Pain in the Butt?
February 17, 2007 6:55 AM   Subscribe

I have a pain in the butt. Help me fix it.

A couple of months ago I strained my lower back on a bike ride. It happened when I got too hot in subzero weather and took off my top layer. Twang. It was sore and stiff but not incapacitating so I carried on riding for the next couple of days. However, on a long ride, again in cold weather, the pain migrated down to my left buttock. After that my whole left leg hurt every time I sat down -- so much so that I had to work standing up for a week. It eventually faded away and I went back to normal.

Last week I strained my back on a hard mountain bike ride (again in cold weather) and it has again migrated down to my buttock and leg. This is really a new thing for me and I'm trying to figure out what's causing it and what I can do. I suspect it may be pressure on the Piriformis nerve or something similar.

My buttock leg is not getting strained during the exercise: it's a pain which migrates from the site of the strain.

(I'm asking this on Metafilter because I have had horrible experiences with PTs and docs trying to fix/figure out muscle pain -- they seem to have no clue whatsoever).

I'm 42, 172lbs and 5'10. I'm fit but not very muscular. I recently lost about 15lbs.

Any suggestions welcome. I realize that cold-weather cycling (and probably not warming up properly) is a contributory factor here... but I really LIKE cycling in freezing temps... and I just bought a singlespeed mtb so I'm likely to be exerting myself even more in the future.
posted by sweet mister to Health & Fitness (11 answers total) 1 user marked this as a favorite
Of course nobody's going to be able to diagnose you over the internet, but sciatica is something you could research.
posted by magicbus at 7:03 AM on February 17, 2007

It sounds like sciatica, which can be hard to pin down or deal with. What I do: Anti-inflammatories around the clock, even if it feels OK. Don't put heat on it, at least not at first. Cold packs, 10 minutes at a time, every hour or two. After two or three days, switch to hot/cold (alternate hot and cold packs, 5-10 minutes of each, 2-3 cycles). After a few days, various stretches while lying on your back, just Google for suggestions. Don't do all of this half-way -- it takes some time out of your day but it works. Beyond that, what you want to do is strengthen your lower back, as much as you can. Get some personal trainer advice on this. And do try to do a little warming up before you go all out.
posted by beagle at 7:04 AM on February 17, 2007

I'll chime in sciatica too. What's happening: a muscle in your lower back is becoming inflamed. It's rubbing against the sciatic nerve, which runs down your leg. The nerve is getting pissed and is sending pain messages to you. Here's more.

Treatment: a lot of stretching + anti-inflammatory drugs (ibuprofen). Heat (a hot water bottle) tends to relieve the pain and relax the muscles too.

Stretching: Lie on your back. Bring left knee to right shoulder and vice-versa. Feel stretch deep in buttocks. The page I linked to describes this same stretch on your side.

Strengthening: Lie on back with knees bent. Lift pelvis off of ground, to form an L-shape (shoulders to knees is straight, knees bent at 90 degree, feet and shoulders only touching ground, thrust pelvis toward ceiling). Clench your buttocks while you do this.
posted by jellicle at 7:23 AM on February 17, 2007 [1 favorite]

Actually, it sounds a lot like the pain I've been having. I thought (what with my dismal anatomical acumen) that something had popped out in my lower back and was working at pinching a nerve that was causing pain down my leg. I went to my chiropractor, and he said it was the piriformis muscle (though I can't recall what he said it was doing--jellicle's description sounds about right). And he said I should do exactly what jellicle described.

He also offered that I should use a stool to keep my feet elevated at work, and that I should avoid sitting/lounging on softer surfaces (i.e., sit on a kitchen chair instead of the sofa), and skeptical as I am, I've found it to help the pain not get so intense.

Good luck with whatever you determine it to be!
posted by monochromaticgirl at 7:58 AM on February 17, 2007

i agree with the sciatica diagnosis, but i think the cause is a little different than described. rather than an irritated muscle in your leg pressing on the nerve, i believe it is your fascia that is causing the problem. fascia is a layer of tough tissue that lies just below the skin. it pretty much covers the entire body, and it's particularly thick and inelastic around the hips and down the sides of the legs. because it's continuous, if you twist or inflame the fascia in your back, it's going to 'pull' on other areas around it (fascia is a lot less stretchy than skin). because the fascia in most folks' hips is already pretty tight, a little extra tension on it is probably enough to slightly compress the sciatic nerve.

alternatively, the problem could be originating where the nerve roots leave your spine. if the discs in your low back get a little compressed (a pretty common occurrence, and perhaps more common among cyclists given the awkward positions they hold for hours?), then your vertebrae will press on the nerves.

i'm afraid i don't have good advice as far as repairing the problem. stretching, antiinflammatories, and alternating ice packs/hot packs will help some if your fascia is the cause. if your discs are really messed up, your options run the range from cartilage rebuilders like chondroitin sulfate right out through surgery depending on severity and your inclinations.

if you can afford it, i'd suggest starting out with a good physical therapist or massage therapist. and there may be a gifted doctor out there who can help you, but weird, lingering musculoskeletal pains are on the list of stuff that western medicine just sucks at dealing with.
posted by 1-2punch at 7:59 AM on February 17, 2007

Is it your piriformis muscle? It's a muscle in your butt. There are stretches you can do if it is. I had butt pain after back surgery and my physical therapist said "here, try this stretch" and it was like hallelujah!
posted by macadamiaranch at 8:58 AM on February 17, 2007

It seems to me that jellicle's and macdamiaranch's answers and links, which both discuss piriformis syndrome, fit your description of your problem extremely well; consider a very interesting sentence from jellicles's link:

The sciatic nerve usually passes underneath the piriformis muscle, but in approximately 15% of the population, it travels through the muscle.

And take a look at a very clear and suggestive picture of an anatomical model I found in one of the advertising links on the page macadamiaranch linked.
posted by jamjam at 11:59 AM on February 17, 2007

I have piriformis syndrome, which leads to the type of pain you describe. A tight or spasming piriformis muscle causes pain in the butt that radiates down my leg. I don't know if you have this problem, but the symptoms are similar.

A physical therapist told me that there are several factors that increase the likelihood of having pain. These include: (1) weak abdominal muscles, especially the transversus abdominus, (2) tight hip flexors, and (3) tight illotibial bands. If you bike a lot, you are very likely to have tight hip flexors.

I also found that massage was incredibly helpful for releasing the muscle spasm.
posted by medusa at 12:01 PM on February 17, 2007

Two suggestions:
Get something that you can wear over your lower back even when you remove your top layer, maybe you could cut the lower torso part off an old fleece to use as a 'backwarmer'.

Stop using your back pockets for anything and see if that helps, I've known it to help others with sciatica.
posted by yohko at 1:43 PM on February 17, 2007

I went rock climbing two months ago without warming up properly, and strained my lower back. The next day I couldn't move, and I wound up spending most of the next 6 weeks in bed. If I moved around too much, I got sciatica. The pain in my lower back forced me into strange positions that wound up creating muscle spasms in my entire back.

I saw two doctors who had no clue, and an orthopedist/chiropractor who was able to fix me up, but after 24 hours I was back to being a cripple. Everybody I knew had some kind of suggestion, but nothing worked.

I finally went to a clinic that specializes in sports injuries, and they insisted that the first thing was to get an MRI. It turns out that I have spondylolisthesis. They put me in an exercise program they run for people with back injuries. It borrows liberally from Pilates, but is focused on rehabilitation. They put a lot of emphasis on correct posture and movements. Since I started I've been getting a little bit better every day.

You may not have what I have, but I'm the same age as you and they told me that it's very common that more serious back problems start to show at that age. It's not so much about the specific injury, it's more the result of accumulated wear and tear on the muscles, ligaments, and disks that hold your spine together. One day you do something you were always able to do, and it pushes your body over the edge.

Here's what I'd suggest based on my experiences (YMMV):

Try to find a traumatologist who specializes in sports injuries.

Get a complete set of diagnostics, including an MRI and a functional profile (X-rays of your back extended in different positions).

Find a stretching program specifically for people with injuries, and work at it seriously. Stay away from normal programs for healthy people, they'll push you too hard and you'll just make things worse. A good one will begin with relaxation exercises that emphasize flexibility in the lumbar area. It'll hurt like a motherfucker at first, but stick with it and things will improve.

Start with these exercises, they look simplistic but they changed my life (more here). Pay careful attention to your breathing.

Don't lose hope. I met people at the clinic who've been living with constant pain for a year or two. You don't have to put up with that. It's really easy to get depressed with this kind of injury, since it affects everything you do. Once you get a diagnosis and a treatment program that's right for you, the world looks a lot more beautiful. Keep trying until you find something.
posted by fuzz at 4:54 AM on February 18, 2007

Thank you for all the suggestions. I had pretty much diagnosed it myself as Piriformis Syndrome but the confirmation is very helpful, as are the recommendations.

In the short term the things I have found most helpful are the various piriformis stretches, especially combined with NSAIDs and one of those hot beanbag things.

To alleviate the discomfort of sitting, the hard chair recommendation is dead on, especially if you put your ankle on the opposing knee so that sitting becomes a kind of piriformis stretch.

I definitely have weak abdominal muscles and uber-tight hip flexors, something my last trainer was trying to work on (but ended up injuring me, so I fired him).

I also have one leg slightly shorter than the other which ends up with some asymmetric stresses when I am working hard.

Thanks again.

(By the way I found that working standing up was very helpful and with the right work surface, I managed it fine).

One of the reasons I love MTBing is that I get a great workout which is fun, something that working out in the gym isn't for me. I wish I could figure out a way to make stretching and ab strengthening fun.
posted by sweet mister at 7:57 PM on February 18, 2007

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