A patient of mine complains of pain in the right gluteal region with referred pain centrally down her whole right leg for 2years. she saw a neuro sugeon 2yrs ago and started on back extension exercises which helped to reduce the pain at that time. she is not sure of the diagnosis!
she presented to me 15days ago after being referred by a orthopedic surgeon who thinks she has S2 problem and asked for back extension exercises. she presented with dull aching continuous pain at the ischeal tuberosity which was radiating to whole of her right leg. no obvious aggravating or relieving factors,no red flags,full painfree ROM at the lumber spine,no pain on compression and distraction of SI joint. Her SLR was negative. She felt that pressure applied over the gluteal region eased that pain slightly. Her right piriformis seems tight and she also appears to have tight abductors.
I have tried doing ultrasound at the tender gluteal area, hot/coldpacks, piriformis strecthing. The only thing which gave her some relief was the cold pack but the pain returned after a few hours. A few days ago, the surgeon requested that I try tractioning the lumbar spine. I have tried this daily for 25minutes for four days and she reports that her pain has eased during the day but is still present at night and first thing in the morning. She owns a shop and is still working as normal. However, today when she arrived she complained of right calf pain which she did not have before.
I am at a loss as to what is the source of her pain. It does not seem to fit neatly into a pattern and I am no longer sure of what to do!! Any ideas of alternative diagnosis or treatment ideas would be greatly appreciated!