After reading your post, I believe your primary problem is a muscular imbalance at the hip, which in turn, has caused you to develop sciatic or piriformis pain. Your condition is likely the result of poor posture and faulty movement patterns in the hip area.
The muscular imbalance at your hip stems from the various activities that you indicte you participate in on a regular basis - soccer, hiking and cycling - all of which places a heavy demand on the psoas muscle, especially soccer.
Within the body, there are muscles that are classified as slow twitch, and muscles that are classified as fast twitch. Slow twitch muscles tend to shorten and tighten with use/overuse, while fast twitch muscles tend to lengthen and weaken with use/overuse. Of all of the muscles in the body, the psoas muscle is the most likely to shorten and tighten the more it is used because it is of the slow twitch type.
This is called a "facilitated muscle" or an "altered neurological flow"between the muscle and the central nervous system.
Because of the psoas' attachment points on the vetebra of the lower bake and the lesser trochanter of the femur, the psoas in a shortened state plays havoc with our spines. One way to tell if you have tight psoas muscles is to back up to a wall so that your head, shoulders, behind and heels touch the wall (called the "wall standing test" for lordosis). Take your hand and slide it between the wall and your lower back at the beltline level. With a proper arch in your lower back, your hand should just slide between the wall and your lower back. If it slides in with extra space between your hand and back, then you most likely have tight psoas muscles. If you look vertically aligned from the side, your shoulder, hip and ankle are aligned vertically above each other, you probably have a kyphosis-lordosis posture.
Let me know what you find after you perform the "wall standing test" and I'll give you some stretches and exercises to do.
Don't despair, your condition is fairly common; especially among more athletic types. It just takes persistence using the correct stretches and exercises.
Your goals are realistic - one year is a long time to rehab your lower back. Hold off on activities that cause a lot of hip flexion, until you have strengthened the weak side of your hip. Try to avoid any activity or movement that causes you pain.
Margie wrote:I've enjoyed reading this thread as there is some good information and the responses adress individual concerns. My problem is similar to some of those adressed but a little different as well. I'm currently battling with what I believe to be an SI joint disfunction that started just under a year ago. X-rays showed no abnormalities in my spine or pelvis. Symptoms I've experienced include:
Pain in the piriformis and general buttock area on my right side at more or less level 6, (now diminished)
Pain around the SI joint on the right side at more or less level 7 (now diminished)
Constant pain at about level 3 on the outer trochanter on the right side when it is under pressure (lying on that side),
Knotted muscles in the hamstring which was relieved by dry needling
More recently pain around the SI joint on the left side, usually after doing something remotely strenuous, this pain has started to move into the left buttock as well
A feeling of being twisted and unbalanced around the pelvic area
I was playing soccer regularly, cycling, hiking and generally quite sporty and active before the injury, I'm 24 years old, never been pregnant and the only back injury I've had was an accident with a swing when I was 6. I also work in a desk job and believe sitting to be a contributer (I'll be looking into buying a swiss ball soon, thanks for the tip)
Diagnosis was done by an orthopeadic (spelling?) doctor who believed the cause of the problem to be repetetive strain combined with ligament laxity. At the time he said he couldn't be sure if a tight piriformis was contributing to the si problem or the other way round. However piriformis symptoms have diminished significantly so I think the SI joint is probably the cause.
I've experienced no numbness and still have good mobility, I can pretty much move normally except movement causes pain after. Treatments included:
Physiotherapy: massage, needlepoint, ultrasound and core stabilising exercises which kept up quite well
I also now wear orthotics inserts for walking
Pain has reduced alot especially since I started wearing the orthotics, for a while I only felt slight pain on the outer trochanter when lying on that side. However my ultimate goal is to be able to return to intense activity and I have hit a wall here. Every time I try something slightly strenuous, I end up in pain again. I am also concerned that the pain has started shifting to the other side of my body and seems to be starting to get worse again.
I'd like to get some additional insight into my problem. Are my goals unrealistic? Should I be trying to manage pain rather then return to my former level of activity? Are there any other actions I should consider? Am I just being impatient. I would really appreciate help or suggestions especially on things I can do without having to pay for expensive treatments.