The most common set of pain complaints I see in the office is some combination of hip, lower back and knee pain. Often, people have difficulty determining what exactly is causing the pain: is it a disc problem or a muscle problem? is it related to their back, or is it in their hips? What about the piriformis muscle that people often talk about? In this article, I am going to discuss how to figure out where the pain is coming from and some exercises that may help.
First let’s look at low back pain. 85% of people that walk through our door in our office likely have back pain associated with a pesky disc. This doesn’t mean that you have a herniated disc or protruding disc but just a disc that decided to push itself into a nerve resulting in lower back pain.
Do you have a disc problem or a muscle problem causing you lower back pain?
The best way to determine if this is the most likely cause is to:
- Lay on your stomach and
- Prop your elbows under you to extend your back and hold.
If your pain changes, by getting better or getting worse that’s usually a strong indicator that your lower back is the cause.
If your pain gets better, this is strong indicator that is a disc and that you should be doing extension exercises. See our videos on the McKenzie lower back exercises to help you on your way.
If the back extension made your back worse, try flipping onto your back and bringing both of your knees up to your chest. If this decreases the pain this could indicate that you have stenosis or mild arthritis in which case knees-to-chest would be the exercise for you. If neither of these exercises change your pain for better or worse, the pain could be coming from your hips or piriformis muscle.
What is the piriformis muscle?
The piriformis muscle is a poorly placed muscle that crosses of over the sciatic nerve. If it becomes too tight it can often cause radiating pain down the leg mimicking sciatica. True sciatica though, comes from your lower back.
To assess whether or not your piriformis muscle is involved, try laying on your back and bringing your legs into a frog leg position. This position complete turns “off” the piriformis muscle. If your pain is relieved by this, that is an indication that the piriformis is too tight.
You can also test the tightness of this muscle by rolling on a tennis ball. The piriformis is located almost right in the center of buttock. If it’s tight you won’t be to roll on the tennis ball for long or at all and it will provoke your symptoms.
Finally, if the pain is coming from your hip the other exercises will give you no relief and your pain persists on walking and standing. You should feel relief when you are at rest. Additionally, you may feel pain in your groin on the side of the hip that is affected and the discomfort often comes and goes.
Of course, these are all generalizations and often times our bodies don’t read the book on how it should behave for a given condition and occasionally there can be more than one area at play for instance people can have stenosis and a disc problem.
If you’re still having symptoms after a couple of days and you can’t tell if you have a disc problem or a muscle problem or have had a recent injury that aggravated these symptoms that usually a good indication to come into the office and get realigned. Till next time!