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chronic confusing back/glute pain

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It all started 7 months ago when I was unbolting a tire standing up and not bending my knees. The jerking of the wrench caused a burning strain sensation in my lower back. In the weeks after this I would feel this pain more in my left side than right and would be triggered by similar bending motions with referred pain to my groin on the same side. Eventually I went to a chiropractor who found that the pain was more noticeable when he'd press on a particular area on the left side lower back close to my vertebrae. He simply released the tension by asking me to bend and touch my toes while he stroked his fingers down this area and stroke in the opposite direction on my way up. I'd leave feeling great only for the pain to return a few days later. My job involves sitting down for prolonged periods of time which began to make it worse the longer I sat. The chiro is certain that I do not have a bulged disc and advised my to stretch my hamstrings, hip flexors and glues every day as they were quite tight. After many months of the same problem and constant visits to chiro and physios who could not fix the problem the pain has now suddenly shifted. One morning I awoke with sharp pain in my glute and decided to go to the chiro for help. Then chiro advised my that one of my si joints was out and popped everything back into place. After a number of days the pain had subsided but still lingered around with lower intensity so I took a trip to the physio. The physio advised me that my left gluteus maximus is not activating properly and seems to be overworked/fatigued causing much instability in that region. The physio treated me and advised me to go home and start doing rear leg raises to strengthen the glute on the left side to compensate for the irregularities. The pain has lessened on the left side significantly but for some reason started on the right glute now. I can't seem to work this out and I'm becoming really frustrated and depressed as I'm itching to go for a run and start doing high intensity training again... somebody please help!!!! To re-cap and summarize my problems here is the list:
- Pain started 7 months ago during bending jerking motion on left side
- chiro treats symptom and advises i have weak core and need pilates (useless)
- Chiro insists I do not have disc issues
- Referred groin pain on left side
- Pain changes 3 months ago from ache in lower left side of back to sharp pain in glute (changing from upper glute to lower glute to left of glute sometimes shifting to right side instead)
- Chiro fixes si problem and advises to start deadlifts and squats to strengthen glutes
- sharp pain persists in glutes and sometimes moving from upper glute to lower back
- physio temporarily fixes pain and advises to start light glute/core exercises and advises maybe problem cannot be fixed but only managed (I won't accept this as a resolution)
- After many weeks of stretching/power walking and elliptical pain has reduced but can easily trigger again when sitting for long periods of time
- Pain is assisted when sitting with rolled up towel placed on chair forcing glutes to push forward and back to arch backward

Any advice would be much appreciated???
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replied October 23rd, 2012
Active User, very eHealthy
Quote:
one of my si joints was out and popped everything back into place.

This means the deep rotators of your hips are out of balance. You need to do exercises such as :
1) "SEATED PILLOW SQUEEZE E-CISE" (Do a Google search)

NEXT

2) "SEATED ABDUCTOR PRESS" Part I
a) Sit at the edge of a low step so your thighs are parallel to the ground.
b) Wrap a belt or Yoga strap around your thighs just ABOVE your knees.
c) Press outwards against the strap for 2 seconds. Repeat 20 times.
- Let your abs relax and your hips rotate forwards, putting an arch into your lower back.
- Do NOT let your feet roll in. Keep weight on the outer edges of your feet and off the balls of your feet.

With particular attention to lack of outward rotation in one hip and lack of inward rotation of the other. This is because outward rotation of the hip / leg makes the lower back arch while inward rotation makes the lower back round. So if one leg tends to rotate out while the other leg tends to rotate in, you will get a twist in your hips and lower back.

Quote:
The physio advised me that my left gluteus maximus is not activating properly and seems to be overworked/fatigued causing much instability in that region. The physio treated me and advised me to go home and start doing rear leg raises to strengthen the glute on the left side to compensate for the irregularities.

As your physio said "your left gluteus is overworked" yet they are telling you to do exercises to strengthen it. Does that make sense? Weakness is NOT your problem here.
The problem is "NEUROLOGICAL INHIBITION". Your glute doesn't fire because it CAN'T fire because the opposing muscle group - the left hip flexor (psoas among others) is too tight. Your body will not let you step on the brakes and gas at the same time. So if your left hip flexor is tight, your left glute CANNOT fire. You can't fire a muscle and it opposing muscle at the same time.

Relax the psoas (hip flexor) first and then the left glute can engage. Stretch it with one of these:

3a) "KNEELING LUNGE STRETCH" (Do a Google search)
3b) "STANDING LUNGE STRETCH" (Do a Google search)
- Front leg up on a step of chair will give a better front-of-hip stretch.
3c) "Supine Groin Stretch" (Do a Google search)
- This is the most gentle stretch for your hips but it can take 20 minutes for the muscles to let go.

and also

4) Standing quad stretch e-cise (Do a Google search for the first hit on the page)

You will probably find one hip is tighter than the other.

Quote:
Pain is assisted when sitting with rolled up towel placed on chair forcing glutes to push forward and back to arch backward

Doing exercise 2 from above KEEPING ABS RELAXED will help to arch your lower back when sitting. This is because outward rotation of the hip / leg (like exercise #2 from above) makes the lower back arch while inward rotation (like exercise #1 from above) makes the lower back round.
Also do:
To put the curve back into your lower back try one of these 2 exercises:
NOTE: Discs move 1mm in 3 minutes. So you may need to hold these for at least that long for the disc to move back into place.

5a) "Static extension on elbows" (Do a Google search)
- To get your shoulders pulled back as well, pinch your shoulders together.
--- or ---
5b) "Static back 90-90 position" (Do a Google search)
- Put a rolled up towel -or- 2 soft foam balls under your lower back just below your beltline.


Finally you should do some single leg 1/4 or 1/2 squats (pistols) to balance out your hips. This will work your gluteus medius muscles and show up imbalances in your hips. Pay particular attention to:
1) Keep hips level. Do NOT let one side go up.
2) Keep foot on standing leg and hips pointing straight ahead. The foot may tend to rotate in or out.
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