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Dr. Andrew Rynne

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Suggest treatment for lower back pain and tingling sensation in legs

Answered by
Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 11657 Questions

Posted on Mon, 2 Nov 2015 in Back Pain
Question: Hi Doctor! I have a question that relates to my iliac crest / sacrum / hip area.

I'm a normal healthy 25 year old. When I finished college and started working a full time job in New York's corporate XXXXXXX i began sitting for long periods of time. Something I was never accustomed to. I'm pretty sure that fact has definitely hurt my posture quite a bit. Since then (exactly 3 years now) I have had lower back pain. This pain is usually intermittent. Sometimes laying down helps, sometimes it doesn't. I used to think it was sciatica, piriformis syndrome, gluteal syndrome. Since seeing doctors, physical therapists, and chiropracters, this has been ruled out pretty much (I don't have many of the needed synptoms, such as tingling sensation down my leg).

My pain is a dull, deep ache in what I call my buttock. I used to think it was bilateral but I think it's mostly on my left side.

Massage and pressure gives me a lot of relief!

I decided to go to an orthopedist a few months ago to finally get it checked out after years of discomfort.

The X-Ray was normal. He then sent me to get a Pelvic MRI (no contrast). This also came back normal.

I was happy nothing was found, but still was curious where the pain I get comes from or why.

A week after getting the normal results, I was getting a massage. The massage therapist focused on my pelvic and buttock areas. She started feeling this "knot" in my lower left side where the iliac crest is. It feels like it's the size of a golf ball or a little bigger. I feel it now too that she brought my attention to it. I have no idea how long it's been there. It could be years or could be less. I feel something similar on my right iliac crest, but much smaller.

As a concerned self addmitted hypochondriac, I immediately called the radiologist who read my initial MRI and asked him to double check it for any soft tissue masses, lipomas, etc. He called me the next day saying, my MRI is completely normal. I then read my inital MRI report and the addendum. He looked for soft tissue masses as well as osseous neoplasm both the first time, and the second time again when I requested him to (soft tissue mass) I mentioned how I felt something and so did the massage therapist. I was happy he couldn't find anything but still wanted more reassurance. (The radiologist is a specialist in the musculoskeletal system and an MD, with years of experience).

I called my referring orthopedist and scheduled a follow up appointment. I mentioned the "lumpy" area I found, as well as what the radiologist came up with when i asked him to re-review my MRI.

The orthopedist told me after physically feeling the lump that it's fine, it's fatty tissue and it wouldn't show up on the MRI. That made me even more reassured, but after doing more research on my own, I saw pictures of lipomas on MRIs. This made me question, if fatty tissue will not show up on an MRI, how come lipomas (made of fat) showed up in MRIs I've seen on the internet.

I'm anxiety ridden, worried, and a hypochondriac by nature. If I can palpate it, why can't anything be seen on MRI? Also, is it possible the MRI missed something because no contrast was used in the MRI?

Just looking for one last piece of reassurance. I'm always worried about the worst case scenarios. (Which involve as you can imagine being a huge hypochondriac, something sinister).

Please let me know what you think!

Thanks so much in advanced!
Answered by Dr. Praveen Tayal 1 hour later
Brief Answer:
Not likely to be a mass or lipoma.

Detailed Answer:
Thanks for posting your query.
A contrast in MRI scan is not needed to find out the lipomas. The consistency of the fatty tissue differentiates a lipoma with subcutaneous fat. The lumpy thing that you are feeling can be a false lump of soft tissue with a normal MRI scan. Such false lump is not palpable with the flat of the hand. If a lump is palpable with the flat of hand then it is likely to be a tumor or a separate encapsulated mass.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Praveen Tayal 6 hours later
Hi thanks for your answer doctor.

I don't know if I can feel it with the flat of my hand. Difficult to explain. If i pass my hand over it with pressure I feel it. If I pass over with the flat of my hand without pressure I don't feel it at all. Which is why it took a deep tissue massage for me to find this thing.

In other words, i should trust my doctor and MRI, an MRI would definitely pick up something if there was something serious, right?

If that's not causing my butt ache, what do you think is and what should I do about it?

Thanks so much in advanced and for your reassurance

Answered by Dr. Praveen Tayal 1 hour later
Brief Answer:
No abnormal mass likely.

Detailed Answer:
Thanks for writing again.
It is best to trust your doctor more than your message therapist. If there was something serious or anatomically abnormal it would have been easily detected on MRI.
The pain in the area is likely to be a muscle pain due to an abnormal posture. It is better to do physiotherapy exercises to strengthen the muscles in the area.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Praveen Tayal 1 hour later
Thank you doctor!!! You really made me feel better!
Answered by Dr. Praveen Tayal 6 hours later
Brief Answer:
You are welcome.

Detailed Answer:
Thank you.
I am happy I could help.
Please do recommend our services to others too in case you found them helpful. For future query, you can directly approach me through my profile URL
Wishing you the best in whatever you do.
Best regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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