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Old 03-25-2011, 04:25 PM   #1
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Throbbing/Pulsing Pain in Lower Back When Sitting

I've had a problem once in awhile in the past where after I sit down I would get this pain in the lower back near the top of the pelvis that feels like it's a nerve pain that is literally throbbing with my pulse. It would usually hurt very bad for a minute or so and then subside and usually disappeared (and always did within an hour or two).

For the past 8 months or so I've been having a lot of pain around my hip and gluteus minimus/medium area with pain down the back of my thighs around the hamstring and near the pelvis. I've seen a half dozen doctors already and I've had x-rays of my back and pelvis and an MRI of the region as well. X-Rays appeared normal. The MRI shows very minor bulges around L5-S1 and L3-L4 (no encroachment of nerve) and a moderate bulge around L4-L5 (slight encroachment of nerve and a tiny annular tear). The doctors think none of those explain my leg/pelvic pain (my Chiropractor and physical therapists disagree, but they're not the back doctor so?). The doctors mostly agree it's some kind of hip or ischeal bursitis (it started when I was sitting long hours on a hard piano bench and a lot of sitting due to shoulder pains before that with hard chairs at work and elsewhere making it hard to keep pressure off the area) and for some reason has become chronic and doesn't want to go away at this point.

Anyway, yesterday my regular doctor tried a shot in the left hip area and gave me flexeril and low-dose two weeks supplly of Prednisone and right after the shot almost every area that EVER hurt in the region and some parts of my shoulder that were hurting last year before the leg problem all were hurting for several hours (the hip pain disappeared some time in the middle of last night as I couldn't sleep very well with it). Today I went to Red Lobster and I had two drink and shell fish (Lobster). I felt fine at the dinner table (thigh pain was minimal) but when I went to sit in the car that throbbing/pulsing back pain appeared and it's been going on/off now for a couple of hours. Hanging upside down on my traction table seems to have no effect. Bending foward or backwards likewise seems to have no effect. When I went to get out of the car for the first time after sitting down, I got a horrible shock all through my left hip up into my pelvis area around my back and I could feel it while walking. I'm sitting right now at the computer and it's still kind of throbbing.

I don't know if the drinks or shellfish could affect it or maybe it's the stress of starting my new job/promotion next week eating at my subconscious (never good from what I've read about stress/tension and all kinds of support muscle pain; a friend showed me a book by Dr. Sarno on Healing Back Pain and it suggests a lot of support muscle pain is associated with stress/tension and beliving you have a problem after getting something like an MRI that shows ANY kind of bulge that might even HINT at needing surgery or something down the line). It almost sounds as good an explanation of any I've read and the long line of doctors that never seem to know what the cause is even with MRIs, X-Rays and countless years of combined experience.

I've seen many posts on other forums with people that describe the same throbbing lower back pain that comes and goes and has no apparent cause (some said they had it on/off over 20 years with no explanation) and yet not one had a solid answer as to what the cause of it is. All I know is having the pain only creates MORE stress/tension and possibly self-perpetuating the problem.

I had shoulder surgery last August to remove two bone spurs and the problem seemed to disappear for over 6 months but as I started to worry about this new job a lot of pains started coming back in that region as well and then disappearing/reappearing so I tend to think stress has a LOT to do with it (neck tension over the trapezoidal region and the shoulder/arm nerves underneath). I don't know if a similar issue could be at work with the hip area, but that books certainly suggests it could.

Has anyone actually found a solid answer to a problem like this?

 
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Old 03-26-2011, 12:02 AM   #2
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

After a bit of reading, it occurs to me that this throbbing pain around the pelvic area (which is now hurting on the front of the thigh, the side of the hip and the center of my back just above my pelvis...too many areas to be one disc for example) may be "cortisone flare" around the localized joints, especially given some of the pain started a few minutes after the shot. These pains are not responding to stretching, bending or hanging upside down on an inversion table. If it were my back, I would expect some kind of reaction to bending forward and stretching backward or hanging upside down. It's getting bad enough I may have to go to the hospital in the next day or so if it doesn't improve overnight. Oh lovely day....

 
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Old 03-26-2011, 09:12 AM   #3
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

Was the injection done under fluoroscopy? I assume you were not under "twilight sedation" when the injection was done...would that be correct? I have never experienced what you have described, and am trying to think of some situations that might bring on those symptoms.

There are many nerves in that area around the lower lumbar/sacral area that have the potential to cause pain in the locations you have mentioned.
The two nerves most likely to cause pain or numbness around the hip are the sciatic and lateral femoral cutaneous nerves. If you enjoy doing research, you might want to look up piriformis syndrome and read up on the sciatic notch.

The sciatic nerve is formed by the co-mingling of the motor and sensory components that come from the L4, L5, S1, S2 and S3 nerve roots. These nerves come together and form the sciatic nerve which passes through the sciatic notch. It is at this point that it can become compressed by the piriformis muscle. This muscle runs across the buttock and attaches over by the hip. It runs right over the top of the sciatic nerve. If it becomes taut or inflamed, it can put pressure on the sciatic nerve. In some people, the sciatic nerve actually runs through the piriformis muscle.

I really have no idea what's going on, but it sounds like a nerve thing...like when someone whacks the "crazy bone" in the elbow, but feels the pain elsewhere. I just know from personal experience that the piriformis-sciatic thing can cause a great deal of pain in a number of different areas. There are stretches you can do to stretch out the piriformis muscle.

Sorry I don't have anything concrete to suggest to you...but sometimes reading about one thing will lead you to something else and another thing that will turn out to be relevant....Good luck!

 
Old 03-26-2011, 10:15 AM   #4
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

I had been doing the piriformis stretches fairly regularly. Up until this shot it always felt fairly "tight" and the stretch generally felt good. After this shot (once the near immediate hip pain settled down about 12 hours later), doing the stretch feels like it has no effect. The pain I was feeling in the piriformis and/or gluteal muscles seemed to disappear. Instead I started getting this lower back and pain around the lower part of the pelvic girdle. It seems somewhat better so far this morning after sleeping last night and I took my first dose of prednisone, but I'm afraid whatever it is will come back. My vacation ends this weekend and I'm supposed to start my new job at work on Monday. I'm afraid I won't be able to even walk. There's nothing quite like going to a doctor and finding things are far worse than when you went in. I may have hurt before, but I could walk and stand up without feeling like I had broken my legs a week earlier....

I've never got any real "shooting pains" during any of this like what I read about most sciatic problems. My immediate pains in my thigh were along the hamstrings. Admittedly, it's hard to tell one thing from another when nearly every site out there describes sciatic pains exactly the same as a half dozen other pains. Clearly, there's a big difference between a tight hamstring caused by ischial gluteal bursitis and sciatic nerve irritation caused by a herniated or bulging disc, but I haven't found a single doctor that can tell the difference even with X-rays, an MRI and ample long descriptions of the symptoms. They just keep trying anti-inflammatories and physical therapy which accomplish little or nothing (or in this case seem to make it worse). So either I'm a total basket case and this is all in my head, the doctors are all incompetent quacks or I have some bizarre problem science has never encountered in the history of man. They don't seem to be trying very hard regardless.

A specialist sent me back to my regular doctor. She tried a few weeks of therapy, an XRay and then an MRI and a shot in each hip and two weeks of low dose Prednisone. No help. She gave up and sent me back to my regular doctor. Another specialist before her said it sounded like hip bursitis and gave me Prednisone (doctors love this stuff even though it's terrible for your immune system). But I couldn't get back in to see him again for 1.5 months for a followup (they were so confident that it would work they didn't schedule the followup the same day I went there the first time and I guess the more experienced doctors are in HUGE demand) so they let me see this other doctor who just gave up. So now my regular doctor is doing what? More Prednisone shots and pills....

I must live in Quackville, USA. I'm just not sure who the quack is, them or me.

 
Old 03-26-2011, 12:20 PM   #5
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

Hi. I'm sorry you are having such a frustrating time trying to get answers. Your post mentions seeing a specialist? Can you tell us what kind of specialist you saw?

At this point, it is hard to say what is going on; in fact, it could be a combination of things. I can only think of a couple of suggestions that might be helpful.

First, if you haven't seen a spine specialist ( a neuro or orthopedic surgeon with fellowship training in spine problems) that might be your next step. These guys are the very best in pinpointing elusive symptoms and may be able to ferret out the problem.

Secondly, you might consider seeing a physiatrist...a physical therapist with advanced training, so to speak.

Your MRI mentions only a small bulge and tiny tear....however, depending on the location, that could be causing problems. Some people can have huge herniations and not have any pain while another patient, like you, can have lots of symptoms. Also, radiologists can look at the same MRI and come to different conclusions or describe the problem in differing terms. So if you see a spine specialist, be sure to take the MRI results (not the written report, but the actual film) so that he/she can see it with their own eyes. Being specially trained and with lots of experience, the doctor might come to different conclusions.

I hope you can get to the root of your problem soon and get the kind of help you need and deserve. Please keep us posted.

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Old 03-26-2011, 12:33 PM   #6
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

As I'm sure you know, "sciatica" is technically not any one issue, but is a collection of symptoms. It can take a variety of forms and cause different symptoms at different times. Sometimes it can be difficult to nail down exactly where a pain is coming from. As you said, many things can mimic true sciatic pain.

Many people think Sarno is onto something. Perhaps when your new job becomes routine, you will discover that your issues settle down, too. Or, it may be that you are in an in between stage and perhaps in the near future, something will happen that will lead to a diagnosis. You might have something going on in a lower lumbar disc, for example, that is causing some symptoms but isn't sufficiently damaged to show up on imaging yet.

Problems with the spine can be very frustrating at times. And the ten-fifteen minutes that a doctor is allotted to deal with a patient is often not enough time to do more than scratch the surface of a complicated issue.

At least, it sounds like your sense of humor is intact!! Good luck with the start of your new job. Maybe taking NSAIDS and using ice will get you back on your feet for Monday.

 
Old 03-26-2011, 12:38 PM   #7
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

Both specialists I saw were Orthopedic Surgeons (the first one who immediately suspected hip bursitis and the 2nd that ordered the MRI and eventually turned me back to my regular doctor). L-4/L-5 doesn't affect the hip region. I got pains last night down the top of my thigh. I don't think any of those discs affect that region. The problem started while sitting long hours, especially on a hard piano bench recording music and it was originally only in the right thigh on the hamstring but eventually seemed to spread. I suppose leaning forward COULD affect the disc at L-5, but it's far more likely the bursa sacks in the hip/gluteal region were inflamed.

What is strange is that after 8 months it hasn't gone away. OTOH, I have hard chairs at work (I did start bringing a donut foam cushion to use on breaks). Given the similar strange pains in the shoulders the 6 months before that (some of which have been reappearing to lesser degrees lately) might indicate an overall related problem (fibromyalgia comes to mind, but the symptom list for it doesn't quite match given it's limited to two areas only).

The book I started reading by Dr. Sarno on Healing Back Pain suggests both these areas (shoulders and lower support muscles and surrounding regions) are the classic areas for "Tension Myositis Syndrome" in most of his patients and he thinks most cases of fibromyalgia are actually TMS as well. Like I said, it sounds strange to me, but someone at work claimed his pains started going away in his back when he started believing that there was actually nothing wrong. Dr. Sarno indicates MOST people with bulges have no symptoms nor should they. But some get worse after they have an MRI that shows a bulge (suggesting tension was the original cause that got them to seek a doctor to look for something wrong and the disc's bulging status is completely arbitrary and has nothing to do with the pain). He also states that if something was pushing on a disc for a prolonged period of time it would go numb, not cause constant pain (and quotes some study that shows this). There clearly is stress in my life right now and has been ever since I was forced to move to this job in the first place so I'm starting to wonder if the book has a point.

My regular doctor suggested seeing another physical therapist, so maybe this "physatrist" would be a good idea. Part of the problem I had with the previous therapists is that they insisted it WAS my back and wouldn't work on anything else and spent most of my time doing push-up like maneuvers designed to shove a disc back in place (which one of the doctors I saw said DON'T do if I feel pain, which the physical therapists dismissed as the doctor doesn't know physical therapy... !?!?)

 
Old 03-26-2011, 12:53 PM   #8
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

The interesting thing about Dr. Sarno's book is that it suggests this TMS problem only occurs in the postural muscles (neck/back/shoulder/pelvis-butt region) and nowhere else. If tension is in the pelvic region, sciatica symptoms may also be present (as with Piriformis syndrome and several other things in that vicinity). My biggest problem with it all is how do I convince my subconscious to settle down? I've never been any good at doing that.

 
Old 03-26-2011, 01:05 PM   #9
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

I forgot to mention that when I had the shoulder surgery last August, all my "sciatic/thigh" pain disappeared for nearly 3 days when I woke up. No doctor has been able to tell me why this would happen, but it tells me there is probably a giant clue there. Anesthetic could have been acting like a muscle relaxant, but given flexeril has little effect, I'm wondering if my mind simply was no longer thinking anything about my legs but concentrating on my shoulder pain from the surgery and as the initial shoulder pain started wearing off after 2-3 days, the brain started back in on tension of the lower regions. It's probably as good as guess as any (given no doctor I talked to had any suggestion what-so-ever, despite the fact it was the one thing that killed the pain for 3 days and I was only under 30 minutes with anesthetic).

 
Old 03-26-2011, 01:24 PM   #10
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

Dermatomes are not as clearly delineated in real life as they are in textbooks and on charts. I definitely had pain in the "hip" area when I had spondylolisthesis at L4-5. I also developed debilitating pain on the front side of my thigh after my fusion. The surgeon thought it was possibly a femoral nerve entrapment from the way I was positioned on the table during surgery.

I would suggest some form of alternative therapy, someone who is experienced in orthopedic body work who could evaluate your body mechanics and structural alignment.

 
Old 03-26-2011, 04:15 PM   #11
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

I've been reading about vasodilators and vasoconstrictors and the whole causality behind this idea of "TMS" and oxygen deprivation. I have had a lot of caffeine intake over the years (both soda and coffee), not to mention pseudophedrine and antihistamines for sinus issues. Throw in stress and it starts to sound plausible. By comparison, there appear to be very few natural vasodilators (alcohol is interesting because early on it killed the thigh pain dead after just a pint or two of beer on an empty stomach). I suppose I could at least try cutting down on caffeine and apparently increasing intake of chili peppers.

 
Old 03-27-2011, 06:14 AM   #12
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

I'm starting to think the "throbbing" pain is a result of sudden increased blood pressure (perhaps doing something strange more so in that region or a sensitivity there) when I sit or lay down (since it's doing it when I lay down again after getting up to use the restroom at night I don't think it's the position of my back like it might be with sitting). I read Prednisone can increase blood pressure and this started shortly after that shot (and now I'm taking the pills as well). Prednisone causes salt and water retention which can raise blood pressure. The increase in weight as a result can also increase blood pressure. So once again, I may be causing some of my own problems with the "solution" the doctor prescribed. It sure won't help my quest to lose weight in the near term.

 
Old 03-27-2011, 08:07 PM   #13
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

Were the ortho surgeons you saw ortho spine surgeons or general orthos?

When do you stop the prednisone pills? Maybe if the throbbing stops at that point, you can conlude perhaps it was caused by the steroid....

 
Old 03-27-2011, 08:25 PM   #14
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

I'm not sure what the last doctor was that seemed clueless (probably just general?). I know at least one of the ones I saw specialized in back surgery and epidural shots. He was the one that suggested hip bursitis.

I'm convinced more than ever the throbbing is some kind of strange blood pressure shift or imbalance. It reminds me of when I had some drugs that I was warned not to sit up or stand up too quickly as my blood pressure might drop. This feels like the opposite as I can feel my heart beating harder when I first sit down (although I don't feel much in my neck/pulse, so maybe it's localized lower somehow?). I haven't had the REALLY bad pelvic pain since Saturday, but my vacation is up in the morning and I have to go back to work and start this new job, so that won't help the stress any.

I've got 6 more days of Prednisone (just finished the 3 tablets each dose for 3 days; tomorrow I start 2 tablets for 3 days and then 1 for 3 days). That book by Dr. Sarno (which I finished reading yesterday) suggests one should stop ALL treatments immediately or else you will just perpetuate the problem in your mind. That may be so, but if it's not just in my mind then that might be a very BAD thing to do.

I did notice back with my shoulder pain that the one I had for 3+ years behind my left shoulder blade disappeared almost instantly after I "pulled" a muscle/tendon in my right shoulder. It was almost like my brain decided to ignore whatever tension it was creating there and concentrate on my right arm. That pain has only recently come back on/off in my left shoulder blade. I'm really starting to believe it's stress/tension related to the muscles in my neck. In fact, I'm really starting to think most of my shoulder pains could be like that. So why NOT something similar in the legs/pelvic region?

The book only talks about those regions and that is where the pain is and it's no secret to me that I've been stressed for years over various things (from job related to relationship related to feeling like I made bad career choices ,etc. and that now I'm getting to be too old to change it). Having that kind of crap eat away at your subconscious but feeling like you cannot do anything about it...well it sounds plausible to me it could cause problems. You don't hear so much about ulcers today. Maybe it manifests as back and shoulder pain instead?

 
Old 03-28-2011, 07:48 AM   #15
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Re: Throbbing/Pulsing Pain in Lower Back When Sitting

I'll have to go back and read the book. I bought it about six years ago when I was beginning to have sciatic-type pains in my leg and hip. As I recall, his "theory" is only appropriate for some conditions, but not including when there is provable mechanical issues.

There's no doubt that stress contributes to pain, and that pain causes stress. It is a vicious cycle. If Sarno's ideas help you, that's fabulous. If you can't implement his ideas yourself, there are therapists that are familiar with his work, and might be of help to you.

 
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