left posterior hip pain
I am writing in this forum, for a few reasons. Firstly so no one will make the same mistake as me and develop chronic disabling pain, and secondly to see if anyone can provide any additional advice.
I have (or had) been running for 12 years with no significant injury up until last year. In that time period, I ran 10km on a daily basis, plus several half marathons, and a couple off road 30-40km runs including mountain tracks, in the snow, etc. I mainly ran for personal enjoyment. I absolutely loved it, running was such an important part of my life. It was a great way to get in to the bush, away from the city, and explore new environments.
Approximately, 10 months ago, my sister asked me if I would like to enter a 36km off road race in NZ. I eagerly agreed, and started a training program with gradual increase in running mileage. Near the end of a 20km run, I developed a sudden onset of posterior left hip pain. I really did not think much of it, continued to run without resting the injury. The following weekend, I did another 20km training run. At the 12km mark, my left posterior hip pain returned forcing me to walk. Unfortunately I continued to train. At this stage my hip pain would flare at the start, and end of runs, whilst driving, or sitting for prolonged periods. I ignored the pain, never seeked medical attention (being a medical professional myself), and continued to run. Nothing was going to stop me. Then one day in october, whilst walking by the sea, the dull posterior hip pain rapidly increased in severity to the extent I could not continue walking. The pain was sharp and localized to posterior hip/SI region. I could barely make it back to the car, and it took me 30minutes to be able to sit down in the car. Since that day, I have not been able to walk more than 5 minutes, let alone return to running. My symptoms include a constant dull posterior hip ache, worse on sitting, walking, and can radiate down the posterior aspect of my thigh, to lateral aspect of my calf and dorsum of foot. In the morning, I will often get a severe sharp posterior hip pain on standing, and taking my first steps. Bending and sitting really increases the sharp pain. If I relax, and stop moving it will gradually reside. There have been a couple of occasions the pain has improved, to the extent I can walk for short periods, however often exacerbated by simple activities (travelling in unsupported back seat of car, or carrying 4kg). Then I am back to square one.
I have been to see sports physician, who queried the possibility of a sacral stress fracture. The MRI was normal (of course). He referred me for a dynamic USS of my hip ?sciatic nerve tethering/nerve entrapment- piriformis syndrome. The radiologist told me my sciatic nerve was extremely tethered, being the worst case he had ever seen. He then proceeded to perform a sciatic nerve hydrodilatation injection to release the nerve. This was a very painful procedure, and exacerbated my pain. A second injection was done 4 weeks later with further worsening of pain. They then repeated an MRI focusing on the piriformis muscle to see if this was causing sciatic nerve entrapment and tethering and whether surgical treatment was necessary. The MRI was not convincing, however the radiologist thought there was some sciatic nerve entrapment at the piriformis. (my sciatic nerve does not pass through the piriformis muscle). There was also oedema around ischial tuberosity where hamstring attaches indicating tendinopathy, although I had this on the right hip as well (common finding in runners).
I was referred to an orthopaedic hip surgeon who felt the diagnosis remained unclear. When he reviewed the MRI he thought there could be a possible labral tear. Thus a diagnostic hip joint injection was done to exclude a joint problem. There was no improvement following the hip injectio
I used to experience severe hip pain on the right side after running about 10 miles. Absolutely nothing I could do but walk slowly to the finish. I did some research and found it could have been IT bands. Always do a stretch routine before running now and its never come back.
Do you think you could have a grade 3 hip flexor strain or hip flexor tendonitis ?
Good that investigations have ruled out structural and joint damage. Sounds like it started out as 'just' pirformis syndrome but because you ignored it your body set up lots of compensatory movement patterns to allow you to carry on running. Intially a tight priformis may have irritated the sciatic but now I would imagine piriformis and contral-lateral hip muscles and hamstrings/adductors/abductors are pullling pelvis 'out' and creating further impingment/irritation of the sciatic.
Without knowing which are tight i would stretch ALL muscles* attached to your pelvis and legs (and lats and obliques for good measure), then start basic gait re-education to make sure muscle firing patterns are right.
*Sorry, should have said stretch all tight/short muscles. Part of compensation strategy probably means there are over-stretched/inhibited muscles in your hip(s) and stretching them will only make problem worse!
Piriformis syndrome and tight hip flexors will initiate problems you have suggested as will an over contracted I.T band / TFL with tendinopathy.
Stretching the I.T band and hip flexors will relieve some of the pain but the gluteal muscles also need checking to see if they are firing in the correct sequence, otherwise compensatory movement patterns are guarenteed which open the door to a multitude of potential problems. Strengthening exercises should also be implemented particularly in the glute/ hamstring and quad areas to facilitate any rehabilitation plan.
A Labral tear can be diagnosed with an MRA ( MRI with a contrast dye) has this been suggested to you? Also I would ask your OS if they have ruled out FAI as this can be an underlying factor to a tear and often causes the posterior symptoms that you describe. No amount of PT will cure a labral tear, it would need an arthroscopy.
Good luck I hope you find an answer soon, after 5 years of dealing with complicated hips and 6 surgeries I know how frustrating it is.
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