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Back Problems Message Board

Back Problems Board Index

OK, now that you describe the appointment, it sounds like from the physical exam and neurologic tests that the doctor was able to surmise what is causing your pain. Now you just have to wonder what is causing the sacroiliitis, if that is indeed what it is.

It is fairly normal for the hip area to be involved when one has lower lumbar issues, and problems with the SI joints. I can't tell you how many people I know who thought they needed a hip replacement and instead they ended up with a fusion at L4-L5 or l5-S1...including my mother-in-law. We had our L4-L5 fusions within a couple months of each other.

Those spinal nerves control sensations that run into the groin, genitals, bladder and bowel, hip and the pelvic girdle area. When the Si joint is inflamed, it can cause problems with the piriformis muscle which runs across the buttock. It attaches on one side to the sacrum and runs across to an attachment near the hip. The problem is that if it is at all irritated it can cause irritation of the sciatic nerve because it is located directly underneath the piriformis. So an irritation of one often results in problems with the other.

Try very hard to be conscious of the way you sit and stand. You want your weight evenly distributed between the two legs and you want to sit equally on both "sit bones." When sitting, try to keep your feet flat on the floor -- do not cross your legs at the knee or ankle...don't cross them at all! I found that I always put more weight on my left leg and kind of stood with my left leg turned and left hip thrust out. Most of my weight was on the one leg. After favoring one side like this for decades and decades, I carried one hip higher than the other and my pelvis was rotated or tilted forward. I'll never know if I developed the spondylolisthesis at L4-L5 due to this "behavior" or did it feel more comfortable to put weight on the one side because of the instability?

I can tell you that most spine surgeons don't believe that a synovial cyst causes pain. From being on boards like this for many years, I can assure you that they can be very painful. So do what this doctor recommends, but if you aren't making some progress in a month or six weeks, you may have to pursue some of these other issues.

You'll find that sometimes the pain management doctor and the spine surgeon will not always agree. My surgeon would order something and sometimes the other doctor would do what he thought best rather than following the surgeon's order. That always put me in an interesting position when I would return to my surgeon to report on the results!

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