you think?

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  24. Sandy, I can certainly relate to the pain you are suffering from your sciatica. Although we can never make an accurate diagnosis from a distance, if I was a betting man, I'd almost certainly bet on the fact you have a pretty bad condition of the L4/L5 or L5/S1 lumbar disk. Sounds like you have a posterior-lateral herniation which would be exacerbated during the action involved in a bowel movement. You need to follow the advice of your chiropractor and get an MRI for a more definitive diagnosis. I'm sure he is thinking the same thing I am and it would explain why you get temporary relief and then have the pain return. You might discuss a trial of lumbar traction with your chiropractor. You likely also need a good lumbo-sacral support to help keep pressure off the disk in between treatment. In the long run, if I'm right core strengthening exercises will be necessary to help keep the problem in check after resolution begins.

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  25. I have a lot of lower back pain and what I get from your article it sounds like I have sciatica pain. Thanks for the great article!

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  26. Hi, i am 21 year old. Traing at gym, i have trained now for 4years, 1 year ago i start deadlifts, it was ok. Then after 5month instart squats. Back pain start appear and some tendon tension of upper buttox startepd mildly. After while it worsen, and i get stiff, then it relieved (was resting for ~1,5month)
    For 2weeks ago i started squat again, but now the pain-situation is different. It start as cramp and spread like electricity down the half thigh (back-side).
    When i cough it feels discomfortable (" cramp on way"). This pain is extra stabbing after i try stand up after a while of sitting (relieve after a while)

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  27. Regarding Nov. 3, 2011 anonymous post about problems after deadlifts and squatting...

    My first thoughts on your issues would be a possible disk herniation, due to the fact that "coughing" increases the symptoms. You could have very well injured a lumbar disk with either squatting and/or performing deadlifts (especially straight-legged type). Proper form during these type of workouts are extremely important.

    In any event, you should immediately cease these two types of exercises until you have resolution. A very good lumbo-sacral support may be temporarily necessary to help decrease pressure on the lumbar disks. You should visit a competent orthopedist or chiropractor to pursue a definitive diagnosis.

    Since the pain seems to not go any lower than your knee, you could simply have an S/I (sacro-iliac) joint dysfunction mimicking a lumbar herniation, but the symptoms are not as commonly exacerbated by "coughing".

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  28. Ok, i was at doctor today and he said that i should visit the neuro-doctor, and give me apointment for X-ray, but he said
    That i am to young for such serious injuy, so i hope that is some muscle infection or tendonisis.
    But i dont have now and lower back pain now only buttox and upper thigh, so could it be disc-dyslocaltion?

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  29. Hello again anonymous with sciatica..

    There is actually not such a thing as "disc-dyslocation", however, it could definitely be a disk herniation. Age is completely irrelevant to herniation. It is more relevant to disk degeneration, although that can also happen at the age of 21 if there is history of an older back injury. X-rays are good to do, but will not be likely to show anything because disks do not actually appear on a plain film X-ray. The doctor will just see the space where the disk is located. If there are degenerative changes, that might show up. In any event, a comprehensive history, combined with a competent orthopedic and neurological examination should help define the problem.

    It is often true that back pain does not necessarily accompany sciatic leg pain, even if the back is the cause of the problem. Best of luck arriving at the true diagnosis.

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  30. Hi backdoc,

    A little over a week ago, my lower left back started hurting. I initially thought it was just a minor sprain from poor sleeping posture and that it would go away in a few days. However, a week later, not only has it not gone away, but it has gotten worse.

    About 4 days after the pain started (it feels like the muscles in my lower left back contract, making it very stiff), i started noticing that when I walked, especially after prolonged sitting, i would feel a sharp stabbing pain in my lower left back, which would emanate to the top of my buttocks. This was especially so when pressure was put on my left foot. I don't feel any pain from my spine itself, so I feel that it might not be a disc herniation, but after sitting for a few hours, and then trying to get up and walk is almost nearly impossible at times.
    Also, while sitting, it is painful to straighten and lift my legs up.

    I don't know what to make of this and wonder whether this is sciatica and something that will just heal over time? I am a law student, which requires me to be sitting for a prolonged period of time, but the fact that it is hard for me to get up from sitting is making my life very difficult at the moment. Any help/advice would be exceptionally helpful!

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  31. Hi Sz,
    Regarding the left back stiffness and stabbing pain in the buttocks. I'm making the assumption that the buttock discomfort/spasm is also on the left. If this is the case, then indeed you may have a sacro-iliac joint dysfunction causing the problem vs. a lumbar disk herniation. This is especially true if there is not pain shooting down below your knee. It would be advisable to seek a referral to a competent chiropractor because conservative care of that type is best suited for resolving a sacro-iliac condition. The chiropractor should be able to differentially diagnose between the SI condition and a herniated disk. Best wishes for a speedy recovery.

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  32. when i was fit and playing football at about age 14 i remember hurting a groin and having to see a physio (just pointing this out incase you think it may of been the beginning of something) . anyway im now 21 and must admit ive packed on the kilos . about 6 months ago i went through severe pain in my lower back, thigh, hips, groin and hamstring . its not a muscle type pain its definately like a non stop pinched nerve feel . like a sharp nagging pain that just persists . i literally had to crawl to places cause i had to lay on the ground it was that painful. it was so bad i had my mother drive me to the hospital where she had to go inside and bring out a wheelchair cause i could not move at all . i went in and had an x-ray , nothing structual was wrong and they diagnosed it as a bad bout of sciatica . im now going through another bout and its been about 3 weeks now . i have tried ice, heat, stretches and nothing is getting rid of it . im 21 and feel like a cripple . its an extremely under rated pain that just does not seem to improve .

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  33. i must also add that im put off seeing a specialist because ive read many forums where people have seen specialists about their problem only to be going in circles and getting no where in the end . who is the best person to see ? a gp, a chiropractor etc ?

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  34. Hello Anonymous with entry on Nov 14th.
    I'm so sorry you are going through such a painful episode. It definitely sounds like "sciatica" would be accurate, although that is a very vague diagnosis. It is more a descriptive term for a symptom, rather than a real, causative diagnosis. Very rarely, would a plain film X-ray offer a lot of insight (other than postural info and signs of long term degenerative changes) with regard to the origin of sciatica. Much of what causes it is "soft-tissue" based and doesn't actually show with an X-ray. Regardless of the cause, stretching and heat are definitely NOT good therapeutic choices. They are more likely to increase the pain. Ice packs on the back might be beneficial. It might help to sleep on your back with one or both knees bent and your entire lower leg supported on a fairly high pillow. An orthopedic bed wedge would likely be helpful. You also sound like you need a good back support like one called "Cybertech Back Brace with mechanical advantage". Beyond that it is crucial that you find a chiropractor or back specialist who will take the time to reach a definitive diagnosis. You're too young to already be suffering with such a debilitating condition. In the long run, you need to take off all extra weight, so that you don't place unnecessary strain on your back.

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  35. Hi, I think I've overstreched the sciatic nerve during a cheer session. I know all cases are individual but how long will it take to heal? I have pain in my lower back, buttock and down my right leg. I also have intermittent tingling in my leg. Any tips apart from rest? Thanks

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  36. To: Anonymous entry Nov. 27th. Sorry it took me so long to respond. Sort of got delayed by holiday affairs. I hope you are feeling better. It is really hard to advise on what to do with so little info. However, heat is probably not a good measure if you still have pain and/or tingling down the leg. If you are cheerleading, I'm guessing you are a rather young person that has been regularly active. The fact you have symptoms of nerve-related pain suggest that you likely should see a doctor if it is still persisting longer than a few days. I'm not sure what action during cheerleading led to the injury. If you are still in pain and let me know as many details as you can convey, I perhaps can offer more specific advise.

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    1. Have had right buttock, hip,calf and heel pain for about 6 months. Ortho took x-rays and bloodwork for ana, ra, lyme etc. and said everything looks fine, sent me for physical therapy which made pain worse. When dr pushed down on leg i feel stabbing pain in buttock. Now i cannot sleep on right side and wake up at night in pain and cannot put weight on leg for long periods. taking celebrex which is not helping. Have gone to chiro in the past for back/neck pain. Now I have appt. to see a physiatrist. Any suggestions?? Scared it might be something serious like tumor or cancer.

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  37. Hi,
    Regarding your right buttock, hip, calf and heel pain... If I were you doctor, the most likely diagnosis I would suspect would be sciatica, most like originating from a herniated or prolapsed lumbar disk. I'm surprised that you were not sent to have an MRI, because plain film X-ray does not show this type of condition. I would find a chiropractor that would recommend an MRI prior to any real manipulative treatment.

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  38. Hi, i was wondering if anyone could help here? I have sharp pain in my right butt cheek which feels like it in my lower back just above that too. what happens is if i lay down lets say watching tv on the couch decide to adjust my body to my side or sit up as soon as i move for 2second's i get this sharp pain shock through my butt cheek and then i feel a dull pain as i complete the motion which then goes away until i move again etc. Same thing when i go to bed and wake up that first lift out of bed always hurts. I've tried a few things but nothing seems to work. My right knee has started playing up the past year more regularly now and the physio thinks its my meniscus with glucosamine supplemented with chondroitin etc this pain goes but comes back after the course has stopped. My biggest concern now is my back/buttcheek please can anyone advise ?

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    1. Sharp Pain in the Right Buttock:

      It sounds like to me that you have the classic symptoms of a sciatic joint (aka: S/I joint) dysfunction. Certainly, there could be other causes of your pain, but you should really consider a "Sacro-iliac Condition" to be a good possibility. You should visit a competent chiropractic or orthopedic physician, depending on your preference for conservative or less conservative type of treatment. I would also emphasize the importance of placing a nice fluffy, but soft pillow between your knees when you side-sleep to relieve stress on this joint. The one I utilize myself is called "Nimble-Pedic Comfort Touch Pillow" Also, make sure that you turn to your side while slowly getting down into or up out of bed.

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  39. Hello I have this problem I can't walk or sit ,been in bed for a month now don't have many money to see a doctor so I have to wait it out how long u think this will last .Last time it lasted me like 3 months need to go back to work should I use heat or cold on it thanks

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  40. hi i recently fell on my lower back got xray came back with non displaced fracture in sacrum s3/4. was then given bone scan and was told no fracture, i have pain radiating from my butt down my right leg into my foot with numbness in the front of my thigh, also have buzzing in my pelvis with hip pain as well, have also pain in lower back. any advice would be most appreciated thanks

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    1. I think you need to have a more thorough examination of the entire lumbar spine, with perhaps and MRI. What you describe would seem unrelated to the S3/S4 fracture possibility and more of mid-lumbar problem. Perhaps during your fall, a lumbar disk was injured or herniated. That does not show on an X-ray or bone scan.

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    2. thanks so much, went back to dr and he,s arranging a mri so hopefully will get it all sorted soon. Also great site with great advice

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    3. hi again just an update mri came back normal, still have the same pain as previous, dont know were to go from here, any suggestions, and thanks again for the sound advice.

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    4. If I were you, I would solicit family or friends for a referral to a competent chiropractic physician. Doesn't look like you are getting anywhere via the typical medical routine.

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  41. I would like to know what is causing the pain in my right buttox, it comes and goes, and when I have the pain it almost causes my right leg to collaspe, when I try to not put weight on my right leg I can feel the different locations of movement that are effected most, when I get this pain stairs are a real problem, during certain motions of stepping my leg just gives out, I'm 68 years old and have had multiple surgerys including fusion of cervacle vertabrae 2,3,4,5, and 6

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    1. There can be a number of different issues that could cause your right buttock pain and giving out feeling in your leg. I think the most likely condition, considering the fact the pain comes and goes is a sacro-iliac joint condition. This is often best examined and treated by a chiropractor. S/I problems regularly cause pain in the buttock and partially down the thigh and can inhibit ones ability to climb stairs. Given your age, you could also be suffering from an arthritic condition of the hip joint that might produce similar symptoms and have a tendency to come and go. A lumbar disk problem is possible, but less likely because it doesn't usually come and go within a short duration of time.

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  42. Hi, i have buttocks pain and it started 2 months ago, its a sharp pain , but it can go away when intake advil, but im tired of taking it almost everyday, when i feel the pain, it makes me wanna go poopoo, i thought it was hemmoroids but no pain is coming from the butthole and i can move bowels regularly, im afraid to see a doctor and i dont have much resources... I cant even sit too long now, what can i do... Thanks backdoc..

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  43. Being that the pain makes you feel the urge to have a bowel movement, it might indicate a problem that involves your colon or rectum and I must encourage you to find out why. You say you're afraid to see a doctor, but if it were me, I'd be more afraid of these symptoms of unknown origin than I would be of going to the doctor. Two months is a long time to have these symptoms when you really don't know why. If you would have had an injury or accident explaining the pain, it wouldn't be as worrisome.

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  44. I am a 30 year old female who has been experiencing chronic back pain for close to two years now. I have been heavy most all of my life. I remember from my childhood (as early at 8-9 years old) my mother making me exercise and after about 20 minutes i would be left with a burning and aching sensation in my right back hip/buttocks region. I would cry from the pain. Where as in the past as long as I wasn't extensively being active, I could walk and move without pain. I even used to go out dancing VERY regularly and didn't feel much pain. Recently though the pain has become debilitating. Standing for more than 30 minutes, walking casually not even for fitness, can leave me the next two days in bed, barely able to move. The pain is local in my SI Joints but if I have been standing or actively walking can extend down, but no farther than, my back/hip buttock area. I HAVE to sit/lie down as soon as the pain flares. It causes me to stand crooked with my left hip slightly more elevated than my left, my spine leaning to the right. I have been seeing a chiropractor for over a year now. I have went from massage and tinge unit therapy, --which always left me hurting worse, in addition to adjustments to multiple ball exercises (twice a day) and adjustments. Overall my spine has been feeling much better but this chronic lower back issue will NOT subside. X rays have not revealed anything of issue. I have asked whether it is muscle, nerve, or bone related, but they can't be sure what the source of the problem is. I have bad habits I've been working on trying to break, --sitting with my right leg bent at the knee with my foot under my left hip, Sitting without good posture and belly tucked in, sleeping without pillow between my legs. I try to do additional low impact exercises to help me lose weight without creating too much stress on my back, such as water aerobics and swimming. At this point after seeing a Chiropractor at least once a week for over a year, it's become extremely expensive, and I JUST want answers of the source of the pain, would an MRI be out of the question? Can my Chiro request for that? Any idea if this sounds like muscle, bone, or nerve issues?

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  45. Also, in addition to my original comments, if I try to "straighten myself" by bringing my spine back to center and left hip down, as I shift I can feel something grab quickly and painfully (it can almost take my breath away) right around the L4 area. Again xrays don't show anything too out of the ordinary however.

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  46. Hi Elizabeth,
    Let me start by saying that one can suffer extreme pain and have lots of problems in their back and still show nothing to speak of on a plain X-ray film. On the other hand, after 20+ years of on and off suffering, especially being overweight for most of your life, it would really surprise me if there was not at least a hint of some positive X-ray finding.

    You describe symptoms that are very familiar with either problems of the posterior joints (facet syndrome) of the spine and/or the sacro-iliac joints as you mentioned in your history. They both can elicit all the symptoms described, including pain with prolonged standing or walking, as well as radiation into the hips and buttocks. At this point, there could be the beginning of a herniated disk as well. That would NOT likely show on an X-ray.

    In all honesty, I'm going to be blunt and say that I'm most concerned with you having been heavy most of your life. Not only is that most certain to shorten your life span, but you can't avoid it wrecking havoc with your lower back, hips and knees. I realize there is a "catch 22" situation here because you are in pain and have a difficult time exercising. Therefore, it is harder to design a program for steady and permanent lifestyle change, leading to weight loss. However, as a practicing wellness coach/fitness trainer, I know for a fact it can be done, whereby you could enable a life-long lifestyle correction that would emancipate you from many health problems and change your life. I would also bet that all back problems you describe would go away. This is true not only due to the weight loss, but also because of the conditioning and lifestyle practices it would take to achieve such.

    With that, perhaps frustrating statement out of the way, certainly your chiropractor can recommend an MRI and certainly it could show some things that an X-ray will not. If nothing else, it can set your mind at peace by either finding a problem you are not aware of, or by demonstrating nothing. That can, at very minimum, rule out any unnoticed issues.

    Additionally, I know you are concerned about your current level of pain. Certainly, there is something that can be done to lessen that in the mean time, but the exact methods are hard to determine from a distance. In general, one must examine all aspects of their day and night. For example, is it worse at work, during sleep, while active, while sitting, while bending, after eating sugar or drinking coffee, etc. You seem to have designated walking/standing as the main culprit. There is not really mention of what type of work you do, or whether it hurts driving or in various types of seating. It is important to examine whether you wake up worse or better than when you went to bed. If better, great. If not, then examine the mattress, position, etc.

    Exercise, in one form or another has to play a part. There are many floor exercises (padded floor) that can make huge differences in core strength and tolerance to walking. Sounds like lumbar traction, might be of benefit to you, so that might be something to discuss with your chiropractor.

    I would also advocate the "Cybertech SPINE Brace with Mechanical Advantage" that you can read about here: http://www.backbenimble.com/bodytech-cybertech-back-brace.htm
    This brace is the ultimate for someone carrying extra weight and should help you take pressure of the back when you walk.

    I wish you were in Houston or Salt Lake City, where I do my wellness coaching. I'm certain I could help you. I would recommend that you look for someone who does wellness coaching and fitness training in your area. That might work well in conjunction with chiropractic care.

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  47. Thank you for your response. I work at a museum doing registration of Historic objects. I do a LOT of sitting at my desk, but our museum is large and I am isolated so I can be up several times a day running back and forth to pick up copies or climbing to reach objects. We do wear business professional though, and our floors are awful concrete. This is awful on my back. Luckily, I don't seem to suffer with knee issues at all.

    In my personal time, I do core ball exercises every morning and occasionally a second time before bed at night, 20 minutes a time, water aerobics twice a week, Mondays/Wednesday for an hour each time followed by about 5-10 laps, Yoga I do twice a week Tuesday/Thursday for an hour each time. Pilates I do once a week for an hour when I don't have to work on Sundays, and Cycling twice a week for 30 minutes while watching TV on Friday and Saturday evenings. I am dedicated to my exercise, I would just like to be dedicated to other forms that seem currently impossible, -i.e. walking, jogging. I'd love to get back into dancing like I used to be. Being "thin" seems even genetically impossible despite all my efforts. Believe me, after all the mental anguish from my mother I've received all my life, about my weight, it's been a nonstop goal of mine that I have not given up on. I am fully satisfied with my eating habits, --*mostly* healthy vegetarian choices and always good portions, and my dedication to fitness for as well as I am able.

    It seems though that it's the standing that is problematic. I have had to relearn how to stand, feet apart, stomach tucked, shoulders back, but if I'm looking in the mirror the left hip is always raised. If I am doing the dishes, I'll have to take 3 or 4 breaks to sit before I can finish. If I'm drying my hair, to bend over to dry the under side, and then come back up (slowly) that seems to further exaggerate that elevated left hip. Even many of the standing yoga poses I am unable to hold for a long time. It seems as long as I am sitting, squatting down, or lying down, I don't feel the intense pain. Though it can be felt when I get back up.

    I spoke with my chiropractor yesterday about a plan of action for an MRI. She agreed to it and hopefully that is going to happen in April. We'll see what we find out! Thanks again for all your help!

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    1. Hi again Elizabeth,

      With your latest comment, it is fairly apparent that there is a component of pelvic imbalance and perhaps mild scolisis (curvature of the spine). That certainly would explain why everything is worse standing. It is sort of like going down the road with tires that are out of alignment. They wear a lot faster and sometimes have a blow out. Combined with the MRI to look at intricate soft tissue details, a stand X-ray showing your pelvic alignment would be very valuable. From there, a possible prescription of Foot Leveler type orthotics from your chiropractor may be just what you need to solve the problem.

      As far as the struggle to try to be skinny the only other advise I can give you from afar is to make sure you are eating at least 5 meals per day in small portions. Spreading your food consumption out among five meals keeps the blood sugar from going up and down and is often the missing link to those struggling with weight control.

      Best of luck

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  48. Hi I am a 48 year old female with back pain to the left side going into the buttock, the pain does not run down my leg ,when I put pressure on the left foot I get the pain shoot up into the buttock then into the back , I have not been able to work for over a year because of the pain because I do a lot of bending and lifting in my job, I have been going to physio therapy for a year now with no real help with stopping the pain although my movement is better than it was. I have had 2 MRI scans and the results were dehydration at l4 l5 and s1 which my doctor said was ok I have no idea what this means, I have tried about 10 different meds I am now on gabbapentin which I have been on for 4 months , I have just had my first pain management session where I was give an injection in my back, I don't know what was in the injection apart from some of it was steroid but it was very painful ,Since having the injection the pain has got worse and I keep having weird feelings in my left leg and foot like pins and needles is this normal . The pain is worse when I bend forward and to the right , No one has actually said what is wrong with my back ,and I am hoping that you can give me some idea .thankyou .

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    1. Wow, sounds like a very frustrating situation for you. I'm sorry to hear you are suffering so. I can't really suggest a diagnosis for such a complicated issue from a distance. However, what is really apparent to me is that the current treatment efforts are failing. Being that you are the patient and do not know what is wrong with you, I'm wondering if there has been a definitive diagnosis made. You should ask your physician this, because having symptoms like yours lasting for a year without any definitive diagnosis and resolution is not acceptable. I'm not sure how a good treatment plan can be developed without a real definitive diagnosis. Perhaps you have just not had a good communication session with your doctor. You are the patient and deserve to know exactly what is wrong, so just ask the doctor.

      You mentioned dehydration of L4 and L5 disks shown on the MRI. Certainly, this is quite common, but certainly not normal. When a patient presents with this and has no symptoms it is often not very worrisome. However, a sign on the MRI like this seen in a patient with symptoms like yours can be quite telling. It may not be the problem, but it is definitely a weak spot and certainly suspect. I'm assuming that they didn't not find an associated disk herniation and therefore did not call much attention to the dehydration. That also might explain the current suggestion to inject steroids in the area for what one might call a "chemical radiculalgia". Oftentimes, when a disk shows degeration like yours, the area can become inflammed and full of swelling that puts pressure on nerves. Your doctor is in a better position to determine that. In defense of the steroid injection plan, it can initially result in greater irritation and does generally take a series of 3 injections to the most beneficial results. If you do have a "chemical radiculalgia" it should help but like with any invasive procedure, it involves both science and skill; so some doctors have better results than others.

      The other thing that sounds suspect with your description is a condition called: "Piriformis Syndrome", so might ask you doctor if that has been ruled out. You may see my article on that at the following link: http://backbenimble.blogspot.com/2012/02/piriformis-syndrome-self-diagnosis-best.html

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  49. Bacdoc,
    My pain started when I was running, the sharp stabbing in my left buttock. I have seen a Physical Therapst and gave me exercises for my back, back presses and laying down, lifting my leg up to straighten. This was 2 weeks ago and pain is still there. I cannot run a step with the sharp pain stopping me dead in my tracks. I have also been stretching with Piriformis exercises, the Clam shell, Piegon stretch, side Planks. As others have mentioned, pain after sitting and getting up from bed. Not sure on the next step??

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    1. The next step should be to attain an exact diagnosis. There are numerous reason that could explain your symptoms and a lot of factors that play a part. If I had to guess at the most likely cause(s), two ideas come to mind:
      (1) Sacro-iliac joint strain/dysfunction
      (2) Strain of the Piriformis muscle
      Being that you are paying some attention to self-care of the Piriformis muscle, perhaps it is even more likely to be a sacro-iliac problem.

      If I am correct in this, your best bet for treatment would be chiropractic care, because the response of this condition to such care if usually quite better than any other mode of treatment. It is also possible that you have a lumbar disk herniation, but if the pain stays isolated in your buttock, that diagnosis is not as likely. As a friend for a referral to a good chiropractor.

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  50. Hi. I am 22 year old male. I play sport at a high level and train every day. two years ago a pain started in my left buttock which was severe when I drove or when I trained. I remember the pain starting while playing in a particular game while running for a ball (Irish Gaelic Football). I went to an orthopedic surgeon and he advised me to go for an MRI scan on my lumber spine and on my Buttocks/thighs. the result came back that I had a split in the tendon in my buttock. He gave me a cortosone injection and advised me to rest for 6 weeks. I did this and although the pain initially went, it came back a few months later while playing again, only to go away again. this year, about 2 months ago, I was playing a game, and whilst running, the exact same pain came back, only this time it was on my right buttock. the pain can be described as a sharp and intense pain deep in my buttock which shoots all the way down my leg. My team physio sent me to a different orthopedic specialist this time. She again told me to get an mri scan on my spine and on my hips. Seemingly nothing showed up, except a tiny bulge of a disc in my back which she said was unrelated, and a possible crack in my pelvic bone, which she again said was a 'red herring'. Even though it was the EXACT same pain which I had experienced on my left side two years previous, she said nothing about a split in my buttock tendon. She advised a cortosone injection again, to allow me to go back playing as soon as possible, and said it was an inflamation of a muscle. I got the injection 3 weeks ago, and I still experience severe pain whilst driving. She told me that I could train lightly after 3 weeks, so I went for a run 2 days ago, but the pain remains. It is very frustating, as the problem seems to be going from one leg to the other, and the injections are doing little for it. I do drive alot, to training and to college, and this is when the pain is at its worst. While playing the pain prevents me from sprinting, and I feel that there is no power in my right leg due the pain. I have been experiencing lower back pain for the past 5 years, so I thought that this is causing the sharp buttock pain, but both specialists I have been to have said nothing alarming is showing up on the MRI scans on my back. The season starts soon and my problem remains. do you have any diagnosis, causes or treatments? I would really appreciate your help. BRIAN-IRELAND

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  51. Brian, I'd love to help you, but I certainly can't make a diagnosis from a distance as well as a competent physician should be able to do in person. However, I certainly do have some thoughts/suggestions for your consideration.

    First of all, I find it very disconcerting that you being a young avid athlete, two doctors have done little but to simply give you the: "I don't have a real definitive diagnosis, so let me just give him a cortisone shot treatment plan". It might make sense for an elderly person or even an athlete that only cares in playing in today's game, but not very sensible for your long term needs. One might make the argument that your first doctor did make a diagnosis of a bifurcated or split Piriformis ,muscle, that can indeed be a real problem and cause the pain you are experiencing. However, the treatment for that should have included physical therapy and stretching or perhaps pressure point massage, followed by cryotherapy. The cortisone might have helped as it seemed to the first time, by halting the inflammation, but the inflammation is a secondary problem. Therefore, symptoms were almost sure to come back. If you had it on that one side, you certainly could also develop the same thing on the other side. Then again, it is possible that, in spite of having such, it was never involved in your pain anyhow. I believe a young athletic person like yourself, needs to align himself with a doctor that practices a more conservative, corrective and preventive approach to caring for you, so that you can participate in your own self-care and understand exactly what is causing the problem(s). Look for a chiropractic physician, an osteopathic physician or a physiatrist (specialist in physical medicine) that specializes in treating sports-related conditions. The physician could also be an orthopedist if he or she is more oriented toward conservative sports' medicine.

    As an added note, I might mention that given your experience of low back pain for the last 5 years, the slight bulge shown on the 2nd MRI can also be playing more of factor that suggested by the physician. A more thorough clinical evaluation and orthopedic examination is needed to delineate such. I hope this helps you in the quest to eliminate your condition.

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  52. Dear backdoc,
    I am so happy to have came across your blog,although I wish I would have found it sooner as I am going in for my 3rd "are we finally going to have an answer to all this pain" apt. with my ortho. I am 23 years old, healthy, non-smoker, was previously a gymnast (10 years ago). I have not been active in sports or working out as I have had four bunionectomys, two initial surgeries and then two revisions (pin removal). September 2011 was most recent surgery where the pain below left buttock began. It stayed in that location for several months and did not change much. Since Jan 2012 the pain has radiated down both backs of the thigh and calf down to the back of my ankle. I do find certain positions increase pain but find that the pain is different depending on the day.

    My ortho doctor has taken numerous xrays. I have had two mri's and both my ortho and pain management doctor say everything looks "relatively normal" I am getting no answers, and having worked for different doctors I do understand there are times where there is not an answer but I would love to know if there is something more we can explore. I have slept very little this past week as the pain is so intense and I cannot find a comfortable position to sleep in. I have began to limp because the pain in left leg is much worse than right and pain has traveled to front of thighs this past week.

    I forgot to mention, the pain doctor did "facet injections,radiofrequency denervation" if I remember correctly and the pain has gotten worse since.

    Thank you for all your time, Jessica

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    1. Hi Jessica,

      Sounds like you have a very complex problem, and perhaps your condition is a result of a multitude of issues coming together to illicit the symptoms you are experiencing. I gather from what you say above that the buttock pain began immediately following a revision of a bunionectomy. That being the case, the first thing to rule out is infection that may have occurred as a result of the surgery and bacteria entering the bloodstream. Although less likely than other diagnoses, it most definitely should be ruled out. On your own you can look for redness, heat, fever, feeling of malaise, etc. If you rule this out, then you can relax a little and take relief in knowing that there is likely a definitive reason for you to be suffering and a reasonable approach to resolve it.

      Let me also say that X-rays and MRIs often help explain why a patient has certain symptoms, but that is not always the case. I've seen patients have positive tests with zero symptoms and negative tests with a great deal of pain. It would seem that you have tried quite radical therapeutic approaches like facet injections and radiofrequency de-nervation. I would have preferred a more conservative approach; especially because these things were tried without any apparent diagnosis.

      The first step is to develop a definitive diagnosis. The red flag that jumps out at me is the fact you experienced bunions at a young age. This is usually due to foot pronation which can definitely wreck havoc with a person's back. You may simply have a real bio-mechanical, postural dysfunction with your hips and spine that is causing malfunction, leading to your symptoms.

      If I were you, before proceeding with any further treatment, I would seek the consultation of a competent chiropractor. Then you will have the opportunity to combine the info you gather from the viewpoint of a conservative practice like chiropractic, with the more radical approach you have submitted to so far. Perhaps, the info gathered from these various perspectives will be quite enlightening. I wish you a speedy resolution.

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    2. I researched biomedical, postural dysfuction, this really may be it. It makes sense. Just put a call into chiro, will keep you posted. I will never ever know how to thank you if you have found an answer via internet when 5 doctors have not!

      Fingers crossed! Jessica

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  53. Backdoc, went to follow up with Ortho today. No answers , Dr informed me that it does not make sense that both legs could be in pain at once , with nothing abnormal showing on xrays and mri's. Wants me to see his colleague whom is a spine surgeon. He made sure I knew he wasn't saying I need surgery but that he hopes his colleague has an answer . Very strange to me as I have read that the pain from buttock down to calf can be occuring in both legs at the same time . I am so frustrated because the doctor is talking about what I have described to him as impossible. Please help

    Thanks again, Jessica (same Jessica from post above)

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    1. Hi again Jessica,
      The most common classical disc herniation that would show up on an MRI would "posterior-lateral disc protrusion". That typically would cause pain only down the one side that the herniation is on. However, the human patient often does not fit the classic cases presented in a text book. I've seen numerous cases of bilateral (both sided) leg pain that occurred in conjunction with a positive finding for a central disc bulge seen on an MRI. I've also seen such symptoms in the absence of any findings on typical diagnostic tests like an MRI. One rationale explanation could be the presence of an internal disc derangement that may not show well on a standard MRI. In any event, I still suggest that in spite of whether you not you see your doctor's colleague that you also get the opinion of a reputable chiropractor.

      Additionally, as a former gymnast that no longer exercises, you could have a swayback with severely tight ilio-psoas muscles that could be a causative factor.

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    2. Thank you so much for your insight, I will be sure to see my chiropractor. I was also researching vitamin deficiencies, I have a very bad diet (do not eat very healthy because I am a picky eater, severe!) I was reading that people with a vitamin d deficiency often experience chronic pain in lower back and legs. I have been having a hard time describing my pain and I read that is a sign as well. I went to my pcp today to have blood work done to see if this is what the problem is. I would think the unhealthy eating habits could catch up?? I will mention your thoughts to my doctors regarding bunions so young and everything else, they do not seem to be thinking outside the box.

      Thank you again for your time, you have made me feel much better even though we aren't sure what is wrong. You have listened unlike all my doctors!

      Best, Jessica

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  54. Dear backdoc,

    Your blog is a very good read. I wonder if you could give me any advice on my condition please?

    I have had severe back problems in the past (Severe back pain and sciatica all the way down my leg to my small toe on left side only), whereby I had a lumbar discectomy (shaving of the disc) of the L5/ S1 region by a neurosurgeon to cure a herniated disc problem.

    This surgery was carried out in 2005 and I was told then that my approach to life in general would be softly softly to begin with, with plenty of stretching (rehabilitation) involved, on a daily basis.

    I have had some problems since the operation, where I have had slight relapses due to prolonged physical exercise or when I have lifted something or things perhaps I should'nt have, on my own. I have got through these relapses through chiropractic care (££££) and generally looking after myself.

    I am around 6ft 3in tall and am slightly overweight for my height. I am 34 years old and am a non smoker.

    However I need advice on a new matter which has occurred only in the last 5 days or so and is affecting my right side this time. I have no back pain in this case, however I have the symptoms of sciatica in my right buttock only.

    I believe the sciatica in the right buttock first developed the day after I thought that I had overstretched during my back exercise routine, however I cannot confirm this. I have not undertaken any undue stresses or lifting in the period leading up to the problem occuring.

    I am worried because the problem is related to my right side, as opposed to the left (previous problems). I am making an appointment today to visit a local good chriopractor to get checked over. I also know of an excellent clinic who specialise in IMS (Intra Muscular Stimulation) I do not have faith in my G.P to diagnose and send me in the right direction.

    Would it be possible for you to give me your honest, experienced opinion on my new condition please? I have read the section on Trauma to the sciatic nerve through over stretching and am hoping that I only need to rest, ice and do gentle excersise for the condition to heal. I am worried that I may require a neurosurgeon again (at a premium cost).

    Your help greatly appreciated.

    Dan - Staffordshire, England

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    1. Dan, please accept my apologies; I thought I had replied to you already, but apparently, I did it without being signed in to the blog and it didn't take. I just noticed there was no reply following your post. In any event, once a disc is degenerative it is always so; and surely that is the case at L5/S1 due to the fact you required and had surgical intervention. The best you can hope for is to slow or halt the progress of such. It is quite common to develop problems in the disc above the operation or in the same disc on the other side, so that certainly could be the case. However, from your description, I suspect it is more likely that you subluxated or irritated your sacro-iliac joint when you were stretching and that could very well be responsible for the symptoms you describe. Hopefully, you have visited your chiropractor and resolution has already begun. If you're a side sleeper, I would suggest a nice thick memory foam pillow placed between your legs while you sleep. This takes a lot of strain off the joint, allowing it to heal faster. Of course, I like the one that I picked out for myself and the folks I know called the "Nimblepedic Comfort Touch Pillow".

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  55. I'm 19 years old and a female and I've noticed in maybe the past few weeks that sometimes, I'll just be sitting on my bed and I'll shift a little and out of nowhere there is excruciating sharp pain in my left butt cheek but it feels like deep inside like my bone or a muscle or something. It goes away within 15 seconds, sometimes I'll still feel a light ache afterwards though and I have no clue why this is happening, Could you please help??

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    1. Sorry to not get back to you sooner. I'm wondering whether there was a fall or incidence of excessive lifting prior to the first symptom. Not knowing such my best guess would that you are having some issues with sacro-iliac joint just below and to the left of the very lowest part of your back and functions to join the lower back to the base of the spine. The fact you shift in bed and illicit the symptom of sharp pain in the buttock make me think you are applying stress to this joint by way of the friction of your pelvis pushing against the bed as you shift. A good chiropractor or a doctor of physical medicine (known as a Physiatrist) might be your best bet for this.

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  56. You are way better than the doctors that I visited. Good job.

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    1. And you're just such a perceptive person. "Just kidding", but thanks for the kind feedback.

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  57. Dear Doctor,
    Thanks for the wonderful blog. I learnt a lot by just reading your responses. In the past 3 weeks, I have suddenly had a pinching pain on upper left button when bending down. It doesn't affect my running or swimming or weight lifting. I just feel this pinching pain at 1 location and it would be gone in a split second. Is this something I should be concerned?
    Thanks
    T

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    1. Glad to offer my help. I'm supposing you made a typo and meant "buttock" as opposed to "button". Regardless of such, being that it doesn't seem to restrict you from your activities, you should be concerned just enough to pay attention and make sure it resolves over the next 2 weeks. If it does not or it re-appears, you should definitely get it checked out. Although not uncommon, what you describe is certainly not normal and a sign of something at least temporarily being wrong. Could be a simple strain of the lower lumbar or sacro-iliac spine. My guess it is not likely to be a disc problem or Piriformis Syndrome because it doesn't appear to fit overall picture of such. Again, probably not worrisome, but just keep an eye on it.

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  58. I'm a 40 y/o male, healthy, work out 5 days/wk, 3 cardios, & 2 intense full body circuit weight sessions. I've seen a chiropractor in the past, but haven't gone regularly since I moved to a new city 2 years ago. I did just go for a checkup/adjustment with my previous chiropractor 3 weeks ago when I was in Austin & he said my spine felt well aligned.

    Thursday morning, I woke up with a bit of leg pain in my left upper thigh area, just below my glute. It's about halfway between the back of the thigh & side if the thigh. It wasn't a huge pain, so u figured I slept wrong. I went ahead and worked out that night, & squats didn't really hurt, so I just did them a bit slower than usual. Friday, I awoke with excruciating pain in the same area when I tried to walk, or stand up /sit down. Trying to put weight on the left leg to put on a pair of pants was brutal. Getting into & out of a car hurt as well. I don't have any back or neck pain, it doesn't hurt when I cough or anything like that, so my girlfriend thinks I pulled a muscle severely. Neither of us are drs though. It doesn't seem like the pain is in the right spot to be a hip flexor, bit I'm no expert. If i were still in Austin, I'd visit my favorite chiropractor anyway, but since it seems like a muscle issue, & i haven't found a new chiropractor in houston, & it's the weekend anyway, I'll rest it & see where I'm at Monday. Very strange, as it came out of nowhere. Maybe I ran wrong the night before, then made it worse by doing squats. Any ideas? Thank you so much for your time.

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    1. Pete,
      Even though you don't have back pain, it could be sciatica, but in your case I think your girlfriend is right. Sounds really like you over did a workout and pulled a hamstring muscle. This can cause really severe pain and be exacerbated by all the movements you describe. Stop doing any workouts or movements that irritate it. Squats and/or deadlifts are out of the question until it resolves. I would suggest that apply an ice pack for 20 minutes twice per day for 2 days then alternate with ice and heat for 2 days. After 4 days, if you start to see improvement, just go to heat only. As far as activity, do the weight-lifting routine you can do without pain. You may also try gentle walking on the treadmill both forward and backward if you can do so. When your muscles are warm, do some very gentle calf, hamstring and quadricep stretches, only to your tolerance, but not let it become painful. If that does not start to resolve the issue it is time to find a sports' chiropractor or physical medicine practitioner in your area.

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  59. Dear Backdoc,

    I spoke to you on April 10th (my name is Jessica) I just want to thank you from the bottom of my heart. I don't know where I would be if you had not given me your insight.After receiving your insight I went straight to my Chiro, before I even let her know you and I had spoke and what your thoughts were. She said the EXACT same thing you did. I have seen her three times and I am already feeling better than ever. I cannot believe I saw so many doctor's and you were able to help me via BLOG !

    Thank you again,
    Jessica

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    1. Yes, I certainly remember you Jessica and appreciate your kind feedback. I'm so glad we were able to send you in the right direction, so that you are now feeling relief.

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  60. I am wondering about your Ice is nice comment - I have found icing just generally makes me a little tense, while heat (in the form of a Bodi-Heat heat patch - activated iron ore) that I get a good deal of relief. Why do you say that heat is bad?

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    1. Please understand that we are discussing Sciatica in this post. Heat is generally aggravating to an acute sciatic because the nerve is already irritated and inflamed. Heat increases circulation to the area and often simultaneously increasing pain and inflammation. There are cases of such that are contrary to this, but as a general rule, ICE is always a safer bet than heat.

      I would agree with you that heat is a better option for relieving tension as you mention, but that is not the scope of this article.

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  61. I have a multitude of health issues that include SLE, RA, Fibromyalgia, Paresthetica Meralgia, hypothyroidism and high blood pressure. Virtually everything is controlled by medication except the Paresthetica Meralgia, which developed after I fell from a train onto the platform on my right side several years ago. I had MRIs and X-Rays taken at the time that showed bulging discs at the L5 and S1 and degenerative disc changes, narrowing of forminal space, etc. I experience a sizzling sensation down the side of my right leg and if I don't shift position, then I get flashes of excruciating pain. OK - I'm living with all of that. However, several months ago, I developed a severe pain in my left butt cheek. My Dr. diagnosed a pulled gluteuas maximus muscle, gave me muscle relaxers and Ketorolac. Then my RA Dr. gave me a steroid injection and after about 6 weeks total, it finally went away. Yesterday, I bent over to remove some files from a file cart and noticed the same pain as what I had experienced in the left butt cheek, only now in the right butt cheek and partially down the back my right leg (the meralgia paresthetica hurts on the outside and front of the leg down to the knee). Could this be a form of sciatica? I don't want to go through another 6 weeks with the kind of pain I had on the left side. I know it's impossible to diagnose from a distance, but should I be asking my doctor for an MRI? Any advice you have would be most appreciated.

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    1. Hi there,
      You are definitely experiencing a form of sciatica. The question is: "what is the origin" of such?" Is it because of the degenerative L5 disc or for another reason. If it hurts when you push to have a bowel movement or cough of sneeze, it is likely to be disc related. In any event, unless you had major trauma several months ago leading to a gluteus maximum strain, that diagnosis might have missed the boat. That muscle is very strong and takes great forces to strain it. If the disc is not the problem, it much more likely that you have a sacro-iliac dysfunction. You might want to investigate the prospect of visiting a chiropractic and naturopathic physician whereby, working together can offer you a holistic approach to dealing with all your conditions. Several things like SLE, RA and Fibromyalgia auto-immune related and can be treated with natural alternatives and a vegetarian, allergy free diet. A good chiropractor can probably resolve your latest pain in the buttocks (both right and left). I'm not saying to discontinue seeing your medical doctor, but it wouldn't hurt to start investigating and alternative for more resolution, rather than simple symptomatic care.

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  62. Thank you for this valuable information, I hope it is okay that I bookmarked your website for further references.

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  63. Great article and I am absolutely agree. It's strange that you are retired!

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  64. Hi I've suffered with lower back pain for about 2 weeks I struggle some days to drive, walk etc the past 5 days the pain has worsened and is in my right buttock and down my leg it sometimes hurts my left leg and can be quite a sharp pain however the lower back pain is more of a dull continuous ache, I've been taking ibuprofen and paracetamol but not been to see my gp as I'm hoping it will get better in time? How long should it take to heal itself and I'm wondering if a fall 6 weeks ago could be the cause of The pain as a delayed reaction coz after I fell I felt fine? Any advise is appreciated thanks

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  65. Responding to regarding your 2 week bout with sciatica, I can certainly feel for your situation. Sciatica can arise from numerous underlying causes, but I think the most likely in your case is indeed a result of the fall you had 6 weeks ago. Sometimes, it is the body's response to an injury that leads to recognizable symptoms. This is certainly very likely and could take some time to show up. If I am correct in this assumption and please note that it is indeed only an assumption, the two most likely reasons for your pain are as follows:

    1) a sprain/strain to the sacro-iliac joint, subsequently referring pain down through the buttock and thigh
    2) an injury to a lower lumbar disc, with subsequent swelling or herniation that is putting pressure on the sciatic nerve.

    To further delineate which one of these is the most likely it would be prudent to note whether coughing/sneezing and/or bearing down for a bowel movement illicit or increase the pain. This is more likely to occur with instance #2, whereby the lumbar disc is involved. Additionally, if the pain runs significantly below the knee, it would be another indication of disc involvement. Otherwise, by process of elimination, you are more likely to have a sacro-iliac joint dysfunction resulting from the strain of the fall.

    For either of these, if medication does help it will be only because the swelling and spasm is reduced as a result of anti-inflammatory and muscle relaxers temporarily relieving your symptoms. Medications are not good protocol for healing or long term results. Your GP may be a good enough diagnostician to determine which one of these conditions, if any are responsible, but would likely need to refer you out for any true resolution. Your pain may ultimately go away insidiously, but the problem you describe will likely return in the future if you do not have responsible care for these conditions. There is some sort of mechanical dysfunction that should first be evaluated and then corrected for the most desirable results.

    Two viable treatment options seem likely: 1) referral to a chiropractic physician; 2) referral to an orthopedic physician with likely referral to physical therapy. Either option should end with a series of exercises to increase flexibility and strengthen your core, as well as good ergonomic advise as it relates to sitting. In my opinion, this is simply due diligence to prevent future bouts.

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  66. Hey Backdoc. Thanks for this great article. I am having a real bad pain in my back and I think it should be related to sciatica. I am used to put my wallet in my jeans back pocket for many years. Last week I snooze and suddenly felt a very bad pain in my low back. Is there anyway to treat this?

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    1. I'm so sorry, I apparently never published your comment nor did I reply to it. Please accept my apologies.

      A sneeze can often cause or exacerbate a back condition as well as the associated sciatica. This usually means there is some lumbar disk involvement. If you cough sneeze or bear down for a bowel movement and get back pain or sciatica, you usually have a compromised or herniated disk. Certainly there are good ways to treat such, but the extent of disk involvement must first be determined. If you haven't already, a thorough exam is in order. This can be done by a competent chiropractor, orthopedist or neurologist. Unless deemed to be a definite surgical case, I prefer conservative care consisting of a combination of manipulation, physical therapy, core strengthening, weight loss )if necessary, supplements for healing and lots of purified water consumption. One also need to take a look at chairs they sit in, shoes they wear and mattresses slept upon. All these can play an important part in the healing of such a condition.

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  67. Hi Doc. I am amazed at how you are helping so many when their doctors can't seem to find the problem. I've had problems with my legs for over 3 years. I started with tingling and weakness in front of thighs only. After several specialist I tested positive for Lyme. Twice. I know it's controversial so I won't go into that but I'm wondering if it could be something else. I was also told that the Lyme could have caused Transverse myelitis since I do have a lesion on my spine. As of now I'm no longer able to work. I can't walk without crutches and now that's getting more difficult so looking into wheelchairs. The pain is really both my front thighs. Pain severe weakness tingling burning. I've had every test possible including ms (I do have brain lesions also) and shows nothing. I see a reg Dr and a neurologist regularly who recently just told me that they want to continue seeing
    me but its gone on so long they have no idea what it could be and I need to learn to live with it. "Sometimes these things happen". I don't want to settle with that answer. Do you have any ideas?

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  68. Here you are paying me such a nice compliment and I take so long to reply. There are no excuses but your case seems quite complicated and I sort of put it off for when I had time to address such. From your description it would appear that you might indeed have either Lyme's Disease or Multiple Sclerosis, being that you have lesions in your brain and in your spine. I"m not sure why you say, they found nothing but have indicated that they did find lesions in your brain and spine.

    A neurologist experienced in both should be able to determine which one. They have some similar symptoms. In any event, I think I may best serve you by simply suggesting some really good nutritional supplements that are beneficial for slowing the progression of many degenerative diseases including the two you mentioned. They will sometimes lead to improvement in symptoms. You should ultimately find a wellness or naturopathic physician who can follow your case and treat you accordingly. Here is at least some good suggestions for you.

    (1)Sublinqual B12 liquid or tabs
    (2)N-acetyl-L-cysteine 600mg per day
    (3)CoQ10 (ubiquinol form 200mg, 2x per day)
    (4)5000 IU vitamin D3 per day with large meal
    (5)BCM-95® Curcumin 400mg 2x per day with food (this one can cause some digestive distress in some but is good for preventing inflammation partially responsible for destructive lesions in both disorders.
    (6)Reishi Mushroom Extract -strengthens immune system agains foreign organisms

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  69. Thank you for Responding. I was told the lesions in both places did not definitely say anything. I was sent to a MS specialist who thought it could be stiff persons syndrome. But all blood test I've ever had show nothing but Lyme. I do take B12 and D3 recommended by the MS specialist. I just know if I believe that "these things happen" and never find a reason for what it is. Thank you for your suggestions I will try those also.

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    1. Well, I suppose it could be "Stiff Person Syndrome", but that is very rare and more often in women. If he suspects that, he could test for such with a blood test for very high levels of anti-GAD antibodies. Then correlate the findings with EMG(electromyography) studies to see if the results are consistent with SPS. If your symtpoms, orthopedic testing and both tests are suggestive of SPS,then that makes for a pretty definitive diagnosis. IF you do have SPS, then the supplement program I suggested should be helpful. You will also benefit greatly by moving to a vegetarian diet with very little intake of animal proteins. Vegan would be even better, but requires a good knowledge of what to eat if you do so. This will help with the autoimmune component that is very likely in either MS or SPS. Animal proteins in people above the age of 40 very commonly cause the body to attack its own tissues and enhance progression of degenerative diseases.

      In any event, the lesions in brain and spinal cord need to be differentially diagnosed to a logical conclusion, rather than just being dismissed as not saying anything definite. "These things happen", is not an acceptable statement when your patient is about to be confined to a wheelchair.

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    2. Thank you so much for all this info. But I thank you the most for your last sentence. That's exactly what I think.

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  70. Hi,

    I completed a marathon on 5/12/13. I felt fine during the race but within a 1/2 hour, began to have pain in my right butt cheeck which runs down my leg to about my knee. As time passes, I can feel some pain in my right lower back that I didn't sense before. Ibuprofen helps some as does the pigeon pose in yoga but does not take it away completely. It feels better when I sit but I have to baby it when I walk. I had my first child on 3/22/12 at the age of 37. During that time, I had back pain and saw a chiropractor who told me my hips were misaligned (I forget if my right or left hip was higher). She repositioned it and it kept for the rest of my pregnancy. Wondering if it sounds to you like a chiropractor would be my best bet re: treatment or if stretching would be better (or maybe the two combined)? There seems to be so many treatments out there and being a working mother, I need to be as efficient as I can with my time. Thanks so much for your time and help! Lauren

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    1. Dear Lauren, you are almost assuredly suffering from a very common lower back disorder known as sacro-iliac joint dysfunction. It also could be associated with "Piriformis Syndrome"(see my article on such), but the back pain you describe during your pregnancy makes me lean toward S-I joint issues. Those joints loosen up during pregnancy and often misalign as they are preparing to allow expansion of the birth canal. The sacro-iliac joints, commonly known as simply: "S-I" joints are the joints that the base of your spine (sacrum) makes with your pelvic bones. They move when you walk, run or simply raise your knee in front of you. S-I dysfunction is the most common cause of lower back pain and it often mimics a herniated disc by presenting with referred nerve pain to the buttocks and down the back of the thigh to about the knee. This type of pain along this nerve path is known as sciatica. To differentiate between a disc problem and S-I problem we look at multiple factors:
      1) Does it hurt a lot when you cough, sneeze of bear down for a bowel movement? This is consistent with disc problems
      2) Is there pain shooting down the calf into the foot? This is not usually seen with S-I problems alone.
      3) Is there associated weakness in the muscles of the foot or "foot drop"? This almost certainly indicative of disc issues, nerve damage of neoplasm.
      4) Is there loss of normal bowel or urinary function? Not associated with S-I problems
      5) Cannot put the heel flat to the ground when walking is more indicative of disc being compromised.

      So, only real valuable treatment for S-I joint dysfunction is chiropractic manipulation combined with core strengthening/stretching. Sometimes there is associated muscle spasm in and around the hip benefiting from deep tissue massage as well. You also want to make sure that when side-sleeping you place a soft fluffy pillow between your knees to take stress off the S/I joints. IF you don't have one that is comfortable I recommend the Nimblepedic Comfort Touch Pillow.
      One more item is that you might need to have a chiropractor take a standing AP lumbar film and measure any hip height discrepancy. Sometimes orthotics or a heel lift are necessary to stabilize the S/I joints if there is greater than a 1/4 inch deficiency. I wish you a speedy recovery and lots of good running years. Be Well ! Dr. Brad

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  71. Hi, i was diagnosed with osteoarthritis 2 years ago in my neck affecting c3 to c7. i went round in circles with my specialist then eventually seen a new one who gave aggressive manipulation of my neck which has really helped relieve the nerve pain. However, for the past 2 weeks ive started suffering really bad with lower back pain, something ive never had a problem with. I do get sciatica down my left side from buttock to toes and can normally deal with it with meds but this time im also getting severe back pain too. its getting that bad that even a journey home from work on the bus after 26 mins had me with pins and needles and total numbness in my back, bottom and thigh for 20 mins after getting off the bus and walking. i know i should go back to my doctors but i feel like they dont listen and fob me off with more meds and pointless referals to an out patient muti skeletal department who dont really help. what can i do as this is driving me mad now. im 46 y/o female and not over weight.

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    1. Being that you have definitive, degenerative changes in most of your cervical spine, it is quite possible you have some complimentary degenerative spondylosis in the lumbar spine of the low back as well. The two problems may or may not be associated, but there is a term known as "Lovett Brothers", a phenomenon that is not often suggested in conventional medicine whereby certain vertebrae in the neck move or fail to move in harmony with vertebrae in the low back. When one region is compromised, may ultimately be affected too. So, treatment of one may affect the other. That being said, it is clear that you are suffering with some fairly advanced sciatic nerve symptoms and the issue needs to be dealt with appropriately. In the very least, I would recommend that you go online and purchase something called a "Skwoosh Posture Comfort Cushion", that is a great seat cushion for removing pressure on the sciatic nerve, lightweight and very portable. That will only be part of what is necessary, but an important part. The origin of the pinching or irritation to the sciatic nerve is very likely a disc problem in your lower back and depending on the results of a thorough exam, may either require lumbar traction, spinal manipulation or even surgery if bad enough. I would start with a reputable chiropractor and then go from there. If you need decide you want to try traction at home, I'd recommend the "Saunders Lumbar Hometrac Traction". Ultimately, any treatment you have should be accompanied by a comprehensive prescription of strengthening and stretching exercises for your core, but you should be on the mend prior to starting such. Best wishes for success and Be Well!

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  72. Dr. Brad-
    What a wonderful gift you offer to the community....may your generosity be returned to you! Thank you for your response. I did see my chiropractor on Thursday who dx me with sacroiliac joint dysfuntion, right hip higher than left (slightly) and some L5 twisting. I have not really seen an improvement in my pain level since the adjustment and not sure if that is a realistic expectation? I have also begun my yoga stretching most for the piriformis muscle and other hip openers...I do need to do some strengthening exercises as well.
    I most appreciated your comment about the deep tissue massage as I've been telling my husband when the ibuprofen wears off, my buttocks muscles seem to be in severe spasms. I feel like they are just so tight and dense that they're really the main source of the issue.

    Could you make any recommendations for how often I would have to have deep muscle massage to see improvement? Also, do you have any opinions about muscle relaxers?

    Thank you again for the time and care you give to so many.

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    1. Thanks for your kind feedback Lauren. Sounds like your moving in the right direction. Often, the pain is actually exacerbated following the first couple of treatments like a soreness after exercise. However, after a series of treatments over a few weeks you should start to see results if on the right track. Forget the muscle relaxers. They are a band-aid and function more to make you sort of useless at work rather than help to resolve problems. They are good for a real acute muscle spasm, but that is not what you are suffering from. Whatever you do on your own to help, just make sure your guide is results-based. IF what you do consistently makes it worse, then stop or lessen the intensity. As far as the deep tissue massage, you can start out with a good new tennis ball where by you sort of sit or position it in your buttocks and hip area from a side laying position. Use your body or hands remove pressure if too intense. Find sore spots and sort of move around slowly in a small circle. Don't over do it on the first trial. If you start to see results with this, then it is quite likely you might even see better results by seeing a neuromuscular therapist or rolfer. Let that person be your guide as to frequency because I'm not there to determine such. Let me know how you do with all this and Be Well !

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  73. Hi,
    I have been reading a lot of forums and yours is the best I have come across yer. I am having L5/S1fusion next week following a failed revision microdiscectomy on 4/2. I was pain free in my right leg for 2 weeks and now I am having severe cramping pain in my right buttock when
    walking or standing. Lying down or squatting relieves the pain which I would describe as a horrible cramping which intensifies into burning feeling in the rectum, pain that goes down the leg stops at the knee. I have been mostly non mobile for 3 week doing a lot of lying down. My doctor doesnot recommend chiro now so close to micro survey but is supportive of chiro treatment. MRI shows severe DDD of the disk with some herniation and fluid around nerve, believe to be surgical fluid from recent surgery. I have gone to a Neuro for another opinion and he conours. He will also be asslisting in OR with ortho (they work together a lot) to examine nerves while I'm open. Would you agree after failed pt treatments and 2 microdiscectomy on the same disc and a couple opinions that the fusion will relieve the above mentioned pain. I am 32 and very active I am looking to get back to living daily life. I come from a family where both parents have had fusions many years ago and they are doing good. I just want relief from this buttock pain that is immobilizing. What are your thoughts? Do you agree that pain mentioned is from L5S1. First microiscectomy lasted a year until I went running and cause scar tissue to wrap around the nerve. My surgeon also said their is heavy calcification and that the joint is narrow and that he removed what he could during the micro but the fusion would fix this as well, is this the case? He is very conservative with invasive surgeries and it is a last effort and he I'd very optimistic of the results that can be expected. Thank you for your feedback and support in advance.

    Thanks,
    Nick

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  74. Nick, I appreciate your kind feedback about our blog. Wow, I must be careful about giving advice on such a delicate case from afar. Sounds like you do have some good docs involved in the case. That being said, I'm probably even more an advocate of saving surgical fusion as a last resort than they might be. The one thing I don't see having been tried is a series of injections for what I call "chemical radiculalgia". Given your description of what has been done and test results, it is very likely that this syndrome is in the very least playing a part in your symptoms. To quickly describe this, it is a vicious cycle of inflammation (swelling) and pain, with the swelling or fluid actually exerting pressure on the nerve roots that cause symptoms similar to what you describe. It occurs as a result of disc derangement/dysfunction whereby the internal damage and degeneration of the disc sends signals or input to the nervous system and reflexively, the body responds by sending inflammatory proteins to the area. This inflammation becomes what perpetuates the problem. The series of injections can be with a steroid or sometimes with a procedure called: "decompressive caudal epidural injections/washings". Either method often breaks the cycle of inflammation. I like to see this sort of trial of injections first because the long term results of surgical fusion vs. not doing so is that the body will often fuse the segments on its own. This is nature's way of trying to solve the problem. Statistically, the 5 year post surgical fusion results is the same as not doing the surgery. However, that does not mean that the surgery will not speed up the result and in the process-- take away your pain. If successful, it may indeed do so and may thus be a viable option. I just wanted to throw out another idea about what might be tried first, should your physician feel you are a candidate for what I mentioned. In the long term, given time for recovery, you will want to seek maintenance care by a chiropractor to keep spinal joints functioning above and below the spinal fusion. Hope this gives you some food for thought. Be Well and best of luck with your decision!

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  75. Thanks for the feedback, it gave me some ease that fusion is an option to correct the problem. we have tried injections and they have not provided the relief. I am at a loss and vey wary, but the pain is so great. Looking back I probably did something during recovery of the microdiscectomy to cause the reherniation . I don't understand your comment, regardingvthe 5 year results. My parents and many people I have polled indicated no issues from that segment, but further up the spine is another story.

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    1. O.K. Nick,if you have already tried the injections then you have taken the right measures. What I'm saying about 5 year statistics is that the symptoms you currently describe have as much chance of not being there in 5 years if you don't do surgery as they do if you do have spinal fusion. That is in part because your body will attempt to make the fusion over the next 5 years on its own.

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  76. Hi,
    I am great fan of your Blog,i am regularly follow your post, every time you give me very useful information. back muscle pain in Canada

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  77. Doc Help!

    Can prolonged sitting cause sciatica? I recently had a 17 hour flight followed by a 10 hour car ride. For the past week I get a stabbing pain in my lower right buttock and down the leg when I stand up. Getting in and out of a car or out of bed is really painful. Once I am up and moving around the pain for the most part goes away. Should rest fix the problem? I fear that I did some damage to my Piriformis muscle and I fear I may have developed Piriformis syndrome and from what I see on the net it can be long term and very debilitating. Thanks for the help

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    1. Well, I can't say that occasional prolonged sitting is like going to cause sciatica. However, many years of prolonged sitting with improper support, padding and posture, could certainly lead to sciatic symptoms. Acutely, it is more likely that a predisposing problem was exacerbated by a bout of prolonged sitting. What you describe could indeed be a "piriformis syndrome". Then again, it could very likely be a sacro-iliac (SI) dysfunction. Both of these conditions can cause pain in the buttock and typically down the back of the thigh, not usually going below the knee. Rest will not likely fix the problem, because as you say yourself, it is movement or getting up and around that makes the pain go away. Therefore, with time, the symptoms will likely resolve. The "problem", however is not as likely to go away for good. You have some sort of weakness there and either SI problems or a piriformis syndrome can as you mention be very debilitating. The episode you are experiencing is a sign of a condition that will likely reappear under the same or similar circumstances. You need to seek long term resolution by being evaluated by a chiropractor, physiatrist (not be be confused with psychiatrist), an osteopath or a conservative orthopedist. By the way, a physiatrist is a doctor of physical medicine.

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    2. Thanks Doc!

      I will take you advice. I have recently retired and will be traveling back and forth from the US to my home in the Philippines in the future. As you say this same set of circumstances will trigger a reappearance so I will seek a long term solution. I am 62 years old and a retired IT professional. Although active I still spent most of my career sitting on my butt. An interesting side note here is that I was stung by an Arizona Bark scorpion in the right leg two weeks prior to the onset. The Bark in the most poisonous scorpion in the US. It injects a neurotoxin that attacks the central nervous system. My right leg (hands, lips) were numb for 48 hours after the sting. I am wondering whether this may have contributed to my problem.

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    3. Hi Robert,
      Bark Scorpion bites and resultant sciatic complaints are certainly a new scenario for me. I haven't had experience with such but I certainly would have to believe that had an impact on what happened to you. My guess is that your years of sitting at work created a weakness and the scorpion bite was a slow trigger as your body responded and adapted in the healing process in response for that. The neurotoxin likely created a muscular imbalance, setting up the predisposing circumstances.

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  78. Doc,

    Thanks again for the helpful advice. Due to bark scorpion paranoia I will be moving out of Las Vegas when my lease expires. Those little buggers pack a wallop!

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  79. Hoping you can help! My boyfriend went to bed the other night and next morning woke up with excruciating pain in his left butt cheek/ upper thigh area. Now he is convinced that it is a pulled muscle (i beg the differ) only because it seems some what of a repeat from a couple years ago when infact he suffered from a bulging disc and with surgery looked as if he was all better until the other night. Please confirm so i can persuade him to seek help ASAP. Thank you

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    1. This is an easy confirmation. A pulled muscle is a traumatic injury, requiring an obvious incident whereby one would experience pain with exertion. It is highly unlikely that one could pull a muscle in their sleep, unless that had some unusually violent movement during their sleep. I pulled muscle is almost always obvious at the time of injury.

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  80. I'm male & 52. I did heavy squats the day before and felt fine going to bed. After I woke up, I bent over to pick something up and felt a sharp pain in my lower back just above my right butt cheek. It's been sore all day, but it really hurts when I sit down. The soreness seems to emanate from where my cheek meets the hip bone near the tail bone. Never had this happen before and am really concerned that could be serious. What do you think Doc? Thank you.

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    1. Well, as long as the pain seems to be localized in and around the buttock/tailbone area and does not radiate when you cough of sneeze, it is probably not of serious concern. I would suspect that you misaligned and strained your right sacro-iliac joints (those joints between the pelvic bones and base of the spine just above the tailbone). If it is not the result of a chronic problem, ice packs and 2-3 chiropractic adjustments should resolve your issue.

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    2. Wow Doc, thanks for the quick reply. One more thing; I noticed that it only seems to briefly & sharply hurt as I'm sitting down then subsides. I also noticed that if I stretch the area, the pain is temporarily relieved even when I sit down. Standing or walking seem to relieve the butt pain somewhat. There's no pain when I cough, sneeze or laugh (even though I don't feel like laughing right now). As a side note I've been doing alot of "toe raises" lately to stengthen my calf muscles - would that have anything to do with it? Thanks again.

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    3. When the sacro-iliac joint is strained and dysfunctioning, there can be associated muscle spasm and gluts and/or piriformis. Your stretching probably helps that. I don't think the calf raises are involved unless you are straining the area trying to get heavy weights on your shoulders. IF you are using machines, probably not an issue.

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  81. I previously had a pain in my lower back which was from a bulging disc. Having seen a chiropractor nothing much changed and eventually it got better. I'm now having a pain in my left buttock when moving from lying down to sitting up and when sneezing. However when I walk it is fine. I can lift weights (squats and dead lifts) and its fine, no pain at all but as soon as i run it hurts again. Jogging seems fine but occasionally the pain disappears or the pain is so great i can hardly move at all. Not sure what I should?

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    1. Hi Dan,
      This is really a hard one to give advice about because it doesn't seem to fit into so-called standard protocol as either a disc problem, piriformis syndrome or Sacro-iliac dysfunction. It is most likely one of those and I lean toward piriformis because of the fact that you can do squats and deadlifts without pain. However, it is clear that you are in no way a surgical candidate, so I can see no reason to visit a neuro or orthopedic surgeon. If I were you, I'd first try a chiropractor combined with deep tissue massage therapy. IF that doesn't work for you, see a physiatrist (no this is not a psychiatrist for you head, but a doctor of physical medicine).

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  82. I have this wierd pain in my left buttocks, im only 18 years old and have been having this wierd pain since August. I don't know what to do, this pain prevents me from playing soccer. I have ignored the pain but it only seems to hurt more the day after. Issac

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    1. If your pain has continued on since August, it is not likely going away without assistance. It is important that you seek a diagnosis from either a chiropractic physician or doctor that specializes in physical medicine like a physiatrist. You like have either a sacro-iliac joint dysfunction or a piriformis syndrome, but you shouldn't just leave it to chance because an acute problem can become chronic and more permanent.

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    2. Thanks for the reply Doc. Another question does it have anything to do with sciatic. Should i rest my body for the meantime or should i exercise my buttocks?

      Thanks, Issac Vasquez

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    3. Hi Issac,
      It certainly could be affecting the sciatic nerve, but sciatica in itself is not really a diagnosis because it can be from multiple origins. I would suggest that you do not participate in specific or strenuous exercise until you know what is going on. Perhaps, walking and gentle stretching after your walk would be advisable as long as nothing you do irritates the issue.

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  83. sorry doc but i need help on how i can explain this to my Gym Trainer at school. I don't want to be participating in gym if it will make the pain worse than it already is.

    Thankd again doc, Issac Vasquez

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    1. Again, you'll have to visit the chiropractor or doctor of your choice for a proper diagnosis. After such, that physician can provide a note for your gym trainer

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  84. THANK YOU for the most informative article ive found so far. For the past year I have been experiencing severe pain in my left butt cheek. The pain comes and goes, lasting upwards of a week a time. The pain is almost crippling. The pain is confined to the left butt cheek area. Although, once it actually switched sides for the day. Bending over and sitting down seem to be the key movements to the onset of pain. I would appreciate any thoughts on this.

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    1. Hi Starla,
      You are probably suffering from either a SI joint problem or Piriformis Syndrome. You certainly need a diagnosis, but I would suspect chiropractic treatment and deep tissue work (including massage and stretching) on the piriformis muscle would likely be helpful for the resolution of such.

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  85. Doc please help me with what is going on with this nerve I can hardly walk once I get up in the morning. I am going to a chiro but cant tell the difference. Several months ago I hurt in my hip joint had an xray that showed nothing. It moved to my left side and feels like a cramp in my thigh and hurts down my leg. It hurts when I am on it for a while, no movement it is fine. Will I ever get back to being normal?

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    1. Sounds like you have a low back condition that is affecting the nerves that run through your hip to your legs. You need a definitive diagnosis, perhaps involving an MRI study to show how the spinal disks may be affecting nerve roots. Treatment should be appropriately correlated with the findings from this, combined with a thorough neuro-orthopedic examination of the issue. You may need lumbar traction, alternative types of chiropractic treatment, exercises or perhaps more invasive therapy if none of that works. You certainly may want to try a back brace like the: "Cybertech Back Brace with Mechanical Advantage"

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  86. Hi I have been getting electric shock like pain in my lower back at the base of my spine. The shock freezes me for a few seconds. Its really painfull.After these shocks both buttocks start to have a painful burning sensation and my lower back pain continues.These keep me awake at night. I also have night sweats. What could it be. Is it sciatic and why the night sweats?
    Also I get sudden urges to go to the toilet and if I dont make it in time I will start to pee. Its embarrassing.

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    1. Hi Alton,
      Well, it is possible that the back pain and urinary urgency situation are separate and unrelated issues, however, not very likely. The burning character of your pain in the lower back, urinary urgency and night sweats simultaneously is very suggestive of either infection of the kidney/urinary tract or perhaps even a kidney stone issue. You should seek diagnosis and care as soon as possible.

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  87. Hello Doctor. ..10 days ago I was lifting a bale of hay and turned suddenly.   I did not feel any pain when I twisted. .. 10 mins later my left buttock began to hurt.  It is very painful.. it has improved about 25% sice the injury.  I have minor fleeting pain in my leg with a extremely almost almost imperceptible ache in calf...just 2 times lasting 30 secs.  This serms to be gone now.  I do not have pain while coughing or laughing. .I have done some tests and I believe it is periformis on sciatic nerve....will this be permanent?   I tried to do to gym just for elliptical machine and upper body today....no core..but it just hurt too much..tylenol seems to remove 90% of tje pain..   I.also have some aching in the front thigh and around hip... How can I recover? What kind of time am I looking at? I have been stretching the periformis but is it too early to see improvements?  I am scared I hurt myself permanently.  Thanks Diana

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    1. Hi Diana,
      Actually, I don't expect that this is a case of Piriformis Syndrome. Much more likely to be a sacro-iliac strain or dysfunction. The pain might eventually go away on its own, but likely to create a weakness that will return in the future if not corrected now. It would be best to find a good chiropractor to verify or deny my educated guess and then resolve your problem for you.

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    2. Thank you ..you are probably right. I have trouble crossing my legs and it is painful negotiating stairs.  It is hard to believe such a minor movement could have caused this.  Do you think this can be resolved if it is?  I am quite worried as the pain is quite extreme at times.. I did go to my chiropractor and we were thinking periformis but as a few days have gone by I do believe it is more.   I will discuss with him.. are there stretches i can do for this?  thank you for your help.. Is the prognosis good for an injury like this?

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    3. Not sure moving a bale of hay would be considered a minor movement by most. To my knowledge, they are either 50, 100 or 200 lb. bales. In any event, in all likelihood, you should be able to find resolution. Exercises like would be done with piriformis syndrome could be utilized with SI problems as well. You should ask you chiropractor to go over some when he thinks you are ready. Sometimes an inflammed SI joint doesn't react well to exercise until it is in the healing phase.

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    4. LoL well.....maybe 40 lbs..it is not the weight so much as the bulk (volume 2x2x3.5ft)...

      What I mean is it seems strange that a minor rotation with a light but bulky load can do so much damage..WOW! It looks like I hurt the sactoiliac joint, the ligaments  attached to illium and the periformis muscle as well.  Maybe even more.  Whew... After 12 days the periformis is resolving but the other two are still quite painful .

      I spoke with my chiropractor and we have done laser and deep tissue massage.  Minimum adjustments after the acute phase maybe in a week from now.. I am just going to have to be patient with this healing..(not a strong suit of mine) keep up with the chiropractor visits and do mild exercise to strengthen my injury site.. I also have ligament laxity which probably slows the healing down.

      Thank you for your experience..you really helped me.. thank you for giving knowledge and peace of mind....it is refreshing.  Take care of yourself.  Diana



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    5. Good Diana, glad your chiropractor has you on the right track! Be Well..

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  88. last sunday my father fell down, till the time he is feeling pain in back side & lower front (left side).
    He is not able to tell the actual location of pain.
    Feeling severe pain in lay down to sitting, sitting to lay own and changing lay down sides. Much comfortable in standing an walking.

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    1. If your father is in severe pain from a fall, it is important that he be properly evaluated to make sure he did not fracture something or herniate a disc in his back. You may be able to try icing down the involved areas and see if there is consistent improvement over a couple days, but if there is not any improvement, it is important to get an immediate X-ray and evaluation. If there is any fever, severe bruising, problems with bowel or urination, then you cannot wait at all.

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