ischial tuberosity and sciatic nerve pain

So to sum up my 2 hour visit and treatment with another doctor:

Hamstrings are very long and over stretched, need to shorten hamstrings. Couple muscles became inactive and caused others to pick up the slack and do things they are not designed to do. There is a lot of hip instability in the ligaments on the left side. My pelvis does orient to the right. My rihht foot does NOT pronate at all- so my tibia is rotated out and knee cap rotates in when i walk/run/etc.

This can all be fixed by correcting diaphragm issues where I am not getting all the air out of my lungs.

I am not a doctor. He was very knowledgable and helpful and made lots of sense. Lots of discussion about sympathetic and autonomic nervous system at play here as well.
 
How did he measure your hamstrings? From what you've shown me, I just can't get that to make sense.

Because:
* Butt tucked under, big time
* Hamstringissues
* Little to none gluteal activity
* + more

I agree that it started as a neuromuscular issue, but ends up with inhibited musculature aswell.

All in all, sounds like you found a good doc. I'm just very skeptic about his opinion on your hamstrings. Training an already overworked hamstring is like asking for injury.
 
kjetil1234 said:
How did he measure your hamstrings? From what you've shown me, I just can't get that to make sense.

Because:
* Butt tucked under, big time
* Hamstringissues
* Little to none gluteal activity
* + more

I agree that it started as a neuromuscular issue, but ends up with inhibited musculature aswell.

All in all, sounds like you found a good doc. I'm just very skeptic about his opinion on your hamstrings.
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He measured the inactivity with a battery of tests which I failed horribly lol . Did specific breathing exercises , saw improvement on tests. Hamstrings he didnt have to really measure, I can put my foot over my head... It's self explanatory they are super stretched out and need to be shortened to allow the pelvis to return to a more neutral alignment

He gave me the exercises and some tips for daily functions like proper sitting, standing, reaching, driving, sleeping to help orient the pelvis back to the center (from the right) I don't have to see him again, he's not trying to like exploit me visit after visit which speaks volumes
 
chedapalooza said:
He measured the inactivity with a battery of tests which I failed horribly lol . Did specific breathing exercises , saw improvement on tests. Hamstrings he didnt have to really measure, I can put my foot over my head... It's self explanatory they are super stretched out and need to be shortened to allow the pelvis to return to a more neutral alignment He gave me the exercises and some tips for daily functions like proper sitting, standing, reaching, driving, sleeping to help orient the pelvis back to the center (from the right) I don't have to see him again, he's not trying to like exploit me visit after visit which speaks volumes
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So basically he didn't measure hamstrings?!?
 
kjetil1234 said:
How did he measure your hamstrings? From what you've shown me, I just can't get that to make sense. Because: * Butt tucked under, big time * Hamstringissues * Little to none gluteal activity * + more I agree that it started as a neuromuscular issue, but ends up with inhibited musculature aswell. All in all, sounds like you found a good doc. I'm just very skeptic about his opinion on your hamstrings.
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Correct me if in wrong though kj, in PPT the glutes are overactive, and under active in APT?
 
chedapalooza said:
He measured the inactivity with a battery of tests which I failed horribly lol . Did specific breathing exercises , saw improvement on tests. Hamstrings he didnt have to really measure, I can put my foot over my head... It's self explanatory they are super stretched out and need to be shortened to allow the pelvis to return to a more neutral alignment

He gave me the exercises and some tips for daily functions like proper sitting, standing, reaching, driving, sleeping to help orient the pelvis back to the center (from the right) I don't have to see him again, he's not trying to like exploit me visit after visit which speaks volumes
Click to expand...

The reason you can put then over toe head is (IME) due to massive hinging in low lumbar, and it doesn't prove anything. This is why the hamstrings HAVE TO be measured with hip hinge, by someone who have experience with hip hinge. You are in PPT and not APT.

Well bro I don't want to come off as a know it all, so of course the choice is yours. But to my ears this doesn't sound correct at all.
 
NattyForLife said:
Correct me if in wrong though kj, in PPT the glutes are overactive, and under active in APT?
Click to expand...

In PPT the glutes are almost always inhibited (because the pelvis is unable to rotate anteriorly). BIG TIME. with chronic tightness of piriformis and hamstrings (because the hams are compensating due to glute inhibition). That's why these clients have big Problems with low back and hip pain. The hamstrings do not efficiently stabilize the femur in the acetabulum, in fact they will pull it out of socket (anterior femoral glide) and is a big culprit of arthritis. The glute max MUST be functional and strong to keep the femur stable in the acetabulum (+ some other smaller stabilizers)

In APT what you'll generally have is weak hamstrings, as they're chronically elongated due to forward pelvis position (psoas major tightness). Now, as already seen in this thread, a lot of people and also professionals misdiagnose APT, and that will screw up the entire plan if correction.

Both conditions are usually causes by poor core stability. Because when the diaphragm and Tr A doesn't properly work as a trunk stabilizer, the pelvis will lock into the most dominant side. Usually that's the posterior tilt, some times the anterior. Same principle applies to the scapula, when serratus anterior isn't working properly, the scapula will lock anteriorly, and cause a lot of problems, like thoracic outlet syndrome,
Rotator cuff inhibition and tears etc.

Now, in ppt (like OP has), the low back will hinge at lumbosacral position to extend. This "illusion of lordosis", plus seemingly anteriorly positioned pelvis (which is also inaccurate) will make a seemingly anterior pelvic tilt.

In true APT the client IS able to rotate his pelvis anteriorly and the hinge of extension is usually at the thoracolumbar junction and NOT lumbosacral.

I'll put some pics to show the difference when I'm home. The point is that it's difficulty to accurately diagnose without doing the hip hinge test, especially when you're not experienced with the issue. So for a therapist (in an office, not in a gym) it's very difficult to see these issues and get experience with them.
 
kjetil1234 said:
In PPT the glutes are almost always inhibited (because the pelvis is unable to rotate anteriorly). BIG TIME. with chronic tightness of piriformis and hamstrings (because the hams are compensating due to glute inhibition). That's why these clients have big Problems with low back and hip pain. The hamstrings do not efficiently stabilize the femur in the acetabulum, in fact they will pull it out of socket (anterior femoral glide) and is a big culprit of arthritis. The glute max MUST be functional and strong to keep the femur stable in the acetabulum (+ some other smaller stabilizers) In APT what you'll generally have is weak hamstrings, as they're chronically elongated due to forward pelvis position (psoas major tightness). Now, as already seen in this thread, a lot of people and also professionals misdiagnose APT, and that will screw up the entire plan if correction. Both conditions are usually causes by poor core stability. Because when the diaphragm and Tr A doesn't properly work as a trunk stabilizer, the pelvis will lock into the most dominant side. Usually that's the posterior tilt, some times the anterior. Same principle applies to the scapula, when serratus anterior isn't working properly, the scapula will lock anteriorly, and cause a lot of problems, like thoracic outlet syndrome, Rotator cuff inhibition and tears etc. Now, in ppt (like OP has), the low back will hinge at lumbosacral position to extend. This "illusion of lordosis", plus seemingly anteriorly positioned pelvis (which is also inaccurate) will make a seemingly anterior pelvic tilt. In true APT the client IS able to rotate his pelvis anteriorly and the hinge of extension is usually at the thoracolumbar junction and NOT lumbosacral. I'll put some pics to show the difference when I'm home. The point is that it's difficulty to accurately diagnose without doing the hip hinge test, especially when you're not experienced with the issue. So for a therapist (in an office, not in a gym) it's very difficult to see these issues and get experience with them.
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Still not getting this my man! When you contract glutes your pelvis Posteriorlyt tilts, so if your glutes are always contracted/tight that will put you in PPT. The opposite is APT were the glutes are hard to get activated because the lowback is usually so tight that is takes over! APT: weak low abs, tight lumbar erectors, tight hip flexors, and weak glutes. PPT: strong low abs, weak hip flexors , weak lumbar erectors, and strong glutes.

I may be wrong but that is my way of thinking about it?!?
 
NattyForLife said:
Still not getting this my man! When you contract glutes your pelvis Posteriorlyt tilts, so if your glutes are always contracted/tight that will put you in PPT. The opposite is APT were the glutes are hard to get activated because the lowback is usually so tight that is takes over! APT: weak low abs, tight lumbar erectors, tight hip flexors, and weak glutes. PPT: strong low abs, weak hip flexors , weak lumbar erectors, and strong glutes.

I may be wrong but that is my way of thinking about it?!?
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All good bro, I'll try to explain better. It's difficult without first hand experience, for sure. First time I heard this, I almost "called bull****". Why? Because SEEMINGLY, Almost all clients are in APT. What I learned and rightfully so, is that this is an illusion.

The glutes are not the reason of PPT, it's the hamstrings. When the hams lock up, that will inhibit the glutes. As there is no room for pelvic flexion. It will also drive the femoral head forward in the acetabulum, and force the back to compensate for lack of pelvic ROM. Thus, PPT is the worst to have and also the most common.

The glutes CAN NOT work while in lumbar flexion. This is why most (all IME) clients with this problem will complain that their glutes aren't sore after training, and usually low back tightness aswell. Reoccurring herniations etc. when something doesn't work, it'll inhibit as the body finds alternatives for movement.

Glutes infact RELY on lumbar erectors(which are useless and inhibited in PPT) as they can not fire during flexion of the lumbar (however excessive lordosis may also cause minor issues, but nothing in the same degree as PPT and flexion of lumbar). The lumbar erectors will cause extension of the lumbar spine and align the pelvis so that the glutes may work. That's why I ALWAYS work on lumbar erectors first with PPT clients, to get them out of lumbar flexion. This is the absolute first step.

I'm not sure why you think a tight lower back means dysfunctional glutes, that's not the case. If you're referring to the lower upper cross thing, it's the hamstrings that are the problem. The upper lower is somewhat a nice base tool, but it's definitely not an absolute diagnostic tool.

More clear now?

Edit: another big problem is that you're much more likely to see diaphragm inhibition in those with PPT, due to the constant rectus abdominus gripping and flexion of T spine strategy that they utilize. Proper breathing is much easier to obtain in APT clients, which in turn helps with proper motor sequences
 
kjetil1234 said:
All good bro, I'll try to explain better. It's difficult without first hand experience, for sure. First time I heard this, I almost "called bull****". Why? Because SEEMINGLY, Almost all clients are in APT. What I learned and rightfully so, is that this is an illusion. The glutes are not the reason of PPT, it's the hamstrings. When the hams lock up, that will inhibit the glutes. As there is no room for pelvic flexion. It will also drive the femoral head forward in the acetabulum, and force the back to compensate for lack of pelvic ROM. Thus, PPT is the worst to have and also the most common. The glutes CAN NOT work while in lumbar flexion. This is why most (all IME) clients with this problem will complain that their glutes aren't sore after training, and usually low back tightness aswell. Reoccurring herniations etc. when something doesn't work, it'll inhibit as the body finds alternatives for movement. Glutes infact RELY on lumbar erectors(which are useless and inhibited in PPT) as they can not fire during flexion of the lumbar (however excessive lordosis may also cause minor issues, but nothing in the same degree as PPT and flexion of lumbar). The lumbar erectors will cause extension of the lumbar spine and align the pelvis so that the glutes may work. That's why I ALWAYS work on lumbar erectors first with PPT clients, to get them out of lumbar flexion. This is the absolute first step. I'm not sure why you think a tight lower back means dysfunctional glutes, that's not the case. If you're referring to the lower upper cross thing, it's the hamstrings that are the problem. The upper lower is somewhat a nice base tool, but it's definitely not an absolute diagnostic tool. More clear now? Edit: another big problem is that you're much more likely to see diaphragm inhibition in those with PPT, due to the constant rectus abdominus gripping strategy that they utilize. Proper breathing is much easier to obtain in APT clients, which in turn helps with proper motor sequences
Click to expand...

Ahhh, i get it now! You mind if i post a lateral posture pic and tell me if im my pelvis is in neutral, APT, or PPT?
 
kjetil1234 said:
All good bro, I'll try to explain better. It's difficult without first hand experience, for sure. First time I heard this, I almost "called bull****". Why? Because SEEMINGLY, Almost all clients are in APT. What I learned and rightfully so, is that this is an illusion. The glutes are not the reason of PPT, it's the hamstrings. When the hams lock up, that will inhibit the glutes. As there is no room for pelvic flexion. It will also drive the femoral head forward in the acetabulum, and force the back to compensate for lack of pelvic ROM. Thus, PPT is the worst to have and also the most common. The glutes CAN NOT work while in lumbar flexion. This is why most (all IME) clients with this problem will complain that their glutes aren't sore after training, and usually low back tightness aswell. Reoccurring herniations etc. when something doesn't work, it'll inhibit as the body finds alternatives for movement. Glutes infact RELY on lumbar erectors(which are useless and inhibited in PPT) as they can not fire during flexion of the lumbar (however excessive lordosis may also cause minor issues, but nothing in the same degree as PPT and flexion of lumbar). The lumbar erectors will cause extension of the lumbar spine and align the pelvis so that the glutes may work. That's why I ALWAYS work on lumbar erectors first with PPT clients, to get them out of lumbar flexion. This is the absolute first step. I'm not sure why you think a tight lower back means dysfunctional glutes, that's not the case. If you're referring to the lower upper cross thing, it's the hamstrings that are the problem. The upper lower is somewhat a nice base tool, but it's definitely not an absolute diagnostic tool. More clear now? Edit: another big problem is that you're much more likely to see diaphragm inhibition in those with PPT, due to the constant rectus abdominus gripping and flexion of T spine strategy that they utilize. Proper breathing is much easier to obtain in APT clients, which in turn helps with proper motor sequences
Click to expand...

I seriously applaud you man! You seem to know your stuff very well!
 
Looks like ATP to me, as the chest is up, stomach isn't tucked and the compensation (due to tight psoas) is in the THORACOlumbar junction.

Hard to say anything for CERTAIN without a physical assessment, and because I can't see your hip well in those pants, but I'm pretty sure you're ATP.

If your butt was tucked under, and the back extension was in the lumbosacral junction, that's a pretty clear sign of PPT (like OP)

Recommendations for you are not a lot (presuming my observation is correct). Optimize breathing and activation of Tr A, and work deep external rotators of hip + glute max. That should calm down the psoas gripping.
 
kjetil1234 said:
Looks like ATP to me, as the chest is up, stomach isn't tucked and the compensation (due to tight psoas) is in the THORACOlumbar junction. Hard to say anything for CERTAIN without a physical assessment, and because I can't see your hip well in those pants, but I'm pretty sure you're ATP. If your butt was tucked under, and the back extension was in the lumbosacral junction, that's a pretty clear sign of PPT (like OP) Recommendations for you are not a lot (presuming my observation is correct). Optimize breathing and activation of Tr A, and work deep external rotators of hip + glute max. That should calm down the psoas gripping.
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Exactly what i figured also! So pretty much work on my glutes, stretch hip flexors( both 1 joint and 2 joint hip flexors)??? And work vacumms? Should i stretch lumbar erectors?
 
NattyForLife said:
Exactly what i figured also! So pretty much work on my glutes, stretch hip flexors( both 1 joint and 2 joint hip flexors)??? And work vacumms? Should i stretch lumbar erectors?
Click to expand...

Watch the video first and examine yourself. If you get the same impressions as me I can tell you what to do.

Since I do not see your pelvis properly, and your head is a little forward(just as likely due to your breathing strategy) I want your physical assessment evaluation first, to reduce chance of misleading advice
 
All of what we did yesterday was about the diaphragm. My pain has actually been doing very well the last two days (almost gone) out of no where
 
kjetil1234 said:
The breathing is extremely important, I have no dispute with that.
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I made sure to make that the focus of my workout today.... Holy crap. Talk about feeling it in the target muscles. My "strength" took a substantial hit, but I actually felt target muscles working 100% as opposed to the flawed breathing and mechanics I have been using for who knows how long!
 
I watched that video and i believe im in APT kjetil!

Here is a couple more pics to let you see!



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Put another pic where you bend for something. Lateral view. Sorry for the odd request LOL! You look ATP.

However your glutes are way underdeveloped compared to legs, which is a typical sign you'll see in PPT clients. I'm suspecting dyskinesis in hip!

I think I'm seeing "butt gripping", which is pretty much glute dysfunction. Palpate yor femoral head and see if it's forward in the socket. Also palpated the posterior aspect of the femoral head and feel if there's a little divot there.
 
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I really couldn't palpate my femoral head. The first pic is me bending over. The second pic is me touching my toes.
 
Honestly bro, I'm not sure. This is a borderline example that's hard to judge by pics. I'm just not sure whether I'm seeing significant flexion or not. When the hyper mobile joint is at L5/S1 it can be almost impossible to spot without physical assessments. The giveaway will be that the glutes (hip) is pointing in a different direction than the rest of the back. There will not be a visible curve, as one would like to think.

Alarming part is the glutes. They look somewhat tucked and are def underdeveloped compared to your legs (which are great btw, gj). Could be genetic, but I strongly doubt it!

Ever sore in glutes after squatting? Tight low back after squats/deads?

Piriformis is also a common compensator when glutes aren't working. In which case they should be really tight; are they?
 
kjetil1234 said:
Honestly bro, I'm not sure. This is a borderline example that's hard to judge by pics. I'm just not sure whether I'm seeing significant flexion or not. When the hyper mobile joint is at L5/S1 it can be almost impossible to spot without physical assessments. The giveaway will be that the glutes (hip) is pointing in a different direction than the rest of the back. There will not be a visible curve, as one would like to think. Alarming part is the glutes. They look somewhat tucked and are def underdeveloped compared to your legs (which are great btw, gj). Ever sore in glutes after squatting? Tight low back after squats/deads? Piriformis is a common compensator when glutes aren't working. In which case they should be really tight; are they?
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I just done the piriformis length test when you lay sidelying and stabize hips and press through knee. Done it by myself the best i could and felt some tighness toward the side of my glute, posterior to greater trochanter. Also i sat at edge of chair and i have significant shortness in my hip external rotators due to not being able to hardly internally rotate my femur!
 
Ok. When sitting, (90 ish degree hip flexion) the piriformis actually becomes an internal rotator due to its insertion to the greater trochanter. Likely tightness of the remains of posterior capsule attachment,
Namely gemelli, obturators etc. these are stabilizers and I don't recommend stretching them. They usually become overworked when the pelvic floor is inhibited (which is LIKELY as you have a poor breathing strategy).

Result is butt gripping (poor gluteal function), chronic tightness in posterior capsule, tight hips... This definitely makes sense to what I'm seeing in the pictures.

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kjetil1234 said:
Ok. When sitting, (90 ish degree hip flexion) the piriformis actually becomes an internal rotator due to its insertion to the greater trochanter. Likely tightness of the remains of posterior capsule attachment, Namely gemelli, obturators etc. these are stabilizers and I don't recommend stretching them. They usually become overworked when the pelvic floor is inhibited (which is LIKELY as you have a poor breathing strategy). Result is butt gripping (poor gluteal function), chronic tightness in posterior capsule, tight hips... This definitely makes sense to what I'm seeing in the pictures. <img src="http://anabolicminds.com/forum/attachment.php?attachmentid=105444"/>
Click to expand...

So do you have a final diagnosis?
 
Also, if there is another pic you need or test to do let me know. Honestly i dont have a lot of pain in my lowback, just a little nag pain!
 
Hard to say without seeing your technique of squat and DL! Likely either the buttgripping (and core stability), technique or both.

Pelvic floor dysfunctions isn't something I have a lot of experience with, I've just read about it. My best advice to you, is to get your breathing and core activation working properly. TA, pelvic floor and diaphragm.

Butt gripping may lead to hip arthritis and chronic pain, and the chest breathing to thoracic outlet syndrome, rotator cuff and scapular dysfunction etc.

Not saying it will, but may happen. Definitely worth getting your breathing going properly mate.

I like your passion btw, you're gonna be an awesome PT bro
 
kjetil1234 said:
Hard to say without seeing your technique of squat and DL! Likely either the buttgripping (and core stability), technique or both. Pelvic floor dysfunctions isn't something I have a lot of experience with, I've just read about it. My best advice to you, is to get your breathing and core activation working properly. TA, pelvic floor and diaphragm. Butt gripping may lead to hip arthritis and chronic pain, and the chest breathing to thoracic outlet syndrome, rotator cuff and scapular dysfunction etc. Not saying it will, but may happen. Definitely worth getting your breathing going properly mate. I like your passion btw, you're gonna be an awesome PT bro
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So what would be best for the breathing?
 
Wanted to update my personal condition.. Got moderate symptom relief from MFR and lots of tissue work. Ended up seeing a new doctor now that I moved back home. He is borderline brilliant and has pinpointed the issue to be my rectus not contracting or supporting anything at all really and thus causing surrounding muscle and joints to pick up the slack (hips and back). Also, my history of being overweight as a child lead to poor mechanics and a "hip swing" or sway, if you will, when I walk, run, do unilateral work, etc... Over time.. Perfect storm of little injuries erupted when I had my poor form deadlift of 310...

He has given me some PT exercises to focus on strengthening and retraining the rectus, and to fix my gait. He says my body/pelvis is "shifted", not rotated as evidenced by many physical tests he conducted on our first visit. My favorite was the march in place with eyes closed... After 30 seconds I was rotated almost a full 90 degrees to my left; it felt like I had not turned an inch....

We are continuing with some serious graston technique twice a week to clear out damaged tissues. After my third visit tonight, I feel like we both have a good grasp on the issue and a solid plan to fix it with some hard consistent work.
 
chedapalooza said:
Wanted to update my personal condition.. Got moderate symptom relief from MFR and lots of tissue work. Ended up seeing a new doctor now that I moved back home. He is borderline brilliant and has pinpointed the issue to be my rectus not contracting or supporting anything at all really and thus causing surrounding muscle and joints to pick up the slack (hips and back). Also, my history of being overweight as a child lead to poor mechanics and a "hip swing" or sway, if you will, when I walk, run, do unilateral work, etc... Over time.. Perfect storm of little injuries erupted when I had my poor form deadlift of 310... He has given me some PT exercises to focus on strengthening and retraining the rectus, and to fix my gait. He says my body/pelvis is "shifted", not rotated as evidenced by many physical tests he conducted on our first visit. My favorite was the march in place with eyes closed... After 30 seconds I was rotated almost a full 90 degrees to my left; it felt like I had not turned an inch.... We are continuing with some serious graston technique twice a week to clear out damaged tissues. After my third visit tonight, I feel like we both have a good grasp on the issue and a solid plan to fix it with some hard consistent work.
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Nice man! Graston is no joke! Stuff can be painful. I actually done it on my clinical rotation for school a while back!
 
NattyForLife said:
Nice man! Graston is no joke! Stuff can be painful. I actually done it on my clinical rotation for school a while back!
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Yeaa he thinks something's wrong with me bc I don't feel it that badly.. I do, I'm lying bc I want him to go as hard as he can and clear that shti out lol. I come home and my gf is like ...uh... Bruises and scratches everywhere

He taped my shoulder and lats tonight and it actually has given a lot of relief as well.. My whole body really is in pain due to this "shift" everything is essentially crooked.
 
chedapalooza said:
Yeaa he thinks something's wrong with me bc I don't feel it that badly.. I do, I'm lying bc I want him to go as hard as he can and clear that shti out lol. I come home and my gf is like ...uh... Bruises and scratches everywhere He taped my shoulder and lats tonight and it actually has given a lot of relief as well.. My whole body really is in pain due to this "shift" everything is essentially crooked.
Click to expand...

When you say shift, was he referring to SI joint?
 
It's most noticeable w how my hands hang. My left hand sits out in front of my quad, and my right hand is essentially touching my quad.
 
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