Thorn in Your Side? Diagnosing Your Back Pain and Treating It!

Having back pain and, even more threatening, having pain from your back or hip into one or both legs can be frightening and…really common.

 In the last week, I have had five patients with pain stemming from either their back or hip and into one or both legs with five different causes. So, if you’re one of those people, how do you figure out where your pain is coming from, and more importantly, how do you make it disappear? First, let’s figure out some potential causes via my five patients and you can think of this blog as one of those books you read as a kid with alternate endings depending on which road you take…the benefit of this book though is that no ending will land you in the fangs of some monster…read and pick one below that sounds like you:
1)  DJD or degenerative joint disease:
- it is arthritis, so you probably aren’t 16 with this problem, but it is a “wear and tear” type condition
- bending backwards is usually painful and stiff, and the majority of the stiffness feels deep in the spine versus in the muscles
- It is progressive, meaning, you probably weren’t perfectly fine yesterday, and then today in excruciating pain.
- Stiffness is usually a more prominent feeling versus pain, but is can be sharp in certain movements
- If there is pinching on a nerve, it can cause numbness and tingling into the legs in a dermatome pattern.

2) Bulging or herniated disc:
- Although it can also be progressive, there was probably one particular thing that was the           proverbial straw that broke the camels back, like bending over and twisting.
- bending over or forward flexion of the spine probably makes the symptoms worse because  discs usually protrude backwards, so the further you round the spine, the more the disc can                protrude.
- Muscle spasms are common with this as the muscles are trying to add stability to the spine.
- more pain first thing in the morning or after sitting a long time is common. First thing in the AM since that is the time the discs are filling up with water since you’re horizontal.
-Can cause numbness, tingling, cramps, and weakness into the legs in a dermatome pattern, see below: If you are getting cross-eyed, basically it goes like this. Pain coming from the upper area of your low back is in the front of the thigh, into the shin on the inside is from the 4th lumbar nerve, and in the back of the leg in the hamstring and calf is from the lower segments.

3) Sciatica:
- It can come from either of the two conditions listed above, but then it is also being compressed in buttock area as well as the spine and symptoms may not be in the back at all, but just in the buttock and further down the back of the leg in the hamstring.
- Can feel like a tight rope that is sharp all the way down the back of the leg
- Symptoms are worse when you try to straighten your leg
- Hurts to sit on the affected side so you might lean onto the buttock that isn’t bothering you.
4) Piriformis syndrome:
- In about 15-30% of the population (depends who you ask) the sciatic nerve (which is the size of a pencil) goes through the piriformis muscle and may be caught in muscle spasms in the piriformis muscle. In this case, it is actually coming from the hip versus the back and can be distinguished by contracting the piriformis muscle or stretching it; both which will increase symptoms.
- Another way to distinguish this is that back movements may not hurt it, but rather hip movements increase pain, especially hip stretches.

5) SIJ or sacroiliac joint dysfunction
- Pain will be more to the side of the back over the PSIS (see below) and may go around the hip into the groin
- This usually occurs in younger people because as we age, the sacroliliac joint fuses, and once it fuses it won’t shift out of place and cause this pain
- Hurts to sit on affected hip, so you will probably lean towards unaffected side
- This might have been caused by something jarring, like falling on your buttock or side, or you might just always lean on one hip in standing.

Now you might be narrowing down the cause…follow the roadmap to the treatment, the numbers will correspond to the above:
1) Stretch tight muscles, which are usually hamstrings, inner and outer thighs, and do spinal flexion-based exercises:

2) Strengthen abs, back, and inner and outer thighs. Mini backbends may be helpful also. If you sit a lot for work or school try to get up or do a press up at least once an hour.

3 and 4) DON’T stretch it! The nerve is inflamed, so you have to find positions that take pressure off the nerve. Decrease amount of sitting as much as possible, don’t forcefully stretch your leg straight even if it feels good temporarily. Maintain more of a neutral position for the back and hips:

5) A healthcare practitioner like a physical therapist may be able to put your SI back into place, and then give you strengthening and stabilizing exercises like #2. Now you have to get rid of habits that put pressure on just one hip.

Stay tuned for a part two with advanced abs….

contributed by Dr. Katie Addis


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