Pain In The Backside? It's More Common Than You Think

by Dr. Martin Knight

Did you know… In 2015, over 3 million people in the UK alone took regular time off work due to back pain? 


With increasing numbers of people suffering from persistent back pain, groin pain, buttock pain and sciatica, the well-known phrase ‘pain in the backside’ is no longer a thing of jest; it’s actually a common problem, causing many people nationwide enormous pain and discomfort, and disrupting their lives.

The lower back and abdomen in particular incur a huge amount of wear and tear on a daily basis. Whether we’re walking, sitting, standing, controlling our posture or something else, they’re constantly in use so, when injured, the movement – and therefore the associated pain – is unavoidable. Painkillers can help but they only work to temporarily mask the problem. For a long-term solution and pain-free unrestricted moment, it is important to seek a more serious form of medical treatment to prevent further damage. 


Did you know… The most common cause of the pain is as simple as altered forward or backward pelvic rotation?


But what causes the pain and how can we prevent it? 
Harley Street Spinal Surgeon, Dr. Martin Knight, has conducted much research into the area using MRI / CAT scans, surgical analysis, discography, endoscopy and various other methods. He says ‘Although the cause of pain can be complex (e.g. due to failed back surgery; slipped discs and vertebrae; inadequate restoration of postural control following abdominal surgery, child birth, caesarean section and more), one of the most common causes is nerve damage due to altered forward or backward rotation of the pelvis.’

‘Over the last 5 years, research into the cause of lower back pain, groin pain and sciatic symptoms has signified a strong influence between the pain manifestation and irritation of the ‘Cluneal’ nerves’  small branches derived from the lumbosacral joints and occasionally the nerve roots after they have left the spine. These branches join together to form leashes of small nerves that cross the iliac crests (i.e. pelvic rims) and, if damaged, can send disjointed or poorly compatible signals to the brain, resulting in aching, burning and feelings of searing pain.’ 

‘What’s interesting is that due to the nature of the symptoms, which can be misleading, often mimicking sciatica down to the knee and the foot, sacroiliac joint pain or radiating to the wider buttock, they are often misdiagnosed as pain arising from the facet joints, the sacroiliac joint, the piriformis muscle or from an inflamed trochanteric bursa.  In such cases, they are purely treated with steroid injections or with radiofrequency ablation, which although are very successful forms of treatment, as they are not the real origin of the symptoms in this scenario, they will only provide limited benefits. Consequently, it’s vital that patients are very honest about the nature of the pain they’re experiencing, where they feel it and the duration of the pain both in terms of longevity and episodic manifestation so that the clinician can make an accurate, informed diagnosis, locating the real source of the pain and helping to restore them to full health as soon as possible.’



The Solution 
The type of treatment recommended by your clinician will depend on the your individual symptoms. However, some of the treatments they may recommend include:

  • Steroid Injections. This is the initial form of treatment. By injecting the Cluneal nerve leashes with steroids and local anesthetic, your clinician can gauge the relative contribution to the predominant symptoms and the remainder arising from other sources. This is very effective; however, if it does not stop the pain, this suggests that the Cluneal nerves are not influencing the pain and that the main cause lies elsewhere.
     
  • Muscle Balance Physiotherapy (Alexander Technique) or Reformer Pilates. Complimentary soothing therapies and non-steroidal anti-inflammatory therapies may be recommended if the steroid injections have significantly improved symptoms for a short time.
     
  • Radiofrequency Ablation. If the above have failed to reduce the symptoms, your clinician may suggest radiofrequency ablation of the sheaths using a tiny probe to target specific nerves as they cross the iliac crests. This is highly therapeutic, with a great success rate.

Dr. Knight says ‘In severe cases, the pain experienced by patients with groin, buttock, back and sciatica pain can be extremely disabling. It affects their mood, relationships, social lives, ability to participate in sports, their body, careers… their whole lives and, in some cases can lead to feelings of depression and despondency. They don’t know how to manage the pain or when it will ever stop. However, there is hope. We recently conducted a 4-year extensive study, which found that not only does radiofrequency ablation successfully offer sustained improvement of the symptoms but it also restores their mobility and overall quality of life. Highly recommended!’

  •  Surgery. When the Cluneal nerves cross the iliac crest in small sheaths, the altered rotation can cause the nerves to ‘kink’, resulting in the irritation. Surgery to ‘de-kink’ the nerves can help to stop the source of the pain.


For more information, visit The Spinal Foundation




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