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When Hiking Becomes A Pain In The Butt - Page #1
 

Author: Viridiana Saenz, MD
Co Author #1: Emily Olson, MD
Senior Editor: Drew Duerson, MD
Editor: Jason Blackham, MD

Patient Presentation:
A 70-year-old active female, avid hiker, and recreational swimmer presented for evaluation of chronic left posterior hip pain that had persisted despite multiple prior interventions.

History:
She described deep left buttock pain with intermittent radiation into the groin and lateral thigh. Symptoms were consistently exacerbated by long-stride walking, squatting, and hiking on inclines or declines. Walking on flat surfaces was relatively well tolerated.

Her symptoms had gradually limited her hiking and other activities requiring longer stride lengths.

She previously underwent extensive conservative and interventional treatment without meaningful improvement, including topical diclofenac, formal physical therapy, a left piriformis injection, left L3-L4 and L5-S1 transforaminal epidural steroid injections, a left sacroiliac joint injection, and a left intra-articular hip corticosteroid injection.

Physical Exam:
The patient appeared well and was in no acute distress. Gait was non-antalgic. Lumbar range of motion was full and pain free. There was no tenderness to palpation over the lumbar paraspinal musculature or sacroiliac joint.

Examination of the left hip demonstrated focal tenderness within the deep gluteal region superior to the ischial tuberosity. Palpation of a cord-like structure reproduced her typical pain. FABER and FADIR maneuvers reproduced deep posterior buttock discomfort without anterior groin pain. A long-stride walking test reproduced her characteristic symptoms.

Log roll, straight leg raise, and lumbar facet loading tests were negative. Hip range of motion was symmetric bilaterally, and the lower extremity neurovascular examination was normal.

Case Photo #1

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NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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