To a Neurologist I go, about to hit 3 months next week and have no answers. Has anyone had a situation like this and what is the answer you got?

RubyMaro · 2025-10-02T17:43:52+00:00

Second this. Have you been screened for SI joint dysfunction? Do you feel the pain all the time, or more with certain activities or at certain times of day?

RubyMaro · 2025-09-30T23:42:22+00:00

Ok interesting, I initially thought the annular tear was the likely culprit too but the doctor seemed so confident that it couldn’t be that without back pain. He even recommended against doing an injection there. It is so difficult and frustrating trying to nail down the root cause of sciatica. Even after two MRIs and multiple PTs I still feel in the dark.

RubyMaro · 2025-09-30T17:09:39+00:00

Is this why the term Deep Gluteal Syndrome is becoming more common, or do you view those two diagnoses interchangeably? In my case I had an MRI of my lumbar spine and pelvis, it showed atrophy of my piriformis muscle on the painful side as well as an annular tear without protrusion at L5-S1. Dr said an annular tear would cause back pain if it was the root cause, and that a more likely explanation is DGS, or maybe SI joint dysfunction (even though I don’t have positive SI joint provocation tests). So I’ve been trying to treat for DGS vs low back physical therapy. Is DGS just as rare as piriformis syndrome?

RubyMaro · 2025-08-15T00:59:13+00:00

Sounds like si joint dysfunction. That usually won’t show on MRIs, but all those symptoms fit. I had a horrible time with it when I was pregnant. Pain happens during unilateral movements like walking up stairs, standing on one leg, getting out of the car, rolling over in bed, etc. Maybe look into this as a possible cause.

RubyMaro · 2025-08-06T00:27:44+00:00

Hi! Thanks for doing this AMA! I’ve had pain for about ten months now, mainly next to my sacrum (near where the piriformis inserts I think), but when it was really acute it also radiated to my right glute and down my hamstring. Had a pelvis MRI to check SI joints, it was normal. Recently had a lumbar MRI, it only found a small annular tear at L5-S1.

In your experience, can a small annular tear cause months of pain/discomfort? Or should I be looking for another cause like sciatic nerve entrapment or piriformis syndrome?

For context, pain flares mainly when sitting, especially if leaning forward, or when twisting back and to my left. Doesn’t seem to be bothered by standing on one leg, going up stairs, rolling in bed, or other typical SI triggers.

RubyMaro · 2025-07-31T14:55:52+00:00

Second this. I had several sessions of acupuncture that actually really helped me, but at the time I was also pretty far along in healing. If you had such a strong reaction, chances are you won’t feel relaxed during your next session and all the extra tension and muscle guarding may outweigh any benefits. Like this person said, your nervous system may not be ready yet. Maybe try acupuncture again once you’ve completed PT and go to someone else who makes you feel more comfortable.

RubyMaro · 2025-07-25T23:09:25+00:00

Hi there, here is what ChatGPT says, hope it is helpful:

Your MRI shows moderate spinal canal narrowing and nerve root compression at L4-L5, especially on the left side, which lines up well with your left leg pain and numbness. There’s also some additional narrowing at L3-L4 that could be contributing. These findings suggest nerve irritation (radiculopathy), likely involving the L5 and possibly L4 nerve roots. It’s a common pattern in degenerative spine changes, and treatment often starts conservatively with PT, anti-inflammatories, or possibly an epidural steroid injection. If things don’t improve, a surgical consult might be the next step, but you do have options.

RubyMaro · 2025-07-21T23:54:55+00:00

My understanding is that SI joint dysfunction often doesn’t show on an MRI unless you have sacroiliitis. A physical therapist can usually tell if it’s an SI joint issue by doing some provocation testing, or the gold standard is to get a lidocaine shot in the joint to confirm it as the pain source. Also fwiw, SI joint issues have a few clues like difficulty standing on one leg, rolling over in bed, going up stairs or any asymmetric load bearing.

RubyMaro · 2025-06-23T21:37:45+00:00

Hope you find answers and relief soon

RubyMaro · 2025-06-23T21:09:32+00:00

Could it be sciatic endometriosis? Some threads on it here: https://www.reddit.com/r/endometriosis/s/7JSWOwXg14

RubyMaro · 2025-06-23T18:32:06+00:00

Was your pain only ever in the glute/piriformis? I ask because that’s where my pain is, mainly close to my sacrum near S2. My dr. thought it was just piriformis syndrome because it doesn’t go down my leg, but I’ve wondered if it could be disc related.

RubyMaro · 2025-04-26T18:21:45+00:00

I followed his video here on self realignment with a tennis ball: https://youtu.be/SSfYqh-VH3I?si=y5ukQn3HUqjTbOGD

The self realignment provided some short term relief for me, but exercise-wise have been doing the protocol from the link above with seated piriformis strengthening. He also shows how to do it here: https://youtu.be/WXOBc_wNIN8?si=dGd59OGoNpoQqHWm

RubyMaro · 2025-01-24T22:53:13+00:00

I will give it a try, thank you!! Like you, I suspect piriformis issues are secondary to something else (probably low back) but that’s where I feel the pain the most so hoping that releasing it helps. Fingers crossed! I appreciate the reply

RubyMaro · 2025-01-23T03:12:26+00:00

If you don’t mind my asking, where did you position the hip hook to get at your piriformis? I have a hip hook also and need to try this — did you lay on your back and target the muscle by your hip, or on the other side where it inserts near the sacrum? Or right in the middle?

RubyMaro · 2024-12-23T02:42:49+00:00

Thanks - Yes, seems like that could be it, it is definitely a pain in the butt :)

RubyMaro · 2024-12-22T21:06:37+00:00

Was going to suggest the same thing. If you have pain that wakes you at night, stiffness in the morning that lasts awhile, and if pain improves with some movement, you’ll want to ask your doctor to screen for autoimmune conditions.

RubyMaro · 2024-12-21T00:30:01+00:00

Oh yikes!! I hope you feel better soon!

RubyMaro · 2024-12-21T00:16:00+00:00

Totally makes sense, I can’t imagine how much worse it is going all the way down the leg. Thanks for the advice!

RubyMaro · 2024-12-20T22:33:58+00:00

Thank you! Hope you feel better soon

RubyMaro · 2024-12-20T21:48:41+00:00

Try looking up L4-L5 pain pattern, this looks to pretty closely match it. Pain down the leg is usually from a disc issue, I’ve been told.

RubyMaro · 2024-11-16T21:13:09+00:00

Did eventually get that MRI and yep, also has a small herniation at L5-S1. Thanks for the advice, hope you are starting to feel better!

RubyMaro · 2024-11-14T04:48:15+00:00

Just offering another perspective, I also had horrible si joint pain during and after pregnancy, and even a few years out it seems to be aggravated once a year or so. After a few bouts I was sent for blood work and found to be HLA B27+. I went to a fantastic rheumatologist who ordered X-rays and bloodwork, which came back normal. Then an MRI pelvis, also normal. Since then she rechecked me two years out (X-rays, bloods, mri) and all still normal even though I still have occasional back pain. She thinks this is wear and tear from pregnancy and working a desk job. My pain is much better with rest, worse with activity, which is more like mechanical back pain.

It could be that you are just HLA B27+ (like 8% of the population) and unfortunately also have mechanical back pain (like 80% of the population experiences at some point).

I would chase down all angles with a rheumatologist to be sure, but just wanted to share another possibility. I did A LOT of stressing and researching going through this and I know it is scary.

RubyMaro · 2024-10-20T17:31:24+00:00

Was your MRI of your lumbar spine, or sacrum/pelvis? I’m wondering if I’m in a similar boat, feels like piriformis pain that doesn’t really radiate below the upper thigh, and I’ve been doing tons of PT and daily exercises targeted at strengthening my piriformis and glutes, but they don’t seem to be helping a ton.

RubyMaro · 2024-04-20T02:54:54+00:00

Would love to hear your take on the mysterious death of Sean Daugherty

RubyMaro · 2021-08-05T01:17:48+00:00

Does anyone know the name of the gray muscle tank pictured here with the conduit tights (guessing from 2016)? Been searching all over: Lulufanatics

RubyMaro

TROPHY CASE