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Scott Parker 01-28-2008 08:12 PM

piriformis symdrome, rotated pelvis, lumbar sublux, out of comission for a while...
a few years ago i subluxed my L5 after the wheels on the stectcher didnt catch after pulling a rather large patient out of the back of an ambulance. i went to a chiropractor, found crossfit and got to a point where every once in a while it would aggrivate me, but it was tolerable. then, about four months ago i was training at the jiu jitsu academy, rolling with a guy 90 pounds heavier than me. i tried to gogoplata him, he postured up out of it, stacked me and compressed my spine and that's when i re-injured my back. for a few months i just tolerated it, went lighter, tried to keep super strict form, but as time passed it got worse and worse. (i don't think the owner of the affiliate i was training at believed me and i think he thought i was just being a big ***** because he would be insistant on me going heavy with KB swings, snatches, DL's etc. some days i could handle it, but other days it just hurt too much. i always listened to my body though).

when i was out at the orange county fire authority cert this past december i started getting a really annoying pain in both my buttocks in addition to the chronic pain i was constantly experiencing. over the next month it got to the point where i couldn't take it. i went to a chiropractor and found i have a L4 and L5 sublux (already knew about the L5), my SI joint is not happy, my pelvis is rotated, and the new pain is from piriformis syndrome, which is when the piriformis muscle aggrivates/puts pressure on the sciatic nerve. all of these combined makes for a very uncomfortable situation. i am going for an MRI soon, but the chiropractor is pretty sure there are no bulging discs. (most of my symptoms/pain aside from the piriformis symdrome is concentrated around my right SI joint).

is there anyone out there who has any experience with any of these types of injuries? the piriformis symdrome sucks and is really annoying. the chiropractor is sure i will make a 100% recovery from this, it will just take some time and patience on my part and strict adherance to ice, ibuprophen and stretching on my part in addition to her treatments.

right now i am pretty much stuck with just doing pull-ups and push ups, and slow air squats. seriously, everything else hurts like hell. i have to be careful not to kip or frog kip to much when doing pull ups as this aggrivates my back as well.

if anyone out there has experience with any of these injuries i would greatly appreciate any input and advice on what you did to recover.

thank you all in advance and look forward to your feedback!


Steven Low 01-28-2008 08:22 PM

Re: piriformis symdrome, rotated pelvis, lumbar sublux, out of comission for a while.
Stretching helps but if you can get some massage that would help. Deep tissue in the glute to loosen up the piriformis and other muscles around that area. Massage in the L4-L5 area should also help.

Chiro (or a good PT) should be able to fix your SI problem. Your chiro sounds fairly good from what you've said so yeah.. hopefully that works out.

Basically yeah you might have to relearn movement patterns if you've been doing stuff on your messed up SI joint depending on how long it has been since that happened. For example, if it's been a couple of months to a year on the wrong movement pattern even fixing the problem and going back to exercise can just put you back where you started because you're moving wrong. Once you start back doing exercise I would suggest very strict form and see if you can videos of your movements so that you can see if something is off. You don't want that to happen again.

Scott Parker 01-28-2008 08:28 PM

Re: piriformis symdrome, rotated pelvis, lumbar sublux, out of comission for a while.
another thing i noticed, and thought te chiropractor was going to tell me i was nuts, was that i swore my left leg was longer than my right, and it was noticable when squatting. she said this was absolutely true because of the way my pelvis is rotated.

Steven Low 01-28-2008 08:49 PM

Re: piriformis symdrome, rotated pelvis, lumbar sublux, out of comission for a while.
SI joint 'slipping' can also make that occur. Well, besides pelvis rotation and what I just mentioned there's also stuff like foot protonation/supination as well as external/internal rotation of the hip.

I had an SI joint slip and one of my PT friends fixed it which was nice of her. :)

Aileen Reid 01-29-2008 01:00 AM

Re: piriformis symdrome, rotated pelvis, lumbar sublux, out of comission for a while.
I know it all, have been going through this for the last - I don't know how long. Its only been the last 4 months that I've had adjustments done and got my leg lengths right but I still get a lot of butt pain. I've tried everything - pilates, stretching etc. Mine is compounded with the fact that my back/pelvis was out for so long it stuffed my right knee up. So I"ve just started squatting again but am not getting very far. I still am taking anti inflammatories on and off- they do help. I'm off to the sports med doc again next Monday, might get a bone scan and prolotherapy. Its really hard to run when you have this piercing pain in your butt! All the massage in the world doesn't last. And for me there's a definite cyclic thing which you don't have to worry about. PMT is my worst time - it always falls in a heap then. Happy to keep you posted, and v. v. please!

Aileen Reid 01-29-2008 01:02 AM

Re: piriformis symdrome, rotated pelvis, lumbar sublux, out of comission for a while.
BTW Steven's right on movement patterns. I have a devil of a job controlling my squatting. Its the one thing that really shows it up!

Lenora Galitz-Pfeffer 01-29-2008 07:28 AM

Re: piriformis symdrome, rotated pelvis, lumbar sublux, out of comission for a while.
Bummer about your back. Steven Low posted some good advice. It can take time to correct rotations in the pelvis, and balancing your legs. You are doing a good thing with slow bw squats. That keeps some basic strength and flexibility, and your back continues to be supported. Pullups and Pushups can do a ton to keep your strength up. They both work the core. If dips are comfortable, the lockout position may take pressure off your back for a moment. I used to do this to take the stress of my back from a back injury years ago. All I could do were pullups and dips at the time. Pullups can also keep your posture good, which also supports your back. Good luck.

Scott Parker 01-29-2008 09:15 AM

Re: piriformis symdrome, rotated pelvis, lumbar sublux, out of comission for a while.
i have always had issues with my squat form, one leg kind of going out to the side a bit, but the interesting thing is i was really good at OHS, and my 1 rep max was 215 (BW 175). i always got comments on how good my OHS form was.

Aileen Reid 01-29-2008 02:49 PM

Re: piriformis symdrome, rotated pelvis, lumbar sublux, out of comission for a while.
The only other thing to is for me my back likes hanging - either from the chinning bar or upside down. I try to do this in with all my other stuff.

Scott Parker 02-20-2008 09:45 AM

Re: piriformis symdrome, rotated pelvis, lumbar sublux, out of comission for a while.
so after waiting a month to get an appointment with this doctor that my PCP referrered me to, i think i finally know what is wrong with my back and the good news is that i am most likely going to make a full recovery. this is absolutely amazing news because i have been living with this for over 5 years since the initial inury, and as a result other issues and injuries has arisen from that initial trauma. in the few weeks leading up to the appointment the piriformis syndrome had gotten so bad i couldn't sit for longer than 5 minutes or stand still in one place without moving around without experiencing horrible pain.

the doctor i went to is an osterpath, and he is double boarded in pain mgmt and rehab medicine. seriously, this doctor was amazing. not only did he not rush me and took the time to actually listen to me and explain everything (the original injury, how i've dealt with it over the years, the activities that i participate in inclding crossfit), he performed the most detailed and thorough physical exam i have ever received. we also went through every slide of the lumbar and pelvic MRI i had done two weeks prior.

there is a lot going on with my back, some of it i didn't even realize, and some things i was told i had that i thought were casue for concern, that ended up not being that serious. in the original dictation (who knows who even performed this dictation of the MRI) all it said was that i had degeneration around L5. from what i know now this is pretty much entirely common in people my age (31, soon to be 32 in a few weeks). after viewing the MRI the doc also saw a small bulge of the disc at L4, but it was so slight that he is pretty confident that this isnt causeing the bulk of my symptoms, but there is a small amount or nerve root impingment. also, the MRI showed that i have a narrower spinal canal that most which means that the potential for pressure on the cord and nerve roots is greater for me since i have less margin for error and less to work with, but otherwise my MRI really wasn't that bad for a healthy, active 31 year old. so i asked the doc, so what the hell is wrong with me? i am in a ton of pain.

so, like i mentioned above there are a few things going on. He diagnosed me with facet syndrome and said that i have a tendency to hyperextend my lower back. i noticed this a while back when doing push jerks and dip drives while looking in a mirror at my profile. i would always make a conscious effort to correct it, but one slip would jack up my back if i didn't keep the strictest form. for this he prescribed postural relearning therapy, which is a form of PT.

Another problem, which has been causing me tremendous amounts of pain for years is my right SI joint. on physical exam when the doc palpated my right SI joint i nearly hit the roof, as it felt like someone flipped a switch and shot a large amount of electricity into my butt cheek. for that he prescribed PT as well.

He also confirmed the diagnosis of piriformis syndrom and, surprise, ordered PT for that as well. The piriformis syndrome had gotten so bad the pain was now radiaiting in my legs and hurt to just stand around.

He also told me that my quads and hams are strong, hipe flexors are stong as well as abdominals, but there is a serious imbalance in my pelvic muscles, which is one of the reasons that i tend to hyperextend my lower back. it's also the reason why my hamstrings are so tight. the postural relearning will target these pelvic muscles, realign my pelvis, open up my lower back and loosen up the hamstrings.

I was also placed on a 6 day taper of oral steroids which will hopefully knock down a lot of the inflammation and give me relief, (i am on day 2 of the steroids and am already experiencing relief) and Diclofenac, which is an NSAID taken by mouth, and a transdermal NSAID patch to apply to my lower back. i am supossed to start the NSAIDs once i finish the course of steroids. my primary doc had given me a muscle relaxer (skelaxin) the week before because the pain and spasms were so bad, but i stopped taking those after two days because i coudn't really function on them. they gorked my pretty bad.

i have to call this morning and schedule my PT, and will keep everyone posted on my progress. One thing i would like to mention, is in another post the debate was brought up whether or not an MRI would change outcomes or course of treatment. i think in my case it may have made a difference. another doc may have treated my symptoms as a disc injury and been prescribed a totally different form of rehab, but who knows. i honestly think the thing that made the biggest difference in my plan for treatment though is that fact that the doc actually took the time to listen to me and did a thorough physical exam and history and didn't rush me out the door.

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