Advice on lower back lateral pain please
Posted , 5 users are following.
Hi,
?I'm a 42-year old male, 85 kg, 1m90, in good general health with no history of back pain. I exercise regularly, usually running twice a week and swimming twice a week (last year I ran a marathon). 9 weeks ago I started to feel pain in my lower left back during the night. It has since made it uncomfortable for me at night and I can't get decent rest beyond the very early hours of the morning. It's very difficult to get out of bed. It gradually goes away during the 1st hour after I get up and I can have a normal day, appart from the obvious fact that I'm not well-rested. The pain is not located anywhere near the spine but rather feels like it's in the top of the ilium bone (or surrounding tissues) on the left. It's also worth pointing that the other time I feel the pain badly (other than in the early hours in bed) is after a swim, when I take deep breaths, possibly due to the tumble turning (?). So I stopped swimming altogether two weeks ago but I don't think it's changed much.
?I've seen a GP (several times if you include the calls) and have been referred for physio where I've be assigned stretches. They haven't made an iota of difference. I've seen an orthopaedic surgeon who had an MRI scan carried out on me and ultrasound scan of my "giblets" (his words) to rule out serious pathology of the L kidney, speen etc. Nothing has come up on either. I was however slightly puzzled by the imaging consultant's MRI report because it was exclusively spine-focussed whereas my pain doesn't seem to stem from that area at all.
?Today I contacted the consultant's secretary to ask for a referral to see a rheumatologist. Instead she said I should come back to see the consultant. My appointment isn't for another 6 days. I've also scheduled more physio, with a different practitioner this time. In the meantime I dread going to bed at night and was wondering if anyone had any ideas that could help?
1 like, 2 replies
ronanwil glider26
Posted
jason00302 glider26
Posted
There are some concerning factors and some positive factors in what you’re describing here. Firstly I believe the soft tissue or muscle involved here is the gluteal medius, where most of its fibres originate around the posterior wall of the iliac crest or ilium bone of the pelvis, as you mentioned. The positive factor being that your discomfort or pain usually goes after the 1st hour or so of your day and you seem fine, having a fairly normal day as you put it. This is a good indication that your pain is more muscular in nature and as blood flow increases as your awake and moving the discomfort subsides.
The concerning factor is that you have discomfort but in particular at night. Night pain at any level is not usually a good sign. However, I believe your discomfort is being triggered, not caused but the immobility at night and lying on this area creating some pressure on this muscular structure, which is already contracted and tight. This in turn further compresses the soft tissue to squeeze on the neural pathways that run through the muscle eliciting a pain response or deep seated aching, that I believe your experiencing.
With any tight and contracted muscle there is going to be a poor supply of blood and oxygen hence why when you are up and walking blood supply is increased and pain subsides. I believe what is precisely causing your pain is related to the fact that your gluteal muscles (the gluteal medius, gluteal maximums and gluteal minimus as well as the deep piriformis muscle) being your external hip rotators that allow you to turn your leg outward have become contracted and tight.
This contraction and tightness is caused by excessive external tibial torsion. This is where the tibial bone is rotated and defines how duck footed we are. This in turn rotates the femur outward and places the external hip rotator muscles into a shortened position. I can guarantee you are duck foot or have your feet turned outward and this would be more on your left foot than right foot. This would explain why you have this problem and pain on your left side. Therefore, the cause of your pain is excess external tibial torsion.
Whilst I specialise with muscular skeletal pain and this type of Inherited Biomechanical DNA as a practitioner for the past 23 years a temporary way to manage your pain and discomfort here would be to use a hot water bottle before bed for about half an hour. This will warm the muscle and improve blood flow prior to sleep, releasing the nerve. You could also try stretching this muscle by lying on your back and pulling the left knee to your chest with the left arm and with the right arm pull your knee at the same time across your chest. This will pinpoint the specific muscle. With the straight right leg turn your foot inward, this will intensify the stretch for you.
But remember it would be wise to tackle the cause of the external tibial torsion long term, and not just the symptoms here.
Good luck and I hope this info helps.