Medically knowledgeable people - best plan of action for me??

Ok so as you know i've been kept from lifting for nearing 3 months now thanks to my left leg injury. For the most part i'm pretty sure my adductor has healed and that it is no longer a muscle tear. However nearly a month ago i started having some left lower back which then spread to my glutes and then the hip and laterally around the front to the groin. (attached pics showing where i feel the pain - green areas is where i feel it) Standing or sitting i generally don't feel the pain, but certain movement's for example the squatting motion, leaning backwards (hip and back extension) exacerbate the pain.





I ended up seeing a doc last week who sent me to a physio who did some trigger point stuff on my glutes, and back. The 2 days after the pain got worse but than suddenly started improving a lot. It seemed to get a lot better but for some strange reason the day before i had my second appointment to see a phsyio at the start of this week, the pain returned in full force. So when i saw the physio again i mentioned this to him and asked him whether i should get some scans. He said to give it another week. Anyways i've had little improvement and since then i've started getting a tingling type feeling down my left glute and back/side of the thigh. With this, i called my physio up to ask him if i should get some scans now and he said basically an X-ray was going to be useless as he found no bony abnormalities on examination, and that i would be better off getting an MRI. Went down to the GP to get a second opinion/get a referral and he basically said the same thing. The GP ruled out sciatica despite the tingling because i also didn't have the other classical symptoms like muscle weakness, etc. He said it was probably more i had some compression/damage to the facet joint in my lumbar veterbrae causing irritation of the nerves (which caused the low back pain) and that caused muscle spasms (causing further pain around the hip and groin). He agreed that X-rays were useless and wrote me a referral for a lumbosacral MRI. However he said that it was too soon to get an MRI (told me to wait a month more and up the physio frequency to 2x a week). Now that i've got the relevant history out of the way (sorry it was so long) my questions are:

1) Should i just go get an MRI now? It's probably going to cost me 250-300 dollars but if it will help diagnose the problem definitively and help me get better faster then i am willing to pay.

2) Should i increase the phsyio session frequency? Currently i've only seen him twice and he is the one who told me to just come back after a week.

3) Would chiropractics, etc be useful? I've had massages 3 times and i found that useful in healing the adductor tear, but other than that in terms of lower back pain and stuff it only provided temporary pain relief.

I want to get this sorted ASAP as i'm going on a road trip the week after next with a bunch of friends. I don't want to be in pain all the time.

just keep doing physio... or go see a sports doctor. they can refer you for mri and that kinda stuff if needed... otherwise its physio treatment.

I've already just got an MRI referral earlier this morning. It just depends whether i should get it. And in terms of physio is once a week really too infrequent to see benefits?

I think they should have put you in for an MRI to rule out any disc issues just to be safe. Once you find out the results from that you at least know if it is a disc or not.

Your injury is similar to mine and a lot of others though. I have an SI joint issue, a (got this way slowly) weak gluteus medius which can spasm and gets irritated from hip flexion with external rotation mainly (sitting in car, sitting in crap chairs etc). I also get a tight piriformis every now and then and it can lead to sharp neural pains in my gluteus medius too. I can tell the difference between SI joint pain (sharp ache), gluteus medius weakness and spams (dull ache) and impinged superior gluteal nerve pain (sharp shoot pain). The SI joint pain is by far the worst of them.

I rarely get pain around the groin though and if I do it is a dull ache in my ULTRA TIGHT hip flexor.

Does any of that sound familiar in any way? SI joint issues are common and it has lead to a bit of back pain now for me when I sit in shit chairs for too long. The pain from the SI joint and hip musculature can radiate up into the lower back but you can easily tell LBP from it by the fact your ass hurts more than your back.

What tests did the physio put you through?

I get a really tight/strained type feel in my lower back that will turn into a sharp pain if i do a particular movement too much such as bending backwards too much or stuff like that. As i said i also seem to be getting a tingling feeling in my left glute mainly but spreading down my posterior thigh as well. I have no idea what's wrong, and i don't know if the groin pain is because of some post-injury effect of my adductor because i definitely injured that 2 months ago. It also is tender when i press on my lateral hip and move around to the front (where the hip flexors i think attach) and the adductor tendons are also a bit tender. Will actually feel pain in those tender areas if i squat or stuff like that.

In terms of what the physio put me through, he just tested me with things like leaning side to side, leaning backwards, then forwards. And also passively flexing my hip, knee joints, etc and just telling me where stuff hurts and so forth. He didn't really give me a diagnosis more a you have really tight hip flexors, etc and also your lower back might be injured irritating your nerves. And then he set me up with some exercises (lower back extension one where you do like a half push up while keeping the back and hip muscles relaxed, a glute stretch, and now a hip flexor stretch as well. Did some trigger point therapy on the glutes as well and some pressure type massage thing on the vertebrae on my back.

Sounds about right, it is near what I do to correct mine plus a lot more core work. Physical therapy is pretty similar for most lower back, SI and hip issues so it won't make it worse. I would get a foam roller and work on your IT band and TFL to make sure it is not too tight and taking over from your gluteus medius. It will lead to the weakness and some pain (one reason for your tenderness on the side of the hip). Also add in some hamstring stretches to bring your flexibility up there.

I would say you need some core work. Activation of the TA and multifidus muscles and then some strengthening. You can do a test for it. Basically time a side bridge on left, side bridge on right, time a glute bridge hold and a normal plank. Make sure you do not sag on any. You want the times to match each other, if they do not then one is over powering the other and that is not good.

Also if you want some manual work try an osteopath. You can also use a foam roller yourself and a rubber ball (Kong dog toys from the supermarket are good) to find trigger points. Just like a massage but cheaper. Find the sore points and put pressure on it for 10 seconds, find another etc etc. At the end roll around a little on it. Really roll up and down the side of your leg for the IT band and TFL though.

Thanks for the quick reply Dave. So i should put pressure on the places that are tender on my hip? And does stretching the hip flexors and such help? I've found that after stretching them, it actually seems more painful/tender afterwards. It doesn't hurt during the movement though.

Here is a little detail on the hip flexors and back pain so you have some background (that I doubt your physio went into).

Tight hip flexors are really bad for lower back issues due to pulling the lumbar spine (the origin of 2 of them) and tilting the pelvis anteriorly. This does not allow the spine to be as stable. They also go hand in hand with weakened abdominals and glutes which posteriorly tilt the pelvis.

So if you have tight hip flexors (through anything other than a direct trauma injury) you will have weak abs and/or glutes. Weak abs and glutes means you are using your spinal erectors to stabilise the spine, move the spine etc. You don't want that it leads to muscle pain in the LB and deactivation of your multifidus muscles that help stabilise the vertebrae.

So destabilised and an overly curved spine can lead to disc problems, muscle pain etc etc. Not good. It may not and you could be fine until one wrong twist under a load and bam acute disc prolapse and super freaken pain.

I would have replied even quicker but I took nap

Now in regards to using the ball. You sit down, lie down, stand against a wall whatever is best to get pressure on the trigger points (look for them on the net there are a lot of free pics to show you and vids too). You should find a hard but tender spot that is a ball of muscle that has spasmed too much. You press into it with as much force as you can take the pain of and hold it for 10 sec and move around and find another.

Now it is much easier to do this by hand (I do it to my wifes back a lot and coupled with anatomy I can easily do it now) as you can feel the hard bits but you eventually get the feel for it with a ball and just work away. If you are off a little it is not going to be bad so don't worry (unless you are crushing into an injury). Most people ball up in the same spot (reason for trigger points) so it should be around the suggested area.

It is quite hard to do this in the hip flexors (besides quadriceps femoris) but you can work on your quads, tensor fascia latae and iliotibial band, hamstrings and glutes. I find it hard to do the lower back but it is doable. If you can get manual work from a professional once a week that would be good then you can do short sessions of this before stretching.

All that directly applies to my injury I reckon.

Yep applies to mine too. All pelvic/hip/Lower back are similar in rehab with minor specific changes for each condition.

My method is:

Deep tissue work on tight muscles/knots
Stretching
Activation
Strengthening

I think you were spot on about the hip flexor problem stressing your back. I'm sure that's the root of my problem.

Just an update. I got this book: The Trigger Point Therapy Workbook by Clair Davies and started applying the trigger point stuff. It's worked really well however i was wondering if anyone also has any experience with chiropracters for situations such as mine. I was wondering if getting some safe back cracking will fix my back problems and my hip. If anyone knows any good chiropracters in the Sydney area (preferably in the city or near epping/carlingford) feel free to recommend them too. Thanks

Mate try an osteo over a chiro. Osteo's are all about manual treatments for all joints with the 'crap' that chiro's put out there. Make sure you get a good one either way (there are a lot of good chiro's but a lot of poor ones too).

Also if I had a chance of a prolapsed disc I would not want a chiro doing any major manipulations on my spine.