T Nation

Injury : Cressey & Robertson- Help?

This is mostly aimed at the amazing minds of Eric Cressey and Mike Robertson and Dr. Ryan but any input is greatly appreciated.

Here is the deal- I have had an injury for damn near a year and I wont heal. I have been over to myalgistat.com and recieved some absolutely amazing advice from TT concerning food allergies and body chemistry and perhaps having fibromyalgia. That side of the coin is in the works concerning healing and I am going to make a post about those issues seperately and beg Dr. Ryan for some help there. Now I am hoping for some help with this side of the coin from the ultimate brains here.

I will start with the fact that I was/am the neanderthal. I exhibit at least some of the tell tale signs of each of the problems addressed in the neanderthal articles. The worst of the conditions was the overactive and tight QL contributing to the overpronounced arch in the lower back. I have tight and inhibited hip flexors and INTERNALLY(i had externally, im an idiot) rotated femurs (the right side is much worse than the left).

Next the injury. The first time it happened i was 19 and replacing windows under the table. My genius boss managed to drop a bay window on my head and my back was injured- it hurt like bloody hell on the lower left side. I was young and healed pretty quickly and thought nothing of it. I had a couple minor episodes from sports or lifting through the years, but nothing major- back in the game within a week or two. The latest injury has sat me down for damn near a year. I was squatting and felt a nice sizzle at the lower left side of the small of my back.

It steadily hurt more and more and more until I went to and ortho. I recieved the diagnosis of a disc problem and got some antis and relaxers. Did some good until the scripts ran out. I went to a chiro and PT and the diagnosis was injury to my QL and piriformis. From reading I have done that diagnosis was dead on. As of late it has been more my piriformis than my QL, but for some reason today my QL is back at it and hurting like a mother. I cant sit for more than ten minutes, I cant do even light upper body work, I cant stand for more than 20 minutes. It makes working on my thesis a royal pain in the rump.

I guess my point is - HELP PLEASE. If there is anything I left out or didnt explain enough or clearly please let me know. I greatly appreciate any help. Thanks.

I am not above begging. Anybody? Pretty Pretty Please?

Are you sure it’s not an injury to an area that innervates the QL and piriformis…say a disc injury or a facet joint injury around L3/L4?

Is the pain in one spot, or is their radicular pain into the glute, leg, heel, etc.?

What movements irritate/reproduce the pain?

Your QL isn’t going to increase your lordosis, but if overactive it will “hike” your hip and create pelvic obliquity.

It’s really tough to tell with what you’ve given us; tell us more and maybe we can help. One thing that I tend to see in this area is someone with an overactive QL and/or a boatload of trigger points/adhesions in their upper glutes. Static stretching/PNF for the QL and foam rolling of the glutes can help immensely if this is the case.

Stay strong
MR

Also, I’m curious as to where you feel tightness. Chances are that this will be a good indicator of how and where you’re compensating.

Hey guys, thanks a million for the replies. Reading back over it I didnt give you much to go on… Sorry about that. My initial post at myalgistat.com was better but i think i skipped half the stuff here.

I saw an ortho about a month after it happened and she diagnosed me w/ a possible herniated disc and possible strained muscle. I got a ton of antis and muscle relaxers. They seemed to do the trick, but as soon as they ran out everything was back. When the ortho suggested surgery I ran for my life to a chiro and PT.

The chiro and PTs inputs were tight QL and problem with the piriformis (inflammationa and tension). ART on the piri helped a ton. In my rehab with the PT we discovered inhibited glutes something horrible, possibly inhibited hip flexors (hip flexor stretches are no problem, though, so I dont know if they are tight or not but I evidently exhibit the signs of tight hip flexors) and an anterior pelvic tilt. We also found freakishly tight calves. My hamstrings are amazingly flexible. My tfl on the right side is tight- i think that is related to the internally rotated femur. My right foot ALWAYS points out, up to 30-40degrees I would say.

I experience pain at the top of my left glute, lower left glute, down my left leg mostly on the outter quad and sometimes down into my calf and heel.

I notice when I stand my hips automatically want to shift forward (anterior tilt). My glutes are practically non-existant when I stand or do squats- except now it feels as if my pirirformis/upper glute is always firing.

As far as the QL, I experience tightness in the morning and really notice it if i sit for more than 10 minutes- it hurts like crazy after sitting.

The predominant pain as of late has been in the piri/upper glute area. Constant burning pain. Anti inflammatories seem to help, which lead me over to Myalgistat- constant inflammation seems to be a sign of fibromyalgia.

I have been doing SMR with the foam roller almost since the article “Feel Better for 10 Bucks” came out. It seems to help for short durations, maybe an hour or so.

Movements that cause pain:
-squatting- Stiffness and pain in the lower back, especially the lower left side (the QL region?)

-The “scorpion” movement described in “Get your butt in gear” lights my left side up. Pain shoots down the left leg into the foot when I lift the left leg in the scorpion movment.

-Sitting in any form. Lower left side (QL?) gets stiff and starts hurting very quickly. The glute also hurts when sitting.

-Bending over. Lower left side of back, and upper left glute (piriformis region?).

-The real bitch is any time I tense any part of my body it hurts in the lower back and upper glute (QL and piriformis?) on the left side. Any tension anywhere in my body causes that region to hurt. Even light upper body training hurts in that region.

Sorry for the lack of information in the initial post. I hope this gives you more of what you need to know. Your thoughts and ideas are truly appreciated. Thanks guys.

I think it’s fair to say that you need to have someone give you a firm diagnosis; Eric, Dr. Ryan and myself can’t possibly do that over the internet.

However, first and foremost I would get an MRI taken. With the radicular pain and the variety of movements that cause pain, I would want to know if/where I have a disc herniation, if in fact that is the case. I can’t understand how someone would simply diagnose you as having a disc injury and prescribe meds. I, personally, would want to have it confirmed via MRI and then set-up a plan of attack.

Once you have a firm diagnosis in place, a better game plan can be laid out. Sometimes this is the toughest part (the diagnosis), but still critical in the grand scheme of things.

Good luck!

Stay strong
MR

Thanks a million for your thoughts, Mr. Robertson. I truly appreciate it. Now the bitch is getting an MRI with no health insurance…

Based on your description, a left sided disc protrusion with radicular symptoms would have to be ruled out.

Obviously, an MRI is the best option, but those aren’t exactly cheap either.

We can try to have you do a few movements and assess your response. Based on the response, some general recommendations could be made:

When you perform these movements, pay attention to the pain in your back and in your leg. It is important to take notice of how the symptoms change with the movements. Does the back pain get better, worse or stay the same? Does the leg pain get better, worse, or stay the same, and how far down the leg does it go.

Bend forward once- pain, location
Bend backwards once- same
Bend left once-same
Bend right once- same
Rotate left once-same
Rotate right once- same

Next repeat the movements above, but do 10 reps of each. Monitor the pain with rep 1 and then how it changes with additional reps.

Finally lay on your stomach and perform a set of ten press-up (Cobra position in yoga) Sort of like a push up except only your upper body lifts up, your pelvis stays in contact with the ground. Monitor symptoms.

Roll on you back and do 10 reps of knees to chest and monitor symptoms.

Provide the above info and maybe we can you help out.

Obviously it would be best to get the MRI and have a doc in your area help you,but we will do what we can.

Check out the Cool Tips archive for the get on a roll tip. It should help make sitting a little easier.

Also, I forgot to mention that with your history of psorasis that you talked about in the other thread, you would also want to rule out any type of inflammatory arthritis affecting the facet or sacroliliac joints.

Take care,

Ryan

First off I just want to say thanks to everybody for their thoughts, efforts and help. I seriously appreciate it.

Dr. Ryan, here are the answers to your diagnostic questions. I am not the greatest at the descriptions so I am going to go question by question with a picture of the general locations followings this post to try to help my pitiful descriptive abilities. The amount of pain is in prentheses and on scale from 0 (no pain) to 10 (friggin horrible pain).

Bend forward once ?pain, location-(3-5) spinal erector area on left side, almost on the spine. (1-2) Slight pain in upper glute and out to the hip region

Bend backwards once ? (1-3) spinal erector area

Bend left once-nada pain- slight stretch in right oblique area (fwd hip area)

Bend right once- (1-3) slight pain in QL area, stretch through area and in oblique area

On the rotations I did two versions- one with the hips staying static and only the shoulders rotating and the others with the hips rotating as well.

Rotate left once- (1-3) slight pain in erector area and glute directly below erector spot with hips static. (2-4) with the hips rotating

Rotate right once-nada if hips static. (0-2) slight in upper left glute if hips rotate

Bend forward 10 times ? (5-6) same location as once, intensified through reps

Bend backwards 10 times?(1-3) same area as bend fwd1-3

Bend left 10 times- (sharp shooting pain, 5-7) tweaked the upper lt glute on a few of the reps-

Bend right 10 times-just a stretch in the lt lower back region

On the rotations I did two versions- one with the hips staying static and only the shoulders rotating and the others with the hips rotating as well.

Rotate left 10 times- (2-3) lower lt and upper glute with hips static. (3-4) If rock hips upper glute- mostly on the outer point of the rotation (farthest rotated point). Tingling a little down the leg at the last few reps

Rotate right 10 times-nada if hips static. (1-2) a little in the upper left glute

Press ups 10 times- (3-5) upper left glute area around rep 5. got up to about a (3-5) by rep 10

Did two versions of knees to the chest. 1 version I straightened the legs out and pulled the knees as high as I could while keeping a neutral spine (I can only get slightly past 90degree femur-hip angle) and 1 version with bent knees going all the way to my chest.

Knee to chest 10 times- (0-1) on the straightened leg version. (1-3) in the lower left back region with the bent leg all the way to chest

As I finish doing these I notice the upper glute/lower back area start to hurt. 2-4.

I also noticed that my left hip rocks forward in relation to my right hip when I stand. Is this the obliquity that Mike Robertson was speaking of?

The pictures follow. Thanks.


Bend forward once ?pain, location-(3-5) spinal erector area on left side, almost on the spine. (1-2) Slight pain in upper glute and out to the hip region. Area is circled in red in picture

Bend backwards once ? (1-3) spinal erector area


Bend left once-nada pain- slight stretch in right oblique area (fwd hip area)- no picture needed- unless you want one.

Bend right once- (1-3) slight pain in QL area, stretch through area and in oblique area

On the rotations I did two versions- one with the hips staying static and only the shoulders rotating and the others with the hips rotating as well.

Rotate left once- (1-3) slight pain in erector area and glute directly below erector spot with hips static. (2-4) with the hips rotating

On the rotations I did two versions- one with the hips staying static and only the shoulders rotating and the others with the hips rotating as well.

Rotate right once-nada if hips static. (0-2) slight in upper left glute if hips rotate

Bend forward 10 times ? (5-6) same location as once, intensified through reps. Pic above

Bend backwards 10 ?(1-3) same area as bend fwd. Pic above

Bend left 10- (sharp shooting pain, 5-7) tweaked the upper lt glute on a few of the reps-

http://images.t-nation.com/forum_images/./1/.1115227356010.bend_left_10.JPG

forgot the darn pic

Bend left 10- (sharp shooting pain, 5-7) tweaked the upper lt glute on a few of the reps-

Bend right 10-just a stretch in the lt lower back region

On the rotations I did two versions- one with the hips staying static and only the shoulders rotating and the others with the hips rotating as well.

Rotate left 10- (2-3) lower lt and upper glute with hips static. (3-4) If rock hips upper glute- mostly on the outer point of the rotation (farthest rotated point). Tingling a little down the leg at the last few reps


Rotate right 10-nada if hips static. (1-2) a little in the upper left glute

Press ups 10- (3-5) upper left glute area around rep 5. got up to about a (3-5) by rep 10

Did two versions of knees to the chest. 1 version I straightened the legs out and pulled the knees as high as I could while keeping a neutral spine (I can only get slightly past 90degree femur-hip angle) and 1 version with bent knees going all the way to my chest.

Knee ups 10- (0-1) on the straightened leg version. (1-3) in the lower left back region with the bent leg all the way to chest