Questions on One-Sided Back Pain

[jimp1234]

I quess this could be "Pain in the Gluteus" part deux, but here goes. I've got pain in my lower back/glute/hip on one side only (left side) and and its gets worse in a pretty linear fashion (i.e. more miles, more intensity == more pain, back off/rest == gets better). I've had this problem off and on for quite a while so last year decided to fix it. For the last 8 - 10 months I've been going all out to try to find a solution, with new frame (worked with some good fitters) orthotics, chiro, core exercises, pilates, orthopedist, etc. Learned a lot but still haven't gotten the magic formula. My latest theory is functional leg length and/or pelvic asymetry. I'm seeing my orthopedist next week, and seeing about doing some xrays for leg length. While I realize there could be many difference causes for this kind of pain I'd be interesed in hearing from anyone with a similar condition. My questions below.


What caused your problem?
Did you fix it?
If yes what did you do to fix it?
If it was leg length was the painful side the "short" side?
Quess there's a couple of different ways to use xrays to determine LL, if so which one did you use?
Any disciples of Steve Hogg, the Aussie who writes a lot about LLD in CyclingNews?


thanx

-Jim

[paczki]

What caused your problem?

Bending over and opening a stuck freezer case at a deli. Right side of lower back. So bad I fell to the ground and couldn't roll over. Recurred until....

If yes what did you do to fix it?

Tai Chi for years -- can't beat it -- and more recently squats and core strengthening. Can tweak it still, on very rare occasions, but goes away quickly. :banana:

[kipjac]

:crap: Sounds to me like it could be sciatica; it's frequently characterized by unilateral pain or numbness or some other weird parathesia down one leg or hip, although honestly, sciatica can take many forms

[Fixed]

never rule out the heart it's pain can be anywhere
imho

[avalonracing]

:crap: Sounds to me like it could be sciatica

Could be...
I would also look into core strength. I had a bit of chronic back pain for the longest time. I started working my abs and it was gone in a few weeks and has never returned.

[regularguy412]

:crap: Sounds to me like it could be sciatica; it's frequently characterized by unilateral pain or numbness or some other weird parathesia down one leg or hip, although honestly, sciatica can take many forms

+1 on sciatica. Get a good set of x-rays -- see if there's anything outta place. I have a compression fracture of L3 and it's corresponding lower disc. Puts stuff out of alignment. I shim my right cleat 3 mm. Won't ever be 'well' from it. But it does go through cycles of better and worse. Core work (esp. the transverse abdominus) will help. So will strength exercises.

Everything at this point is pure conjecture, without a definite professional assessment. Let us know how it goes. I'd be very interested, personally, to know what you find and of any remedies.

Mike in AR

[Ti Designs]

My latest theory is functional leg length and/or pelvic asymetry. I'm seeing my orthopedist next week, and seeing about doing some xrays for leg length. While I realize there could be many difference causes for this kind of pain I'd be interesed in hearing from anyone with a similar condition.

Pain in the lower back directly above the hip does indicate an asymetry in the two sides, but what to do about it depends on what it is. The bike is one of the rare cases where the motion of the foot is dictated by the crank. When walking the foot is held in place only when it's on the ground, when it's in the air the two sides are free to have their own, often different paths. I was recently shown something very interesting, a person with a significant leg length difference being filmed walking on a treadmill. The strides were almost exactly the same length, but their position relative to the pelvis was staggered. On the bike that's not possible because both cranks rotate on the same bottom bracket. The lower back pain shows up on the side with the longer femur, or the forward hip.

Without knowing more I refuse to spew advice on a solution. There are changes in cleat position based on femur lenght differences, there are shim solutuions for tibia lenght differences, there's even a footbed trick for pelvic twist...

[dave thompson]

While "sciatica" was the descriptive term to describe my wife's pain of the lower back/glute/hip on one side of her body, the source of the "sciatica" was an arthritic L5/S1 joint, which she underwent surgery for just this Monday to have fused.

I would tell you to see a good back surgeon who can rule out, or diagnose such a problem. My wife underwent 3 years of chiro, exercise, PT and various injections to no avail. The pain, treatments and the medications intensified over the years and oddly enough riding her bike was not painful, just afterwards.

Beware of interweb diagnoses.

[Ginger]

Where is it from: Mortocycle accident. (scotty dog fracture of one of my vertebrae and bulging discs at L2/L3 and L5/S1) Aggravated by lifting a heavy duffel bag while on vacation.

Demonstrated issue: Pain in the left glute and in the hip joint itself. Some numbness in my left foot. Some sciatica that I thought was a pulled hamstring. No amount of stretching and rubbing will release that. Even causes my periformis to knot up. And that makes it worse. Oh...what really clued them in to the impinged nerves was muscle loss in the right leg (no pain on that side, but evidently a more serious problem...)

How they found it: First, a physical nerve check by my PT. Then X ray and MRI (to determine the extent of the damage to the nerves as they left the spine)

What fixes it: Core work. Transverse abdominal work in particular. Planks

what you need to know: I think you'd find a study out there (memory fades) that given two groups of people, one set have surgery and one set has PT, in two years time they're both at the same place.

[girlie]

Sounds to me like it could be sciatica
Could be sciatica....and also nerve damage if you had some kind of impact. It could be a combination of things.....rather over time an injury can evolve into many.
I have an issue also down the left side of my body: lower back and left leg...right down into the very end of my big toe.
This was cased from a bulge in the lower part of my spine and some impact in my quad from an accident:(
My point being that sometimes it takes some investigation to find the source. Do not get discouraged if it takes sometime and if you find it is a series of "unfortunate event."
MRI lower back and nerve tests are what finally helped me figure out the issue.
I'd start with assuming it maybe sciatica. For a lot of people the sciatic nerve runs through your piriformis muscle for others it's more on the outside of the muscle. So when your piriformis gets tight it tightens around your sciatic nerve. There are nerve flossing exercises and stretches which help.
What do I know other than what I know......MRI - NERVE tests.
I am sorry and good luck!
Also for cyclists it is often on the left side of the body....simply because this is the side we tend to crash on......so they say.

[Ginger]

Girlie is spot on.

But...I hate nerve tests. Any doc who tells me that sticking a couple big needles into me and applying current to see if it makes it from one spot to another doesn't hurt-- has never had the test done themselves.

Although...I wholly recommend the test.

AND if they do a nerve test on your leg? Insist that they do the test on both right and left legs.

When I had one done on my legs after the accident they did one side and said: "Oh, you're well within limits, we don't need to test any more."
I insisted that since we were there, and they had the time scheduled that they test the "good" side as well
They found that my response on the injured side was only half of my response on the "good" side.

So. Always remember that you're a bright and shiny individual. Average response for you is not necessarily the mythical medical "average."

good luck!

[AgilisMerlin]

take your wallet out of your back pocket........i shyt you not.........really

Pick your own pocket. A bulging billfold in your hip pocket can crimp your sciatic nerve, especially if you sit on the wallet for long periods of time, says Scott Haldeman, M.D., D.C., Ph.D., associate clinical professor in the Department of Neurology at the University of California, Irvine, and adjunct professor at the Los Angeles Chiropractic College. He suggests that you put the wallet in a coat pocket or purse to make sure you don't put lopsided pressure on one buttock.


google wallet and sciatica

this is no joke.................

solved my sciatic episode.................. :D http://www.google.com/search?hl=en&q=sciatic+wallet&btnG=Google+Search

[imm]

For me the cure was an l4/l5 lamenectomy. It left me feeling great, although I'm much slower up hills than I might be if I didn't have that I imagine.

Also http://en.wikipedia.org/wiki/Piriformis_muscle syndrome was something I dealt with for a while, PT and MT helped, esp. deep tissue myofascial work.

[jhcakilmer]

There are so many things that can cause back pain! Sciatica, piriformis syndrome, hip flexor contracture, abductor contracture, disc heriation, inominate assymetry, pelvic assymetry, osteophyte formation.....the list goes on!

Because of this, it is virtually impossible to diagnosis, or even begin to recommend a course of treatment for idiopathic back pain. If I had to narrow down the two most common etiologies, I'd have to say core strength, and tight hip flexors (increase lordotic lumbar curve) as the most common.

Any DC, DO, or orthopedic specialist should be able to palpate, or test to determine if there is a dysfunction causing a leg length disparity.

[FMS_rider]

I quess this could be "Pain in the Gluteus" part deux, but here goes. I've got pain in my lower back/glute/hip on one side only (left side) and and its gets worse in a pretty linear fashion (i.e. more miles, more intensity == more pain, back off/rest == gets better). ...........

-JimSince you are only asking for input from others who have experienced a similar problem rather than from experts (which I am not), I will add a couple of cents, especially since I eventually found a solution to my problem.

Characteristics of my pain: 1) gradual increase in intensity during individual rides, usually starting at ~30mins. 2) pain was dull ache centered near the junction of my lower back and glutes, and always on my right side only. 3) never experienced any radiation of pain away from the focus, which I interpreted as indicating a muscle rather than nerve root/ back problem (I have had root pain and it has an entirely different character). 4) I could not elicit the pain by applying pressure where I felt it or anywhere along my lower spinal column, which I interpreted as indicating that a deep muscle was involved (if you Google "lower back pain" you will find anatomical drawings that show the multiple layers, including one located deep to the ribs. 5) Stopping and leaning/stretching my lower back in multiple directions while in a standing position would ease the pain. 6) The pain never persisted for very long after returning home, and I never experienced a similar pain from any activity other than riding.

I have read everything Steve Hogg has written on Cyclingnews and his web site, and I tried every fix I could think of based on his advice to others, and opinions of various self-described experts that I have come into contact with. I have an asymmetry that I have long been aware of because my left knee angles in toward the top tube at the top of my pedal stroke. I corrected that with several Lemond wedges (tilting my left shoe outward), but it had no effect on the pain. While visiting a physical therapist for an unrelated problem I asked her to check my hips while standing to look for an obvious tilt and she could detect none. When sitting in a chair, both knees appear to extend for an equal distance suggesting that with my back at a 90 degree tilt, my pelvis is not twisted horizontally.

The observation that led to a solution (i.e. seeking professional help) was that when I am in riding position (leaning forward at ~45 deg) my left knee extends ~2 cm further forward than my right. I figured that out by taking photograhs with a carefully aligned camera while I was on my trainer. When I did the "plumb bob" KOPS thing on both sides, the large discrepancy was again apparent (I had used that trick many times when assessing my position on multiple bikes, but had previously done it on one side only).

As a result of the discovery of a twist in my pelvis while leaning forward on a bike, I went to a highly experienced fitter about whom I had heard rave reports, some of which are on the internet (Colin O'Brien at Cronometro in Madison, Wisconsin). Being a stuborn idiot who always believes I can figure out anything on my own, I had never been to a "real" professional fitter (hacks only in the past) --dumb, dumb, dumb in hindsight.

I wrote Colin a detailed description of my riding history, habits, and problems that I was aware of before the fitting (something like 4 single-spaced pages) thinking that would expedite the process. However when I got there I discovered that so many problems were apparent to him from my email (which he actually read in its entirety!) that he had scheduled 2 consecutive time slots for my fitting (but he only charged me for one). He also advised a 3rd follow up session (which he again did not charge me for). He made so many changes in my position that it is unclear which one(s) eliminated the pain but there are a couple of things that stand out:

First, as a result of shoulder-neck pain (much worse than the lower back pain), I had progressively moved my entire position rear-ward with respect to the bottom bracket (saddle and bar) and raised my handlebar, following Steve Hogg's advice. This did help the shoulder/neck problem (at the $$ expense of a long series of new seatposts, saddles, stems and bars), but that pain continued to be a problem and limited my rides to under 4 hours (the pain often became intolerable by 3 hours). When I told Colin about Steve's advice he said that moving the entire position back in that fashion can mask a number of different problems (i.e. lessen them without getting at the root cause). To my amazement, he was able to move me to a more standard position with my handlebar below my saddle (for the first time in many years) and with my saddle several cm further forward than I was used to, while actually decreasing the extent to which I was supporting my weight with my arms. He also switched me to a bar that was much narrower than what I had been using based on the "common wisdom" that bar width should be approximately equal to shoulder width, which also apparently helped to alleviate the shoulder/neck pain (he had some interesting historical comments regarding the evolution of bar-width standards, but I will spare you the details since it is OT with respect to your back pain).

Another change Colin made that I suspect may have been the primary factor in alleviating my lower back pain (again counter-intuitive at least for me, and counter to my reading of Steve Hogg's advice to others --I am NOT bashing Steve Hogg), was to add a substantial spacer under my left cleat (no tilt) and wedge the inside of my right cleat). By adding wedges under the outside of my left cleat I had succeeded in eliminating the inward movement of my left knee at the top of my pedal stroke, but that had done nothing to get at the root cause of my problem. I do not understand why Colin's manipulation was effective, but it not only keeps my left knee from hitting the top tube, but it significantly improved a substantial left-right power asymmetry that I was unaware of --and it may have contributed to fixing my lower back pain, which is now completely gone.

OK, bottom lines: I have no idea if the source of your pain is the same as mine, or if it would be alleviated by similar changes. However, based on my experience my advice would be to find a highly experienced, intelligent fitter with the patience of Job if it is required --even if you have to travel some distance. Based on the advice from others who have had lower back pain that resulted from serious underlying physical problems (in above posts) you might be wise to visit appropriate health professionals first --my comments and suggestions are based only on my problem that turned out to be solely bike-related.

I will be happy to answer any questions you might have, but only regarding my particular problem.

Good luck,
Lew

[thejen12]

Had a similar sounding pain, brought on by a car accident. It remained, at a low level, for about 20 years. Then I aggravated it by trying to move a couch by myself and it became severe for about 9 months.

I finally solved it by accident. I went to a podiatrist, unrelated to the back pain, and he prescribed 10 minutes of calf stretching per day. 5 minutes in the morning (30 seconds one calf, 30 seconds the other calf, repeat for 5 minutes) and 5 minutes in the evening. I did that and after about 3 weeks my lower back was better than it had been since my early 20s! I was amazed! The doc didn't even know I had lower back pain, he prescribed the calf stretches to keep my feet better aligned.

While you may not have the same problem, this is a pretty easy fix to try anyway, just in case it helps.

Jenn

[jimp1234]

Thanks all for the feedback.


-Jim