Have you had an EMG?

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Two wheels good. Four wheels bad.

Yes about 6 weeks after I hurt my back occurred, it was negative as for showing any issues. The most recent doctor thought it might be advisable to do another one though as sometimes it takes a while for the nerve damage to show up. Thanks

Another EMG, done by a reputable electromyographer (preferably a neuromuscular sub-specialist or at least fellowship trained doc) if you can get to one, may be helpful. Best of luck.

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Two wheels good. Four wheels bad.

Sorry to be a bit ignorant on the subject but what is a electromyographer the first one was done by a neurologist who does the EMG tests all the time, I was looking at another local neurologist who does these types of EMG tests.
Thanks LA Rob

You would want to make sure that the neurologist (or PMR specialist, these are the two medical specialties who train in doing EMG) are fellowship trained and board certified (ABEM) for doing EMG's, and preferably are an AANEM approved laboratory. Just because a neurologist "does them all the time" does not actually mean they know what they are doing. The best would be a sub-specialist, who specializes in nerve/muscle/peripheral neurological disease.

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Two wheels good. Four wheels bad.

Thank you that is good to know. I will certainly ask about that for sure. LA Rob

I've had a psoas issue for the better part of a year unfortunately. I have a very good sports massage therapist who diagnosed the problem; my problem originated with a PF issue on my left foot that was treated with accupuncture. She thinks that the overtighted tendon essentially migrated the problem up my left leg and now manifests itself in my psoas.
I get massages pretty regularly which goes relieve the pain.

Im still not 100%... :(

I just got back from the local hospital surgical center where I had a psoas steroid nerve block, right now my back is sore from where they injected me but my groin feels good, so fingers crossed this will help do the trick if not I just don't know what to do next with my bloody back and groin issue. Perhaps it is something to consider if your pain is so long lasting and the massage only helps to a certain extent, worth checking out I would think.

I got there by first seeing a neurosurgeon who then referred me to the pain specialist who is very bright and was thinking out the box which for me was good and didn't just recommend the usual epidural for my back pain which of course didn't work with the first pain specialist I saw. But good luck because if it is any where near the pain I have been going through then I know you must be hurting.. I wouldn't wish this on anyone for sure. .. Cheers LA Rob

FWIW, we thought I had a strained psoas for months, only to find out it was actually a sports hernia.
It is difficult for you to do a basic lunge-stretch? Lying on your back with half of your body hanging off the side of the bed, can you let the affected leg hang down and touch the floor with ease?

If NO, then quite possibly a psoas. If YES, it could be something else...

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I can do the lunges and lie on the bed dropping the leg no problem. I do have a feeling that something majoring is happening from the back to the groin though as that psoas block I had yesterday has not helped with the nerve pain in the groin or the low back pain.

I did have a sports hernia surgery back in 2012 in the same groin along with having two of the nerves in there cut to relieve pain back then but this feels different as back then I didn't have the back pain. Cheers LA Rob

Any more ideas welcomed as I am at a total loss of what to do next. The pain doc said he will put in for a psoas and groin MRI, but at this rate I am going to be glowing, this will be my 4th MRI in 8 months!

My PT figured out that I had psoas issues after I thought I had thrown out my back out twice in three months. I had just switched to a desk job and was seated for 5+ hours a day, so this did not help with already tight psoas. After 6 months of a stretching and strengthening routine developed by my PT, I found that the high lunge and low lunge stretches were most effective.

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Oui, mais pas de femme toute de suite (yes, but I am not ready for a woman straight away) -Stephen Roche's reply when asked whether he was okay after collapsing at the finish in the La Plagne stage of the 1987 Tour

Nerves and pain are your instruments of dysfunction. In other words like a temperature gauge, or dial indicator, they tell you roughly what's going on and where. Everything seems to funnel or channel to the low back section tho, as this flex joint is most easily pulled out of alignment (vs the secure hip ball and socket) by traumatized connective tissues. We never used to take NSAIDs during ski season for this reason - as injuries would get worse without pain feedback.

What's the history? How did you arrive the hernia and we talking about left side (same as me)? How did the imbalance come about?

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No idea how it came about back in 2012 when I had the sports hernia on the right side, just happened after a bike ride, felt a lot of pain in my groin and it went from there. This episode so much different when my back went out on me, nothing caused it that I did special but it laid me up for a few days as I say all on the left then within the month all the pain went over to the right side, nerve pain and muscle pain. Then it started in my right groin after about 6 or 7 months of suffering low back pain, maybe be coincidental I don't know but the two MRI's on my back show small herniation's of the disks but according to the doctors not something that should be causing me all this pain, and not something they would consider doing surgery on. Even with MRI of the nerves across the hips and thigh which didn't show up anything, so not much else to look at there I guess.

So two epidurals later, plus months of physical therapy still no help, hence the new approach to try the psoas muscle, and have the block there yesterday but speaking with the doctor today he said it would take up to a couple of weeks to feel the full affects as still no pain relief today. Next week another MRI on the groin and abdomen so hopefully that might show something up!

What caused it, and what imbalance I might have I have no idea other than getting older and wear and tear after the past 35 years of being so active who knows, but I have always routinely stretched, never had a back issue in my life until this episode and always tried to keep strong and active in the gym besides the usual swim bike run stuff, but I will say this the pain has been pretty incredible to say the least and I am tired of it for sure. Hence me reaching out to anyone who has anything similar that me and the many doctors and P/T's have not looked at. Cheers LA Rob

FWIW, I never had symptoms from a tight psoas until after herniated disc L4/5. On year four of recovery, and it remains a problem. Manifests itself in at least two ways: 1) when it is particularly tight, it creates tension on the herniated disc, replicating symptoms from the nerve root compression, and 2) pain in my groin following any intensity on the bike or run. The "usual" stretches did not help. After years of experiencing a fairly high level of pain from the herniated disc, my body goes into an automatically guarding defense that tightens everything up.

After (painful) soft tissue work to get the thing to start to release, stretches, and change to a combination of sit/stand/walk desk, PT has me focused on relaxing muscles and releasing tension. Much of it is mental work. Part of it involves the PT sticking his finger into a muscle and saying "move x without contracting y." Backs are complicated....

FWIW, you won't "glow" from the MRIs. No radiation exposure. It's really a pretty amazing technology. Too bad it's so costly.

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No coasting in running and no crying in baseball

Thanks your issue sounds very similar, the bike seemed to make the ache in the groin a lot worse hence I have stopped cycling for a while, plus dealing with the back pain. I know mental relaxing does help, but it is hard especially when dealing with the pain constantly for so long.

As for the costly MRI's thankfully I do have a decent PPO insurance but the MR Neurogram that I had done with UCLA ended up not being approved by my insurance due to them classifying it as experimental but thankfully the insurance said I do not need to pay and I am not responsible but I am sure UCLA will be coming after me as this MRI cost $14000 and my portion the insurance told me I had to pay was only $50.

Thanks for your insights.. Cheers LA Rob

hercules wrote:

Even with MRI of the nerves across the hips and thigh which didn't show up anything, so not much else to look at there I guess. So two epidurals later, plus months of physical therapy still no help, hence the new approach to try the psoas muscle, and have the block there yesterday but speaking with the doctor today he said it would take up to a couple of weeks to feel the full affects as still no pain relief today. What caused it, and what imbalance I might have I have no idea other than getting older and wear and tear after the past 35 years of being so active who knows, but I have always routinely stretched, never had a back issue in my life until this episode and always tried to keep strong and active in the gym besides the usual swim bike run stuff, but I will say this the pain has been pretty incredible to say the least and I am tired of it for sure. Hence me reaching out to anyone who has anything similar that me and the many doctors and P/T's have not looked at. Cheers LA Rob

Age is only a marker of how long you have been over-doing certain activities (other than walking). So a swimmer will likely suffer injuries after about 6-8 years national-level competitive duty cycles, or same for say other sports e.g cycling/track/sprinting without a proper re-hab strategy in place.

Lower back issues causate from underneath, so up from the function of the legs and the two hip joints. And also implicated is the upper spine and neck positions re: cycling :(.

So our starting point is** : "Most chronic injuries are a result of either too much or not enough muscle activation". True so the goal of PT is to identify and correct the repetitive use patterns with opposing algorithms. Not an easy task depending on how you got there.

But it sounds like your situation should be correctable with some basic functional diagnostic tests, then bread and butter athlete rehab - probably involving strength such as squats, etc. and range of motion moves.

The single leg hip hinge is a good basic test. It can be done with a table top. How do you with one side vs the other. Are your hip joints gliding freely and can you layout horizontal with the back leg extended, supporting leg straight? I can't btw, my left leg supporting is a bit of a mess.

Refer to link: ** https://www.trxtraining.com/.../piriformis-syndrome

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Training Tweets: https://twitter.com/Jagersport_com
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Is see that it has been a few years since you've posted in this thread, but I wanted to know if you have found relief from this back pain? My son (34 yrs old) has been dealing with these same issues for about 10 years. He's had MRI's, x-rays, been to neurologists, chiropractors, PT, GI's, back/spine doctors, etc. The one thing that is different than you, is that his pain started on the left and has remained on the left. He recently read about psoas muscle pain and says it describes his pain to a T. His hopes for a cure or relief have been built up so many times only to find none of the Doc's have done anything to fix it. So he may be willing to go to a doc one more time. I've been looking for a doc who will take his condition seriously and make a concerted effort to find a solution. Hoping you are better. Can you share any positive actions that worked for you?

Hello, yes it has been a while and no not much relief at all, the latest is I had a sit down MRI at Beverly Hills MRI where you sit down and they scan you, then you lean forward and back and so it shows a lot of the way the spine moves and is under normal pressure as opposed to lying in the MRI tube. The MRI did show some issues when I lean forward showing the disk narrowing. The pain is still on the left side, I had a stem cell injection back in February and it did help some of the nerve pain but not the psoas muscle pain. I go for another stem cell next week, the neurosurgeon cannot really explain what is causing the pain which is now going out to my flank and some days it is very painful.

The latest neurosurgeon I am seeing is Dr Larry Khoo in LA and he is pretty incredible really thinks outside normal issues and has been great with his help. I hope you get some help for your son but it is frustrating to go to so many doctors, try so many physical therapy appointments and nothing works. Cheers LA Rob

I thought I had a tight/strained psoas, so did the Physical Therapist. Did some soft tissue work that seemed to help for 15 minutes or so and then I was right back where I started. Long story short, after PT wasn't working, I got an MRI and sure enough have a torn hip labrum.

I only say this because if you google symptoms, you'll see that a lot of times hip issues manifest as lower back pain and migrates into the quad and glute.

Thanks for the input, I did have a hip MRI a couple of years back when this all first started but the MRI didn't see much maybe a bit of narrowing of the ball joint but apart from that nothing showed up.. it is like everything you don't mind going through all the pain, all the tests, all the p/t etc. if only it could be narrowed down to what is causing the pain, it is just dam frustrating... Cheers LA Rob

Good grief. I would swear that it is my son posting as "Hercules". But I happen to be visiting him in Iowa right now and I have read this thread to him. I know it isn't him. It's just that the description you write about is exactly what is happening to him and reflects his frustration level, too. Wondering if I should contact Dr. Khoo and explain that there are two of you out there with this issue? My other son, lives in West Hollywood, so we could arrange an appt. with him if that would be promising. Any ideas on this? There are not many qualified neuromuscular/neurosurgeons around our area. Would you recommend the stem cell injections?

Hi, well all I can say is I must have seen 6 other neurosurgeons, 2 were at UCLA spine clinic and 2 orthopedic back doctors all of them really couldn't offer too much help as although they could see on the MRI's two disks with annular tearing but it really wasn't in the place to cause all the pain on the right side and into the right groin according to them and none thought regular back surgery was the way to go even though I had a 6mm protrusion. Now I know I had some irregular issues going into this prior to hurting my back on July 4th 2016 like a IVC filter rupture back in 2012 but that only caused the right groin pain.

Then I found Dr Larry Khoo who is located down town LA, he used to be the top doctor at UCLA spine clinic Santa Monica before he went on his own, for me he was just the right doctor who took the time to listen to all the issues I had been through, he was the one who suggested the sit down MRI with flexation which showed up more issues than the regular lie flat MRI's I had been having. Then he suggested the stem cell and rich platelet injections into the L3 disk. I did feel a lot of relief after about a month but I will admit the first couple of weeks were painful from internal pressure but then by about 3 months out a lot of the nerve pain has gone which he is happy about as it is now past the time for it to be the steroids he also injected around the area to be masking the pain. Over the past few years I have had over 6 epidurals which didn't help, one psoas steroid injection which didn't help, right femoral nerve ablation at UCLA helped for a very short period of time, numerous steroid nerve blocks into the groin which really didn't help for long. I had even had some nerves cut in the right groin which did help for a couple of years but then the pain came back in 2016 after I hurt my back again, so I would say I have been around the block with trying various treatments.

The problem is the stem cell injections didn't help much with the flank pain somedays it is really bad especially after riding or gym work, even swimming can sometimes make if feel like a knife in the side. He suggested the next stem cell which I will have next Monday so we'll see. But I can honestly recommend him as a great doctor, who does take the time to sit and listen and think out of the box. When you do get an appointment you will have to wait especially later on in the day because he does take his time with his patients. After seeing so many other doctors I think he is the best, it sounds like your son may have gone through a number of doctors as well so what have you got to loose at this stage. Cheers LA Rob

Did you get the stem cell injection Monday? How ya doing?

Yes I got the second stem cell injection Monday, no nerve pain right now which is good, back is sore but otherwise all went very well. Thanks for asking, did you consider contacting the doctor for your son? Cheers LA Rob