I'm not treating the hip at all specifically.

The surgeon basically said that he believes all the issues, the high ham tendonopathy, the piriformis-like glute pain when driving, the visible atrophy of the glute on that side compared to my good side - claims its all due to the CAM/FAI causing the entire region to react. He also said that surgery is far from a guaranteed fix, and from what I've read online, that seems to be correct. He only recommended surgery if the pain got to be really really bad, and I agree.

My physio and I don't dispute that I have CAM/FAI, but any and all movements he does with my leg don't cause anything he would expect to see - limited range, grinding, etc. So while it may be the cause, we don't see any reason not to try to re-strengthen everything. I think for the past 20+ years I haven't had proper 'glide' in that hip (likely due to the CAM), so everything started compensating. When I sit on a bike, that hip wants to move forward since it doesn't glide well, and my knee goes in and out, etc........So now try to rebuild and maintain it well as possible.

With regards to the L4/5 herniation, the surgeon basically said he could take 100 people off the street, and half of them would have similar. Basically saying that it wasn't the root cause. Agreed that it -might- be responsible for some of the nerve like pain I sometimes get in the middle/front of my quad on that side, but again its nowhere near bothersome enough to warrant any kind of invasive surgery or needles.

Feel free to PM me if you have any specific questions.

Give this a good read: https://www.ncbi.nlm.nih.gov/...articles/PMC4487155/. It might help.

This reference is for "localized injections" of HGH and testosterone for LBP with no control group. I'm very skeptical that the results have anything to do with local effects and not the effects of 4-5 weeks of doping with HGH and testosterone. These drugs may or may not be effective for pain, but are banned substances.

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Brian
“Eat and Drink, spin the legs and you’re going to effin push (today).” A Howe

OP, are you a professional athlete? They're not banned substances for a patient that's trying to resume being a healthy human being. If I had severe and/or frequent pain, I'd absolutely be considering anything that would help me regain the life I enjoy.

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https://connect.garmin.com/modern/profile/domingjm

I'm pretty disappointed to hear that the injections haven't helped. I just had MRI's analyzed and the diagnosis appears to be similar to yours. To this point, I've basically been self-treating with aggressive glute, hamstring and calf stretching, as well as foam rolling on my glutes. I'm starting injections next week but we've also briefly discussed fusion surgery at L4/L5. What's your perspective on surgery?

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https://connect.garmin.com/modern/profile/domingjm

Instead of stretching, have you tried strengthening?? I did stretching, massage, chiro (ART & Graston), traction, etc. Only thing that finally helped was strengthening all those areas.

Yes, strength levels are good. But that's always a good suggestion. It appears that the problem has arisen from a prior vertebral fracture, which is now causing some alignment problems such that the nerve is being pinched. They don't know if the nerve inflammation is acute or chronic but they recommended the injections as a first step. That surgical procedure appears to require a pretty long recovery period :-/

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https://connect.garmin.com/modern/profile/domingjm

My perspective on surgery is that I'd strongly prefer not to have it. I'm pretty confident there is a non-surgical solution to my issue.

"The intervention appeared to be safe and the results provide a reasonable expectation that the intervention would be beneficial for a population of individuals with chronic nonradicular lower back pain."

Thanks but if I understand the situation correctly all my pain is radicular. My actual lower back doesn't really hurt.

I know you mention your strength is good, but is it uneven between your left and right side?

My power meter always showed about a 4% diff between my two sides, my bad side being the weaker one. I always just ignored it.

In physio this past year, they could very easily see the difference in size between the good and bad glute. And my hamstring on the bad side had almost zero strength in it. Interestingly, the calf on the bad side was actually bigger than the good side, so maybe that was over-compensating for the other weaknesses. Ugghh....everything is a big chain with this stuff, all connected....

Have you given Chiropractic a shot? Made a major difference with me.

Radicular pain should almost always respond well to epidurals. What you’re probably not aware of is that there are different types of epidurals. The most common is trans laminar. Basically the needle goes in straight center between the lamina and into the epidural space. The problem with this is that it’s the hand grenade of medication delivery. You put a volume of meds in the epidural space and hope it gets to where it needs.

The trans foraminal approach is much more specific as the needle goes towards only one foramen. So say you’re having right sided sciatica ( pain that radiates down the back of right leg). The right L5/S1 foramina would be targeted so the steroid gets directly on that hot spot.

Two things, I don’t believe the epidurals worked because you didn’t get an effective does of steroid to the right nerve root. Secondly, the injections should have been spaced one week apart for max effectiveness.

FWIW you can have six epidurals a year.

Good info, thanks. I did know there are different types but I'm pretty sure they referred to my procedure as interlaminar - is that the same as translaminar? I know it wasn't transforaminal. The injections were spaced out more like 3 weeks, maybe even a little longer. My doc required a follow-up two weeks after each shot, then it would take at least another week to schedule the next one and get insurance approval. Is there a reason they don't approve them as a series of multiple injections knowing that many people require several? Also, what determines which type of injection is used? Is it simply severity of symptoms?

Interestingly, now that I'm almost a month out, I'm starting to notice some improvement. Delayed reaction I guess?

Yeah inter laminar and trans laminar are the same thing. I don't know who your physician was but that sounds to me like an excuse to collect copays and office visit fees (yes people actually do this). Yes insurance auth for all three injections could have been done at once, this is typically how its done. I'm assuming the reason it was not in your case was because of the follow up office visit after each shot. Honestly not trying to be too judgmental but it sounds like your physician dropping the ball here. 3 injections in quick succesion to get the inflammation down is pretty much standard course of treatment.

Type of injection done depends on the physician performing the procedure. Did you have your MRI done before your injection? If they knew for example you had a right sided disc protrusion at L5/S1, some docs would go straight to the trans foraminal. Some would also try the standard trans laminar approach first, and if that failed, they'd then try the trans. All depends on the physician though. Everyone has their own styles.