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chronic posterior lateral glute pain
Age: 33
sex: male
height: 6 foot
race: Caucasian
drinking 3-6 drinks a week, no recreational drugs
Personal Background: During the time of the first triggering event I was a CNA (12 hour shifts) on a busy neurology and nephrology floor. This meant moving lots of patients and sometimes moving them myself (bending over and twisting to pull them up in bed). I don’t ever remember this prosses hurting but I remember twisting to walk out of the door and having sharp pain. I have since moved jobs and now work as a RN in an operating room and working 4 10s. I used to be in very good physical shape during the initial incident but have since backed off of most heavy exercises.
Possible injury activities: The first incident happen on 1/6/23. I feel weeks before that we had a big ice storm, I had almost slip on the ice but didn’t end up falling. I remember violently trying to keep my feet below me as my torso tilted forward (no sharp pain), I had increased my running miles with a run 1/3/23 4.27 miles with 600 feet elevation gain, 12/27/22 3 miles, but before that I hadn’t run for a month and only 1.3 miles. Otherwise I don’t feel like there’s anything else besides getting really drunk on 1/1/23.
Where the pain is located:
Somewhere medial to the great trochanter is the greatest pain. But it seems to spread towards my SI joint.
Description of pain: Pain feels like a sharp sensation, almost like something has given out, When this pain happens is it usually occurs intermittently, meaning the pain is triggered a singler time, conversely once this pain is triggered it is more likely to happen again that day. The pain level can range anywhere from a 1 to a 7. The pain also does not radiate, burn or tingle. Palpation is inconsistent meaning nothing feels like the right spot, but the muscles in that general area can be tender to the touch. Even if sharp pain is not trigger I feel a dull achy sensation and hip muscles are very tight.
Triggering activities: walking > 20 minutes, twisting under load especially if crouching (example: grabbing a heavy shopping cart and twisting with my upper torso while my bottom torso is planted), pushing things forward with poor posture (rarely but still sometimes have pain), single leg pallof press where my injured leg is the one standing, deadlifts (cause extreme tightness but not sharp pain), bjj (lifting person with one leg),
Irritating activities: standing for long periods of time, sitting for long periods of time, pushing off my right leg and twisting, swimming (while twisting my body to breathe), cycling (sitting), bjj (standing and grappling), most hamstring exercises, several times a backwards step has triggered the pain
What I’ve tried: Months of physical therapy with 4 different physical therapists. Their diagnosis ranged from gluteal tendinopathy, SI joint instability, and severe tendonitis. Physical therapy has helped a little bit however progress is extremely slow and small triggering events send me back to the beginning. Multiple different injections with lidocaine and Kenalog (joint space, deep gluteal space x 2, SI joint), multiple x-rays (nothing of note), multiple MRI’s with and without contrast (found an anterior labral tear). I had surgery for this on august 6th 2024. The surgeon shaved part of my femur, did a capsular release and cleaned up the labrum. I spent 3 months off work and doing rehab. Unfortunately, this did not work.
What helps: Ice (only sometimes), Physical therapy (generally feels better after PT exercises), rest (doing nothing on the weekend but lay around and maybe very light walking.
Potentially irrelevant information: somehow both snowboarding and waterskiing irritate it very little even though the duration of those activities is long, bench press can hurt it the next day (maybe because of picking up weights to rack), Sometimes after a run or longer walk I step and feel that triggering pain but felt good during the run.
Currently: Still going to physical therapy doing lots of BFR training, dry needling and abductor exercises. Saw another doctor that recommended shockwave therapy which did not help. Other than that he suggested maybe a pelvic floor specialist or maybe get a low back MRI.
At this point, I am desperate, this has ruined my sense of identity and honestly ruined my life. I am looking for answers, anecdotal evidence, suggestions, doctor recommendations in the Seattle area, anything that may help. Thank you for your time.
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@roy103
Did they look at your gluteal and hamstring tendons to see if you had any tears? You had MRI of pelvis and hips only? Not lumbar spine? When was your last MRI of hips/pelvis?
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3 ReactionsHi Roy,
Your commented:
"Somewhere medial to the great trochanter is the greatest pain. But it seems to spread towards my SI joint."
This could be an arthritic hip joint. The pain is felt usually in the groin, the medial side of the greater trochanter.
Anyway, just a thought. If it is your hip, it can be treated conservatively with cortisone, or a hip replacement at the other end of the treatment scale. I had pain in my groin for close to a year before I finally got an xray. I was surprised it was an arthritic hip, but the actual hip joint sits just under the groin.
All the best to you.
Joe
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3 Reactions@dlydailyhope unfortunately I had 3 MRis and none of them showed any tears. Last MRI was about a year ago.
I have not had any of the lumbar spine. I have a lot of doubt that it is anything to do with my back but also thats probably one of the only options I can think of
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1 Reaction@heyjoe415
Thanks for the response. I don't feel any pain in the groin and I've had a lot of injections into the joint itself with no relief.
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1 ReactionThanks Roy,
Wow I don't know what to say. If you're not experiencing groin pain I doubt that you have an arthritic hip. Groin pain is a common symptom of a bad hip, but not present in every case.
One other possibility - two years ago I was experiencing sporadic but intense cramping, mostly in my hamstrings, even after stretching. I finally found a Dr. who, after an MRI, diagnosed the problem as tight lower back muscles. I think the muscles would have small, short spasms and this caused pressure on my sciatic nerves (both legs were affected),
So I started adding more aggressive stretches for my lower back, and it worked well. I also tried acupuncture for my lower back and this worked as well. And Medicare Part B provides some coverage for acupuncture treatment - only for the lower back, fortunately.
That's all I got Roy. Please let me know how you're doing and if (hopefully) you've found at least some relief.
Joe
I am sorry for your frustration and PAIN. Those of us here know and empathize, right @heyjoe415 ? We've been through it! My journey was 20 years before pain relieving surgeries started. Gotta go through the motions....
First - you have to figure out if your pain is localized or referred. That is critical.
Then that directs the next step.
Early on I was diagnosed with similar things. Eventually I needed my hips replaced, then by lumbar.
I think you need to find doctors who will work together to agree on a "plan of care." Without that, they just do isolated things with only temporary success.
You should know that MRI's don't reveal everything about needing hip or spine surgeries. You should know that bad SI joints, piriformis dysfunction (my two troublesome areas in addition!) sometimes rear their head and totally screw up a clear diagnosis! You should try several hip/spine doctors and have some good pain management doctors on your team. It's about creating a team going forward. I had some very successful RFA's along my facet joint (heat, not pulse), which alleviated pain for 15 years. Also, try shoe inserts to see if you get some relief at the hip joint and find a GREAT MFR therapist! Mine doesn't accept insurance, but they isolate your problems and will give AMAZING insight! Botox is a great help if you have muscles that are in spasm and put pressure on other areas because the muscle/muscle group is in constant tension. After all of my surgeries, I can still get a tight IT band pulling on my hip. I can still get sciatica because I've sat too long (tax season). But for the most part, they are temporary, and I deal with them in short order when they arise. Start with the orthopedic doctors and rule out corrective surgery, then you can move to how to correct the muscle groups and inflammation that is arising. Also, take into account your genes. If I tried to hard to do too much I'd cause a lot of inflammatory reaction. I ended up with gout and osteoarthritis. Muscles wasted during perimenopause. I just followed the genetics of those before me. There are some great medications which allowed me to get back to exercising and keeping everything tip top.
@roy103 you do need to check your spine. I was really saddened when my hip surgery did not relieve my pain. No one ever deeply looked at my spine. The neurosurgeon kept me with him. So when I said "fine, I'll go home and just take the opioids." he said "....uh, wait...let's schedule with the spine surgeon (orthopedic spine Dr.) and bingo! he found a gazillion things wrong and into surgery I went! (L3 - L5). he was shocked I had lived with all that disc compression for 20 years. My disc fell completely out and my vertabrae grafted together and crushed the nerves. (that was the pain part). He sawed it apart and put hardware in and all but my tailbone was resolved. It ALL needed doing. But by different doctors. And a little at a time.
Hi Lorie,
Oh yes, we are very familiar with pain, especially in the joints and in, or caused by, the lower back.
You bring up an extremely important difference here:
"First - you have to figure out if your pain is localized or referred. That is critical."
A lot of people don't understand that almost all pain from sciatica is referred, the source is the sciatic nerves in the lumbar spine being pinched (by osteoarthritis, spinal canal narrowing or stenosis, curving of the spine to scoliosis, and on and on).
Local pain is just that, local to the place where you feel the pain.
Anyway, thanks for bringing that up.
(Finally, after years of skepticism, I tried acupuncture while on a cruise two weeks ago. My lower back is very tight ever and I got immediate relief. I had two more sessions on board, and will continue them back home. And Medicare Part B covers acupuncture for lower back pain/stiffness, so Medicare Supplement and Medicare Advantage need to cover it as well.)
Joe
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1 ReactionLucky for you you’re at a hospital. You need an evaluation by a good PT with athletic trainer knowledge. Glad the stretches helped and you should keep on doing them. What about your foot wear? Do you always wear the same shoes when on your feet? I’m a retired nurse and when I worked in burn care for 5 years I learned you need to rotate shoes for work. Otherwise they wear out and no longer offer support.
@heyjoe415 I used acupuncture for years and years about 20 years ago and I just loved it. I’m glad you got to try it. Not all sciatica is referred from the spine. Some is from a piriformis disorder where the nerves run through your butt muscles and get squeezed. Supposedly I have a piriformis disorder. It doesn’t seem to have too much to do with my spine just the muscles seem to tighten down when I sit too much. Have a nice holiday season joe!