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Glute hip and coccyx pain

May 31st, 2020

Hello

I sincerely hope you can help or at least provide some guidance. My situation is as follows.

I am an avid road cyclist although for the last couple of years I have cycled less due to an issue with my nervous system (never diagnosed but gradually got better on its own). This year I had been steadily getting back into my mountain biking. Back in Feb I started going for short runs ( I used to see do a lot of running too but slowly moved away from running as I got into road biking) and on one occasion felt a pain in right hamstring which was put down to hamstring injury.

After many weeks physio it seems to be gradually settling to the point where I have little to no discomfort in my hamstring, I do still have random intermittent tightness behind my right knee. The rehab of my hamstring seemed to take much longer than expected for a minor injury (no bruising or swelling).

During the hamstring rehab I slowly started to notice some gradual onset of pain on the outside of my right hip and after some tennis Ball soft tissue release in around my glutes (sore) I developed some localised glute pain.

Over recent weeks and past month I have had episodes of quite sore glute, lateral hip pain extending down the outside of my right leg plus what I can only describe as a warmth in my hip area. Throughout this I have been encouraged to keep riding my bike by physio (on rollers) which I have done so on and off.

When on my road bike i have noticed over recent years that I develop a sore lumbar spine on right side also (usually within the 1st 10-15min of starting a ride). The glute and hip pain certainly seems to be aggregated by riding although the onset of pain is usually delayed b y several hours. On most recent outing on my bike my glutes feel on edge and I do get some localised hip pain (road bike only) when I increase effort such as a hill, causing me to causiously back off.

One other symptom I have become aware of is some minor tingling in both feet. Over the last few years I have had multiple MRI scans of cervical, thoracic and lumbar spine none of which have identified anything of note.

My symptoms flared up most recently with hip exercises and glute stretches, trialled as part of hamstring rehab, so backed off these for now.

My symptoms flared up most recently while does cat stretches for thoracic spine.

Apologies for the long winded question but I hope you can offer some advice or suggestion.

Regards

d.

May 31st, 2020

The Guru Responded:

Hi Daff

Good, detailed set of events there.

I sure the (resolved by time) issue of your nervous system is of interest – most of these issue have something to do with central sensitisation or your autonomic nervous system, which I think is rooted (amongst other places) in poorer quality of motion in your thoracic spine than elsewhere.

It sounds as if your symptoms today are either neurally controlled or overloaded tissue – both have a common pathway to your lumbar spine.

I don’t think you need to be stretching anything – maintaining mobility through all tissue but not repetitive, end range stretching. I think the muscles that feel tight – hammies, glutes etc are actually stiff. They are protecting the underlying joints (lumbar spine) which has too joint play (not necessarily range of motion) and causing your symptoms. The more you stretch, the less control of the joint play you have, the more symptoms you feel…so you stretch more etc etc.

Instead you need to get control – not strength. You need to be mobile, across all joints not the ones that feel stiff, because the stiffest ones don’t move and you have no reception back….and the stiffness you feel is probably coming from the muscle surrounding the joint, not the joint itself.

It’s why the cat stretches seems to be problematic. Whilst thinking that it’s a decent thoracic spine stretch, because you have lack of control around your lumbar spine when your arch/hollow your back you’re going for increasing range of motion and not quality. All the movement you do is through your lumbar spine, because your thoracic spine doesn’t move very much and you can’t control the motion of your lumbar. Hence you just wind the tissues up.

I wonder what your single knee squat is like on your right compared to left. Poor I’d imagine – and this needs work especially if on a bike. Your set up could be keep too especially if it’s too short to your handlebars https://www.sixphysio.com/videos/cycling

Try lots of specific (as you can be) thoracic spine mobility drills https://www.sixphysio.com/videos/back-pain

Hope this makes some sense.

The Guru

Jun 01st, 2020

Thanks for your comprehensive reply.

By “wind up the tissue” does this mean make everything even tighter and cause more pain?

I fully now get the more you stretch the less control and more symptoms appear. It feels like I’ve been on a downhill spiral of symptoms from the very start perhaps made worse by stretching what I thought was tight.

Stretching to end of range doesn’t equal mobility. Now get that (I think).

The glute and hip pain (plus feeling of warmth?) also emanate from the spine?

Is there a physio in the six physio team that I’d benefit from being in touch with (in a virtual manner)?

Daft question perhaps but with symptoms I describe should i continue to cycle (my passion)? Feels like my glute and hip on edge (of something bad) with any imminent increase in output on bike.

Regards

D

Jun 01st, 2020

The Guru Responded:

Ha!

Wind up as in the more you irritate/overuse the tissue the more the tissues become overused, irritated and generally more sensitive/painful.

Nervous sensation can become a lot of different things – and the feeling of warmth, rather than actually being warm to touch, is exactly that.

I think getting a session with Neil on the virtual team (cc’d above) would be a great idea. There’s a lot he can assess and do virtually.

Have a look at the bike setup videos from before – if you think the set up is OK then cycle BUT do less, say 50% and see what gives. It’ll give an indication as to whether the issue is about structure or about how you use (ie control) your structure.

The Guru.

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