Sacroiliac joint, piriformis, or sciatica?

@motorcarrier I can see from your other posts that you also have had stress fractures and tendon tears in your foot and ankle and were wearing a boot from the podiatrist. My husband had a very similar experience in that he got a stress fracture in a foot bone, was put in a boot, and then had a partial Achilles tendon tear. We think that the boot on one foot contributed to the Achilles tear on the other ankle because of extras stress by walking when the feet were not level with each other. The foot that is not in a boot needs to match the boot height with heel height such as a hiking boot, etc. If unmatched, that of course also throws off the pelvis and every pounding step adds to the uneven stress on the pelvis and lumbar spine. It is very easy for the pelvis to be out of alignment which causes pain similar to a spine problem and sciatic pain. That happens to me when my pelvis gets out of alignment. Here is a link that explains a lot about issues of misalignment of the pelvis.
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/
A physical therapist may be able to resolve this. I presume that there were no orthopedic findings or spine issues since you have been seen by that specialty and the treatment was injections. Have you been evaluated by a physical therapist?

Thanks for taking the time to compose a thoughtful reply. I have indeed thought about my pelvis being out of alignment and I've actually considered that physical therapy will likely be the next step. I return to my doctor in two weeks and I'll see what he suggests. Thanks again.

I have had similar issues and it has been suggested that I have the steroid shots in the SI joint. I am very resistant to doing this. I have had them in my hip and with limited success and have had adverse effects from steroids, which have left me with multiple joint problems. I have also been told piriformis and or sciatica could be the issue. I have been through quite a lot of PT with some positive effect, although I do believe that that is a good next step. Recently took Meloxicam and found that to be the best relief, but had to stop. The worst part is the pain at night leading to no rest. Makes it so difficult to deal with, even with relief during the day. I completely understand the issue and will be interested to see if you find relief through PT. I have recently done ART, Active Release Therapy, and it was definitely helpful in getting me to stand up straight and releasing the piriformis. You need someone who is specifically trained to do this type of PT. That in combination with the Meloxicam gave me the most relief I have had in over a year.

I had issues with sciatica, piriformis & SI joint - horrible pain that went on and on. I was unable to drive or to ride in the car without pain and lived on high doses of ibuprofen & Tylenol. I also have spinal stenosis & arthritis. Steroid injections relieved it temporarily, PT was excruciating. Chiropractor helped for maybe a day at a time. Then, increasing immobility and pain in both hips resulted in x-rays by my primary and a referral to ortho - and 2 hip replacements. This resolved the hip pain, but the other pain continued at a lower level.

Finally, an alert physical therapist gave me several exercises to be performed diligently, every day, followed by icing with a flexible ice pack for 20-30 minutes. We spent many sessions fine-tuning the routine until it worked (with implants and spine issues, many modifications were needed.) At first, I cried as I stretched, but now I am pain free unless I skip the stretches or overdo (both of which describe what I did this weekend!)

Have you tried PT specifically for this issue?

Sue

Thanks for the reply and no, I haven't yet tried PT but I've been thinking it's probably the next step. Steroid injections (I've had a few) worked great - for about three weeks.

Are you able to share what exercises your PT set in place for you? Been thru similar issues as you described and quite a bit of PT, but still having issues. Appreciate any input!

Thank you for asking, but sorry to say that I choose not to share specific exercises that involve back or spine issues. They need to be customized to work for each individual depending on their specific and then supervised at first to make sure they are being done correctly. I was referred to a physical therapist in a rehab group, not what I call a "cookie cutter" practice (this pain, this exercise, that pain that exercise, give you a sheet of drawings, have you do it once and send you on the way.)

My therapist read the referral, took her own history, watched me move, manipulated my body on the table, then worked out the stretches & exercises with me over several visits. I was instructed how often to do each, how many reps, what to do for pain...

My suggestion for anyone with sciatic, piriformis or SI pain that doesn't respond to NSAIDs, ice and the stretches you find on line is to ask a trusted doctor to help you find a rehab therapist - often through a rehab center, orthopedic center, or pain clinic.

Sue

I sympathize with you. I have had cortisone shots epidural going to PT. Nothing has helped my back so far. I will try your advice. I have that medicine but it’s bad for my stomach. Hope you get well soon

@sus34 Sue makes a great point. Therapeutic exercises need to be taylored to you and your strengths and weaknesses and recommended by a clinician who has specific knowledge of your case. Spine issues are very complex and patients are different. One may have collapsed discs or some disc herniations that compromise the exiting spinal nerves in different places, and someone else like me had a compressed spinal cord. Others may have vertebra that slip past each other. When you move the spine and change its position, you can change the pressure on damaged areas or possibly cause vertebrae to slip if the discs can't maintain proper height or alignment. Even twisting the spine can cause a bulging disc to herniate. I did that in my neck by turning my head, and it didn't take much to pop that disc because it was ready to go.

The best bet is take your questions to the experts in these areas, and also ask your physical therapist how these kinds of issues can progress and what postural habits could escalate the issue. There can be laxity in an SI joint, and PT can help stabilize that. Surgeons also do fusions of the SI joint, but that doesn't always solve the pain when you stop a joint from moving that is meant to move and you can't undo the surgery. Sometimes it is hard to tell if the symptoms are coming from the spine or the pelvis, and an evaluation with a spine specialist or neurologist may be able to answer some questions. I had shared a link earlier in this discussion that you may want to look at for information to help further your discussions with your specialists.
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/