Herniated Disc vs SI Joint vs Piriformis Problem (How To Know The Difference)
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- Опубликовано: 4 ноя 2024
- Have you been experiencing back, butt or leg/sciatic nerve pain and you're not sure whether it's caused by a Herniated Disc or Piriformis Syndrome or your SI Joint? How can you tell the difference? In this video, I walk you step by step through a flowchart that helps you put the pieces together and get closer to the cause of your pain. Literally, I let you inside my brain and want to offer you access to this mindmap so that you can finally gain clarity and insight into your problem...
Possible causes of pain could be a Herniated Disc, Disc Extrusion (where the disc material actually exits the disc), Spinal Stenosis, Piriformis Syndrome, Sacroiliac (SI) Joint Dysfunction, Sciatica... it's complicated. It can be SO confusing and frustrating. This is a super diagnostically "muddy" area - even for professionals! I get it and see it all the time (this is my exclusive specialty).
Whether you have pain just in the lower back... or if it is just deep in the glute/buttock... or if it also goes down the back of your leg... or even to your foot...
I walk you through the exact self-tests you can do, and depending on the result/outcome of each self-test, lead you to the most likely cause of your pain.
And if you want to download your own free copy of this flowchart, you can find it inside my FREE FACEBOOK GROUP 👉 The DIY Diagnostic Network - urlgeni.us/fac... (just request to join the group and once inside, you can find it in the "Files" section).
#drcharliejohnsonpt #herniateddisc #piriformis #sijoint #selftest #selftreatment
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• Herniated Disc vs SI J...
Thanks for watching! If you want a free copy of the flowchart I walked through here to download for yourself, you can join my FREE FACEBOOK GROUP 👉 The DIY Diagnostic Network - urlgeni.us/facebook/YUTB
Excellent diagnostic chart for diagnosing SI pain, thank you!
thanks so much! Appreciate you checking out my content!
Any specific questions for me?
I get results of my MRI scan tomorrow but touch wood not to jinx the last couple of days not as bad. I've had severe pain for nine solid weeks and have been struggling to cope/work and income loss. Feel so so sorry for people out there suffering for years on end but there is always hope for a resolution, especially with the guidance from legends like Dr Charlie doing such an incredible job 🙏
Thank you for showing in depth how to diagnose these problems.
You're welcome! thanks for watching! Any specific questions for me?!
@@drcharliejohnsonI'm 39 female 4 children naturally birthed. I was a personal trainer up until the pregnancy of my 4 th child. He has a very large skull and the pregnancy was very painful. I released to much relastin hormones way to early and ended up with a range of si and hip problems. I don't train any more or workout. I'm working from home now. I'm in to much pain to workout. So I SMR and do simple stretches . I'm at healthy weight and maintain myself.I fell last year onto my tail bone and a lot of problems started up again. He's 9 and at this point I have DDD 3 anular lumbar disc tears and found I have flat back. I took all sugar and trans fats out of my diet. The inflammation has been recking havok for almost a decade now and I'm desperately trying tofind an answer. Currently I'm nursing a herniated disc. I want to get back to where I was 10 years ago. I blame hormones and loss of ligament and collagen. I know my pelvis is over stretched and injured. I was a pilates instructor and now I just have popping and grinding coming from inside lumbar areas.i know my core is not that strong but I have stage 2 organ prolapse from all of my problems so I just take it day to day with mild marching on my back and back core strength. I can't squat comfortably or bend . I try bending at the hip now and not the l5 or l4. As I accidentally fell into bad movement patterns from a span of loss of mind muscle connection. It helps but my problems are so many I have to start getting the inflammation out and a easy going core activated program to support my DDD. Unfortunately my son is ADHD and my time is for him. Im trying SMR and diet. My goal is to incorporate more collagen and glucosamine and prayerfully soon with the right moves and strength program I will get stronger. Unfortunately with DDD I end up injured often. Thank you for your videos and concern. If you have any tips I'm all ears. 😊
Im 39 and female. I had 4 children naturally and was a body builder Personal trainer and pilates instructor. 10 years later I have flat back and DDD and pelvic organ prolapse. I'm currently SMR foam rolling with a mild stretching program to stretch glutes and back core. Not much I can do. I have pain and inflammation daily. I went on strict diet of fruits and vegetables and some meats for B12 and eat raw mostly. Unfortunately I keep reinjuring and end up back to square 1. I want to strengthen my core and glutes because that's the support of the back. My SI and hips are always in pain in that belt area. From back to front every day. I'm not sure what to do.
In my case, sitting makes the symptoms worse, but so can walking. Often, if I go for a walk after sitting, I can have pain in my leg while walking. Standing still or lying down or on my belly are the 3 best pain lowering options I have. I think back extensions help as well but I'm not sure anymore, so I'll be testing those. Hanging (spine decompression using a bar) helped me in the past, but I haven't tested it in a while.
Straight leg test doesn't make pain worse, unless I do it a lot.
I think my situation is this way because of a or multiple flattened disc(s). But I don't focus on the cause that much, I focus on the movements that I can do or tolerate.
I have pain and numbness in my foot SLR positive initially but now negative no back pain no pain in moving my back as you told but felt burning and tingling while stretching piriformis muscle plus no pain in standing and walking but initially had worse pain while sitting and laying down
Great video. I had cauda equina syndrome back in 2006 and was operated on within 48hrs. Nubmness but no pain. Fast forward to December 2023, i had started running on track 400m at the age of 45. Within 1 week i pulled a hamstring, 2 months later i pulled my back. MRI scan showed slight herniated discs at L5/S1 and L5/L4. I opted to have surgery privately paid for on the L4/L5 disc. This was June 2024. Now in October 2024 i still have pain when standing or walking, goes when sitting. Moving my back and bending does not cause any pain symptoms. I am convinced ive had unnecessary surgery and have Piriformis Syndrome. My left side is the oain side, and my figure 4 is very tight on that side. Any idea, as im getting quite down with the whole thing.
Superb!!! Thank you greatly for this detailed clarification; the answer to everything these days are "swallow this; take that; let me chop on you..."
Your information immediately had me recall the exact moment that could've caused my pain {childbirth}...Thanks Again!!
Glad it was helpful!
Amazing video. Wish more doctors had the same passion for helping people. I’m getting my MRI in a week. Not sure if it’s a pinched nerve, sacroiliitis or spinal stenosis. Had my back go out a few times over the years but resolved within a week. Going on 3 months now. Leg pain, weakness, numbness, upper groin pain near hip flexors (both sides), lower back muscles tight causing excessive arch. Symptoms get worse from prolonged standing, walking, sitting. Laying is not pain free but better of all the options. Went from being extremely active to zero activity. Thoughts??
Hey! Thanks for watching. Definitely sounds spine related.. MRI will likely show disc. What are you currently do to resolve it?
@@drcharliejohnson ^
I’m sure your treatments are wonderful and I plan to watch your videos but I definitely disagree that pain only goes down river. I just felt the need to say that. No attack you seem like a great guy who does lots of good in the world!
I have pain in lower left back around the dimple you mentioned. I also have pain in lower left abdomen. Sometimes around my left hip. No leg pain but the tips of my toes on both feet have gone numb.When l stand after sitting or kneeling l get severe pain that sometimes shoots up to my bottom jaw like electric shock. If l keep still it gradually goes away. Running doesnt seem to be a problem but l have trouble climbing stairs sometimes and digging. Jolting the left leg also hurts my back badly .My GP is stumped. I am in my sixties.
Some great information in here.Thank you for empowering me to figure this out for myself..as you said I have to do things for myself.
Welcome! Let me know if you need some help!
Yes Charlie..Im in desperate need of your help.I need to follow a program to get me better and I believe you have.I am in a small Pacific Island and resources for this type of problem is really hard to come by.I am willing to pay for this program so I can improve my quality of life.Please help me.
Thanks for the information. I’m a little bit more confused & think I might have a couple things going on at same time. Really thought it was a nerve issue because Dr put me on lyrica & has helped with the pain. I still have pain (bad pain believe me) but it does help me to get up & get moving in the morning. I’m just tired of the pain. Been in pain for now 10 weeks. I mean debilitating pain.
Thank you Dr Charlie Amazing video.I find out thst I have Trochanteric Pain Syndrrome. du you have a vedio of it. iGot little pain in the back and in the right hip goes doun and ifront and its burning as hell and comes in grown too .can’t have information medicin because i have Chrons desease I am suffering of burning 🔥 What do you think it is.Hope you have a video about it. Thank you so much.
Do you also have a video on diagnosing the SI joint problems with the help of radiology?
I'm 43. Exercise with weights,bands, and walk every day for 40 minutes. Was riding bike leisurely with my youngest when I noticed a bit of aching pain in my left medial glut , near what I would think is the lowest part of the spine (way beneath pants belt line). No back pain, no leg raise pain, pain travels laterally and down my glut. Not stabbing or shocking, pressure helps. It really hurts. Bumpy car ride really hurt. Stretching the pirformace felt like the right location but caused the pain to worsen and spasm above the area for the rest of the night. What should I do or not do to improve it? I am so scared to do anything and make it worse.
Hey Jill! Sorry to hear. Could be many things… doesn’t sound nervy (especially with normal leg raise). Don’t stretch it #1 - and #2 are you open to some help/potentially working together?
No pressure, but I’d love to review your case and see how I can help.
If you’re interested, apply here www.drcharliejohnsonpt.com/apply
Hang in there!
@@drcharliejohnson Thank you! I will contact you using that link. You are so right about not stretching it! I did try a stretch before I saw your reply and that made it 100x worse . I just went for a walk and it went well, it actually feels a bit better. Awesome advice! If it matters, on a x ray for a different issue a while back, the radiologist report said there is partial fusion of the lowest lumbar vertebrae. I wonder if that caused this pain in the a$$? Anyway, thank you so much. I hope you can review my case. ❤️
Thank you so much! I figure out what I have, I have herniated disc, I thought it was si joint but after this I'm confident it's a disc... any tips or advise? Stretches, exercises? Thank you!
How are you doing now with your back? :)
I have no back pain but Radiating pain and numbness down into my foot. Positive straight leg test on one side only and pain in my SI joint. I’m always grabbing my SI joint and supporting it. I did read that if you tear your ligament in SI joint it can affect L5, S1 and mimick sciatica.
Hey Kelly! If you have a positive leg raise and numbness into foot- pretty much guaranteed to NOT be an SIJ issue... more likely a spine problem causing nerve involvement. The SI Joint is a joint... and can refer pain down leg a bit... but will not cause radiating nerve pain.
Make sense?
What are you doing for treatment?
@@drcharliejohnson It is so confusing since so many published reports say the opposite, that numbness and tingling in the foot can come from the SI joint. Hopefully they give me an MRI. Ice on SI joint helps so much and rest, along with anti inflammatory drugs. Prednisone cleared up the pain for a time. Light movement and walking for now.
@@drcharliejohnson I had an acute injury to my SI joint. It mimics sciatica almost to a T. My L-5 and S-1 nerve is affected all the way to weakness in big toe, numbness and tingling. This was confirmed by my PT with muscle testing etc. “The L5 nerve root crosses the sacral ala 2 cm medial to the SI joint. In the case of injury, the nerve root can be involved causing radicular pain. SI joint innervation occurs via the ventral rami of the L4 and L5 vertebra, as well as the dorsal rami of L5-S2, and the superior gluteal nerve. Injury to these nerves can cause neuropathic SI joint pain. Generalized gluteal pain can be secondary to an injury of the SI joint or local nerves surrounding the SI joint, causing radiculopathy. When the S1 nerve root is directly injured during SI joint injury, it can also create radiculopathy.”
@@kellykell9620 hey! I hear you... if you have neurological weakness- chances are MUCH higher it is due to a lower lumbar spine (disc) injury impacting L5 nerv. You're quoting Dydyk et al. 2022 article. Anatomically, correct, the nerve roots do pass in front of the SI Joint region. But truthfully, there's still arguments about whether the SI Joint even moves... let alone moves significantly to cause peripheral nerve injury. I'm not trying to belittle anything you're experiencing... but statistically, disc issue at L5 is MUCH more likely. Have you had this ruled out?
Hope this makes sense.
@@drcharliejohnson It makes sense that is why It’s been hard to pinpoint what is going on but I do feel that it is my SI joint. I jumped over a fence and landed weird and then a few days later had a spasm where I thrusted my knee quickly up into my chest and got stuck in that position for hours. I believe I did tear some ligaments and shift the position of my SI joint enough to irritate my nerves. It’s already getting better though but it has taken almost 2 months. I appreciate talking to you about this thank you and no matter what I will be taking care of my lumbar area as well.
When the doc pushes down on the knee or thigh when patient is sitting, and patient can’t raise leg, that’s a loss of signal from spine. Also the inside of thigh or top of thigh is numb, and top thigh muscle falls kind of down onto top of knee, that’s a nerve that’s being severely compressed. Also interior thigh/groin pain. Walking pattern isn’t normal…
I’m confused, love the video but, I struggle to get up in the morning out of bed. It hurts to dress , mostly one side but both cause irritation. Sitting in the car isn’t horrible but my work desk chair hurts. Running isn’t great but I do it. I feel it after and ice or try to stretch. I just don’t know that I was any of these but herniated disc seemed the most realistic. I don’t feel it down my leg but I also have trouble getting to standing. Lifting things. I don’t know. But I liked your video.
Hey Brittany! Thanks for watching 👊🏼. Appreciate your feedback. Have you checked out my DIY Diagnostic Guide - May help clear some things up 👍. You can grab a free copy here- www.drcharliejohnsonpt.com/DIYGuide
Doctor, i get bad pain in my left hip radiating to leg(no numbness) from prolonged sitting or walking. Better when i lie down. Not back pain, just the hip and thighs mostly,but sometimes even lower. What could it be?
What is responsible for keeping the femur stable? I have random sharp 10+ pain while my leg feels it goes “out of socket” and I cannot put any weight on it at all. X-ray did not show any breaks. Pain is only dull until it tweaks and goes out of socket.
Pain is deep in buttock, groin, where femur ends right under my buttock is swollen, down my hamstring, side of hip.
But, if I tweak it, I can no longer use that leg until it “goes back in” and my pain is unbearable.
Ortho and PT don’t know what it is and next is an MRA.
I have pain on front and back of knee, behind buttocks, thigh and calve on both sides but very mildly on the right and not always but on my left hip it feels painful when I stand up as if I’m pressing on the the joint when i walk causing me to limp but it goes away after a few steps! Any ideas what this can be would be greatly appreciated! Thanks
I am being told by all the doctors I've seen that I have piriformis syndrome, mild buldging discs in l4-5 and l5-S1 aswell as slight widening of the anterior superior third sacroiliac joint with erosion along the iliac side with marginal sclerosis what would cause this I started feeling severe pain at work overtime but workers comp is saying that the injury didn't happen from work I run a concrete line pump
Hey there! Nursing student, former (DPT student before pandemic). Noticed been sitting so much and I feel restricted in my right floating ribs/flank area. Back gets tight if I don’t try and mobilize it, but recently self Joint mobes haven’t done much, the restriction comes back. Any advice? I have insurance but the PT appointments are only 30 minutes long every two weeks but I feel like I need an adjustment or some mobilization. Anything I can do for myself? I’m restricted in right torso rotation, torso right lat flexion. Thanks!
Hey Mark! Thanks for watching man… honestly, difficult to give specifics without eval/testing some things. Before trying to mob things… can you simply change you environment. How you sit (instead of on edge, up tall, leaning in to study/work… relaxing back, supported back, open hip trunk angle? OR standing option?)
The disc extrusion symptoms is me to a T. What excercises/stretches can I do?
Hey- thanks for watching.
Oftentimes people with true disc extrusions respond best to forward motions vs traditional “pressups.” Backward motions cause further stenosis or narrowing of the space where the nerves travel- vs forward motions create more space for the nervous system. Disclaimer- this is not always the case.
Honestly, hard to say without knowing more details of your specific case.
No pressure, but would you be open to me reviewing your case to see if/how I can help?
If so, just visit www.drcharliejohnsonpt.com/apply - select a time to chat, then follow instructions to submit a formal case review.
Okay?
Want to pinpoint the source of your back, butt, or sciatica pain without needing expensive images or a specialist?🔥Grab my FREE “Better Than an MRI DIY Diagnostic Guide” here 👉 www.drcharliejohnsonpt.com/diyguide
I never seem to get that guide, but I do get all your other emails.
@@deanderekant1 hey John! Odd- it should be automatically sent to you. Sometimes ends up in junk/spam/promotions for some reason. Have you checked there? If you still don't see it- shoot me a personally email at charliejohnsondpt@physicaltherapyjohnson.com with the subject line "GUIDE" and I'll make sure to reply personally to it!
Thanks so much for checking out my content!
Dr. Charlie
For the SI joint can sneezing and coughing cause pain and also doing ab work??
when I put both hands on my SI joints I can feel that on the right one there is something bulging slightly. I can only feel discomfort in that point if I lean back, flex my glutes and extend my L spine. Any ideas? No other symptoms and the discomfort is pretty minimal
What if i can sit and raise my opposite leg without pain
Hi, i feel pain in my lower back bone just above the buttocks and its affect the area above it so around the lumbar vertebrate what excerises do you recommend also i feel pain in my si joint left side and sometimes it would switch to the right could that be as a result of my lower middle disc problem that i have?
Thanks!
Welcome! Let me know if ya need some more help or have questions. 👍
so i have everything that leads it to be SI joint except that IT DOES sometimes go from one SI to the other SI from day to day.
Not uncommon to have pain shift around. You're right- usually DOES NOT shift with true SIJ... either way- what are you doing to solve it?
@@drcharliejohnson ive been doing clam shells and bridges and the SI pain has went away, lower back has been sore so ive been working on proper posture and not sitting so much, but those strength exercises fixed SI issue. Took 3 days of doing 2x a day. 30 reps each side.
@@Gnorde Way to go! Let me know if ya get stuck trying to get rid of back pain!
If i stand or walk i have no Problems. It starts when i sit.
Did you have any luck in your journey? I currently have the same symptoms
@@zachherron4219 I think it's the piriformis muscle, may be it's thight.
That’s what my thinking was. Find any relief since your original comment?
I’m about to watch your video. I’ve been in bed 95% of the day for 2+ years. I’ve had lumbar spine injections, SI Joint injections. The second round of SI injections have given me relief from “cattle prod like” searing pain in right buttock, but I still have low back pain and debilitating tension and pain if I try to do anything. I’m waiting to hear back from a Dr ( he’s checking my MRI ) to see if I’m a candidate for the Intracept procedure.
Bless you 😢❤️🙏
@Clark Harris I’m no expert, just a pain sufferer like yourself. The second round of SI joint injection I had, I asked for a double dose, spread across the SI joint. I had seen a video explaining this procedure from a hospital in London. I have been free of that pain for 4 months. Watching a very recent discussion from the Seattle Science Foundation, a number of surgeons said that the percentage of people helped by SI joint fusion is quite likely inflated by the manufacturers of the various mechanisms used in the procedures. Good luck in your search for pain relief, I know the road is long and arduous.
@Clark Harris
Sorry you are in pain and I'm in the same boat with si joint pain. I just did prp therapy and feel much better.
From the research I have done I would def recommend you get two or three opinions and do some research yourself on doing spinal fusion it's very high risk. I have seen cases where people have said it's the worse decision they ever made. Any type of surgery involving the back is a very delicate procedure to say the least. Reason being there are many nerves in that area that can easily be damaged permanently therefore making the outcome of your surgery a lot worse than you were before you had the procedure done. My friend I wish you the best of luck and health and I hope you feel better soon take care and be safe out there God Bless you 🙏
@Clark Harris
Your welcome my friend and yes I highly recommend prp therapy. My best friend in highschool his father is a back surgeon, and he told me surgery is the last resort and only if you truly need it "Life or death" situation. This is coming direct from the horse's mouth lol! Please do your research brotha wish you the best of luck take care
Thank you. I think I have both si joint problem and piriformis syndrome.
Does it make sense. Can treatment of one make the other worse?
I thought it was sciatica now I'm thinking it's sacrilitis