Pain in the butt - Bilateral Hamstring conjoint tendinosis

Posted by lgerkin @lgerkin, Aug 9 8:31pm

I've had sit bone pain for over a year now, and finally got an ultrasound that showed tendonitis on upper hamstrings and some calcification of the tendons as well as thickening of the bursa sacs and partial enthesial tearing at the ischial tuberosity. This was after months of myofascial release therapy and exercises from a pelvic floor specialist that didn't help. Last month, I had cortisone shots around both ischial tuberosity joints and went to a new PT who did some scraping on that area with a graston tool as well as stretching and strengthening exercises. The pain is now worse, so I'm going back to the doctor who injected the cortisone next week. I'm wondering if anyone has had successful treatment for this condition. I've seen posts about enzymes and supplements like Turmeric that help, but I'm on a blood thinner so most of these would pose a bleeding risk. Any suggestions are appreciated.

Hello @lgerkin– this does sound like a pain, and I'm sure has not been fun to deal with! Great question related to enzymes and supplements, especially considering you are on a blood thinner. I am glad you are going back to your provider and hopefully can find some relief from the pain, and maybe find some answers. Dealing with multiple joint pain and bilateral hamstring tendonitis can put a wrench on everyday life. I would like to bring in @sparshall @richman54660 @jenniferhunter @johnbishop – they might have more to add.

As we wait for others to join the conversation, I was able to find the following information. Of course, before trying any supplement I would recommend you connect with your provider to make sure it won't interfere with any meds, etc.. Here is the study: "Nutraceutical supplement in the management of tendinopathies: a systematic review" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915461/

Other than the cortisone shot, are you on any medications for treatment or pain?

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Hi Kelly – thanks so much for your reply and for the helpful article on nutraceuticals. I wasn't at all familiar with them but am seeing posts that discuss the benefits of enzymes, so I'll definitely mention this to my doctor. Currently, I'm taking 5 mg of Flexeril in the evenings. It helps, but only a little and has a negative effect on m mood, so it's not a long term solution. The dosage is for 3/day but that would be way too sedating for my comfort. Ideally, I'd like to heal the tendons and the partial tear, not cover it up with pain relieving products (although right now, pain relief sounds pretty good). I can't take aspirin or other NSAIDs because of the blood thinner. Lidocaine doesn't help much either, unfortunately. I'm trying to be hopeful that there's a treatment that will work and I'm open to suggestions. Thanks again:)

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@lgerkin I found a few links that may be of interest. One of them suggests that malfunctioning SI joints can also contribute to a problem like this. I know that my pelvis goes out of alignment because of the SI joints and my physical therapist assesses and adjusts this, so you might ask your therapist if your pelvis is aligned properly and if it stays that way or shifts.. The others are about case studies of a similar problems. The link from MSK Neurology explains problems that can contribute to similar symptoms from other sources. I realize your imaging shows calcification of tendons. It may be possible that your pain is coming from more than one source, so it may be work asking if there is also any nerve impingement between tight muscle groups as described by the MSK neurology article. Have they assesses your lumbar spine for any possible issues?
https://www.caringmedical.com/prolotherapy-news/ischial-tuberosity-pain-ischiofemoral-impingement/
https://iaom-us.com/the-differential-diagnosis-and-conservative-treatment-of-a-distance-runner-with-hamstring-syndrome-a-case-study/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812833/
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/

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@jenniferhunter

@lgerkin I found a few links that may be of interest. One of them suggests that malfunctioning SI joints can also contribute to a problem like this. I know that my pelvis goes out of alignment because of the SI joints and my physical therapist assesses and adjusts this, so you might ask your therapist if your pelvis is aligned properly and if it stays that way or shifts.. The others are about case studies of a similar problems. The link from MSK Neurology explains problems that can contribute to similar symptoms from other sources. I realize your imaging shows calcification of tendons. It may be possible that your pain is coming from more than one source, so it may be work asking if there is also any nerve impingement between tight muscle groups as described by the MSK neurology article. Have they assesses your lumbar spine for any possible issues?
https://www.caringmedical.com/prolotherapy-news/ischial-tuberosity-pain-ischiofemoral-impingement/
https://iaom-us.com/the-differential-diagnosis-and-conservative-treatment-of-a-distance-runner-with-hamstring-syndrome-a-case-study/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812833/
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/

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Thank you, I'll definitely check out the links. I did have an MRI of the lumbar area and it didn't show any indication of nerve impingement or other issues that may contribute to the pain (mild to moderate DJD but otherwise pretty good). I just saw my doctor today for a follow up from the cortisone injections and he thought there may be issues in some deeper areas around the ischial tuberosity that the ultrasound didn't show. He ordered an MRI of the pelvic area, so that should hopefully clear up some things. I'll mention the SI joints and take a look at the sites you shared.

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@jenniferhunter

@lgerkin I found a few links that may be of interest. One of them suggests that malfunctioning SI joints can also contribute to a problem like this. I know that my pelvis goes out of alignment because of the SI joints and my physical therapist assesses and adjusts this, so you might ask your therapist if your pelvis is aligned properly and if it stays that way or shifts.. The others are about case studies of a similar problems. The link from MSK Neurology explains problems that can contribute to similar symptoms from other sources. I realize your imaging shows calcification of tendons. It may be possible that your pain is coming from more than one source, so it may be work asking if there is also any nerve impingement between tight muscle groups as described by the MSK neurology article. Have they assesses your lumbar spine for any possible issues?
https://www.caringmedical.com/prolotherapy-news/ischial-tuberosity-pain-ischiofemoral-impingement/
https://iaom-us.com/the-differential-diagnosis-and-conservative-treatment-of-a-distance-runner-with-hamstring-syndrome-a-case-study/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812833/
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/

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@migizii thank you for all this information! As I journey into the world of arthritis and already have a hip replacement ad mid foot fusion I am recovering from, I am having strange pain symptoms coming from these areas. I will definitely tell my PT about it!

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Hi – I'm updating my status to see if anyone has had successful treatment for sit bone pain/tendinosis using Instrument Assisted Soft Tissue mobilization, specifically Hawkgrips. My chiropractor has done some adjustment to my hip area and I'm also doing exercises to stretch and strengthen the area, but it hasn't addressed the pain when I sit. So, she began using Hawkgrips two weeks ago and I've had two treatments so far. The pain is actually worse, although she said it would probably take three treatments to see if it made a difference. I'm interested to see if anyone else has had this treatment and whether it helped. Thanks!

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