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Q. I have lower back and hip pain. Is it due to SI joint problem?

Answered by
Dr. Atul Prakash
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 23, 2020

Hi doctor,

I am going to mention all of my issues together since I think they may be related to each other. I have been suffering from lower back, glute, hip pain that radiates down my legs sometimes into my heels even, for around five years. This began after a hard fall onto my right buttock, although weirdly now most of the pain is on the left side.

I have also had some foot issues metatarsal pain and now pain on the outer edge of the front of my feet (I have not been diagnosed with a bunion but it is on its way there). I have been prescribed insoles that help with the metatarsal pain but not the bunion pain. When I initially presented with metatarsal pain, the podiatrist also diagnosed me with tight hamstrings which I definitely notice also. Since then, I have done all sorts of physiotherapies aimed at lessening the pain in my lower back/hip. As far as I can tell, it is the SI joint causing me issues. The pain gets worse if I am static in any position for too long (sitting, standing, laying down).

I recently decided to investigate further and had an MRI scan which revealed no issues in my SI joint, but showed that my back is fairly straight (as in, not a very pronounced curve) which is probably contributing to the pain in my lower back. The orthopedic surgeon also mentioned that my lower three discs are somewhat degenerated, and bulging a little too. Something that could eventually become a hernia, but is not necessarily the cause of my pain right now.

So I don't have any straight answers so far. My plan for the moment is to focus on strengthening my back (my core is quite strong but I will continue to work on that too) and working compression exercises for my lower back into my routine. I think this may help to stop or reverse my bulging disc issue. I have been doing more forward folds than backbends (I practice yoga regularly, and am incorporating more strength training into that routine), so I am reversing that trend now, after learning about my bulging discs. I will also try to strengthen my glutes as I heard this can help with the pain.

Having read all of this, what can you recommend? Does my regime sound good? I also have an appointment with a physiotherapist who specializes in backs near where I live, but in the meantime, I would like to hear as much as possible from outside sources about what their assessment and advice would be.

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Hello,

Welcome to icliniq.com.

Looking at the discs in the MRI that you sent (attachment removed to protect patient identity) I do not think there is a cause of leg pain there. Degeneration of discs leads to overload and pain in the back with local radiation. Leg pain comes from disc pathology with entrapment of the adjacent nerve roots. The second possibility is the SI (sacroiliac joint) joint that you are saying is normal.

Core and back strengthening will help always and I will recommend that you do more isometrics of the spine and reduce forward flexion that causes the disc to bulge backward. Gluteal and hamstrings stretches are crucial. Finally, try Pregabalin 75 mg twice a day for three weeks to see if the pain is relieved. Metatarsal pain is just an incidental issue that have happened together with leg and back pain.


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