I’m so frustrated that I can’t find the solution for this.
Anyone else have this problem and what did you find that worked for you?
[quote]Jelena Abbou wrote:
I’m so frustrated that I can’t find the solution for this.
Anyone else have this problem and what did you find that worked for you?[/quote]
What’s the problem?
problem is pain in my butt 
both sides. hurts when i walk, sit, stretch, do cardio and most leg exercises.
[quote]Jelena Abbou wrote:
problem is pain in my butt both sides. hurts when i walk, sit, stretch, do cardio and most leg exercises.
[/quote]
Can you give more details?
- How long has this been going on?
- What makes it worse?
- What makes it better?
- What is your exercise routine like?
- How many days a week do you exercise?
- Do you sit as a desk job?
- How is your mobility?
- Have you had any injuries?
- Have you tried anything to help this? (Chiro, PT, Rest)
Are you positive it’s the bone that is hurting, or could it be a muscle in that area?
-
How long has this been going on? On and off for 2 years
-
What makes it worse? Doing deadlifts, stretching hamstring and walking fast i really feel it
-
What makes it better? Only doing ART helped a little. Rest didn’t really do anything
-
What is your exercise routine like? Legs are twice a week. I don’t lift to heavy, but I do lots of exercises for legs.
-
How many days a week do you exercise? 5 times a week weights and cardio 3-5 times a week. Cardio is spin, eliptical and stair master. Can’t run that hurts a lot
-
Do you sit as a desk job? No
-
How is your mobility? I’m very flexible but I have extremely tight hips/hip flexors
-
Have you had any injuries? Never
-
Have you tried anything to help this? (Chiro, PT, Rest) I’ve tried chiro, massage, acupuncture all no help. Only little bit help I got was from ART. rest helped a little but once I started doing legs went to back to square one.I use to ice after training legs (like sit on big ice pack while driving, that was bit better)
My sports orthopedic suggested one cortisone shot but I didn’t do it.Also I was recommended to try PRP injections and now I’m waiting to hear from insurance if they going to cover it
Also I roll on the medicine and baseball ball and foam roller after doing legs and cardio
thank you so much
Sounds like it could be piriformis syndrome.
The piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve. This referred pain, called “sciatica”, often goes down the back of the thigh and/or into the lower back. Patients generally complain of pain deep in the buttocks, which is made worse by sitting, climbing stairs, or performing squats. The piriformis muscle assists in abducting and laterally rotating the thigh.
Anatomically, the piriformis muscle lies deep to the gluteal muscles. It originates from the sacral spine and attaches to the greater trochanter of the femur, which is the big, bony “bump” on the outside top of the thigh. The sciatic nerve usually passes underneath the piriformis muscle, but in approximately 15% of the population, it travels through the muscle.
It is thought that acute or chronic injury causes swelling of the muscle and irritates the sciatic nerve, resulting in sciatica. Patients with an aberrant course of the nerve through the muscle are particularly predisposed to this condition.
She didn’t describe having any sciatica.
[quote]andersons wrote:
She didn’t describe having any sciatica. [/quote]
X2
[quote]Jelena Abbou wrote:
-
How long has this been going on? On and off for 2 years
-
What makes it worse? Doing deadlifts, stretching hamstring and walking fast i really feel it
-
What makes it better? Only doing ART helped a little. Rest didn’t really do anything
-
What is your exercise routine like? Legs are twice a week. I don’t lift to heavy, but I do lots of exercises for legs.
-
How many days a week do you exercise? 5 times a week weights and cardio 3-5 times a week. Cardio is spin, eliptical and stair master. Can’t run that hurts a lot
-
Do you sit as a desk job? No
-
How is your mobility? I’m very flexible but I have extremely tight hips/hip flexors
-
Have you had any injuries? Never
-
Have you tried anything to help this? (Chiro, PT, Rest) I’ve tried chiro, massage, acupuncture all no help. Only little bit help I got was from ART. rest helped a little but once I started doing legs went to back to square one.I use to ice after training legs (like sit on big ice pack while driving, that was bit better)
My sports orthopedic suggested one cortisone shot but I didn’t do it.Also I was recommended to try PRP injections and now I’m waiting to hear from insurance if they going to cover it
Also I roll on the medicine and baseball ball and foam roller after doing legs and cardio
thank you so much[/quote]
Definitely don’t get the cortisone shots. Glad you decided against it. That won’t help with anything it seems.
You’re situation sounded like what happened with me. What it turned out to be was bad body mechanics resulting in too much tension in pelvic muscles. In my case, the only thing that helped was ART. Start working on pelvic mobility as a warmup. This could be beneficial. I would look into something like Yoga as well, just to loosen up the hips and pelvis. You would be surprised how tightness in one area causes pain in another.
I tried Prolotherapy injections and had very negative results from them. I wouldn’t recommend either that or PRP until you get a MRI.
Most doctors aren’t very knowledgeable about pelvic issues. You can find one that specializes in pelvic treatments (they are much more common for women). But honestly, I’ve seen the best results from ART. They seem to address the issue better than these doctors do.
Good luck!
Chronic hamstring tightness can be secondary to hip flexor tightness. If you are stretching them with no results try to stretch out your hip flexors so your hammies won’t stay spastic to try and keep your hips level. This chronic tightness can put stress on your periosteum and aggravate the bursas which can both be sources of pain.
[quote]grrrsauce wrote:
Chronic hamstring tightness can be secondary to hip flexor tightness. If you are stretching them with no results try to stretch out your hip flexors so your hammies won’t stay spastic to try and keep your hips level. This chronic tightness can put stress on your periosteum and aggravate the bursas which can both be sources of pain.[/quote]
X2
Tight Hip Flexors can lead to an anterior pelvic tilt, placing added stress/tension on the hamstrings and surrounding structures, as grrrsauce stated. I would take some time focusing on the hip flexor flexibility. Also, I would address your hip internal and external rotation and see if there are any deficits there as well.
I don’t know, you guys might be right, but Jelena’s pain is unusual. People with APT are a dime a dozen, and half of those have lower back pain, or pain across the top of the pelvis. Not at the ischial tuberosity on both sides.
Jelena, I am guessing that you have already tried stretching hip flexors, right?
Looking at the anatomy, the lower portion of the ischial tuberosity gives attachment to the Adductor magnus and sacrotuberous ligament; the upper to the hamstrings.
If tightness of any or all of those muscles is causing most of the pain, you should be able to fix it easily with the right mobilization. I would recommend mobilizations from Cressey/Robertson/Hartman’s Assess & Correct DVD/manual, especially 4.2 & 5.3 Split Stance Kneeling Adductor Mobs (with external rotation). Especially 5.3 can hit tight hamstrings as well as the adductors, so it might be just the move to help you. Really all the hip mobility drills are helpful.
Getting ART on those tissues while you are working on the mobilizations may also help.
If mobilization like that doesn’t immediately help, I would guess that there is tendonitis/tendonosis. If this were the case, seems you should be able to get a diagnosis from a regular doctor. Tendonitis/tendonosis take a loooong time to heal because of poor blood supply. Like 6 months, 9 months or so. Even if this is the case, though, reducing tension on the tendons by getting their attached muscles to lengthen would only help matters. If I ever get tendonitis/tendonosis again, I would try to get the muscles attached to it to relax; if there’s inflammation I would definitely take strong anti-inflammatory, perhaps a prescription one; and I might buy an infrared heat device in hopes it would enhance blood flow and speed healing.
There are also bursa around the glutes that might be inflamed (bursitis); however, your symptoms don’t fit the typical symptoms for bursitis.
Awesome suggestions guys. thank you so much
I def think it’s not siatica, pain doesn’t radiate anywhere it’s just that one spot.
andersons, yes I stretch hip flexors in kneeling position and in lunge. Both are very painful and I feel tightness it’s coming all the way up from under rib cage
Jelena,
You said your sports orthopedic suggested a cortisone shot. Did he give you a specific diagnosis? Take an imaging (x-rays, MRI)?
Have you been told or noticed that you have an anterior pelvic tilt (APT)? As anderson said, you want to take the tension off of those muscles attaching at the ischial tuberosity. Being in an APT will place all muscles originating at the ischial tuberosity to be on a higher tension since the ischial tuberosity will be positioned more superiorly with the anterior pelvic tilt.
It sounds like your hip flexors and abdominals and the associated fascia are all tight/restricted since you are feeling your hip flexor stretch all the way up to your ribcage. You may also want to check your latissimus dorsi and thoracolumbar fascia for tightness as well, as that can cause an APT as well.
If you haven’t gotten at least an x-ray, it wouldn’t hurt to do that. Worse case scenario, there may be a small avulsion to the ischial tuberosity from the hamstring or adductor tendon (I have only seen that in one case before). I would guess that there is just a tendonopathy occurring, but it doesn’t hurt to be too save considering it has been an ongoing issue.
no hi didn’t gave me specific diagnosis. But two acupuncturis and chiro i went to said it’s ischial tuberosity. Also guy that was doing ATR said MRI would be a waste and wouldn’t show anything. Also I would have to pay like $1000 ( my detectable) . I’m planing to see another dr and see if he also suggest MRI I’ll do it.
And yes I have been told I have APT.
I’m not sure what the acupuncturist and chiro meant by an “ischial tuberosity” diagnosis. Ischial tuberosity is just a boney prominence that is part of your hip. I’m assuming they just gave it a general diagnosis of ischial tuberosity pain, but that can be associated to a number of things already mentioned in this thread, including tendonopathy and bursitis. Your symptoms don’t match a bursitis issue. Since the pain comes and goes, you have pain with hamstring stretches/deadlift exercises, and have an APT with tight hip flexors, would definitely lean towards a hamstring tendonopathy.
Where did the ART practitioner work on you? Mostly hamstring glute area or did he address the hip flexors as well? If he/she didn’t work on the hip flexors, the next time you get a session done, I would ask if you could get some work done on your hip flexors. With you saying you are already extremely flexible but have extremely tight hips/hip flexors, your hamstrings are probably in a long, locked position, meaning your APT is placing added stress and tension on your hamstring tendons, which will in turn place added stress on your ischial tuberosity. Stretching your hamstrings won’t help the matter and may irritate the area further. Your focus should be hip flexor/quad mobility and improving the soft tissue quality of the glutes, quads, hip flexors, adductors, ITB/TFL, etc. That should help with reverting the APT and decreasing the stress placed on the ischial tuberosity.
I said this in a previous post, the likelihood of having any kind of avulsion to the ischial tuberosity is fairly low, but x-rays are an easy and inexpensive way to rule it out. If I were in your shoes, I would want an orthopedic exam and x-rays to rule out any avulsion issue that may be occurring. Again, chances are low, but why take the chance.
Everyone makes valid points but there are a few things missed from this situation.
First, find someone in your area, or that you can drive to that specializes in working with athletes with this type of chronic issue.
From your short health history it sounds like there are a couple of other biomechanical disfunctions going on.
Possible, there could be a horizontal axis at the sacrum, which could either be coming from the innomonant or Lumbar vertebrae. The Axis at the sacrum with cause a BILATERAL hypertenicity at the piriformis and other external and internal rotaters. It will also give that local pain which Jelena has described.
Get on a proper foam rolling program and activation program that can be done prior to exercise and on off days, find a good manual practitioner Osteopath and/or Chiropractor that also does ART and some form of acupuncuture, which is good for releasing muscle tension.
[quote]Jelena Abbou wrote:
no hi didn’t gave me specific diagnosis. But two acupuncturis and chiro i went to said it’s ischial tuberosity. Also guy that was doing ATR said MRI would be a waste and wouldn’t show anything. Also I would have to pay like $1000 ( my detectable) . I’m planing to see another dr and see if he also suggest MRI I’ll do it.
And yes I have been told I have APT.[/quote]
We went through this via P and over at the sister site (pun not intended). Yes you do have APT and yes it’s still my strong opinion that until you correct it you can efectively forget about resolving your issues. Not because the APT is necessarily the root cause, but because until you attaine optimum length/tension relationships in your hip muculature, you won’t be able to properly diagnose/rule out other issues.
At the time you seemed strangely reluctant to admit to your APT and/or do anything about it. Correct me if I’m wrong, but your comment “and yes I have been told I have APT” suggess to me that you are still of that old mind set.
I appreciate that you make money from photos and that a lot of those poses must require you to stick your butt out in a heavy APT (judging by what I have seen of yourself, Jamie Eason, etc, etc), but you don’t lose the ability to stick your butt out when you lose your APT you know.
In my professional opinion: You DO have an APT and you DO need to correct it.
BBB
[quote]Adam - Dynamic wrote:
Everyone makes valid points but there are a few things missed from this situation.
First, find someone in your area, or that you can drive to that specializes in working with athletes with this type of chronic issue.
From your short health history it sounds like there are a couple of other biomechanical disfunctions going on.[/quote]
Agreed on these two points
[quote]
Possible, there could be a horizontal axis at the sacrum, which could either be coming from the innomonant or Lumbar vertebrae. The Axis at the sacrum with cause a BILATERAL hypertenicity at the piriformis and other external and internal rotaters. It will also give that local pain which Jelena has described. [/quote]
[b]This is classic ‘baffle them with bullshit’ technique. I hate it, sorry.
Firstly I don’t think you actually understand the concept you are trying to espouse. Of course there is a horizontal axis - at the sacrum and everywhere else in space. It’s just a hypothetical line, which structures are proposed to rotate about or translate along.
However the horizontal axis is the one that the sacrum nutates or couter-nutates around. A bilateral nutation might indeed cause a bilateral hypertonicity (not tenacity), but it is more likely simply to alter the resting length of the piriformis, resulting in a lengthened and weakened muscle. However It won’t be ‘coming from’(what is ‘coming from’? the pain? No, that’s coming from the ischial tuberosities) the lumbar vertebra or innominate (not innomonant), since these do not connect with the piriformis at either origin or insertion.
The way you have lumped all the internal and external rotators together, suggests this is a weak point in your understanding and anatomy knowledge. I used to be just like you until I realised that I owed it to my patients to be better than that. Get your anatomy books out mate 
In short, unless you can rationalise everything you just said above, I will be viewing your posts from now on with deep suspicion. I would have let it slide, but you came in with a condescending approach to guys who have deep knowledge (andersons, Grrrsauce and others), claiming their advice was OK but you had spotted several omissions. You did make a couple of valid but obvious points. Then you spouted crap, quite honestly.
I do hate to let people read rubbish, in case they believe it, hence my ‘step in’. I’ve probably offended you, which I do sincerely apologise for - it wasn’t my intent, merely a byproduct of two egos clashing.
If you can rationalise your comments above (and they are shown to be correct), I will publicly prostrate myself for your edification. I will also get my books aout and throw them away for being inaccurate
BBB[b]