Hamstring/Glute pain

[ahuramazda]

Hi, I have moderate pain from my right glute/hamstring area. I've had it for a long time, tolerated it, but it doesn't seem to resolve itself.

My right leg is 1.2cm shorter than the left. Consequently, I wear an 8mm orthotic in my right shoe. However, when I'm around the house, I don't bother with an orthotic and just wear my sandals. I do a fair amount of activity: cycling, walking, yoga.

When I do yoga, I do most of the usual postures and throw in an extra glute stretch like this:

However, I can't seem to do a stretch that targets the effected area.

The problem obviously comes from the extra load being placed on the right leg. Maybe I need an orthotic that balances out the whole 1.2cm differential but at the same time I don't want to become too dependent on it.

I'd be interested to hear people's views on this. Thanks.

[old goat]

more likely a spinal problem. (I'm in the process of being evaluated for a similar problem, which has progressed to sciatica). See a doc.

[jmedslc]

Got the same sorta problem here ... Sore left hammy for...say the last 4years

[UllrsParadise]

Also currently working through a similar problem. Pain and tightness even with a regular dose of stretching. Legs are the same length but have a 8mm difference in pelvic bone height. My hips are out of whack which sends the spine out of whack and interferes with the nerves. I'm only a week into chiropractic therapy but doc seems confident in being able to correct it and relieve the pain and tightness. Might want to at least get a consultation. Good luck.

[ahuramazda]

Yea, will see what the physio says.

In the meantime, I found this stretch helps, which is another variation:



Thanks.

[jma233]

A real leg length difference is rare and pretty difficult to measure. Takes a radiologist who is on the ball and a carefully planned series of xrays.

Apparent leg length differences are extremely common and the methods to detect them don't stand up to any kind of scientific rigor. Worse yet, there is incredibly poor interrater and even intrarater reliability. Get tested by 10 different PTs or chiros and you'll get 10 different leg length difference measurements and disagreements on which leg is actually short.

Also apparent leg length differences are not skeletal, they are caused by weakness and/or tightness and/or habit (ie: motor programs or functional adaptations to work around tightness/weakness). My advice would be to focus on things like yoga, aggressive massages/rolfing, pilates, etc and be leary of wearing shims.

The other thing you'll occasionally see are PT's or chiros telling folks that their pelvis is tilted or rotated, etc. That may be true but its tightness/weakness that is causing the abnormality and not the SI joints being 'stuck' like some claim. Sometimes a quick manipulation of a SI joint will relieve symptoms but this is most likely due to a reduction in tone following the manipulation and not freeing a 'stuck' joint.

[My Pet Powder Goat]

more likely a spinal problem. (I'm in the process of being evaluated for a similar problem, which has progressed to sciatica). See a doc.

Old goat is the man when it comes to these things. I'd listen to him.

What kind of pain? stabbing or shooting pain? pins and needles? dull ache?

I don't know where OG stands on chiropractic work, but it's helped me in the past, as well as deep tissue massage, and acupuncture.
the hips are very dynamic; ball joint with lots of big muscles, smaller stabilizer muscles, and ligaments all trying to work together = plenty of ways for them to get out of alignment (so to speak)

[ahuramazda]

"A real leg length difference is rare"

Not to my knowledge, nor from my observations. When I study people in the street, I notice a lot of people whose left leg is longer than their right. I'm right handed and played a lot of racket sports when young as well soccer both of which can cause an imbalance which could then lead to the issues you outlined, which would then result in the effect of leg length shortening.

As to the type of pain, it's more a dull ache. I can function pretty normally with it but knowing exactly why I'm getting the pain would be helpful.

[whyturn]

I have a recent calf strain from similar issue with low back and hip
Have been using hot rice bag which works well and getting ultrasound treatments. Also flexibility and stretching helps but I don't do that enough cause I'm a typical guy
Anyways I heat it in the morning for 30-40 minutes and it really helps

[dcpnz]

There are numerous variations of the "figure 4" stretch that seem to get slightly different places for me.
1) sitting on chair lay ankle of one leg across knee of other and gently push knee down
2) laying on your back cross legs above the knee and pull lower leg gently toward you.
3) laying on back put ankle on knee and gently pull lower leg toward.

All look/sound fairly similar but try them all for subtle variation

If you are looking for professional help I've become a big fan of A.R.T. - Active Release Techniques.
http://www.activerelease.com

Recently had a stuck SI joint caused by muscle tension resulting in extreme lower back pain - fixed in a couple of ART sessions and rigorous stretching at home prevents recurrence even when I feel symptoms coming on.

[ahuramazda]

leg length differences are not skeletal, they are caused by weakness and/or tightness and/or habit (ie: motor programs or functional adaptations to work around tightness/weakness). My advice would be to focus on things like yoga, aggressive massages/rolfing, pilates, etc and be leary of wearing shims.

I had the crazy idea of trying to stretch out the shorter leg. If it is true that the problem is caused by muscle and tendon weaknesses in the hip, then I could gradually tease out the leg so that it aligns better.

I was thinking if I suspended myself upside down from the ceiling a bit like this:



Obviously, with the emphasis on the right leg - if I was to do this for a few mins every day for a few weeks, it could be interesting to see the results.

[jma233]

I had the crazy idea of trying to stretch out the shorter leg. If it is true that the problem is caused by muscle and tendon weaknesses in the hip, then I could gradually tease out the leg so that it aligns better..

I doubt that would work. In my experience the difference has to do with femoral rotation and abduction. Ever watch someone walk or stand that has had a bad stroke? Their affected leg will have virtually no abduction...granted this is an extreme example. I like the variations of figure 4 stretches mentioned earlier and all the hip stretches in yoga. Also, the pain source being from the low back makes a lot of sense.

[old goat]

Old goat is the man when it comes to these things. I'd listen to him.

What kind of pain? stabbing or shooting pain? pins and needles? dull ache?

I don't know where OG stands on chiropractic work, but it's helped me in the past, as well as deep tissue massage, and acupuncture.
the hips are very dynamic; ball joint with lots of big muscles, smaller stabilizer muscles, and ligaments all trying to work together = plenty of ways for them to get out of alignment (so to speak)

Thanks for the compliment but I'm a general surgeon, so I don't claim a lot of expertise in this area. I'm coming at this more from a patient's perspective. As far as chiro, I don't have a strong opinion. I'm thinking of trying it myself if my MRI tomorrow doesn't show a herniated disc. If there is a disc herniation I wouldn't want to try it--I'd be concerned about making the nerve impingement worse. (And I wouldn't let a chiropracter manipulate my neck due to the small risk of carotid or vertebral artery damage) Chiropractic isn't risk free but neither is popping advil all day.

JMA is right on about the leg length thing. Before anyone can advise you on how to treat your problem you need a diagnosis. Who told you about the leg length discrepancy. Might be worth a second opinion on that. I'd still guess back, but you need a real diagnosis. A physiatrist (physical medicine doc--MD) might be the place to start.

[ahuramazda]

Who told you about the leg length discrepancy.

A podiatrist told me.

[old goat]

A podiatrist told me.

I have nothing against podiatrists--I go to one myself--but I think a leg length discrepancy might be a bit out of their expertise to diagnose. Any podiatrists around care to weigh in?

[robgoose]

Yea, will see what the physio says.

In the meantime, I found this stretch helps, which is another variation:



Thanks.

I found this to be really helpful-- including when I had mild sciatic issues. Tried stretching out over the knee with my chest, If that makes sense

[neufox47]

You need a good PT.

[spindrift]

Not a doc. Don't play one on TV. That out of the way, my spouse took a fast hard fall in some weird snow last spring. She (and I by proxy - but me minus the reattachment surgery she had) learned a whole bunch about hamstring avulsions. If you've ever had what seemed a really bad hamstring pull (esp with large moving bruises), there is some chance this is the long term impact of that... Sciatic nerve issues are also common. You might research that avulsion thing a bit - if there were every any events that could have caused such a tear.

This seems to be a go-to resource. http://www.injuryupdate.com.au/forum...r-from-pelvis) Obviously there are many pages to that thread. And the state of diagnosis and repair has advanced markedly since it was started. So you may want to skip closer to the end. Assuming it seems a possible issue at all.

Good luck with getting this solved.

[Shredhead]

If you've ever had what seemed a really bad hamstring pull (esp with large moving bruises), there is some chance this is the long term impact of that. .

You mean like this?



My water ski season was cut short last season by a pulled hamstring in late July. I have a bud that's a head trainer for a major university and he told me to get as many massages as I could afford, to break up the scar tissue. I did 3 or 4 a week for a couple of months and still do a couple a month.

It's still a little stiff this year, but I'm pretty much back to normal.

[spindrift]

Yeah, pretty much like that. Except in cloudpeak's case it sort of shifted around a bit on a daily basis.

Turns out that the proximal hamstring connections are pretty complicated. And partial tears can still inflict long term damage. Apparently the loose ends try to bind where they land. Often in the sciatic nerve zone. Watersking is a frequent villain. In fact cloudpeak's ortho (luckily an expert in this) cleared her to for cycling and skiing pretty early. But asked that she please never ever waterski...

The hassle is that the only "for sure" diagnostic is an MRI. cloudpeak has a crazy high tolerance for pain - so the doc initially thought maybe it was a minor tear. When the MRI came back, he was like "how about we do pre-op this afternoon and operate tomorrow".

[shafty85]

I do a fair amount of activity: cycling, walking, yoga.

If you consider walking to be a physical activity, do you really do a 'fair amount of activity'?

[spindrift]

Oh - one last comment. It is typical for pain to drop off after the hamstring is partially torn off the bone. But the damage is likely to be long lasting as the ton tendons typically retract. Repair, if needed, is best done sooner than later as those ends do bind where they land.

Most PT's, general docs, etc. massage folks, etc. are not really equipped to recognize this as a possible issue. It is mostly higher end sports orthos who are gonna know how to deal with it (and whether or not surgical repair is actually needed).

[CarolB]

My leg was shorter but that's partially because of the arthritis in my hip. Getting a new hip has been bizarre as I now have more length and need to relearn a different posture and stretch out my ITB band and thigh muscles-not an easy task. I thought I had a good posture before surgery but now can see how I was rotating in on one side for sure and hence the constant visits to physio for re-tiliting/abduction. Guess that's why the knees took a beating as well.
My issues seemed to start at around 40 when I started dirtbiking (many hours) which uses alot of adductors. I think I lost the abductor strength/balance. So, I wonder if stretching the abductors, as shown in those pics is the only answer and maybe it's more of a problem of needing to strengthen the abductors as well? With my new hip that's pretty much what rehab focuses on and you get to realize how weak they are, in comparison.

p.s- I'd also go for there being no way that anyone without a proper XRay machine (or maybe had you knocked out cold and with no muscle tension) could tell you that your leg is truly bone length shorter. They could maybe tell you that your posture/positioning makes the leg shorter, based on pelvis positioning. I sometimes wonder if orthothics might make things worse by continuing imbalances on people who really need to muscle balance (like me). I got orthotics at 30- hmmm... start of the problem never fixed and then moved on to Arthritis?