What could be wrong with my hip/leg?

October 1, 2012 5:39 AM

YANMD, I know, but my doctor hasn't been very helpful, so I figured I'd try asking the hivemind.

So in the aftermath to this question, I find that I'm better, but not great. My concern is that running causes discomfort, and stretching is painful - if I try to do a butterfly stretch, for example, I end up making an acute angle (left leg can go completely down, right leg only goes down max to about 45 degrees). After I do the stretch I feel some pain along the middle of the right side of the buttock. The pain is hard to describe; kind of like trying to shove a spatula in the area maybe? Not the sharp knife I had on the trip (it's not as intense). It sometimes feels like I have to crack it, but it won't give.

This is going on a month now. I'm young (mid twenties), I exercise (not a lot, but some), and I haven't injured myself recently as far as I know (hence why the pain on the trip freaked me out).

Any ideas as to what could be causing this?

posted by Sakura3210 to health & fitness (25 answers total)

I failed at hyperlinking; here's the earlier question: http://ask.metafilter.com/222804/Should-I-go-to-the-emergency-room
posted by Sakura3210 at 5:40 AM on October 1, 2012

Here's the hyperlink version.

What has your doctor said? You say your doctor "wasn't very helpful," but what did they say?
posted by EmpressCallipygos at 5:55 AM on October 1, 2012

If it hurts from the back of your butt down your leg to your ankle it's sciatica and hi, welcome to my world.

I had two disks dessicate in the aftermath of an accident about 15 years ago. One day, I did something at the gym and I was in agony. Apparently a piece of disk was sitting on the nerve. I had two injections of cortisone and that seemed to cure it for the past decase and a half. It's back now and every day I weight the hassle of doing the injections again, against the pain.

Ibuprophen is where I am with it now.

This is one of those things where you do an MRI, talk to about 3 specialists and then maybe, just maybe the cortisone will work. Also, cortisone is a terrible drug, unless you need it.
posted by Ruthless Bunny at 5:57 AM on October 1, 2012 [1 favorite]

You might want to contact a qualified chiropractor. Like Ruthless Bunny, I had two discs badly damaged in an accident, and when the pain got so acute (many years later) that I couldn't even get out of bed, I was taken to a chiropractor, who fixed it for me. Long, slow procedure, but with lasting benefit and not invasve. No painkillers needed, but an annual visit and short series of top-up treatment (covered by my health insurance) has kept me sane.

And a decent, well qualified chiro (can you get recommendations from a friend) will also have the grace to tell you that this isn't something s|he can cure, but it's something different, so don't waste your money on me if that's the case.
posted by aqsakal at 6:07 AM on October 1, 2012

Yeah, what did your doctor say? What kind of tests did your doc do? Were you given any advice or medication?

This is going to be really hard to answer over the internet without more details. Upon reading your other question, my first throught was "labrum tear", but honestly, there are a TON of things that could be causing this. It could be anything from muscular disfunction to joint/bony pathology to sciatica or pseudo-sciatica, to auto-immune like arthritis.
posted by windykites at 6:16 AM on October 1, 2012

Doctor said it's sciatica, and didn't want to do any tests, just suggested ibuprofen. I went to a second doctor who took an X-ray of my back (but not the hip) to make sure it wasn't related to scoliosis surgery I had a decade ago, and that came back fine.

The pain does not travel through my leg, it's pretty much exclusive to my right buttock, with a little upper thigh (right around the hip) sometimes thrown in.

I thought about a chiropractor, but am wary given the hardware in my back. Same worry about having an MRI.
posted by Sakura3210 at 6:20 AM on October 1, 2012 [1 favorite]

Oh, gosh, that sounds almost exactly like my history of sort-of-around-the-hip problems. IANYD and I recognize that words are imperfect and we may sound like we're describing the same thing but we're not.

Here is what happened to me:

1. As a young, fit woman about your age, I hurt my hip/piriformis/weird-spot-between-ass-and-hip really badly - doing absolutely nothing except going for a long walk in the cold. No idea what happened, except that my leg started to hurt and putting weight on it was excruciating and impossible. I had to call my brother to pick me up because I couldn't move. I couldn't sit either - had to lie down and could barely roll over. The pain receded over days.

2. Through my mid-thirties I had occasional twinges of the same kind of pain out of the blue but no real flare-ups.

3. After my mid-thirties it got worse slowly, to the point where on bad days I could not walk long distances or stand for long periods. I worked around this by riding my bike everywhere, but this also concealed from me how bad it had really gotten.

4. Just a couple of weeks ago (I'm 38) I had a terrible, terrible flare-up brought on by nothing, as far as I could tell. It hurt like something was rotten and grinding. If I stood, the whole leg gradually felt heavy and full and very painful. I couldn't walk more than fifty yards. It gradually got terrifyingly worse - biking started to hurt (which it hadn't initially; even sitting hurt.) And then whoa, one morning it was gone - just a few ghost twinges that went away over the next week. I'm back at about 110% now, better than I was before.

There is sort of a spot - not quite hip, not quite ass - where the pain is concentrated. It doesn't go to the spine; it doesn't go down the leg.

I've talked to various doctors about this and even had a hip x-ray as they thought it might be arthritis. Nothing turned up.

Here's what I think: it's either piriformis muscle problems or a hip-flexor/hip-capsule injury of some kind - after the most recent round, I'm leaning toward hip-flexor.

I've found that lying in bed with my knees up, then putting the ankle of my bad leg on the knee of my good leg and sort of relaxing/leaning into that stretch helps a lot. I do this at night when I'm reading. I feel the stretch in my hip and thigh.

Since the most recent flare-up, I've decided to do some core exercises and to try to lose a little weight - I tend to be stocky and muscular with kind of weirdly-shaped hips and I'm a bit worried about the long term even though otherwise my health metrics are good and I wouldn't be worried about weight.
posted by Frowner at 6:22 AM on October 1, 2012 [1 favorite]

Oh, dude, your update makes it sound just like mine - that's exactly how mine feels. I don't think it's sciatica either. I think sciatica-like treatment makes some sense, though - stretches, core exercises. (Piriformis stuff is related to sciatica but isn't.)

Say, do you have really narrow hips for your build by any chance?
posted by Frowner at 6:23 AM on October 1, 2012 [1 favorite]

I went to a chiropractor, had TENS therapy and did this three times a week for two years, BEFORE doing the cortisone. Very little relief. It was only after the cortison injections that I got relief and I suspect it's because the cortisone pushed the bit of disk irritating the nerve off of it.

YMMV, as these things are all VERY specific to each person.
posted by Ruthless Bunny at 6:26 AM on October 1, 2012

Find someone like an RMT or PT to do an assessment and differentiate the of the sciatica. Sciatica just means "pain in the area where the sciatic nerve goes", basically- it's a very general term.

If you've had surgery for scoliosis, it's really really possible that this is due to muscular (not bony) reactions to that surgery, and muscular dysfunctions aren't going to show up on an xray.
If the sciatic nerve is impinged by bone, there's not much that can be done about it other than to take NSAIDS, unfortunately. If it's entrapped by the muscle, though, massage and/or physiotherapy should help you.

However, if the pain is that localised and you feel like you need to "crack" your hip, I think there's probly more to it. I wouldn't be surprised if there was weak glut medius, or piriformis syndrome, or something else, happening.

IANAD. Get a full assessment done by a competent bodywork practitioner.
posted by windykites at 6:31 AM on October 1, 2012 [1 favorite]

that did say "differentiate the cause of the sciatica". I'm not sure what happened.
posted by windykites at 6:32 AM on October 1, 2012

I'm a doctor, so my opinion is biased, but I suggest referral to either sports medicine doctor or orthopedist. I place no faith in chiropractors and this may or may not be a back problem. It definitely could be sciatica but there are always other possibilities.

Let your doctor tell you whether you need an MRI and whether the hardware in your back is compatible with it. Most orthopedic hardware used these days is compatible with MRI machines without a problem.
posted by treehorn+bunny at 6:50 AM on October 1, 2012 [4 favorites]

I am a skeptical person and opposed to all kinds of woo, but for this kind of thing a good massage therapist (even if they are a chiropractor or actual witch doctor) may likely be more helpful than a doctor or PT.
posted by callmejay at 7:23 AM on October 1, 2012

Frowner, that does seem really similar to me; and I do indeed have narrow hips. Do you think that might have something to do with it?

I went to a rehab doctor, and he told me I should get a hip X-ray and go to a PT. I'm slightly disinclined about PT though, since it didn't seem very useful the last time I went (some ice packs and those electro massage thingies).

Also, a quick update, in case it helps anyone: I stretched this morning, and then did my commute (sitting most of the way). While I was sitting I ended up feeling some of the original sharp pains I had on my trip (not as bad, but enough to make me gasp).
posted by Sakura3210 at 7:41 AM on October 1, 2012

Except now the pain is directly under the buttock, right where the leg meets it.
posted by Sakura3210 at 7:43 AM on October 1, 2012

Ok, last comment for now. Potentially relevant is that I am hyperflexible (double jointed arms, fingers, etc.).
posted by Sakura3210 at 7:46 AM on October 1, 2012

This seems like something a good sports physiotherapist could diagnose and (hopefully) treat for you.

on preview, what callmejay said.
posted by piyushnz at 7:58 AM on October 1, 2012 [2 favorites]

To me, this sounds like a sprained psoas. Second seeing a sports physiotherapist. If your insurance covers acupuncture, that's also worth a try.
posted by munyeca at 8:02 AM on October 1, 2012 [1 favorite]

I have something very similar which is apparently a combination of my weirdly overflexible SI joint slipping around all the time and fucking shit up, and a labral tear in my left hip. The combination of the two issues makes it totally vital for me to do a whole lot of piriformis stretching every single day without fail or my gait goes super wonky and I end up sitting in my office angrily punching my butt cheek all day.

Physical therapy to strengthen the nearby muscles + deep (often painful) massage = bliss.


As an aside, I have extremely hypermobile joints pretty much everywhere, and I had problems like this constantly until I started concentrating on core strength, mainly lower abs, lower back, and legs & butts.
posted by elizardbits at 8:28 AM on October 1, 2012 [1 favorite]

I have a whole different set of issues from you but I want to add my 2 cents worth about seeing a GOOD physical therapist. You said last time you had ice packs and electromassage stuff. My physical therapist has me do all sorts of exercises, sometimes using a stretch band thing or an exercise ball, does manual therapy (massage on steroids basically), and prescribes very specific things for me to work on at home. If you are only getting ice packs and a machine treatment thing at your PT, I would think about changing practices. A good PT can make a huge difference in your degree of function, in my experience.
posted by SweetTeaAndABiscuit at 9:04 AM on October 1, 2012 [4 favorites]

Could it be piriformis syndrome? I had issues with this when I started running. It can cause sciatica in the absence of any skeletal issues. My symptoms were a sudden, intense, jarring yet dull pain in my left butt muscle. My symptoms resolved very quickly after I googled "piriformis syndrome stretches" and spent a few days gently stretching things out. This link has some good ones and the stretch that is pictured was particularly effective. As long as I've done these stretches after running, the pain has not returned. I skipped the stretches once and felt it the next morning. There are also active exercises you can do, but I found that the stretches were enough for me.
posted by keep it under cover at 12:28 PM on October 1, 2012 [1 favorite]

You may want to look into trigger points as the source of your pain. IANAD, IANYD, etc., but Clair Davies' book has helped me quite a bit with various aches and pains over the years.
posted by tuesdayschild at 1:12 PM on October 1, 2012

I would definitely see a PT about this. My doc prescribed it after my MRI showed a herniated disk and lumbar spondylosis. My sciatica pain was just horrible before the PT; now it's very manageable. I went to a PT clinic that specializes in back issues. Also, be sure you give it enough time to work--up to 8 weeks to see results.
posted by WorkingMyWayHome at 1:26 PM on October 1, 2012

Just got back from the emergency room (I was having sharp stabbing pains again), where I got an X-ray on the hip. They diagnosed me with osteoarthritis; I was pretty surprised as I didn't realize someone my age could get it.

Thanks for your help everyone, I'm definitely going to take the advice offered (exercise, PT, etc.), as I figure it's still relevant to this situation. Thanks again!
posted by Sakura3210 at 2:59 PM on October 1, 2012

I had something similar but mine was a complication from overly tight muscles in my lower back. Years and years of tension compounded by terrible core muscles. Ten months of PT from a sports guy fixed it but I'll still get twinges if I don't do enough stretching/core work. I def. recommend PT - in ten months it did more than the years of chiro I had specifically for lower back issues.
posted by geek anachronism at 1:06 AM on October 2, 2012