Low Back Pain May Be Sacroiliac Joint Inflammation, Special Treatment

I have been diagnosed with lumbar spinal stenosis with neurogenic claudication and neural foraminal stenosis. I will see a neurosurgeon in a couple of weeks. I thought I would see if anyone here has had a similar diagnosis, and how it was treated? A little over a year ago I had R L-4, L-5-S1 laminotomy and foraminotomy. I believe this time my problems are lower. My back pain is not sever, but always present. What bothers me most is the constant 24/7 pins and needles, tingling, numb feeling in my feet and ankles...sometimes in the groin area. Could my current issues be an extension of the former?

I have a congenital defect(s) in my L4, L5 in the foramens, being too narrow. I don't have specifics on my SI, though it is also a part of my problem. I didn't know I had these - worked around them I guess, when I hurt it bouncing off a wall playing racketball. It got bad (didn't know anything about SI, L4, L5 at the time). Turns out my brothers' both have the same congenital issues. I am 68.
Aside from the serious back pain, it hurt even more if I coughed or moved my bowels, I had painful shooting sciatica, etc. Desperate I saw a chiropractor who used older techniques you won't easily find today. It helped immensely, and have gone to chiros off and on since, but none with results as good as hers. I have Osteoarthritis in SI, lower back area and at most major sports - lots of hockey and football probably exacerbated. I would consider getting out of the Western Medicine Realm and try a good chiropractor to see if you can get pain relief, flexibility. If you are sedentary, that will hurt your groins. I have chronic groin issues and when I sit at the computer for 45 min or more, I can feel the pain in each going coming. Try a gym and get a personal trainer to get you on the right path. Physical Therapists have helped me loads, as long as I do the exercises (mostly core strengthening). Then back to Western if you are still hurting, I don't know their plans. I have found these treatments work, without drugs or surgery - so far - 38 years.

Yes, I agree with you. It took me a year to get right diagnosis for my back pain until my piriformis muscle started to spasm. I went to a hip specialist because I thought it felt like my pelvic area. (I had my pubis synthesis separated in child birth 35 years ago). He said I needed a pain injection in the joint. My physical rehab specialist said the muscle not the joint in my case. I have piriformis syndrome. No surgery is needed. I had a nerve block to relieve pain and a muscle relaxant to stop the muscle from spasms. Yes. PT needs to be someone that area of the pelvic. Proper pelvic floor exercises.

Aren’t your 24/7 symptoms of tingling in legs and groin exactly the definition of sciatica? I’m no doc. But pressure on that nerve… Rest and PT and heat/ice treatments are the usual course of action, not more dangerous surgery. plus have you tried Gabapentin for the pins and needles? Hope this helps

What did your imaging show in your SI joints? I believe I suffer from chronic SI problems but it doesn’t show in MRI so it’s been brushed off as muscular. I do have some degree of pelvic floor dysfunction and my core is weak, so I know I’m not kind to my lower back anyway. But I just know it’s my SI joints. So was that shot the only way to definitively get your diagnosis? And how long did it help?

I had tingling (pins/needles sensation) and numbness in legs and feet. It felt like pain shooting down the back of my legs. Rest, stretching with exercises from PT and ice helped. Must do stretching slowly. My physicial therapist said that when I was raking leaves i may have irritated the muscle with the motion of pulling the leaves toward me. But the real winner was nerve block in the piriformis muscle. The use ultra sound to guide to make sure that they hit the priorformis muscle. They said the pirformis muscle was spasms against the sciatica nerve. They did not inject medication in the SI joint. It is sharp pain down the leg.

Yes i take gapbenpatin when I have nerve pain, (burning pain, horrible pins/needle sensation). I also use gabenpatin for the nerve pain due to MS. But this SI syndrome was truly a pain in the (derrière). When we drive I had to even protect my tail bone. No bumps. And I couldn’t sit long, especially in the car. There was pain in low back, but all it showed was a pinched nerve which they gave in me a coritisone injection. For muscle spasms i use baclofen and when it’s real bad, cyclobenzaprine. But one can’t use it often because it slows everything down, and can get you constipated. My MRI indicate it was not the SI joint. Before I went to the rehabilitative and physical medicine specialist, I went to a hip specialist. But he referred me back to the same physician I went the first time when I had low back pain and I told him I felt something in my pelvic. So I didn’t go back to him. I didn’t trust him to do an a SI joint injection. But the rehab/physical medicine doctor said that with his examination it was not the SI joint and looking at the MRI. He said it was the muscle. My muscle was stiff and bothersome. The PT person gave me a lacrosse ball for me to place between me and a wall. And massage only the muscle. That was a great massage.

@tonyiarobinson Is your physical rehab specialist that you refer to a pelvic floor/pelvic health physical therapist? Or otherwise? I’m just now entering this realm of PT and would like to work on more than my floor so I’m curious. Ty

My rehabilitative and physical medicine specialist and my gynecologist refer me to pelvic floor PT. I have been referred to this type of PT many years ago for bladder control. There are some rehab specialists that specialize in pelvic area but in my area they were not covered by insurance. I also went to regular PT for the condition for stretching and building strength (stamina) by a neuro-PT. Also did help me with balance issues and waking. Piriformis syndrome makes it difficult to sit, stand and walking. And my MS benefited for the same therapy. OT therapist was helpful but mainly for my hands from relapse. I was exhausted from so much therapy. But didn’t do pelvic floor PT until I finished working with neuro-PT and OT.

Pelvic area has alot of nerves that can become inflamed. Also the ligaments and tendons that hold it all together. I had multiple scans and there is now osteoarthritis that is building up in the SI joints. I saw a PT that also specializes in pelvic floor dysfunction. It has helped and has given me tools to cope . Lyrica helps alot with the nerve pains and Baclofen helps with the muscle spasms . Never fully goes away but you can't let it control you. You still need to live. Being around people/friends gets your mind off of the issues going on in the body.