sitting pain

I have pain on sitting as though my ischial tuberosities bilaterally were made of concrete lumps plus it pulls/stings a bit down the verytop of my hamstrings. No pain standing or walking
MRI clear and bloods normal. Has worsened over a few years.
An UNGUIDED diagnostic injection into hamstring attachments by a musculoskeletal doctor in London eliminated pain whilst anaesethic lasted. As treatment I subsequently had dry needling and prolotherapy but this was ineffective.
Subsequent MRI of spine showed medium sized disc bulge touching nerve bilaterally. Back specialist speculated that the unguided injection had spilled over into sciatic nerve thus masking pain from bulge - however caudal epidural had no effect and subsequent nerve conduction studies indicated that the bulge not the cause of buttock pain.
No sciatica.
Piriformis is considered to be of normal length.
Have done a 12 week core stability machine based exercise programme and currentlly now do leg strengthening exercises -curls, leg extension and leg press. If anything I think this makes me worse in terms of stinging type pain but am persisting as its important to strengthen and stretch.
I wear orthotics uncomfortable flat feet.
SI joints do not give pain.
A few weeks ago had a GUIDED hamstring attachment injection. My hamstrings felt very relaxed but sitting on a lump feeling didnt go this time around!
Considered MRN but advised by a consultant radiologist that nerve imaging isnt up to much in UK - he has never read a positive scan even though on surgery patients have been subsequently shown to have some nerve entrapment. In the USA there are some specialist centres but that would be last resort as am in London. And I do not have any sciatica type pain. anyway.
So the really BIG question - where could the unguided injection have gone the first time around when it eliminated pain? I really didnt 'imagine' the pain had gone.
Myofascial pain perhaps (in gluteus maximus maybe?) - should I try trigger point therapy - I know that has to be followed up by appropriate exercises but could trigger point therapy at least be useful diagnostically?
Should I see a neurologist?
I would so like to get to a diagnosis - for example it could be that botox injections would help but its no good till we know where the pain is from.
Any thoughts would very much be appreciated.

You seem very well informed on the condition and nothing strikes me as obviously being the cause of your pain. I think trying trigger point therapy for diagnosis would be a good idea.
I'd like to know if you've had any more news however? Have you had a repeat MRI and is the disc bulge still pressing on the nerves?

thank you for taking the time to reply. I have now seen a pain management specialist who thinks the pressure pain has a hypersensitivity componet now and wants to see so has put me on Lyrica. But only 50mg for one week then 100mg for two weeks - my general practictioner seems to think such a low dose will have no effect but we will see and I will post if there is anything that will help anyone else.

a follow up to my original post...can anyone help?
I have sitting pain, my ischial tuberosities feel like I am sitting on stones. So far exercises havent helped and lyrica medication no benefit. MRI is clear and a diagnostic injection into hamstring attachment at the ischial tuberosity did not relieve the pain. When examined by a physiotherapist in the crook lying position I had a great deal of pain when he pressed into the anterior surface of the ischium. This was unchanged by hamstring contraction but it increased considerably (a surge of pain) with resisted adduction.
The physio did not know what the significance of this was if any but he speculated that perhaps the problem is with the attachment of the adductor magnus to the ischial tuberosity rather than the hamstring.
I have asked the physio if he will consult with colleagues for me but I would very much like any views from this forum - you are very helpful to a lot of struggling patients!

Perhaps your ongoing pain has now caused some chronic changes in how your nerves in that area function now, which is why the 2nd course injection was not very effective?

Just a thought (probably already considered it though). Sounds like a component of a chronic inflammatory condition of the hamstring/adductor origins at the ischial tuberosity. I had a hamstring tendinosis several years ago (one sided). As a result, sfter a certain period of sitting I would start to get aching down my leg.

I saw a sports physician who suggested an eccentric strengthening programme of the hamstrings (in a specific way) to be carried out at a gym. He suggested I attach a cable weight to my ankle, take several steps away from the cable machine and rotate my body a quarter turn away. Then, I was to very slowly (about a 4 second count) and very controlled, allow my leg to extend and abduct away from my body. This movement of extension and abduction of the hip (with a straight leg) is activating the 'adductor fibres of the hamstring' (or 'hip extending fibres of the adductors'). I would perform 3 sets of 15 of these everyday.

Obviously, your would need to consult your health professional about this. You would start at a very low resistance (possible a theraband first) and progress as you tolerated. It would probably aggravate the hip initially but chronic tendons often are quite uncomfortable to rehab in the beginning.

Perhaps it's worth a try - probably won't make much improvement in the first 6-8 weeks though...

Hi Hillary
I would agree with therapist101 about the eccentric exercises.
Also very important is gradual hamstring stretches, concentrating more on the hip flexion component than the knee extension component. be careful with these stretches as you dont want to aggravate your lower back - see your therapist to explain and supervise the stretches.

And then it would help to try a doughnut pillow when sitting to relief the pressure off the ischial tuberosities.

Good luck

howdy.

is it possible that it may be an ischial bursitis?

has this been discussed before, i only glanced over the postings. an unguided injection could have hit the bursa(e) and relieved inflammation for a period allowing your hamstrings etc to settle down and relax. the bursa is located under the proximal tendons of your hamstrings and adductor magnus and if inflamed is sore to sit on and can be sore to resisted testing of hams/magnus at times.

also have you had yur hip joints assessed fully?

Thank you to those of you who have taken the time and trouble to reply to me. I do hope you will read this as further comment would be great. There has been a small development since I posted. I went to see a new doctor who sees mainly sports injuries. I asked him about the unguided injection into ischial tuberosities which gave me pain relief. I had wondered if injection had spilled into adductor magnus since a subsequent guided injection into hamstring attachment shows the pain is not from there. He said that if an injection was unguided it was unlikely to have gone into the adductor magnus as this is deep and the practitiioner would have been doing litttle more than feeling for the hamstring attachment to the bone not going particularly deep. I told him that the adductor magnus was painful under resisted adduction but he said it is quite easy to make the adductor magnus feel painful when it is been examined in this way - it is that sort of muscle. I wondered, as physios - do you agree - that the adductor magnusis is a sensitive muscle? If all this is so then I should obviously park the idea of sitting pain coming from this muscle.

He did say that it could be that pain is coming from the sacrotuberous ligament attachment. I cuold consider an ultrasound diagnostic injection to see if this is so but he was disuading me from that because he says that if it is the ligamentous attachment there is nothing that can be done anyway- no injections or exercise.

I have also separately been told by a physio to really really strengthen the gluteus maximus to provide support however from what I have read glut max doesnt cover the tuberosities when you sit down. So am a bit puzzled by that.

Any comments on what I have now been told and reported in this post would be gratefully received. I think its possible to crack most things with persistence although I probably wont get a complete cure as have had the problem a long time.
Thanks again everyone, what a good bunch you are!!
Hilary

Great stuff. I'm life to count on to bring out irrefutable again to bring about decided I got it all.