Psoas and Piriformis Issues

[Adam Wander]

I have been plagued with recurring lower back pain that I have recently narrowed down to issues my psoas and piriformis. It has been really frustrating - I have to take time off from CF until I feel like I can get back into it (usually 2-3 weeks) and then I'll be in the middle of a WOD and Bam!, I get an excruciating twinge of pain in my lower back. The psoas and piriformis go into spasm and it takes another couple weeks before I can get back again.

I have finally found a good chiro who is doing the electric stim thing, ultra sound, myofascial release, neural flossing (I think that's what it is), etc. I am stretching multiple times per day and foam rolling when I get home from work. I have also been swimming a couple of nights a week.

My question is: I am about to jump back into the WODs after this most recent recurrence and I am going to continue with the chiro, stretching, and rolling, but is there something I can do or things I should avoid as I begin CFing again that will limit the likelihood of re-injury?

[Mike Mallory]

electric stim and ultrasound and all of that is total nonsense IMO......

A little more information would help too.........symptoms, location, onset, etc.

[Adam Wander]

Originally Posted by Mike Mallory

electric stim and ultrasound and all of that is total nonsense IMO......

I find his treatments help a lot. When I leave I have considerably less discomfort.

Originally Posted by Mike Mallory

A little more information would help too.........symptoms, location, onset, etc.

I will preface that throughout my adult life I have had issues with lower back pain/injury, but I don't recall what or when the first incident was.

The most recent incidences seem to have the same cycle. I will be doing some physical activity - it could be a strenuous workout, simply bending over to pick something up, jogging, etc - and will immediately get an intense twinge of pain in my lower back. (The past handful have been on the left side.) This twinge is followed by extreme pain and stiffness which is centered around my lower back just above my butt (again, most recently on my left side), which lasts for days.

Over the course of the next few weeks, as the pain starts to dissipate, I have a different, aching-type pain that begins to come on around the front of my pelvis/hip area. The pain and stiffness increases as I attempt to stand from a sitting position or if I am in a sitting position and attempt to lift my leg parallel with the floor. During this time, I also have pain/tightness in my butt cheek area.

I get a popping sound/feeling (no pain at all) in my left hip when I move my left leg in certain ways (e.g., laying flat on my back, bringing my knee to my chest, and then extending it straight again). I believe this is present all of the time, regardless of whether I am injured.

This is awkward and I apologize: I have a hard time moving my bowels when the injury is present.

[Adam Wander]

Oh - here is a rough idea of the areas I'm referring to...

[Gerhard Lavin]

Originally Posted by Mike Mallory

electric stim and ultrasound and all of that is total nonsense IMO......

That is my experience too. It a cheap and non interactive way for a therapist to appear to be doing something. It also give the impression of being hi tech medicine.

Actual hands on treatment is both more time consuming (less patients per hour) and physically demanding for the therapist but always (for me at least) give significant better results. I now refuse electric stim.

[Gerhard Lavin]

Originally Posted by Adam Wander

Oh - here is a rough idea of the areas I'm referring to...

I have similar symptoms that I believe are SI joint related. Despite seeing lots of different therapist I have no permanent fix thus far. My sport -fencing - exasperates the issue but I'm too stupid to quit.

[Mike Mallory]

Originally Posted by Adam Wander

I find his treatments help a lot. When I leave I have considerably less discomfort.



I will preface that throughout my adult life I have had issues with lower back pain/injury, but I don't recall what or when the first incident was.

The most recent incidences seem to have the same cycle. I will be doing some physical activity - it could be a strenuous workout, simply bending over to pick something up, jogging, etc - and will immediately get an intense twinge of pain in my lower back. (The past handful have been on the left side.) This twinge is followed by extreme pain and stiffness which is centered around my lower back just above my butt (again, most recently on my left side), which lasts for days.

Over the course of the next few weeks, as the pain starts to dissipate, I have a different, aching-type pain that begins to come on around the front of my pelvis/hip area. The pain and stiffness increases as I attempt to stand from a sitting position or if I am in a sitting position and attempt to lift my leg parallel with the floor. During this time, I also have pain/tightness in my butt cheek area.

I get a popping sound/feeling (no pain at all) in my left hip when I move my left leg in certain ways (e.g., laying flat on my back, bringing my knee to my chest, and then extending it straight again). I believe this is present all of the time, regardless of whether I am injured.

This is awkward and I apologize: I have a hard time moving my bowels when the injury is present.

good clarification!

It sounds relatively minor, but you need a proper assessment, which you clearly haven't received yet.

Myofascial release and nerve flossing is OK for symptom relief, but it won't solve the root cause of your dysfunction. If you want to solve your problem you need to move away from symptom relief and move towards causative factors. Find some one (be it Chiro, PT, etc.) who will examine you properly, tell you exactly what's going on, and outline a plan to solve the problem. They are out there, but you may have to do some homework.

You're symptoms point towards SI joint subluxation......But there are a number of different ways this can happen, and we don't have much way of knowing if its the actual pain generator.

BM's slow down when the body is stressed

sympathetic activity-->less non-critical physiological function-->less Small intesitine motility.

There are fixes for these issues, but they are typically very deep and seemingly unrelated, which is why people run around with this type of thing their whole life.

[Steven Low]

Estim/ultra seems to be variable for a lot of people.

Some people swear that it helps them (patients) but the rate is probably very low around like 10-20%.

When I'm a PT I'll just ask if it's helping or not and offer it but I'm definitely not going to require it, heh.

[Beck Randelin]

wow - your symptoms sound exactly like mine, including the "popping/no pain" thing... My chiro diagnosed it as SI, a year ago it was bad enough I couldn't walk - well, if I held my breath and walked in mincing steps, it would loosen up enough I could get to a full stride then I could run just fine! At least the first day... stupid me!

Saw an ortho, prednisone shots, got an MRI, clean bill. Doc said do what you want but don't make yourself miserable. Googled everything I could find on low back pain and one program that came up consistently was Mark Vestergen's "CORE Performance"... I started with the CORE's 3-week section of "If you're coming off of an injury" - full workouts with movement prep, foam rolling, dynamic stretching, swiss ball, joint mobility & weights.

Now, I *love* crossfit, but for my back I'm continuing to use the CORE Performance "Movement Prep" exercises during my warmups to keep my back mobile.

I'm pain free if I'm doing a MP + a solid weight lifting program (CF is awesome!)- If I skip workouts for even two weeks, my back lets me know it's not happy. I actually quite the chiro stuff cuz the exercise is more effective. My chiro is chagrined - he says I'm looking very fit and I'm one of his only patients that actually does the exercises he prescribes! I started with his PT routine and moved into CORE from there.

I'm 51, female, 10# overweight again - losing those will help too. Very fit according to my families standards, not so fit according to CF standards!

One thing you haven't mentioned is your state? age/weight/fitness level - those can all play into it too...

Now for sure our backs are *not* the same and you should definitely find a professional to guide you, but the degree that fitness and an appropriate warm-up play into this could be important too...

[Beck Randelin]

p.s. I agree with the comments on the symptom-easing treatments - they can provide some pain relief at the time but I didn't find they helped anything long term. The only long term relief I've found is in appropriate workouts. I think a good PT is a better help with this than a chiro -- or maybe a chiro that truly understands fitness (mine doesn't)