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Help with groin/hip flexor, hamstring, and lower back pain

Old 07-27-22, 07:41 AM
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jtruest
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Help with groin/hip flexor, hamstring, and lower back pain

I have been riding for over 15 years racing XC, road, cyclocross, and now gravel and have had a nagging injury for almost a year that I'm hoping to get some advice on. I have constant lower back pain, hamstring tightness, and groin/hip flexor tightness and pain all on my left side. I have seen an orthopedic doctor for my spine (MRI negative), and now several PTs for muscular imbalances with no relief or fix. I have taken time off the bike (8 weeks of no riding/activity), tried to ride through it, and spent many gym sessions strengthening my core, stretching, doing yoga, etc. but the problem doesn't go away. I've also been professionally fit on my gravel bike with no change to how I feel so I know that is also correct.

I guess I'm just looking for anyone who might have had a similar issue. I'm from the Boston area so plenty of access to doctors but at this point I'm getting desperate and would love a recommendation to a doctor or PT that understands cycling better and can put me on the right path.

Let me know, thanks!
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Old 07-27-22, 08:08 AM
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Do you get any less tight or experience any pain relief at all after stretching and yoga? You mention pain all on your left side. Is it all in the back?
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Old 07-27-22, 08:22 AM
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I had chronic low back pain and went to PT and sports doctors and got stretches, core strengthening exercises, etc. I found the best cure is a firm mattress, and daily toe-touch stretches to stretch the hamstrings and lower back.
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Old 07-27-22, 08:24 AM
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The pain is left hamstring, left lower back, and left groin/hip flexor. I get a bit of relief while stretching/yoga but it doesn't last and I wake up in the morning with the tightness. It's chronic so riding makes it worse but I feel it all day.
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Old 07-27-22, 08:24 AM
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get a foam roller plus massage gun and get to work on those areas. Find some RMTs who specialize working deep tissue, they will be very helpful for you. Supplement this with stretching. work around the entire area, anterior to posterior, on both sides of your body.
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Old 07-27-22, 07:16 PM
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Originally Posted by jtruest View Post
The pain is left hamstring, left lower back, and left groin/hip flexor. I get a bit of relief while stretching/yoga but it doesn't last and I wake up in the morning with the tightness. It's chronic so riding makes it worse but I feel it all day.
Not a MD, just have been a sufferer of a variety of serious back issues, over the years...
Have the Professionals you've consulted ruled out any form of Sciatica ?

one thing to try - if you don;t have any bad reactions to Ibuprofen, I suggest taking 200 mg 4x a day, or 400 mg 3x a day - make sure to space evenly, stay well hydrated to not create kidney issues... take last pill before bed - do for 2 days. If you experience relief in the am, then you know some more... If the pain in the hip area is 'internal' and deep, and the hamstring pain is defined and right down the middle - check for sciatica ...
I've had it a few times... One time, on bike very regular (every day) I was riding a 135 width saddle... turns out this width is very marginal for me. I need 140mm+, 143 works great.
If you're on 130 to 135 saddle, I suggest trying a 143 width... too narrow a saddle can really irritate, even damage the sciatic and other nerves and vessels in that pelvic area.
Again, I'm NOT an MD... everything you relate is also associated with sciatic issues...
Ride On
Yuri
EDIT: I also went to a bunch of MDs and specialists back in '70s and 80's, but no resolution, until I saw one MD, he noted symptoms, and prescribed Motrin (Ibuprofen) for me (this was before it was available OTC). I had it really bad for 6 months before seeing him, could barely bend over, excruciating ... he had me on 2000 mg a day (400 mg 5x), lots of water, and it took about 2 weeks to get really some apparent relief, and 6 weeks before I was able to easily do common stuff, 8 weeks to where it was just a bit apparent, in the back ground. Mine was Piriformis syndrome - info available on the interweb.
morning was always the worst time, because the muscles involved actually tighten up as you lay in bed for extended period...
if you experience some relief in AM and things go back to problem level, that's expected... until further resolution starts happening.
Thanks to WolfChild - I'm adding more more clarification ...
2 days ONLY with IBU - if you see any 'improvement in that time; THEN go see MD again and discuss this further. Do not treat yourself without working with physician!

Last edited by cyclezen; 07-27-22 at 10:26 PM.
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Old 07-27-22, 07:51 PM
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Originally Posted by cyclezen View Post

one thing to try - if you don;t have any bad reactions to Ibuprofen, I suggest taking 200 mg 4x a day, or 400 mg 3x a day - make sure to space evenly, stay well hydrated to not create kidney issues... take last pill before bed - do for 2 days. If you experience relief in the am, then you know some more..
Pain killers only offer temporary relief. Taking pain killers will not fix the problem. Pain killers will also delay recovery and prevent adaptations to exercise.
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Old 07-27-22, 08:43 PM
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Originally Posted by jtruest View Post
The pain is left hamstring, left lower back, and left groin/hip flexor. I get a bit of relief while stretching/yoga but it doesn't last and I wake up in the morning with the tightness. It's chronic so riding makes it worse but I feel it all day.
Asymmetric issues happen to many riders simply because we tend to favor use of one side of our appendages over the other side.

This is something that can be resolved with focused training on your pedaling technique. In your case, consciously try to raise effort driving the pedals with your right legs or conversely, reduce the effort on your left legs.

Another thing you can do is AVOID pulling (lifting) the pedals on the upstroke. With so many leg, back, and even saddle complaints I heard from riders, most of them are either riding with the saddle too high or they're pulling hard on the upstroke.

You may "pull" BUT with only enough force to unload the upstroke pedal. I suppose the best way to practice it is switch to using flat pedals without using any foot retention/straps. Our legs are not well adapted to pulling or flexion nor as strong and efficient in flexion as does extension due to millions of years of evolution and adaptation to running (as opposed to cycling with clipless pedals, since the technology did not exist millions of years ago)
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Old 07-27-22, 10:16 PM
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Originally Posted by wolfchild View Post
Pain killers only offer temporary relief. Taking pain killers will not fix the problem. Pain killers will also delay recovery and prevent adaptations to exercise.
well, Yes and No.
Ibuprofen is used as a 'Pain Killer', but it's primary purposes are as a 'blood thinner' and anti-inflammatory...
so given a situation which is mostly crippling and inhibiting someone to function, the idea of 'adaptation to exercise' is hardly worth consideration, at that time/moment.
Delay recovery - depends...
In the OPs case, he hasn't gotten sufficient good feedback from his PROS on the issue - no real diagnosis or direction for recovery.
I suggested he use IBU for a couple of days - if he gets some indication that some relief is experienced, then there's a good assumption that 'inflammation' is directly involved , could be muscle/soft tissue. And points further where to investigate... that would be progress for him. and maybe spur some further ideas from the PROS.
Delay Recovery...
just my case... I suffered greatly for 6 months, having gone to 2 MDs, 3 chiros, and a Physical therapist - none to come up with a real diagnosis and no real treatment which had any positive effect..
Until I saw one doctor, recommended by a friend /athlete. This doc listened and asked... He came back with a number of possibilities, but said the one most likely was also the one we could treat in the most minimal way, and see if that started some relief and healing process.
Piriformis syndrome is a spasm of the piriformis muscle,(link provided) which surrounds the sciatic nerve, and if the spasm becomes chronic, long lasting, can cause serious damage to the nerve.
The piriformis is deep within the pelvic girdle and not accessible from the body surface...
I won;t go into the whole ordeal, But as noted in my prior post, Doc prescribed Motrin for extended period as treatment. It worked, took 2 months for my condition to be mostly healed and had to be strict about good hydration because of possible affects to the kidneys... Nothing else prior had any positive effect. Waiting for the piriformis to stop spasming hadn't work in all those months.
I am not suggesting the OP treat himself, just do a 2 day trial, see if it has any positive effect - THEN see his DOC and discuss further...
Blind adherence to some particular 'guideline/faith/doctrine' alone often assures that one doesn't do things which might help - being wise and aware enough to measure and observe progress or not, is important.
I'm currently battling a very serious condition for which there is no 'cure', nothing surgical, nothing wholly medicinal. So I'm throwing everything I can at it, which shows results, scientific or strong anecdotal - as long as there are no counter-indicative effects against other methods being used for me. Western Medicine, Holistic/Homeopathic medicine - I've considered a lot, decided on some, and using what My MD thinks is good and what some Holistic practitioners will benefit. So far, I'm lucky, and things are getting better, contrary to what happens to many.
I try to bring an open mind to an issue, a problem. Listen to experts from many sides, many angles. Finally leaving decisions to others, isn;t always (or even 'often') the best way to proceed.
Pain Killers are killing 'pain' because they do something else... which often is their primary effect.
It's good that they're temporary. and Yes and No, sometimes they don;t help healing, but sometimes they do - depends...
Ride On
Yuri

Last edited by cyclezen; 07-27-22 at 10:20 PM.
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Old 07-28-22, 06:26 AM
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OP....I feel your pain. Riding about 50 years now and now have similar pain on my left. I never had any pain in the years past. I have not figured out my problem but one thing that has helped a little is moving the saddle forwards and very slightly lowering it (lower seatpost, not the saddle nose angle). This takes some pressure off the hamstrings and flexors, putting more emphasis on the VL and rest of the quads. It is slight benefit to me. Cost me $400 at a fitter.

I cannot do more than about a 10 minute hard effort before the pain is too much to bear. If I keep the effort down and periodically get off the saddle, I can ride a long distance but cannot ride real hard. Very frustrating.

My next step is to my Chiro who will look a myofascial tension. My Chiro is also a cyclist and has worked the Olympics a few times, so, I trust his cycling specific knowledge. If i were you, I would try to find either a PT or Chiro with cycling or sports expertise. GL
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Old 07-28-22, 08:59 AM
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Originally Posted by jtruest View Post
The pain is left hamstring, left lower back, and left groin/hip flexor. I get a bit of relief while stretching/yoga but it doesn't last and I wake up in the morning with the tightness. It's chronic so riding makes it worse but I feel it all day.
I've had years of lower back pain and SI injections. It's been 5 years now though since I've had an injection. My relief does come from stretching and yoga and diet. I can tell you though that all of it has to be done religiously, every day. If I get lax about it, I start having problems again and it takes several days to a week or more of everyday routine to get pain free again. The food side of it has to do with inflammation. Many people have undiagnosed food allergies that cause inflammation. They simply chalk it up to old age or old injury.
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Old 08-02-22, 09:24 PM
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I've had varieties of back pain over the years, including diagnosed sciatica. The only thing I've ever found which produced real results was walking. Yeah, walking. I think the thing about walking is that is has to be a symmetrical exercise or we can force it to be one if it's resistant. And it's easy to tell. No bike fit issues. My method is to walk at a moderate pace maybe 3 times a week while revolving each hip with a more or less circular motion in the fore-and-aft plane. I don't care what it looks like. The first time I did it, it hurt like the very devil for about a mile, then got better. I gradually increased the distance to 5 miles at a 3 mph pace, then increased the pace to 4 mph. This took most of the summer. I used a neighborhood with about 200' of gain per mile, round trip.

That was a few years ago. The back pain hasn't come back, maybe because I walk or hike in the mountains at least once a week. This past year has been a bit sucky for me because I couldn't seem to fit strength training in, the first year in decades. My big events are over for the year and I'm getting back in the gym this week. Strength training is another one of those things which has to be symmetrical. You're forced to perform perfectly symmetrical movements with resistance - you use a mirror. I think that's key.

Yuri's idea of using ibuprofen as a diagnostic aid is a good one. I've done that many times myself. If the pain goes away, it's almost certainly a tendon/tendon sheath issue, IOW tendonitis/tendinosis depending on how long it's been going on. With a self-diagnosis of tendon issues, you can try a self-programmed treatment plan, which is better than "I have no idea." It either works, validating your diagnosis, or it doesn't, with the opposite result. I like yes/no things, maybes being useless.
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Old 08-02-22, 09:58 PM
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I have suffered with Low Back Pain for years and years but mine is associated with true bony and soft tissue injuries. It appears your studies are negative, but that does not mean you are not injured! I have had many patients that were in real pain and I could not find a specific precipitating source of the injury. One thing that my patients have always appreciated is that I never stop looking. I have had great success with the use of Epidural Steroid injections combined with Osteopathic manipulation. Finding a DO that still does manipulation can be very hard now days so often I would send my patients to a chiropractor after near epidural steroid injections. True epidural steroid injections are now done with Sonogram Guidance by MDs and DOs only and I am an old PA-C.

Check your supplements: Low dose NSAIDs twice a day (for effect not pain), Glucosamine/Chondroitin (for joints), Omega3s (for soft tissues), Calcium (for bones), Magnesium (for muscles), Zinc (for recovery), Famatodine (H2 Blocker), Allegra (H1 Blocker). Each one of these can bring you a little more relief and homeostasis.

Piriformis Syndrome is a real bugger and sneaky sneaky. And another one of those injuries that has little physical evidence other than pain.

For your bike try not only getting a wide seat but lowering it about 1/2" and also raise or tilt your bars about an 1".

Stretching goes without saying but I have had many true athletes profess that thier masseuse worked out the most effective stretching routine for them. Not everyone is the same.

Don't forget Othotics. Back support or weight belt, Compression stockings or Leggings, and the all holy "MASSAGE CHAIR".

Remember that the pain we feel today may not have anything to do with what we did today but rather what we have done one or two days ago...
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Old 08-03-22, 07:33 PM
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I just ran across an interesting study in JAMA - journal of the American medical association -
https://jamanetwork.com/journals/jam...rticle/2794765

That article didn't tell me much, but it piqued my interest and I googled away. The most interesting thing I saw was that the usual instruction given to those who are or might be experiencing lower back pain is "to be careful of your back." That advice is the exact opposite of the advice which should be given. The process of being careful starts harmlessly enough, but then, as we've often heard from friends, "I was holding this box and I just turned wrong and my back went out." What you really want to do is to behave as though your back was in great shape, all the time. Disused back muscles allow things to slip out of alignment and then you have a problem.

I've always behaved as though I were 21, even at 77. My back is fine. Not that it's always been fine, but whenever it wasn't fine, I exercised it until it was fine again. It's a constant mental image thing. Just move like a normal person, even though all of us on here are probably far from "normal."

Anyway, here's a good look at what I've been reading about:
https://www.sciencedaily.com/release...0802121722.htm

Googling "sensorimotor training exercises" gets some good hits.
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