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  • Piriformis vs L4/L5 vs SI Joint - S1 pain pattern

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    Old 11-11-2014, 06:34 AM   #1
    Felicity-745
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    Question Piriformis vs L4/L5 vs SI Joint - S1 pain pattern

    This is long, I apologize but am hoping to spark a new direction before seeing my Dr's again.

    It seems the longer I'm in pain and the more I educate myself about possible causes the more questions I have. I'm working with my GP, a Physiatrist to resolve an ongoing set of pains in my buttocks,hamstring and calf. In the past month I also now have groin and iliac crest area pain.

    MAKES IT WORSE or BRINGS IT ON: Sitting, reclining in Laz-y-Boy, Lying on affected side, Walking briskly, Standing in one spot too long
    RELIEVES: Advil, prolonged heat, booze (yikes)
    All that screams muscular to me but cannot seem to get through the hump. I've seen diagrams of Gluteus Minimus trigger points that look like my pain pattern (aside from groin)

    Am currently trying accupuncture (no improvement so far) in addition to foam rolling/tenis ball release. Have had sports massage/osteopathy/physio... ALL with at best very slight improvement (10% maybe) or an increase in pain.

    I used to have issues on the RIGHT side caused by true sciatica due to L4/L5 disc bulges. Had an MRI in 2012 comfirming this. So I know what "true" sciatica feels like. I am able to keep pain & numbness at bay by streching and following good back hygiene.

    TESTS:
    I had an MRI this summer for the LEFT side which shows exactly the same thing as in 2012: "Broad based protusion L4/5 level, centrally & to the right. Mild flattening of dural tube. NO COMPRESSION of any adjacent L4/5 nerve roots. Central tube is not narrowed. No Stenosis. L5-S1: Normal aspect"

    I had a nuclear medicine bone scan of my sacrum = Normal + Inflammation markers blood tests = Normal
    I had lumbar XRays=Normal

    My pain is not reproduced by any of the testing manoeuvres except that my affected leg is much stiffer than the other and ankle flexion towards head is slightly off compared to other side. I do nerve flossing and stetches to help that. There is no difference in stenght/reflexes/nerve conductivity (sensation/numbness) between right & left leg.

    PRESENT: We are proceding by elimination at this point. I have a script for a fluoroscopic SI joint cortisone shot but because all my tests are normal I doubt its wise to get it.

    QUESTION: Anyone have this pain pattern ? Wouldn't "true" sciatica have periods of being better/how can this stay constant so long? MRI shows no compression at S1 but pain follows same pattern ? What about Botox/cortisone shots in glute muscles? Would glutes cause the brief but shooting pain I get in my SI joint sometimes?

    I appreciate the time and hopefully I'll solve this and help someone else in the process.

    This was my original question/thread, a year ago
    http://www.healthboards.com/boards/back-problems/964342-can-bulging-discs-cause-si-joint-pain.html

    Last edited by Administrator; 11-11-2014 at 08:08 AM.

     
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    Old 11-11-2014, 07:24 AM   #2
    teteri66
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    Re: Piriformis vs L4/L5 vs SI Joint - S1 pain pattern

    Did you ever consult with a spine specialist? It was mentioned in the other thread....has the disc bulge progressed or changed? Was anything else mentioned in the new MRI? Did you have flexion/extension x-rays to check for a spondylolisthesis? That could explain why the pain has shifted to the other leg.

     
    Old 11-11-2014, 09:13 AM   #3
    Felicity-745
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    Re: Piriformis vs L4/L5 vs SI Joint - S1 pain pattern

    "Did you ever consult with a spine specialist?" The physiatrist(s) I saw are considered musculoskeletal/spine specialists
    "has the disc bulge progressed or changed?" Not according to the new 2014 MRI. Same diagnosis as the 2012 one.

    "Was anything else mentioned in the new MRI?" The only difference is that the 2014 one is in french (I live in Canada). There is mention that thee is no lytic lesion.

    "Did you have flexion/extension x-rays to check for a spondylolisthesis?" No but was told it would have been picked up on the Bone scan/MRI/XRay

     
    Old 11-11-2014, 10:34 AM   #4
    teteri66
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    Re: Piriformis vs L4/L5 vs SI Joint - S1 pain pattern

    I gather no one has suggested doing anything about the bulging disc? I assume you have not been evaluated by a spine surgeon.

    If the SI injection is diagnostic, hopefully it will rule in or out a problem in this area.

    Was the piriformis checked out to see whether you might be one of the small percentage of people whose sciatic nerve is bisected by the piriformis muscle?

    Have you ever tried laying off all the stretching, massage etc. for a few weeks to see if the sciatic nerve calms down?

    In a certain percentage of people, the cause of sciatic pain cannot be determined. It may be that your attempts to stretch out the nerve, etc. are irritating it rather than helping it. When sciatic pain becomes chronic, a portion of the nerve can become scarred. It can continue to send off signals that the brain interprets as pain even past the point when the nerve is still compressed.

    I would think an epidural steroid injection to treat the bulging disc at L4-L5 might help to calm it down if you don't get any results from the SI procedure.

     
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    diagnose me, disc bulge, muscle pain, sacroiliac dysfunction, sciatica pain



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