A few years ago, (after much cycling over some months) I developed low back pain and sciatic pain on right side and consulted a physiotherapist. Was told I had as misaligned pelvis caused by posture and was given piriformis streches which seemed to work. However since then have had pain after walking or standing and have done my best with postural awareness and stretching but have not been able to exercise fully as before. I am 42, female, 168lbs, 5' 7". Overweight, am slowly losing weight. Was always about 155lbs.
However, in May I developed hamstring pain left side which I assumed was a strain although had not done anything to cause trauma apart from walking as normal - which is no more than a mile or so. This went on for 2 months, so I saw a physio, who said it was SI joint issue which she manipulated. This relieved hamstring pain but caused deep low back pain, which two osteopaths have said probably was disc irritation. I have an MRI scan on Friday of this week.
5 days ago I saw a highly recommended osteopath who specialises in helping runners/sports people. Very good bloke and thorough. He said he too thinks my pelvis is 'wonky' and after a thorough exam said he suspects that L5 disc may have some wear and tear but primarily I have muscle imbalances and specifically I have VERY tight psoas muscles. Tight on right, and tight but weaker on left. My left side appears to be the "crooked side". Anterior pelvic tilt and also left side is more forward.
He adjusted my lumbar area which provided relief to low back and disc pain, but also did some attempted release of psoas muscles and - he pressed whlist I slowly moved knee up and down. He told me NOT TO STRETCH IT at home. He said I was not ready for that yet, that we had to try and release the psoas muscles and that this was pulling my pelvis out of alignment and affecting SI joint and hamstrings. He is away now for couple of weeks.
During the night and all next couple of days the left psoas muscle felt very swollen and inflamed. I have iced it, had baths, and taken anti inflammatory drugs which I was taking anyway.
Right psoas is fine. Left psoas is was unhappy indeed. This very much reminds me of what happened when I had sports massage on my left hamstring back in May and it reacted in the same way - swollen and inflammed. It is easing now, and I can walk.
My question is this: If my psoas muscle needs release, but can't because a disc is causing the nerve pain and muscle spasm when we try, how can this be treated?
Many thanks.
Hi Lampy, welcome to HP!
For a specific answer on the detail you'd need to discus with your osteopath, but there are various ways to see any problem. Personally I'm not a fan of micromanaging every aspect, ie. deciding for the body what should be released and when, but that's just my preference. Pain is natures primary signal to avoid something, it isn't wrong.
Reiki Pixie has just reminded me (here ) of something my mentor said, which is that ruptured discs are not a lazy person's disease. Maybe some wisdom here.
Which is to say that you don't always need the right exercise, you need to allow the body sufficent chance at recovery. Time is still the greatest healer of them all.
If you're worried about your training, then remember that you don't get fitter while you train, only when you rest. The biggest obstacle to your fitness right now is this injury, which from the sounds of it needs treating with a great deal of respect.
Good luck, take it easy, mend well!
Hello and thanks for your response. I agree with you about rest....somehow I seem to have given the impression that I haven't been resting? I have done little else since May.
I have barely been able to walk for more than a few minutes or stand up since then. Things did improve with the rest, but not to the point of being able to function properly, let alone 'train'. I cycle for leisure. At this stage I would just like to be able to walk to the corner shop! I spend about 23 out of 24 hours horizontal.
🙂
My apologies for jumping to conclusions, just from experience of treating athletes, often the hardest part of helping them is getting them to stop, but clearly not always.
The thing is that the human body is in my observation completely self-repairing, when it fails to recover it is because of obstacles to healing. Hence we do not heal anybody, the body heals itself, we (practitioners) just clear the way.
In other words, the only reason you are not better is that something is maintaining the problem. From here of course it's only possible to talk in generalities, but the various acquired adaptations of posture and movement are for some reason focussing forces at vulnerable tissues. The spine is a system of levers, and levers chan change their effect through just a few angle changes.
When these adverse forces develop, prior to tissue damage, muscles local to areas in trouble become tonic, they are bracing the area to limit movement and prevent damage. So a tight psoas, for example, is just as likely your body's emergency response to the angle changes as it is the cause of the torsion. Usually these situations involve whole flocks of chickens and eggs all over the place. If a major muscle is resisting release then it is not because lack of skill to release it, it is because your body really needs that adaptation to prevent more severe damage. Moreover, in this hypersensitive state too, the reaction to provocation of sensitive tissues can be quite exaggerated, psoas is a deep muscle buried under other senstive structures also, so beware giving it too hard a time.
Initially, the bracing may be light, and is reduced by modest manual therapy. The muscles relax and there is some relief of discomfort. However, the strain to deeper tissues then increases and the bracing returns yet stronger. So then elbows are used, then muscle relaxants, needles, etc etc, until finally, months later, the appointment for the scan arrives, and it turns out that the problem really was a damaged disc 'all along'. This could conveniently explain why nobody was able to help, but so could trying to go too fast to solve the problem.
Which is why I would never compel the body to change, we never really know what it is trying to do. We can 'invite' the change, by gentle coaxing, then un-needed adaptations are diminished, and the ones we really need remain. This way we remove straws from the camel's back, a few at a time, and monitor the effect. A 5 percent improvement in one session is a result, later we may proceed faster. 90 percent would be nicer, but at the risk of making it worse this would not be agreeable, so we proceed with caution and never assume we know better than the body.
Hence, you would be better to wait until you can contact your osteopath before forcing any issues. On the other hand, if he is completely out of reach and you are left in distress, perhaps you could seek a recommendation to somebody else? My field is osteopathy also, but we are all different, what matters is not the name of the therapy but the vision of the practitioner.
I agree with your more holistic approach kvdp, and interestingly it has parallels with my own work as a psychotherapist. I am happy to wait until my osteopath returns, and he seemed very much to favour a conservative, gentler approach, hence his advice to me not to try stretching. I was just curious about whether the reaction I had was something other practitioners were familiar with.
In the mind, I am very used to working with areas that are tight and defended and protected and one must proceed very carefully! It takes years to enable someone to take a more comfortable, less protected position. You can't steam in with interpretations and brilliant insights. Well, not for a few years and by then the client does it themself 😉
It is hard to be patient though. It's frustrating and painful and boring. And I have a fairly high threshold!
Have a good weekend.
Do you mean you can feel actual swelling of the psoas? It's a very deep muscle, you'd find it a challenge to touch it and be sure that's what you were feeling? It is closest to the surface in the inguinal area - and other structures may be more easily felt. Swelling in that area can also be a hernia, but you'd probably know already if you had one of those.
These inhibitive exercises and techniques to the psoas are pretty arduous, the muscles could be sensitised by reflex activity related to the strained areas in the spine, in which case it could well be disproportionately sore afterwards. That's not necessarily the same as a healing reaction. If the tissues that have been worked are sore afterwards, it's quite possible they are feeling the intensity of the treatment.
I would suggest trying to contact your osteopath and just seek his view. Your own practitioner has the best overview of the situation, and he may have important advice before the next appointment.
The swelling was actually around the hip bone - and he had explained that there were 2 muscles - one being the iliacus? It's around that area. The adductor muscles on inside of both legs feel now very tight and won't allow usual stretching. I think they're all compensating.
Unfortunately my osteopath is away on holiday until after the Aug bank holiday.
It is easing, but my legs feel very tight and I get pain in the night. Have been resting it as much as possible. I have had a lot of emotional stuff going on for a few months and I know it affects it.
Time is still the greatest healer, and if you think there is a pathological emergency of some kind then there is alwaysl NHS direct.
Otherwise, if there is some position you can adopt and rest in then that's what you have to do, for as long as it takes. Far more worrying would be if in any position there was constant intractable pain.
There is often an urge to do something about the problem, but even with the best treatment, space and time for recovery are essential elements, there's no escaping that.
Even if the osteopath is away, I would hope he can return a call or email if you are seriously worried about your situation (I do for my patients). His reassurance may be all that is required. In the meantime he risks losing you to another practitioner, no? So perhaps he'd like you to try and reach him?
As an osteopath I get very frustrated when patients have been through something and not tried to call, very often I find out far too late and miss an opportunity to move the situation onwards. So I emphasise time and again, please please phone if there's anything I should know.
In the meantime, you may well discover that this is in some way an opportunity: even if you just get to watch loads of dvds that might be a result, catch up on reading or other things you never have time for. You will learn a lot about yourself, and perhaps discover reserves of energy in the universe that you didn't know existed.
In my case recovery from a broken back was the start of a career in osteopathy, so it's true what they say about every cloud.
Well, I know all about rest and quiet and discovering myself 😀 I've been a Buddhist and ther apist for years. Both require much much much patience. I did speak to colleague of my osteo. Resting is helping.
I got my MRI scan results today, but I am not sure they really indicate much as it seems many people would have such a result. Interested?
"Normal alignment and curvature of the lumbar spine. There are disc bulges at L1-2, L3-4, L5-S1 levels without nerve root compression. Degenerative spine changes with dehydration signal change in L5-S1 disc. Schmorl's nodes are seen at lower dorsal levels. Facet joints are normal. Cord is normal. No radiological recommendation".
From what I have read, this can mean something or not.
Hi Lampy
Since you are a Buddhist, do you regularly meditate? The reason i ask is, do you spend long periods in sitting meditation, especially crosslegged? I'm wondering if your meditation posture may be reinforcing your pelvic/psoas imbalance, and compression of the lower spine. Just an idea to explore.
Best Wishes
RP
If rest is helping then that bodes very well, that's all you have to do for now. Sorry if it's boring, but if only all problems were that easy to solve.
For what it's worth, I generally advise against memory-foam mattresses and pillows, they tend to absorb our patterns and then keep us in them.
That's about as far as I'll interefere in a colleague's case, the following is just information.
Disc bulges are normal for a large percentage of the population, and often are completely without symptoms. They do point towards the various stresses you are under, however.
To some, degenerative changes are wear-and-tear, to my mind they are likely adaptive changes, products of the problem, rather than cause. When the spine has been under stress for a long time, it may be deprived of its basic needs, the tissues themselves may be in poor health. The roughness of the joints limits movement to protect from damage under stress, as the general bodily health improves these changes may reverse to an extent.
So think 'living tissue' and 'general health' as your watchwords for long term improvement in your problem. Thinking mechanically as if this is the ball-joints in a car will only get us so far.
Schmorl's nodes may be much older but still an adaptation, probably to repetitive stress earlier in life. Less likely to reverse, but see it as a response rather than an affliction.
Best wishes,
Mend well.
Many thanks I very much appreciate your time and help. I emailed my Osteo today with the results and he's been emailing me all afternoon which was a nice surprise. He has advised me much as you have, leave it alone and he'll examine me in 10 days or so.
I agree with you about the bulges resulting from strain etc, have been told before about posture, use of body etc and have been working on that in recent years.
Many thanks again. Funny you're in London, just saw that, so am I. PM me your clinic I shall recommend you if I know anyone in your area!
Hi Lampy
Since you are a Buddhist, do you regularly meditate? The reason i ask is, do you spend long periods in sitting meditation, especially crosslegged? I'm wondering if your meditation posture may be reinforcing your pelvic/psoas imbalance, and compression of the lower spine. Just an idea to explore.
Best Wishes
RP
Thanks RP - I have not been able to do seated meditation for some years because of discomfort- But when I did I was very careful about posture - but thank you - many people meditate in a very bad position. The centre I attend are very careful about posture and spend a lot of time on it. Best wishes, Lampy
That's OK Lampy, worth the exploration, might help other members.
Cheers, RP