Staying in the Game:Putting off a medical evaluation is rarely an appropriate option

“You wrote about me.” This is what my new patient said as I introduced myself to her.

She had read my previous column about lower back and leg pain caused by the sacroiliac joint. She was one of many readers that emailed me for more information. She also wanted an appointment for an evaluation.

She has been an athlete all her life. She also has coached women’s basketball at the college and high school levels. Now all she wants to do is play golf without pain while summering in Maine.

She tells me her pain is in the right side of her back and goes into her buttocks. She has had the pain for several months. It was not going away.

I asked if there was any weakness in her leg. She said her foot feels weak at times, especially when she gets tired.

My examination found muscle spasm in the lower back and buttocks. She can stand on her heals and toes. The strength of her large toe is weak. Stretching the sciatic nerve is negative.

Overall she is a very fit and healthy woman.

I diagnosed her with a possible herniated disc in her lumbar spine. This was indicated by the weakness in her leg and was complicated by her sacroiliac and pelvic misalignment.

Not all herniated discs need surgery. Studies indicate only about three percent of patients with herniated discs require surgery. Surgery is warranted for severe and unrelenting pain or when neurological signs like motor weakness progress.

Portland is fortunate to have an excellent neurosurgical group. Our practices work well together and we often refer our patients to the most appropriate care.

I agreed to treat her. I told her we would constantly monitor her for any negative changes in her neurological signs. If this happened she would be referred for an MRI and neurosurgical consultation.

We started using chiropractic manipulation. The strength came back in her toes and her pain subsided so she could play golf in comfort.

She was thrilled. After three visits she stated “this is the best I have felt in years.”

Another patient contacted our office for an appointment after reading my last column. She is training for the Beach to Beacon 10K. She had pain in her left-lower back and buttocks.

As athletes increase the intensity of their workouts this puts more strain on their structure. If they are out of balance they are prone to injuries.

I found that her pelvis was not level. She had a weakness of the hip flexor and gluteus maximus. She had one very tender spot on the outside of her buttocks. This is the attachment of the piriformis muscle.

This muscle was described by Dr. Glazer in his column last week. He wrote how training with a properly fitted bike is so important to a cyclist with piriformis syndrome.

I recommended manipulating her sacroiliac and some sacroiliac exercises before and after each run. These exercises are easy to do and are so effective. They help heal and prevent abnormal gait issues.

On her follow-up visit the strength of the hip flexor and gluteal muscles returned to normal strength. What most impressed her was the pain in her piriformis was reduced by 50 percent after one visit. She is expecting to run a great race.

If you are training for a summer competition and your training is not going well, your structure may be out of balance. Do not postpone an evaluation. Diagnosing and correcting the problem will make your summer more enjoyable.