• Katie O'Bright, DPT

Butt pain and Nether Regions.

I've been dealing with hip pain from a condition called femoroacetabular impingement (FAI) for a long time. This is something that happens when the shape of your hip socket and thigh bone don't quite mesh well together. My symptoms involved mostly groin pain, but I also had some pain in my lower back and butt; when it got really bad, it radiated (sort of diffusely) down the side of my thigh, like this:

For me, it got to the point where I was unable to sit on the floor with my kids without pain, or even put my legs together side by side, among many other activities. I had FAI surgery on Jan 30, 2019. As early as a day after the surgery, I noticed a difference and did not have the same pain as before. I'm really glad that I did it. No doubt I am 100x better than I was pre-op, but I'm still recovering, even a year out. I'm not quite back to doing the things I'd like to be doing, like running... and still dealing with intermittent bouts of butt/groin pain. This got me thinking about other potential sources. Perhaps this is not my hip? I'll continue my personal story in the next post.

For now, I want to talk about the fascinating (and really annoying, for patients), complexity of pain in the lumbar, pelvic and hip area. Differential diagnosis (which is the process of figuring out the origin of the symptoms) is incredibly important in this area. The more I learn about it, the more I am beginning to recognize that there are more presentations of symptoms than their are diagnosis labels. Often times, butt pain is just labeled 'piriformis syndrome' or 'sciatica', because these are the things most practitioners learn about as diagnostic "labels". But there are tons of patients that, when they describe their symptoms, don't fit in to either of these categories. So what is their "diagnosis".... well, it's complicated!

Let's look at a butt. Because who doesn't like a nice butt ;) Side note: my 3 year old does a program at school called "stretch n grow". He came home one day and started talking about his 'gluteus maximus'. I was SO proud! Ms. Terry is the teacher. Right on Ms. Terry. Right on!

I'll direct your attention to the green X's above. Pain is a very complicated thing that is driven by the central nervous system. While pain can be sort of all over the place in some individuals with chronic pain and other contributing factors, I have found in my practice that there are a few distinct differences in origin of symptoms when a patient comes in stating 'my pain is here' and notes an 'X' marks the spot. Each 'X' denoted in the picture above represents a different primary location of symptoms that various patients have presented to me with. I'll discuss more about each of these locations in the next post. For now, I'm interested in hearing from you. Have you ever had symptoms in any of these spots? Which one? What was your diagnosis?

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