Help for hip / glute / SI pain when riding

[BigMama1]

So I did a dumb thing and ignored some mild to moderate low back pain / hip / glute pain for a few weeks…ok maybe more like a month or two. It got progressively worse compounded by some other factors like having to sit on an airplane for long periods (always hard on my hip), stress, carrying some really heavy furniture at work. As well I’ve been working on my riding position to have a longer leg with more inward rotation, and working on hip flexor stretches and core work out of the saddle to help with this.

Three weeks ago, on a day the pain in my right hip / back was particularly annoying I just reached and turned slightly at work and it went into full spam, putting me on the floor in agony.

After several horrible days of pain, spasms and lots of meds, I slowly started to get some relief and mobility back with the help of physiotherapy (acupuncture, muscle stim and shockwave). Adding chiropractic has really helped as well and I started being able to do some gentle stretching and strengthening exercises.

Both the chiro and physio agree the primary problem is with my SI joint, which is then causing the irritation in my hip flexor and glute.

So now it’s 3 weeks since the day it completely gave out and can now do most things in small increments without much pain. The one thing I can’t seem to do is ride. I can get on if I’m careful swinging my leg over, and I can walk around on a long rein as long as I don’t allow my hips to follow the horse’s movement the way they usually would. Posting trot is agonizing after 5 or 6 strides. In the tiniest western jog type trot, I can sit for about 1 full 20m circle. Obviously haven’t tried canter because my hips would have to swing.

Still carrying on with chiro and physio but they don’t have any real suggestions other than being patient. And I’m trying, I swear, but thoughts I’d seek the wisdom of COTH for any other ideas on ways to lessen the pain / speed up healing.

[Simkie]

Have you gone to an actual doctor? That would be a good idea. Preferably a hip specialist, but a good ortho could get you started. Or a physiatrist.

[BigMama1]

General unspecified pain without a specific injury is unlikely to get you referred to an ortho here, however I will ask my family doctor at my next appointment.

I didn’t go to the doctor this time because I’ve had this problem a few times in the past, particularly when I used to run and also muck 15 stalls several times a week. There was never anything visible on x-ray and treatment was always focused on correcting alignment issues and imbalances, improving posture and strength, and making sure I was using the correct muscle groups (I’m one of those people who apparently don’t fire their flutes and overwork the low back / hip muscles as a result)

Haven’t had the problem in many years, so totally ignored all the warning signs this time. And when I used to have the problem in the past, it was at a time in my life when I wasn’t riding. So after a few weeks of physio and chiro I would feel better. Currently riding is the only thing that triggers such an immediate, intense reaction. Sitting for long periods gets uncomfortable and driving with my right leg extended is worse. But both are now bearable. Riding is it.

[Simkie]

Truly, you need a doc. “Immediate intense reaction” is ortho-worthy. It sounds like they need to screen your lower spine, SI joints and hips. Just because nothing was seen years ago doesn’t mean nothing will be seen now. And nothing years ago doesn’t even really mean nothing…it’s just crazy how often obvious issues are missed.

The problems you describe with sitting is certainly how I felt with hip instability & labral tear, although it’s one of many things that could present with those symptoms.

[punchy]

Nobody can give you ideas on how to lessen the pain or heal faster if no one knows what’s wrong with you. You’ll just have to suck it up and see a doc who can do some diagnostic imaging and go from there.

[BigMama1]

@Simkie

Truly, you need a doc. “Immediate intense reaction” is ortho-worthy. It sounds like they need to screen your lower spine, SI joints and hips. Just because nothing was seen years ago doesn’t mean nothing will be seen now. And nothing years ago doesn’t even really mean nothing…it’s just crazy how often obvious issues are missed.

The problems you describe with sitting is certainly how I felt with hip instability & labral tear, although it’s one of many things that could present with those symptoms.

I don’t disagree that a doctor would be helpful, but here you are generally only referred to an orthopaedic doctor if your primary care doc suspects surgery would be needed. And in non-urgent cases, the wait to see one would be about 6 months, plus another several months on top of that to get an MRI appointment.

Here we have private X-ray and ultrasound clinics, so those can be done in the same day, but MRIs are only available at the hospital. If it’s something potentially life threatening or life altering and you show up at the ER, you’ll get one right away. Referrals for cancer screening here would take a couple of weeks. Non urgent joint / soft tissue pain would be months. The other option is to pay $550 US and drive to Buffalo to get one immediately, which is doable now that the border is open, but spendy.

My appt with my family doc is next week so I’ll see what she says, but likely she will just order X-rays.

I was just hoping someone had experienced something similar and might have advice for avoiding / reducing the pain while riding in the meantime. Besides the obvious solution, which is to only walk for now until it hurts less.

[Simkie]

Best to get the ball rolling on seeing an ortho. Sounds like you have a chronic, progressive problem. Entirely possible that a steroid injection will make you feel quite a lot better, but no one but a physician can do that for you.

A TENS unit isn’t expensive and might provide some relief. Dry needling might be useful. A really good massage therapist could help.

But do start the process on getting the imaging you need to figure out what’s actually wrong. Having your primary start with some simple radiographs–pelvis & lumbar spine would be my guess–is a good way to start.

[luvmyhackney]

When I had issues with mine, they injected lidocaine in my SI joint and that caused my pain to go away so they did a joint injection and sent me to Physical Therapy. No X-rays or other scans needed.

I went to a sports ortho specialist for the diagnostic work and joint injection.

[TB_eventer]

It sounds like the doctor is the best option.

Take this with a huge grain of salt, because your issue may be completely different from my SI pain earlier this year, but I found some stretches that really helped me on a YouTube channel- search “Bob and Brad SI pain” on YouTube and you’ll find a channel with these two physically therapists (who I think are pretty funny and have been helpful to me for a few things now) with some suggestions.

Move carefully though… definitely don’t want to do more damage. I found when I injured mine that the stretches would help, but it took awhile for the joint the settle down overall. So time/patience is likely going to be needed no matter the answer.

Good luck!!

[Piaffe11]

Your pain sounds a lot like where I was in the middle of my injury OP. I started with a disc herniation, which started getting better - and then symptoms like the ones you described started building. For me, riding was comfortable as long as I was moving. If I stood around or if I walked too long - I was toast. At the time, my physio and osteo thought it may be a tear in my glutes?

My symptoms now are neurological and I’m on nerve blockers - so something else is going on. I joked with my coach that if I was a horse, she would have already had me put down lol

I will sympathize about the MRI. We are both in Ontario, so I get it. My doc sent in a requisition in September for me to the nearby hospital that multiple people in the medical field have told me is the fastest for MRIs. I heard nothing. Once my neuro symptoms started - she sent an emergency request again. 3+ weeks later I just heard back from them to be put on the cancelations list. My appointment date: May 4, 2022

I have another appointment with my doc next week. Hoping she can make some calls as I think I have more symptoms than I realized and my symptoms are enough that it is really affecting my life. I can’t ride at all now due to the pain.

I would start with the xrays, just so they can rule them out. They also may be able to tell some things from a CT scan (I’m trying to get one of those booked too - hospitals are all backed up). In the meantime, I would do gentle stretching and put a lot of heat on it. That always makes mine feel better!

[S1969]

@BigMama1

Three weeks ago, on a day the pain in my right hip / back was particularly annoying I just reached and turned slightly at work and it went into full spam, putting me on the floor in agony.

After several horrible days of pain, spasms and lots of meds…

Both the chiro and physio agree the primary problem is with my SI joint, which is then causing the irritation in my hip flexor and glute.

Sounds more like a disc issue than SI joint. I had a very similar situation and my primary doc agreed that it sounded like SI but when I was referred to PT they said nope - definitely a disc based on the description of how it presented initially (tightness, a little sore, then I twisted wrong and agony) as well as current symptoms. Nothing in my back actually hurt but the way the pain radiated (through the SI and down the front of my leg, causing muscle spasms in my quad) suggested a bulging disc touching nerves.

What do they actually think is wrong with the SI joint? (Arthritis? Injury?)

Xrays can help a lot to identify (or rule out) disc issues, so no reason not to try to get them. And might be able to look more closely at the SI joint specifically.

[downen]

I have a decent amount of osteoarthritis in my hips and my SI. I have found incredible relief using an SI belt. It helps stabilize the joints and keep the inflammation at bay. I got mine from Amazon, I’ve tried a few until I found one that works and fits well.

Best of luck to you!

[BigMama1]

@Piaffe11

I will sympathize about the MRI. We are both in Ontario, so I get it. My doc sent in a requisition in September for me to the nearby hospital that multiple people in the medical field have told me is the fastest for MRIs. I heard nothing. Once my neuro symptoms started - she sent an emergency request again. 3+ weeks later I just heard back from them to be put on the cancelations list. My appointment date: May 4, 2022

It’s a pain to wait for sure. Generally I don’t mind the wait times in our healthcare system, knowing the urgent cases really do get seen ASAP, but I have twice now had fractures missed on x-ray and misdiagnosed at my local hospital and of course I made them much worse by walking around on them for 5 weeks…one I just went back to the ER and got another X-ray (they could see the fracture this time.) The other they had scheduled me for an MRI because they thought I’d torn an ACL. 3 month wait for the appointment, meantime it was getting worse every day so I drove to Buffalo for one.

I’m pretty sure this is a soft tissue problem but probably caused either by SI dysfunction or super tight psoas. I just don’t quite understand why it’s taking so long to get better when I didn’t actually hurt it. Will start with X-rays but not expected them to show anything except arthritis.

[BigMama1]

@downen

I have a decent amount of osteoarthritis in my hips and my SI. I have found incredible relief using an SI belt. It helps stabilize the joints and keep the inflammation at bay. I got mine from Amazon, I’ve tried a few until I found one that works and fits well.

Yes to this! I couldn’t walk without one during both of my pregnancies and dug it out a week ago. It did help tremendously as far as being on my feet and walking but it’s not comfortable for sitting at my desk. I’m just trying to stand up and stretch every 15 minutes or so at work.

[S1969]

@BigMama1

I’m pretty sure this is a soft tissue problem but probably caused either by SI dysfunction or super tight psoas. I just don’t quite understand why it’s taking so long to get better when I didn’t actually hurt it. Will start with X-rays but not expected them to show anything except arthritis.

I am still guessing you have a disc issue based on the severity of the pain. I literally hit my dog with a pillow in my bed and it felt like someone stabbed me.

See if this helps decide between SI dysfunction and disc pain: https://www.topdoctors.co.uk/medical-articles/sacroiliac-joint-pain-or-herniated-disc

[BigMama1]

Thank you! Based on that I’m going to say SI pain, as I’m not getting sciatica. It’s more like reverse sciatica with the pain running down the front of my leg. However I had severe whiplash from a car accident, several nasty falls that hurt my back as a teenager and one really good fall as an adult about 6 years ago, so I wouldn’t rule out other parts of my spine being involved.

[Jealoushe]

I had really bad SI issues over the last few years, ended up emerge over it.

Ended up being that my hip was rotated, and also my core very very weak. I have a strong back by nature so my core was beyond weak.

I also had whiplash from someone dropping a dresser on my head/neck while unloading it.

Pilates all winter with yoga and chiro has completed healed me.

I went from having to jump off my horse and crawl out of the arena to having 0 pain.

Just some anecdotal info from a fellow dressage rider.

[S1969]

@BigMama1

Thank you! Based on that I’m going to say SI pain, as I’m not getting sciatica. It’s more like reverse sciatica with the pain running down the front of my leg. However I had severe whiplash from a car accident, several nasty falls that hurt my back as a teenager and one really good fall as an adult about 6 years ago, so I wouldn’t rule out other parts of my spine being involved.

Either way, I think it’s nerve pain, whether from inflammation in the SI joint or bulging/herniated disc. I don’t think it’s likely to be a soft tissue injury, even if the place you feel it is in a non-joint place. When I had my disc issue it radiated down the front of my leg and my quad would spasm.

It was weird because I could do some things - I went to a dog show 4 days later and could run around the ring and also walk and stand. But sitting was terrible - the 4 hour drive nearly killed me - and lying down for more than an hour or so became painful.

It was really terrible. I feel bad for anyone in that kind of pain. It’s very difficult to avoid. What helped was NSAIDs although eventually my stomach was in agony and drove me to physical therapy. They said I should have come sooner because if they saw me while I was in more pain it would have been easier to understand which way my disc was bulging, and could help push it back in place. In my case - it was a twisting motion that did the damage so one of the exercises was lying on my back and putting my knee across my body toward the opposite wall - so essentially twisting (gently) in the opposite direction.

[BigMama1]

Yup, sounds like what my physio told me for years. Weak core, glutes not firing, pelvis way out of alignment. Lots of strengthening and work to gradually fix it, haven’t had issues in years.

I think going back to the OfficeMax September after 18 months of working at home was probably the catalyst for this, and then the stress, plane trip, changing my riding position and carrying heavy stuff awkwardly put me over the edge.

I’ve also been really fighting thr saddle on my lease horse - twist too wide and really hurts my hips to keep legs rotated inward. Finally replaced it with something a million times more comfortable for me and I’m hoping it will make a big difference. Naturally it arrived the same day my back went out completely so I haven’t really put it to the test.

[PaddockWood]

I have a hip/disk/SI journey story that may be helpful. Some 20 yrs ago after a riding fall and landing on my side I started needing to lay down during they day, multiple time a day, and crack my back. It was an urge I had to satisfy and never had anything like that before.

Then must have become more uncomfortable because I started going from doc to doc to figure it out. Xrays etc and finally got an MRI done. That doc pointed out a bad disk and suggested an injection. Did not do the injection at that disk.

Went to a well known chiro, she put my xray and MRI up on the lights and said wow your whole pelvis is off and I think we can fix you if you’ll just SIT on an ischial lift. Sure enough my symptoms immediately went away. Meaning as long as I sat on this little hard rubber square pad which lifted my seat bone up a wee bit…all discomfort was immed gone.

I sat on it for years and eventually didn’t need it. Ever again. Never had the symptoms again but did have moments here and there of stabbing pain near the disk and always knew that was the disk warning me what I was doing was not helpful. I was also told to NEVER lift and twist.

Years later (more recently) if I sat in a car for 30 min or longer it felt like my hip had “gone out” and went I got out of the car I could hardly walk for several steps.

Went to a DO doc and chiro guy also well known and described everything - my left SI, hip and even knee were all regularly pissed off. Sore, tender…you know.

He gets out the Kelly Starrett book, Becoming A Supple Leopard, and prescribed hip stretches AND use a hard rubber ball and “lay into” and release anywhere I find that is sore.

OMG I would lay on the ball and find REALLY pissed off tissue around and in my hip and lay and smash that crap and do you know all my issues go away?

So I still do that when things flare up.

My thought would be you would be well served to get an MRI and find out exactly what is going on. You need to know that in order to move forward on what will solve your problem.

Here’s a Kelly Starrett video about the hip work.

Hips and psoas | Feat. Kelly Starrett | Ep. 25 | MobilityWOD

The ball work I do is right at the start of the video where he shows the skeleton and then the ball work.
It hurts like hell. As painful as anything I’ve ever experienced but do you know it all gets released and pretty much immediately.

If you get the book or get your hands on one - starting at page 300 is a detailed description of using the ball to release tight tissue.

P.S. I now use my hard rubber balls (I have them all over the house and in the car) and use them to dig out pissed off tissue all over my body. Knees, hips, back, neck, shoulders. It works for me and keeps me going and feeling good. All from Kelly Starrett.

He’s a famous PT who has worked on pro athletes and even featured once on 60 minutes.

I knew about him before the doc suggested his ball work and stretches. And, it validated the power of releasing tight tissue which Jack Meagher was all about on horses (and people).

Hope this helps you. You could get a hard ball and do some gentle work and see if it helps before digging til you scream.