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Complex SI joint / lumbar / mechanical leg problems

This is my first post here, it seems like a great resource. I'm a 40 year old man, have had back problems for about 8-10 years and things have become worse recently. The problems started long ago when I stepped off a curb and the next day had tremendous pain in the left SI joint and base of spine. I could barely move for around 3-4 days. Apparently I had a disc herniation at L5-S1. Went to chiro and PT for years, things got better. I've had flare-ups over the years since, with better periods where I could be as active as I wanted (playing lots of tennis, racquetball, etc). Lately things have gotten worse, and gotten kind of weird. More sciatic pain down the left leg, but with shooting pain in the groin, SI joint, glute, pain in foot, etc. I went to a good physiatrist who said my left medial glute had stopped firing as I had almost no strength there. I started doing very expensive PT ($135 per session) which has helped restore some of the mechanical problems -- medial glute strength, leg length (pelvic?) discrepancy, sciatic pain. I still have SI joint pain that's plaguing me, and glute pain that comes and go. When it's bad the pain is sharp, but it's usually there in a nagging sense.

Getting to the point -- I've had hip and lumbar MRIs done in the past couple months. The hip MRI said "SI joints are unremarkable." The lumbar MRI shows that my L5-S1 herniation has receded to a minor bulge, but showed facet joint hypertophy at every level. This got me thinking of inflammatory arthritis, particularly ankylosing spondylits. I'm seeing a rheumatologist tomorrow, who I presume will order blood work. But my issues seem to be a combination of spinal, SI joint, and sciatic. So I'm looking for someone here who's dealt with some of these things that can give guidance. I'm spending $300-400 per week on out-of-pocket medical expenses, on top of health insurance. I'm pretty depressed as I used to be athletic and active, but now just lay down when I'm not working other than taking some short walks. I suppose my questions are:

1) Would the hip MRI necessarily show sacroilitis? It reads "facet joints unremarkable" but I have pain there pretty regularly.

2) Are the leg/pelvis imbalance problems and weakness causing the SI joint pain, or vice versa?

3) Are there any specialists in this area that people can recommend?

Thanks for reading this long post.




  • L4_L5LL4_L5 Posts: 1,481
    edited 12/18/2018 - 7:16 AM

    There is something called an MRA (MRI arthrogram) which many doctors claim is much better for diagnosing problems of the hip (as opposed to a regular MRI).

    Google “MRA HIP” for more info.

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