Questionwell you did mention that you love detailed feedback. well i also appreciate, live for the detailed answers. thanks very much for all your trouble. i hope you dont mind cause this email will be long as well as the first. i myself did take some kinesiology , exercise physiology, and the related courses at university but i only was there just 1 year before i droped out. it was so long ago i cant really even remember what i actually did take. but i have been weightlifting for years and read alot on the internet about many areas of bodybuilding, strength training, posture correction. i have also read an incredible amount on all the things that can go wrong with the back and their inter relationship. and then is the medical texts that i did read. i am a not a professional although 2 doctors that i dd see asked what i did for a living thinking that i was some kind of a doctor. but the answer can be as detailed as possible as if there was something i did not understand i could figure out things from further research. actually so far it does not seem all that difficult to understand all the medical texts. it just take paitence and time to read it all.
anyways this ql or iliocostalis lumborum (i dont really know for sure) i can find a rather large latent or active trigger point at around L2 about 1" from the vertabrae. now i did not mention this and the many others things i have found cause i do believe they are secondary causes of pain. or like the bulge disc of L4-L5 and the spina bifida of L5 not causing pain just a non event i believe. i did a test from the ultimate back fitness back to see if the bulged disc was a source of pain and it appears that from the results of the test that it is not a cause. this myofascial pain syndrome in my case i think is not the real reason why i am pain but caused from something else. so myself as well as you did come to the same conclusion that this ql muscle did begin to take the strain of the body when i begin a movement. but to my knowledge all the gluteals muscles that i have i have never found any trigger points. i know for a fact that the gluteus medius on the left side is inhibited from the tests that i did perform.
i am guessing that the SI joint has been damaged and or the SI joint ligaments damaged or somehow need to be reset if that is still possible. this has went on for many years but in the last 4 years has gotten much worse. but from doing a very complex postural weightlifting program i think i have helped the situation as i have hopefully strengthened the certain inhibited muscles and stretched the tight muscles. i did have the classic double S. excessive lumbar lordosis, exaggerated kyphosis, anterior pelvic tilt, forward head posture. and also the pseudo-scoliosis or functional scoliosis. now i have brought the pain down somewhat compared to before as i had pain ontop of pain but the perpeduating factors such as sitting keep the pain active. BUT i think all that i have done is create a stronger more balanced core to deal with hardships that come my way but the same main problem still exists.
the doctors that i did see have never ever proven where or what the problem was. i have an incredible number of medical misdiagnosises. i believe if a doctor or chiro or therapist ever really examined or were actually knowledgable about analysizng dynanmic posture that when i do an squat motion or the bird dog or standing on one leg and kicking the other back and forth the answer to what is actually wrong would become more clear. when i do a squat motion when i get to about 110 degress the body seems to twist always clockwise. when i stand on one left leg and kick the right leg back and forth the left side of the torso is NOT symetrical with the right side and this same kind of unstability as i observed with the bird dog excersize is observed. but doing the standing on the right leg and kicking the left leg it is near 100% stabile and symmetry of the torso is almost identical.
i just kind of get the idea that all the doctors, chiros that i did see dont really know that much. so many questions that i did ask i just got blank stares. ok i admit it that there is an incredible amount of complexity with the back BUT they have never tried to really see the whole picture. the chiro did not try to understand what was actually wrong. all he did was his routine of subluxation of the spine (i think that is what it is called when someone tries to get the spine more mobile)and the doctors just look at a xray and try to make a judgment from this. they never really seemed to be looking for what the actual cause was. anyways if you have any other comments i would be happy to hear them. and i am thinking that it is physical therapy done from a chiro or therapists directed only at the SI joint. any idea who would be the better choice to see?
thanking you in advance.
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Followup To
Question -
i am now a 38 year old male of good health except i have all kinds of problems or possibly pain causing areas of the back. i have read the trigger point manual vol 2 (lower body) - travel and simmons. and am now half way thru one of the world leaders in back treatments (ultimate back fitness - stuart mcgill). i have read alot on posture and anatomy and function and by doing stretches of the inhibted muscles and strengthening/activating the inhibited muscles i have reduced the pain somewhat. i have observed several muscles of my back and hip that are short and tight and other the antagonist that is long weak and inhibited.
anyways the more i look into all the things i have found wrong with my back and hip area and all the things a few doctors i did see found (but as i now live in thailand the doctors so far i have seen are almost useless basically telling me the reason i have pain is beauce i dont have enough anti-inflammorties in my body thus that is all they did was prescribe them. there is myriad of things that i have found wrong with my back and hip. but i wont mention all of them cause it would takes pages and pages and i am guessing that these are the secondary causes of pain and or symptoms.
the real cause of pain started when i had an ice hockey accident some 17 years ago having me fall on my side of the hip a few times in 1 day. the area was purple and the hip would slip if i put most of the pressure of standing to only one leg. i feel that i may have damaged the si joint on the right side. i did manage to get out of chiro that the right side of the si joint is locked. when i do excersizes such as the bird dog me standing on all 4's(i hope you know what it is) when i do the right leg coming off the ground combined with the left arm there is a serious stability problem. but the left leg and right arm combo is fine. know it should be said that i do have hip banding in the left side. the gluteus medius on that side is long and inhibited. i have tried to get this muscle activated daily with a few good excersizes that i have. so i am guessing that either this glutues medius or the locked si joint is causing this stability problem. there are also different movements that i can do with body that basically shows the same kind of dysfunction pattern as when i do the bird dog.
now anyways i was figuring i should be trying to get this right side of the si joint more mobile. i do do a stretch where i lie on my back and bring the right foot up to the knee and then slowly lower and raise the knee all the while keeping the foot attached to the knee. and i do the bird dog for strenghthening as well.
the questions that i have are could i be correct in thinking that if when i do the bird dog and simmilar movements that the dysfunction i see be caused by the right side si joint being locked? and do you have different stretches and strenghten excersizes that you could give me for increasing mobility in that right side si joint and area of the si joint?
also i do have another question but may not be related exactly. when i do a piriformis stretch the best one so far i have found i place the right knee on the ground roughly in line with your left shoulder. the right foot just in front of the left knee. i thne press the hips towards the ground so that your bodyweight is on the right leg. now when i do this i can really get into a tremendous stretch of the piriformis on that particular side. actually both sides afterwards for hours later i get a throbing pain (almost enough to start to drive you crazy) in the piriformis muscle that also radiates down the leg to areas of the hamstring. i am guessing psuedo sciata but perhaps it is just the hamstring also acting up. now do you think i should be continuing to do this stretch if i get these results afterwards? is this helping the muscle or hurting it?
thanking you in advance.
Answer -
Greetings Jii. You certainly sound as if you have your hands full with that hip. It is hard at times to know exactly what is going on, and what is causing what; even palpating and touching the area can lead to few clues.
My guess (and this is only a guess) is that the imbalance would more likely be caused by problems stemming form the locked SI joint. FRom feeling how my body reacts to the movement, I feel that an imbalance would be caused because the muscles are twitching/tender/sensitive/weak - all a possibility. Initially when a joint is locked up, a few things happen to the muscles around it. They will begin to weaken over time, since they are not being used, and they can also begin to spasm and tighten up. These may sound like the same thing, but they are not. The muscles become spastic and "twitchy". These problems can then lead to similar conditions in the muscles around them. What I felt might be happening is that the glutes and the quadratus lumborum (the QL is the small muscle in the low back that attaches at the SI and the iliac crest and inserts along the lower rib) begin to take the strain of your body when you begin the movement. Because of the weakness and the "twitchy-ness" of the muscles, they then suddenly fail - they cannot take the weight. It is not enough to cause pain, but then your weight is thrown off by the loss of this support.
Have you iced your lowback and glutes much? I would try icing them - 15 minutes on, 30 minutes off, repeat 2-3 times - before stretching would help decrease the spasms and avoid the failure of the muscle.
In regards to the stretch that you do: I would definately keep doing it (it would be more damaging to not be moving it), but at a much lighter level. Don't push too hard, and don't bounce in the stretch. Even if you are not stretching hard right now, I would lighten up some, just to give your muscles time to slowly extend and relax. You might be activating some trigger points (those tight little knots in the muscle fibers) in the piriformis, and the tension is right over an artery, causing what is called piriformis syndrome. It is similar to sciatica, but the cause is the muscle, not a problem in the lumbar vertebra.
Knowing and describing the pain is excellent, as that helps give us an idea what is causing it. Throbing pains usually indicate problems with or near the circulatory system; electric or zingy pains are usually nervous problems; deep aches usually muscle; sharp, stabing pains are usually acute injury, bone, or ligament.
There is another great stretch for the piriformis muscle. Lie on your back. Starting by stretching the healthier side. This kind of gives your muscles and brain knowledge of what you are going to do to the injured side. Keeping your right leg straight, bend your left knee into the air and place your left foot outside your right knee.
If alone: gently pushing the left hip into the floor, use your right hand to pull your left knee across your legs, toward the right side while your left foot stays in contact with the floor.
If someone can help you (best way to do it): have them kneel on your right side, place their left hand on your hip and press firmly but gently down. Use a towel if the hand hurts your hip. This stabilizes your pelvis and insures that it stays put. Have them take their right hand and pull your left knee toward the right side.
Don't pull so hard that it hurts, but pull firmly. Hold for 10 seconds. You can then let your left foot leave the floor, and gently pull your left knee toward your head, while it is on the side of your body. Here it is okay to let your hips rotate off the floor. This helps stetch the piriformis, the glutes, and the QL.
Straighten back out, then repeat - gently - on the other side.
I hope this was clear enough, and that is was of some help. Please feel free to write with any other questions.
Sincerely,
Christopher Hall
AnswerGreetings, Jii. Your situation makes me laugh (not at you) and cringe, too: it is a classic case of exactly what is wrong with modern medicine. I think that you're right, that many doctors don't even know that much about the area. They also, I think, get stuck in diagnosing "ruts", where they develope a habit of diagnosing the same thing, time and again, when the symptoms superficially resemble something - and I find it very common with carpal tunnel syndrome vs thoracic outlet syndrome and piriformis syndrom vs sciatica. Many doctors also don't have time to spend really listening to their patient; they have to cram as many patients in as possible, and so really don't even think of looking deeper into problems.
And it iis hard for a doctor to admit that there is something that they don't know.
Your best bet would be finding an expert in the field, one who specializes in the back and/or nerve damage. That might be difficult in your case, as you live in a somewhat under developed area. The same goes for a chiropractor or a physical therapist; they best might not be around there. I would imagine a PT might be best, especially one specifically trained in injury rehabilitation. They would know more kinestieology, more about muslce movement and balance. It might also take the combined techniques of them both to achieve results.
I am curious: have you sought more traditional healing methods? I am not an expert in healing over there, but I do know that they have an amazing form of massage, one that is gaining in popularity and validity here. Maybe finding the best in that field could give you the attention and knowledge that you need, something that you are not getting from "traditional" medicine.
You mentioning the twist when you do a squat makes me think of the fascia. If you haven't found it yet, fascia is the connective tissue that covers and shapes all the organs, muscles, and bones. It also forms ligaments and tendons. A body technique called Rolphing is designed to straigthen and correct twisted fascia. It is a deep form of massage, and it can be a bit . . . . . . intense, and can help a lot of problems that other modalities can't. I am not sure of the availability of it over there, so it might not be possible to explore.
It is also, if I amy go on, very interesting to see something else: more and more people are going to doctors more knowledgable and prepared than ever before. I think that this throws some doctors; they are no longer the masters of knowledge of the body, and it is a bit of a "demotion". Some attribute it to drug ads seen on TV, and that can be a bad thing. Some people go to the doctor, having self diagnosed themselves, and the doctor just blindly prescribes what ever the person wants. Some of this is also due to the drug company's tactic of paying doctors for prescribing a certain medicine. It is also positively attributed to things like the internet, news, and TV. Peoepl are able to get so much information, and that can help doctors determine exactly what is wrong. IT is a bit of a double edged sword; it can be both helpful and harmful.
And it seems like alternative healing modalities, like massage, herbalism, and chiropractic, are gaining popularity and filling in that gap in Western Medicine.
I also am starting to find more and more people knowing more than their doctors. And more people are taking responsibility for their health, instead of asking the Mighty Doctor for a Magic Pill to fix their problems. In extreme cases, like yours, you will probably find what you need at the edges, where modern medicine ends and natural medicine begins. You might have to do more by yourself than most people, until you can team up with someone who has the knowledge and expertise that your case needs.
Please keep in touch, Jii. Let me know what you find that does work, and what doesn't. I can really learn a lot from people like you (saving myself from having to go through it). This is knowledge that can be used to help others in your situation.
Sincerely,
Christopher
