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Having pain in buttocks even after lying down with a pillow below knees to reduce disk pressure. Is it due to herniated disc?

May 2014
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Answered by

Practicing since : 2002
Answered : 6316 Questions
Please see mri, need second opinion. Included profile view. Please tell me how bad it is.
Thanks. Also, I was laying down on the mri machine with a pillow below my knees, if that helps, likely reduced disk pressure. Pain still after 9 months, now in both buttocks. Don't know if its solely due to herniated disc but I feel like there are other muscles involved maybe psoas or piriformis. My spine tilted to the right also and right hip is higher where previously it was not.
Posted Fri, 1 Nov 2013 in X-ray, Lab tests and Scans
Answered by Dr. Vivek Chail 1 hour later
Brief Answer:
Annular tear and disc dessication at L5 - S1 level

Detailed Answer:
Thanks for writing in to us.

I have read through your query in detail.

The X rays Lumbar spine show normal alignment and curvature of the lumbosacral spine. The vertebrae are normal. There is mild reduction in inter vertebral disc space is at L5 - S1 level. Rest of the inter vertebral disc spaces are normal. The paravertebral soft tissues appear normal. The posterior elements and pedicles are normal.

The MRI lumbosacral spine images sent are 1. T2 weighted image in sagittal plane and 2. T2 weighted image at level through iliac bone in transverse plane.

The sagittal image shows dessication (decreased water content) of the inter vertebral disc at L5 - S1 level. Posteriorly there is mild disc herniation at the same level with annular tear.

Pain in the buttocks can be explained from the above findings. The disc between two vertebrae is like a jelly donut. The "jelly" (nucleus pulposus) has the texture of crabmeat and the "donut" (annulus fibrosus) is ligament that is attached to the vertebrae above and below. An annular tear is a tear in the donut through which jelly might ooze out.

It is not exactly clear why some degenerated discs are painful and some are not. As with many common causes of back pain, there is probably a variety of reasons that discs can become painful. Some theories are:
If a disc is injured, it may become painful because of the resultant instability from the disc injury, which in turn can lead to an inflammatory reaction that results in low back pain.
Some people seem to have nerve endings that penetrate more deeply into the outer annulus than others, and this is thought to make the disc susceptible to becoming a pain generator.

Coming to muscle disorders, psoas is not showing any obvious abnormality.

Hope your initial query is answered.
Please feel free to ask further clarifications.

Above answer was peer-reviewed by
Follow-up: Having pain in buttocks even after lying down with a pillow below knees to reduce disk pressure. Is it due to herniated disc? 10 minutes later
Is surgery needed? The pics I sent were of the l5s1 disc as you said. Can you tell me in laymans terms what my next steps are? The first month I got injured I couldn't even move out of bed ( 9 months ago). Its been getting better ever since but ive been stuck at a rating of 6.5/10, where 10 is normal for the last 8 months. I cant run, when I run my buttocks hurt. I can bend down just fine with no pain in flexion or extension but I try not to do it at all. Surgery, cortisone, physical therapy, or what.

Side note: My left knee keeps popping when I bend it, this has been happening since the injury. My right knee when bent makes clicking noises in the back hip/buttock area and I know its related to my injury where I was picking heavy things up and twisting. How do I cure these things? All this is related to the fateful day where I did this dumb stuff. Can hip and sacrum be misaligned? My right pelvis is higher than my right and spine tilted to the right. I think pain also has to do with this misalignment. Is this correctable?
Answered by Dr. Vivek Chail 5 hours later
Brief Answer:
Please find detailed answer below.

Detailed Answer:
Thanks for writing in with an update.

An L5/S1 annular tear is extremely common and treatment usually only requires a regimen of conservative, nonsurgical techniques. In fact, an annular tear can sometimes heal entirely after a few weeks of treatment (which is unfortunately not happening with you).

Some examples of effective herniated disc treatments include:
Pain medication, anti-inflammatories and muscle relaxants
Hot or cold therapy
Epidural injections
Pain patches
Low-impact exercises or stretching classes
Deep massage

I think you require some more comprehensive treatment and encouragement. Please note that the treatment of annular tear is individualized. In the event that nonsurgical treatments prove ineffective, your physician may recommend surgery to treat your L5/S1 annular tear.

Left knee popping: Patients may experience a symptom of popping called a "mechanical symptom." This may feel as though something is caught within the knee and is popping as the knee bends back and forth. This type of mechanical symptom is often a sign of a meniscus tear or a loose piece of cartilage within the joint. The torn meniscus or loose cartilage may catch in the knee as it moves back and forth causing a popping sensation.
Right knee bent – buttock click: In most cases, snapping is caused by the movement of a muscle or tendon over a bony structure in the hip. The most common site is on the outside of the hip where a band of connective tissue known as the iliotibial band passes over part of the thigh bone that juts out -- called the greater trochanter. When you stand up straight, the band is behind the trochanter. When you bend your hip, however, the band moves over and in front of the trochanter. This may cause the snapping noise.
Another site of snapping is where the ball at the top of the thigh bone fits into the socket in the pelvis to form the hip joint. The snapping occurs when the rectus femoris tendon, which runs from inside the thighbone up through the pelvis, moves back and forth across the ball when the hip is bent and straightened.
Less commonly, a cartilage tear or bits of broken cartilage or bone in the joint space can cause snapping, or a loose piece of cartilage can cause the hip to lock up. This can cause pain and disability.

For minor snapping syndrome pain, try home treatments such as:
Reducing or modifying activity
Applying ice
Using over-the-counter pain relievers
For more severe pain or pain that does not improve with home treatment, see your doctor.
Physical therapy with emphasis on stretching, strengthening, and alignment can often help. Sometimes, treatment with a corticosteroid injection to the area can relieve inflammation. In rare cases, doctors may recommend surgery.

Your pelvis misalignment might have something to do with the sacro iliac joint. Over-diagnosis and attention on herniated discs has led to the SI joint becoming an underappreciated pain generator in an estimated 15% to 25% of patients with axial low back pain. This needs to be evaluated clinically by your orthopaedic surgeon and treated if necessary.

Hope your query is answered.
Do write back in case of doubts.

Above answer was peer-reviewed by
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