Question
Hi Doc,
 Thanks ahead of time for your thoughts.  I am a 54 year old, avid male cyclist experiencing chronic buttock pain since 2 Feb 07.  In the 12 months leading up to that date I started experiencing increasing stiffness in both hips, especially after hard efforts in Spin class, probably due to a poor fitting bike and poor technique. On 2 Feb I did a hard ride on my real bike, and towards the end started to feel a severe pain in my left hip/buttock area.  I went to the Doc who said it was probably tendonitis, gave me Feldine, and sent me to a physical therapist.  The PT gave me strengthening and stretching exercises to do at home.  I did these daily, but found the strengthening exercises (lunges/step-ups) made the pain much worse so I stopped doing them.  After two months I went back to the Doc who ordered hip and lower spine x-rays.  A few days later I was referred to an orthopedic surgeon due to the x-rays showing a compressed spine.  The ortho looked at the x-rays, and then bent and twisted me, all of which did not produce the hip pain.  He said that while I had spinal compression typical of an athlete my age, he didn't think it was causing the buttock pain and that it was probably bursitis.  That was six weeks ago, I've been resting ever since, and if anything the pain is as bad or worse than it was back in Feb. Sorry this is so long but I wanted you to know the whole story.  I'd greatly appreciate your thoughts as I'm dying to get back on the bike.

Answer
Hi Bill,

Unless you're, "on your game", as a sports physician, you'll miss this.

What you probably have is a piriformis syndrome, it is very common among cyclists. It is also known as "wallet" syndrome. Without examing you, you may also have TFL syndrome. If it is a SI subluxation or the other two, a D.C. should catch it.

The orthopedic test for piriformis syndrome is a positive Hibbs test. When you lay face down, the Dr. has you bend your knee 90 degrees and pulls the foot outward away from the body stretching the piriformis muscle down on the sciatic nerve. This should reproduce the pain. If it doesn't, try having the or PT stretch the TFL, they'll know what you are talking about.

Any Orthopedic anything that can't reproduce the pain in the hip by passively moving it, cannot diagnose bursitis. This condition hurts with anybody moving your hip passively.

I think he/she had no idea what you had and passed it off to the PT to get lucky and catch it. That's what happens when you are in a hurry or don't listen to the patient.

If you Google any of the above conditions, it will explain much better what they are, however, to treat them requires Low Volt therapy.

Find a D.C. in your area that does Low Volt muscle stim on piriformis and TFL muscles and ice. I bet you'll be home free after a few visits.

Unfortunately medicine failed to properly diagnose and treat your condition, this happens hourly, that's why there is an alternative, Chiropractic.

Try it next time as your first point of contact for these conditions and the probability of a mis-diagnosis and wrong treatment will drop significantly.

Good Luck,

If you have any further questions that require more detail or clarification, please ask.

Dr. Timothy Durnin
drs.chiroweb.com