Adam Rufa - 10/9/2006

Question
Problem:  pain at ischial tuberosity area for 1 year, sciatica like pain to mid-calf, some low back pain, MRI & CT scan ruled out disc related issues. Chiro for 6 wks, no relief. Phys. therapy for 6 wks, very little relief. No real pattern to more/less pain day to day. Phys. therapists pegged that it looked like high hamstring @ ischial rather than piriformis, but ultrasound, massage, stretching, etc. did not bring much relief. Tried Celebrex this summer and everything disappeared, but plateau occurred at 3 wk mark and all returned. Am working out, but not any more Spin classes or walking or running. Sticking to aerobics classes, weight classes, and still stretching, icing, massaging & rolling on foam roll.  Having difficulty finding a doctor who knows much or is willing to reallly try to figure it out.  Pain is now beginning in other leg in same area --- maybe not a strain after all?  Very frustrated and interested in locating the right TYPE of doctor to see.  Saw an orthopedic this summer to confirm that it looked like a hamstring injury, but didn't do any real examination.  No nerve damage yet, but affected side is very spastic on bike, elliptical, or after cardio workout (feels weak, leg not too cooperative).  Any thoughts, questions, or ideas?  I'm really needing to find the right doctor........

Stacy


Answer
Stacy,

Sorry that your pain has persisted for so long. It is uncommon for a hamstring strain to last this long without some underlying problem.  

Orthopedic problems can be frustrating because we do not have definitive tests. I would suspect a dysfunction of the nervous system, potentially some type of nerve tension.

You are not a surgical candidate so an orthopedist is not your best bet. I would look for a physiatrist (Dr. of physical medicine) and give him/her a try. If you are starting to get symptoms on the other side it is even more doubtful that you have a local hamstring problem.

Sometimes these problems are not musculoskeletal and are a problem in the pain system itself.  The nerves, spinal chord, or modulating centers in the brain can all have dysfunction in them and this can result in persistent pain.

Good luck.

Adam