T Nation

Ab/Groin/Back Pain, Dr Doesn't Know Why


#1

Lots of smart people on here so I'm hoping someone may have some suggestions about what may be wrong. This could get long so I will just try to highlight the problems and what doctors have tested.

I have been dealing with a pain in my inguinal area that goes up into the lower right quadrant of my abdomen. I also have pain that runs along my low back just above my right butt cheek and acrossed the middle of my back right around my t spine.

The inguinal area feels like a swelling type pain, a constand 2 to 3 out of 10 pain scale. The abdomen feels heavy and dull and pain ranges from 0 to maybe a 5 when it "flares" up. Back pain is constant and annoying but not incapacitating, almost feels like really weak muscles.

I tried resting which doesn't seem to help. After resting and being inactive for about 5 months I finally went to a doctor. He thought it may be a hernia so I was sent to a surgeon who specialized in hernias. After 3 appointments stretching over about 5 more months I was told I have no hernia.

Went to an orthopedic surgeon who did find a very small labral tear in my hip but they seemed pretty suprised it was even causing me pain. I'm not convinced this is what is causing everything because resting or working out seems to make no difference.

Kept having pain and went to urgent care a few months after the orthopedic. Did urine and blood tests for infection and stds. Sonogram to confirm no hernia or muscle tears etc. Didn't find any problems with blood or urine tests. No hernia but they said I have a minor inguinal strain and I just needed rest. If this was the problem I have certainly rested it enough, why hasn't it healed?The week of rest with naproxen twice a day is over, it helped swelling but theres still pain.

My GP checked my flexability and took both legs through range of motion and did some tests against resistance. No pain through any range of motion, said my flexability is good.

He had me lay on back and try to pull knee to chest. On my right side I could not move my leg against the Dr's resistance, I felt like my back was trying to pull my leg and it was notably weaker than my left side. When the doctor tested my left leg I pulled him of balance and felt no pulling from the back feeling. He said I just need to strengthen my muscles but did not say this could be causing my pain. I also have noticed it is difficult to balance on my right leg when I always used to have great balance and my left side is still good.

Sorry for such a long post, I don't know what else to have tested and my doctors aren't sure what is actualy wrong. They say I seem very healthy but I know there is something wrong it just doesn't feel right. I am afraid to work out the way I want to or even at all. It has been about a year since I have felt ok enough to go to the gym for more than a week and I just want to lift.

I hope someone out there may have an answer. Some of my research makes me thing I might have a tight psoas muscle. I really have no clue I just want to feel normal again and be able to lift and live everyday life pain free.


#2

I have no idea what you have, and probably my advice is dangerous, but have you tried doing BW squats daily and light deadlifts and goodmorninings and see what happens?


#3

I am suspicious of sacro-iliac dysfunction. That could cause pain and stress on the ilio-inguinal ligament, pain in the low back (the S-I joint itself) and pain to the lower t-spine via the quadratus lumborum muscle (which is almost ALWAYS tight in sacro-iliac problems).

Obviously take this with a grain of salt; I try not to make internet diagnoses without seeing a person, but I also hate to see people suffer and spend untold amounts of money for a doctor to shrug and say "live with it". Have you tried a reputable chiropractor?


#4

Was a disc bulge ruled out? Certain disc bulges can cause referral pain into the groin area and also cause muscle guarding/spasming in the low back around where the bulge is located?

As Dr J stated, an internet diagnosis is no the best thing to use, especially when we can't physically eval you. He is also correct that it may be an SI joint issue as well.

Can you tell us more about your physical attributes? How is your mobility? And pelvic listing or tilting? Gluteal activation? Play on sports or just lift? Anything specific cause the initial pain?


#5

OP,

Tight muscles do not cause pain and weak muscles do not cause pain. Sacroiliac joint upslips/downslips/rotations/torsions, vertebral subluxations etc have never been reliably identified, have no valid means or relationship to back pain (or anything) and exist in asymptomatic patients.

With that said, if any of your sought out 'healthcare professionals' make claims similar to the ones I've identified, move on, save your money. This includes any and all rehabilitation professions. If they use this terminology they have not opened a high quality research article in ten years.

A few questions:

How did this start: injury, gradual, sudden, etc?

Any history of this or anything similar to it?

How was the labral lesion identified? MRA (not MRI) has the most clinical utility. Understand this may correlate (not cause) to your symptoms, but these are present in a large percentage of adult populations.

Mr. Levelheaded makes a valid point. I wouldn't say a disc bulge, because these are also present in a large percentage of the population. Attempt to rule out lumbar spine referral. Pain with bending over? Leaning backward, Right, left, etc? Pain with sitting with R leg extended? Pain when laying down and performing a straight leg raise?

What specific activities (SPECIFIC!) create your pain. What makes the groin worse? What makes the back worse? What makes the abdomen worse? If one is worse, do the others follow? Are they separate or related?

Any changes with eating, going to the bathroom, loss of bowel or bladder. If there are, go back to your GP and tell them so.


#6

Certainly sounds like a psoas issue. Reading about your examination, the doc has performed a psoas strength test (there's a certain name for it, but can't remember) and your couldn't move against the resistance, which is a positive result for a weak psoas.

The abdominal/groin region of pain you describe also sounds pretty bang-on for psoas. Have a look over the first half of this article, and see if you notice any of the compensations for a weak psoas, which may help to clarify things a little more: http://www.elitefts.com/documents/hip_flexor.htm

The pain could be due to any number of things; it may have gone into spasm, it may have been sprained, it may even have just been overstretched (hopefully someone else can offer better insight.) Properly resting it will of course be difficult, due to its involement in everyday activities, and any attempts at myofascial release will be difficult due to it being such a deep muscle.

It may be worth going to see a physio, or perhaps an ART specialist, if you can find one. This is all my own personal thoughts on the matter, obviosuly take from it what you will!


#7

I may have explained poorly. It seemed to happen gradually and the mid back pain happened a few months after the groin pain.

The labral tear was discovered through an MRI.

There is no pain with bending or anything. The pain seems to come and go through the day and sitting for a long time makes it worse.


#8

So it looks like I have a bit of Anterior Pelvic tilt, could this be casuing all my problems? I have been working on it with stretching and trying to stand with better posture.

Some things I have noticed is that heat helps while it is applied, but pain comes right back within a few min of removing heat. Stretching seems to help my groin area temporarily.

Thinking back it seems as if everything has gotten progressively worse and more frequent, to the point of being almost constant, since starting a job a year ago where I sit all night long. So I am sitting most of the day while in class and most of the night while at work.


#9

If the pain comes and goes try an elisa test and or western blot for Lymes disease. I recently got diagnosed. Search google and see if any of the symptoms match what your experinceing cause its an elusive fucking bacteria.

Hope you get well


#10

Thanks, it doesn't really sound like lyme disease. After really focusing on it, pretty much constantly, I think it is due to posture. I will try to get some pictures up.

I know I have APT but sometimes it feels like my right leg is shorter. I'm hoping this is it and I just finished reading the neanderthal no more series and am thinking about following that program. I will also be seeing a chiropractor soon, so hopefully if it is a postural problem they will be able to identify it.