WWYD, Hip, Glute, Low Back, & Groin Edition

[Anonymous]

My apologies this is so long.

I'm 52 and was very active (walked 6 miles a day, took weight training & pilates classes, and lifted free weights) until March, 2023 when I had a recurrence of an issue from 2 years before that was resolved with PT. Exercise has been my go-to to reduce anxiety, so I'm having a terrible time. I've been in therapy since June and my Zoloft dosage has been increased.

My symptoms started as R hip tightness; hip pain when walking, running, going up the steps; as well as glute, SI, low back, and groin pain. The pain was transient and not consistent. I had been doing my PT exercises a couple of times a week since 2021, but I couldn't resolve the symptoms, so I self-referred to PT, which I did from April through early June. It seemed PT was working, but then the pain and tightness returned.

I saw a sports medicine dr. who ordered an MRI, which showed a small labral tear and tendinopathy in my glute. Dr. did a diagnostic injection, which didn't help the pain. She said that meant the labral tear is not likely to be the pain source and sent me back to PT, but at a different place with an emphasis on eccentric exercises. I started that in late June and again, it seemed like PT was working and the hip issue seemed resolved, but then the glute and hip started hurting again, although not as bad as it was in the very beginning. PT was encouraging me to do modified weight training after a few weeks, which I did. Celebrex didn't help much, but heat and compression have been helpful.

Dr. and PT then thought it was my low back. I saw a spine specialist who did an MRI, which showed some mild stenosis at L4-L5 and some other minor issues not inconsistent with my age. PT started work on my low back and I also started seeing a chiropractor who hasn't helped much, if at all.

Pain continued. Saw 2 other recommended orthos. One said he thinks it's a tight pelvic floor and prescribed gabapentin to take before bed, which has helped and pelvic floor PT. I started pelvic floor PT yesterday. I've stopped doing stretches that may further tighten the pelvic floor, as well as kegels and have started stretches that are supposed to loosen the pelvic floor. I'm also doing about 10 minutes of lower body pilates a day. This has all also seemed to help.

Other ortho said he didn't see where he could do any kind of cortisone injection (I didn't ask for one), but ordered a nuclear medicine bone scan to see where there may be inflammation to treat. I haven't had that test yet.

Discussed back MRI results with spine specialist who recommended a cortisone injection for the stenosis.

All medical professionals agree nothing major has shown up on the MRIs.

I'm going on 8 months of this issue and can't do more than walk 1 very slow mile a day on flat ground. I'm no longer lifting any kind of weight.

I intend to continue the pelvic floor PT, but will it hurt me to get the cortisone shot? Does anyone know if the bone scan might be useful? Any words of advice? I'm losing my mind.

Thank you!!!

[Anonymous]

Try swimming.

[Anonymous]

Anonymous wrote:Try swimming.

Thanks, but due to an ear birth defect, I never learned how to swim as a child and have nowhere to learn or swim now.

[Anonymous]

The cortisone injection will be diagnostic if it alleviates your symptoms. They could very well be L4-5 related.

[Anonymous]

I don’t know if the cortisone shot in your lower back will help, but ask for a DEXA scan first. You don’t want to inject cortisone (which can contribute to osteoporosis) if your bones are already showing signs of weakness.

I also have hip pain and an intense muscle pull in what might be the piriformis. My doctor recommended a DEXA scan and a blood test for autoimmune markers (ankylosing spondolitis? I have long-standing SI pain). Haven’t been able to go on walks for 2 weeks.

I wish I had a solution for you. Please keep us updated on your treatment and progress. Good luck!

[Anonymous]

Anonymous wrote:The cortisone injection will be diagnostic if it alleviates your symptoms. They could very well be L4-5 related.

Thank you!

[Anonymous]

Anonymous wrote:I don’t know if the cortisone shot in your lower back will help, but ask for a DEXA scan first. You don’t want to inject cortisone (which can contribute to osteoporosis) if your bones are already showing signs of weakness.

I also have hip pain and an intense muscle pull in what might be the piriformis. My doctor recommended a DEXA scan and a blood test for autoimmune markers (ankylosing spondolitis? I have long-standing SI pain). Haven’t been able to go on walks for 2 weeks.

I wish I had a solution for you. Please keep us updated on your treatment and progress. Good luck!

Thank you; I hope you get relief soon!

[Anonymous]

It does sound like some of the changes you have made are helping:

"I've stopped doing stretches that may further tighten the pelvic floor, as well as kegels and have started stretches that are supposed to loosen the pelvic floor. I'm also doing about 10 minutes of lower body pilates a day. This has all also seemed to help. "

Is it possible that you have a hair line fracture somewhere in your hip that has not been picked up, or rather not seen on the MRI?

My sister, who is only 35 is going through similar pain right now. It turned out she had a hairline fracture on her foot that was not treated (no boot etc) and now has one in her hip. She has had to stop the vigorous daily exercise routine she had been doing.

[Anonymous]

Dry needling. It’s a GameChanger.

[Anonymous]

I'm going through the same thing, but I have a 10 year history of moderate lumbar spinal stenosis, facet arthropathy, sciatica, bulging discs. This time though it's presented as hip pain, it band, and now sciatica. I had much success with epidurals a few sessions over the years, but this time have done two shots in the bursa, pt for 6 weeks, two sessions of dry needling and it's only getting worse. No relief at all and not getting much sleep. Going for new MRI next week as it's been three years since my last one. My mother had pretty bad spinal stenosis too and after many years of other treatments, finally had the surgery at 72. It worked well, but unfortunately, she died of cancer six months later.
I'm 59 but very active (walk dogs every morning for 1.5 miles), have gym in house, and play tennis twice a week.

[Anonymous]

Have you considered seeing a chiropractor? Your pelvis/hips may benefit from an adjustment. They can also do electric stimulation to help relax your tight muscles

[Anonymous]

I have been struggling with lower back pain and hip pain for a year now. Have done PT with some success, but pain continues to flare up. I wanted to share that a few weeks ago during a flare I got Covid, which knocked me on my a** for a good three days. During those days, I stayed in bed under the covers and slept. Hardly got up, although I did make sure to do some pt stretches every day. Beyond that, I don’t even remember the last time I spent so much time sleeping/resting. Maybe middle school lol. Well, when I finally recovered, my back and hip pain were gone. It has since come back, but not as intensely. Which is to say, maybe serious rest can help an acute flare up, even though no doctor or pt therapist ever suggested it to me. Food for thought…
Best wishes - it is hard to deal with this kind of pain.

[Anonymous]

Long ago I had similar hip pain related to running that was hard to pin down. I did much less diagnostics than you have done: hip MRI showed a small labrum tear, had the surgery, issue resolved. Maybe revisit whether your issue could be the tear? My best wishes to you, that sounds very challenging.

[Anonymous]

Anonymous wrote:It does sound like some of the changes you have made are helping:

"I've stopped doing stretches that may further tighten the pelvic floor, as well as kegels and have started stretches that are supposed to loosen the pelvic floor. I'm also doing about 10 minutes of lower body pilates a day. This has all also seemed to help. "

Is it possible that you have a hair line fracture somewhere in your hip that has not been picked up, or rather not seen on the MRI?

My sister, who is only 35 is going through similar pain right now. It turned out she had a hairline fracture on her foot that was not treated (no boot etc) and now has one in her hip. She has had to stop the vigorous daily exercise routine she had been doing.

At this point, I think just about anything's possible! My only hesitation is that 4 doctors and the radiologist have viewed the MRIs; I'd hope 1 of them may have seen a fracture? It's definitely something I'll ask about, though; thanks for the suggestion!

I'm sorry to hear about your sister; I hope she's better soon!

[Anonymous]

Anonymous wrote:Have you considered seeing a chiropractor? Your pelvis/hips may benefit from an adjustment. They can also do electric stimulation to help relax your tight muscles

I have been seeing a chiropractor, but it hasn't seemed to help much.

Thanks for the suggestion, though!