Repetitive Strain Injury/abdominal pain Right side

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Question
Julie,

Long story.  I am a 46 year old male.
I noticed a slight groin pain a year ago stepping off a curb. It came and went.  Shortly after that I started having Right lower quadrant abdominal/intestinal pain.  Shortly after that I had Right medial knee pain.  This was all within a month time frame.  

Sept 2014 - CT scan revealed nothing unusual in intestines/organs.
October - Colonoscopy reveal one pocket of diverticulosis.
October - Endoscopy and pill cam nothing unusual but acid reflux.
November - Ultrasound to Right testicle and groin for possible inguinal hernia.  negative

R medial knee worsened to the point of using crutches and limping really bad.  No heal strike, knee flexed due to painful extension with weight bearing.

December 2014 - CT scan again due to lower R quadrant pain like appendicitis. ( It really never went away it just got worse). Ultrasound to organs negative.

December 2014 - MRI Right knee revealed SPONK (spontaneous osteonecrosis of the knee) with a hairline fracture in the medial knee.  Right hip showed small tears in the central and anterior labrum.  Back showed small herniation L4-L5, L5-S1 4mm? Wore a hinge brace for the next couple months until a follow up MRI that showed knee was healing.

Cardiac stress test was good but difficult to perform with knee SPONK (by now I was beginning to really panic)

February 2015 - HIDA scan came back at 31% for gallbladder function.  Stool consistency has changed over the corse of all this, but donít know if its stress related or not?  Iím always stressed and tense with pain - sometimes near panic attacks.  

March 2015 - MRI R knee showed healing.

all blood work and urine testing has come back good in 2014 and 2015

Pain continues to increase in R lower quadrant and around the pelvic rim to the back.  Right back pain - it always feels tight like when doing Cat and cow.  thought I had and SI problem because it seemed like something was clicking and clunking but not central - to the Right. (hip/back)?  Sometimes flank pain.  Sometimes just below rib cage.  The kicker is that when I touch what I call very tender spots on my right stomach they feel like ridges or bumps under my skin.  Im not pressing very hard.  On good days I donít feel those as much.

I have a PRP injection scheduled for thursday for the hip labrum tear.

Pain remains Right lower quadrant and right back/hip rim.  It never really keeps me up at night and I feel pretty good in the morning until about 20-30 minutes the routine starts all over again.  A couple of days ago I started feeling the same lumpy sensitive knots on my left lower quadrant.

What are your thoughts on all this?  What are these ridges or bumps?  When itís bad it is really bad and I am one step away from the ER again.  Not sure which pain to take serious anymore?
Exercise and stretching suggestions?  I am at a loss

Thank you for your time
Paul

Answer
Hi Paul,

First I want to clarify that I am a massage therapist who has specialized in chronic pain and sports injuries for the past 26 years.  Much of what you are saying is way over my expertise, such as gallbladder function, diverticulosis, and acid reflux. I'm glad the last two were negative, and I agree that stress can play havoc with the body (and mind) so that could account for the stool situation.  

One thing I will mention is that all muscle spasms feel like lumpy sensitive knots. This is true whether they are in your shoulder, your abdominal region, or your leg, or anyplace else. It's good that you've been tested for appendicitis and that came back negative.

With all that, it's sounding more and more like it could possibly be spasms in several muscles, especially your psoas, iliacus, quadratus lumborum, and rectus femoris.  These muscles will pull your pelvis out of alignment, bringing it down in the front and up in the back.  The down/front problem will cause spasms to form in the middle of the rectus femoris (a thigh muscle) which will then put a strain on your knee. The rotation also causes all the muscles of your hip to go into spasm, totally pulling your hip out of alignment and causing a pain that feels like a dull poker is being jammed into your knee joint.  To check on this one, take a tennis ball and put it right at the side seam of your pants, at the point in your hip where it's hurting, and then lean into a wall.  If it hurts, the chances are good that there are spasms in the muscle.  Keep leaning into the ball for 30 seconds, then move your weight off the ball for 10 seconds, and then repeat the lean/release five or six times.

It's too complicated to explain here, but a spasm in a muscle called popliteus (inside the posterior knee joint) will cause severe knee pain when you try to straighten your leg.

The more I read your message, the more I think it could all be muscles, especially since you've had all of the medical tests and everything keeps coming back normal.  There aren't any tests for muscle spasms, so they are usually overlooked.

I suggest you go to the following websites and read them carefully: http://www.Julstro.com and http://www.15MinuteBackPainSolution.com. There is an ebook by the same name, and it demonstrates how to do the self-treatments for each of the muscles involved. While you're on the websites, I suggest you also read the blogs attached to the both websites and you'll get more answers from them.  You can take a look at each of the muscles I've mentioned by going to http://www.GetBodySmart.com and putting the muscle name into the search bar.  It's important to note that muscles always move from the origin to the insertion, and that pain is normally felt at the insertion point.  You'll understand that better when you look at each muscle and click on the link to make the graphic body move.  Think of it as this analogy: when you pull your hair your head hurts and you can't move in the opposite direction.  When a muscle pulls on the tendon the joint moves, but if the muscle goes into a spasm, it is putting a strain on the joint and you can't move the joint in the opposite direction.  For example, if the muscle is pulling your knee into the bent position, and it goes into a spasm, you can't straighten your leg.

I know this has been a very long and confusing answer to your question, but you have a lot going on.  I'm not going into everything here as it would just make it even more confusing to you.

I really think there is an answer to your pain, and I believe it has to do with finding the spasms in each of the muscles and releasing them.  Don't stretch yet, that could potentially tear the muscle fibers. First you need to release the spasms, then you can stretch safely. If you go to http://www.FlexibleAthlete.com you will see a DVD program that teaches you how to first release spasms in your entire body, and then 2 DVDs show you how to do 15 minutes of the self-treatments and 30 minutes of yoga stretching.  It's a great program and could be really helpful to you.

Hang in there Paul, I just know that you're going to get better. Please stay calm (easier said than done, but I mean it) because the doctors have eliminated all the life-threatening possibilities, which leaves a clear path for exploring the muscles as the cause of your pain.

Wishing you well,
   Julie Donnelly  

Repetitive Strain Injury

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Julie Donnelly, LMT

Expertise

I can accept questions that relate to chronic or acute pain caused by muscle spasms and contractions. Repetitive Strain Injury is actually Cumulative Trauma to muscles. Releasing the spasm &/or contraction will relieve the strain that is felt at the insertion point on the bone. I am the co-developer of the unique safe-stretching program "Focused Flexibility Training," which combines easy instruction for self-treating spasms throughout your body with proven yoga stretches. I have recently authored two new books: "The 15 Minute Back Pain Solution," and "The Secret to Your Best Golf Game EVER!

Experience

Since 1989 I have been working with endurance athletes and individuals suffering from chronic pain conditions. I have authored seven self-treatment books and three self-treatment DVDs and I have developed the Julstro System for the treatment of carpal tunnel syndrome, Trigger Finger, and other Hand/Wrist pain. I am a national and international presenter at conventions, seminars, and workshops. Principle topics are "Work Shouldn't Hurt," and "The Pain Free Athlete." In 2005 and 2006 I was the massage therapist for ultracyclists competing in the Race Across America (RAAM) 3000+ mile race from San Diego, CA to Atlantic City, NJ. I've taught the Julstro techniques to physical therapists at the Cleveland Clinic, to massage therapists in areas around the USA, and I've taught Julstro self-treatment clinics to dancers at Juilliard School of Performing Arts (NYC),the sprinting team at NC State, and I am working closely with several Olympic-hopeful. We have successfully eliminated the repetitive strain injuries that could keep them out of the Olympic Games, and the best part is they know how to do the self-treatments so they can stay pain-free and flexible.

Publications
Triathlete Magazine, Endurance Magazine, multiple national and international trade journals.

Education/Credentials
Swedish Institute of Allied Health, NY, NY - Initial education in massage therapy Licensed NYS Massage Therapist since 1989. SUNY Empire State College, Saratoga Springs, NY - B.Sc. degree in Interdisciplinary Health Education I was an Associate Professor helping to develop the massage training program for SUNY Rockland Community College

Past/Present Clients
Privacy prevents me from filling in this section without prior consent from my clients. Life Experience: I have been specializing in the treatment of chronic pain and sports injuries since receiving my NY massage license in 1989. A personal bout with carpal tunnel syndrome was the catalyst to my developing a self-treatment that heals the symptoms of carpal tunnel syndrome quickly and without surgery. My work with endurance athletes was the inspiration to teach people how to self-treat so they could stop pains even during a race or heavy training day. Both of these situations ultimately became the products that are sold on my websites: http://www.FlexibleAthlete.com and http://www.julstro.com. I currently treat people in my offices in Sarasota, FL, Cary, NC, or Pearl River, NY

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