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.