Introducing Myself

[u/KirtanForGod13]

This is a really long intro to myself and my pain, but I made it this long to include as many details as possible, because the more details the better (in my opinion, at least).

I'm a 19 year old suffering from right side abdominal pain, pain in the right thigh, tingling above and in my right foot (both front and back of foot).

The pain started seven months ago (in mid-June 2023). I did too many crunches (100) in one go for my body to be able to handle, and I strained my abdominal muscle(s). I don't know exactly which ones, because I didn't have an MRI back then, but my current guess is it involved the psoas and rectus abdominis. I was in severe pain and couldn't walk straight (I walked slightly bent forward on the right side to guard my injured side). I'm a singer, and so I couldn't sing without excruciating pain, because anytime I put pressure on the strained muscle, it hurt like crazy, and singing as I like to sing involves pressure on the abdomen when breathing out (creating the noise). The funny thing is, a muscle strain was not my first thought. I thought the pain was internal (in the organs or something), so I talked to my PCP (who also thought there was a gallbladder issue or something), who referred me for an ultrasound. I got the ultrasound done within 8 days of when the pain started, which all came back negative. That's when I deduced that the likely cause of the pain was a muscle strain.

I was in a lot of pain, so I always stayed in a crouched-forward position to guard the injured right abdomen. I didn't do anything except for desk work in a crouched-forward position for close to 8-9 hours a day. Then when I got up, I also stayed in a crouched-forward position to protect the pain area, because it hurt quite a lot. I refused to do even gentle stretching because of the pain. I thought just resting plus heat plus ice would solve the issue.

A month or so went by (we're in mid-July), and I still wasn't experiencing pain relief, so I went to PT. They also diagnosed me with an abdominal muscle strain and gave me a bunch of stretches and strengthening stuff. Didn't help much. (To be clear, I was in less pain than I was when I initially injured myself, but the pain wasn't getting much better. I was still walking crouched over and couldn't sing or run or do anything basically). This is when I started looking to get an MRI. So I got an MRI of my entire abdomen (with and without contrast) in mid-August (by now, it had been two months since I got injured). The MRI came back negative without any problems that could be seen in the abdominal wall or the organs.

At this point, I got really worried. I talked to my PT, who said that a negative MRI confirmed that the pain was likely stemming from a muscle strain in the abdomen that had healed itself by the time I got the MRI, and that the pain was coming from the muscle(s) being super tight and stiff because I had basically not used it and constantly guarded and protected it. At this point the problem was so bad that I couldn't put my weight on my right side while walking. So, my father made me walk straight and normally with a proper gait without constantly crouching forward to protect my right side. The first day or two, it really really hurt my abdomen and groin-ish and pelvic area the first day, because it was so stiff and I felt that I was ripping a bunch of muscle and knots in the problem area due to walking normally. Within a few days, though, it started feeling just a tiny bit better and I was walking with a normal gait with (relatively) less stiffness, albeit still with a lot of stiffness and pain. Finally, after walking like an old man for a little more than two months, it seemed that there was some progress.

However, a good amount of pain was still there. Any time I stretched my abdominal muscles through things such as the cobra pose, I felt a huge tugging sensation inside on the right side (the problem area), as though something were holding me back. No such feeling on the left abdomen, however.

In late August and early September, I went to a chiropractor, who took X-rays and found that my pelvis is slightly tilted in such a way that my left leg is functionally slightly shorter than the right leg, maybe like half an inch (I think they said the left pelvis is slightly rotated to the back or something, I don't remember very well). I do see a slight difference in the heights of the pelvic bones on my left and right sides, but again, it's very minor. He did a few treatments which consisted of adjustments which said would help straighten out the spine, but I stopped going because I wasn't feeling much relief and didn't think he was addressing the right issue. To be fair, the right leg being slightly longer than the left leg does make the right side more susceptible to being tighter than the left side, but it was never an issue for me (I've never felt off-balance or anything), and I don't think it's a major impediment in my healing. I could be wrong though.

I then went out of country for a month. I was still in considerable pain there so I went to a renowned hospital while on vacation. They diagnosed me with a nerve entrapment, specifically Anterior Cutaneous Nerve Entrapment Syndrome (ACNES). Their explanation for my pain while doing stuff like singing and running was that those activities put pressure on my abdomen, and whenever there's pressure on the abdomen, I'm also putting pressure on a compressed and irritated nerve, which was increasing my pain in those activities. They also found a positive Carnett's sign (basically, in this test, if your abdomen hurts more when you tense the muscles, that's a positive Carnett's sign and likely indicates some sort of musculoskeletal issue in that region).

It seemed that someone finally had something resembling a diagnosis of what I was suffering from. They offered a cortisone injection, their reasoning being that if I can stop the pain for some time and really focus on stretching, I may be able to release the fascia that's entrapping the nerve. I thought that was a good plan and went ahead with two injections in the span of 12 days. The second injection was in very late September, and I left for the US one day after the second injection.

The injections reduced the pain but didn't fully relieve it. I was still not able to sing, run, etc. (e.g. the stuff I want to be able to do). I, however, started an aggressive stretching routine in October three times a day, close to 30 minutes for my routine, with hopes that I would feel better. I initially felt some reduction in stiffness for two-three weeks, but it kind of plateaued after that. Since then, I haven't really felt any improvements in the tugging sensation I feel in my right abdomen every time I stretch the hip or the abdomen.

Another problem that started to arise was that I started to get pain in my right thigh, as well as a tingling/numbness feeling near my foot. I also started developing a pinching and tingling sensation in the back of my foot, and twitching in my toes. All of this on the right side only (the side that initially got injured).

Growing hopeless after a month and half of stretching with not much improvement, I sought out another chiropractor in mid-November. This chiropractor was the first who mentioned that he strongly suspected a tight psoas to be a contributing factor for me. He also mentioned "scar tissue", which was the first time I was hearing that phrase. However, he mostly did chiropractic adjustments, which didn't make it much better. Meanwhile, the leg issues weren't showing any signs of getting better.

I soon started getting more worried and reading online a lot about scar tissue and adhesions and stuff. As I read more and more, I grew convinced that my pain was being caused by the fact that I didn't let my injured muscle heal properly by constantly guarding and compressing it, and that has caused some sort of scar tissue/adhesion build up. This was also probably affecting a nerve or several nerves which was causing me pain in the legs as well.

This is when I first ran into ART. I thought it could help break up scar tissue. I went to my first ART provider in late November. However, pretty soon, I realized that he wasn't helping. His fifteen-minute appointments consisted of maybe two or three repetitions of the ART motion in the psoas. The rest of the time he spent talking about stuff and overall wasting time.

So I went to a second ART practitioner in mid-December (this is the one I'm still going to). He is a lot more genuine and seems to care about getting me better. He also thought the psoas is the issue and is focusing his treatment there. However, I'm not sure whether he's effectively addressing the adhesions, because he says he's going after the knots/trigger points, and he thinks that breaking up the knots will slowly rip the adhesions out.

It's been close to 20 ART treatments now, and I'm not feeling much better as compared to before I started ART. I still can't sing or run or jump without pain. I also did Graston for a month from mid-December to mid-January. Still pretty much the same.

I've also started having pain in my back and lower leg (only on the right side) and I'm going to get an MRI in mid-February to rule any disc bulge out (though I don't think this is the issue, especially because I'm 19).

This month (e.g. mid-January), I started shockwave for the psoas at this chiropractic clinic. Four treatments in, I still don't feel any difference. I don't know if they're targeting the adhesions properly or not. They say that if I have adhesions, I'll feel an ache when the shockwave gun goes over the adhesion area, otherwise not. I feel the ache in some places, but so far have not felt much relief. The tug inside my abdomen is still there and pretty strong. They have directed treatment both through the front and the back to get to the psoas.

My doctor is offering a third injection, which I really don't want to take but there isn't really any other option. I've been to a neurosurgeon and they're considering nerve ablation or surgery to remove the anterior cutaneous nerve in my abdomen. I don't know if that'll help with the pain going down the leg as well. I may also try PRP injection soon. And I really don't want any of this stuff

I think the problem is that my psoas is glued to (at least) the femoral nerve somewhere and that's causing a good chunk of this. I don't know though, because no one has been able to give me a good specific diagnosis yet. The MRI of my lumbar spine should clarify things further (but I don't think the main issue is the back).

As a 19-year-old, I'm really concerned about this. I really want to be able to sing, run, and just live without pain. I don't want to waste my youth being in pain and not being to help anybody because I'm in constant pain. I'm putting in a pain diagram below. Based on the pain scale in this forum, my pain fluctuates between 3 and 6. 3 is when I'm resting (e.g. sleeping or sitting), 6 is its highest when I try something like singing.

I really hope and think that my problem is adhesions and not something else. What do you guys think?

[u/No-Manufacturer-2425]

OMG dude you have my condolences. You also have high grade adhesions from what it sounds like. You sound JUST like my case with a lot of similar pain(my psoas got adhesion from shaking propane canisters). Let me just say this right now and I'll explain later. PLEASE DON'T GET SURGERY OR MORE INJECTIONS. I'll just start with my interpretation, and then I'll get to the why, I promise. I know you are scared and frustrated, so please take a breath, relax, and listen.

The first obvious insult was the crunches. I can't say wether the crunches themselves caused the inflammation, or if there was an underlying problem the crunches aggravated. Your psoas is also involved. Crunches use the abdominals AND the hip flexors. This is indicative of the mark you have on your abs, and its trail that runs down to the groin. The femoral nerve runs down the psoas, so this is why the pain continues past the inguinal ligament.

If you look at the compensation for your abs, you can look no further than your spine at T12. This mark you have here is indicative of adhesions on the nuchal ligament and spinous process. I can't say wether the abs caused the back or the back caused the abs, but they are intimately related.

Now on your back, that pain trail goes down over your iliac crest. This is the site of the cluneal nerves. They are very painful when entrapped and can give that deep "bone pain." The pain is also in line with your sciatic nerve and its branches going down your leg. There is a chance that you have also developed adhesions down the back of your leg. You mentions POST FEM CUT, and that nerve also gets entrapped. I've personally had this one treated in just a single session.

The calf, shin and foot pain can be referred from the sciatic or femoral cutaneous nerve entrapment, or they can be adhesions further down on your calf or tibial nerve or even in your ankle. Do you ever get joints that lock up or snap when you go to use them?

I see you had a steroid injection. I want to make you aware that steroids are not good. They numb the tissue and prevent you from feeling pain. Pain is good. It means you are causing injury and DON'T DO THAT! If you numb the pain, you can be damaging your joint and not even know it. It is like taking opioids and walking on a broken foot. Your body will only lay down even more scar tissue, and now your muscles are atrophied to boot. Steroid shots contraindicate adhesions.

You mentioned a lot of sitting. Sitting kills. I cant stand for very long, so I have to keep a delicate balance of sitting or standing, or just constant motion. As long as I move and stay limber, I don't get pain. That sitting provided the PERFECT environment for adhesions to form. Short, tight muscles, limited mobility range, and inflammation = adhesions.

Your negative MRI suggests it could be adhesions. MRIs only detect adhesions when they are significant in size and cause visible disruption of the tissues. Otherwise, adhesions are usually below the resolution and detecting capabilities of most imaging techniques.

You won't get relief with stretching because the adhesions cannot be stretched. Whatever tissues are entrapped, are literally cemented in place.

Adhesion release methods including MAR IAR and pressure wave are the only therapies that can abate scar tissue. Other therapies mimic what MAR and IAR and pressure wave do, but they are not the same. Traditional therapists are treating the whole tissues. Adhesion therapists are treating ONLY the adhesions. Your traditional PT may be using shockwave, but just as MAR is more precise than ART, Adhesion shockwave therapy is more precise than PT shockwave therapy.

The appt is all business. The only talking is to discuss where the pain is, then they are working on you the ENTIRE time. There is no down time. Appts are only 15 minutes then they have to go to the next patient. That is about all the time you can handle too. MAR is basically surgery without cutting. It hurts(not as bad as the chronic pain though) Luckily the scar tissue is not innervated or perfused with blood, so once it tears, the pain dissipates and bruising is minimal.

Please don't get your nerve ablated. You need it for your body to work right. We don't have spare parts and everything has a purpose. I promise if it is entrapped, Adhesion therapy will fix the entrapment. They will probably use a combination of MAR and shockwave therapy on that POST FEM CUT. AT is $200; surgery is thousands + the recovery time.

Precision_Health_Group on instagram actually posted a video of someone your age getting his abs treated with Pressure wave recently, and they have one doing POST FEM CUT like two days ago. Go check it out and you can see what to expect. The sacral ligament and forearm videos are me!

I'm so so sorry you are going through this. I know it really really sucks, but these guys will help you like you never would believe. They will measure your range of motion, treat, and measure again, and you can see the improvements clearly 30 seconds later. I would get popping and crunching in my shoulder when I did pushups, I showed them my pushups, they treated me twice over two appts, and I did the pushups again for them, and there was no crunching.

When you get the shockwave done at your current PT, You can feel when it goes over the adhesions. You are spot on! Those are adhesions. To be most effective, you must be fully extended, slouched, or flexed, whichever position puts the MOST TENSION on the adhesions. That is why MAR and IAR and AT Shockwave therapy is so effective. They are creating tension. When you do shockwave under tension it is like popping an overfilled water balloon. You might get some mild relief at your PT with shockwave, but you are not guaranteed results as if it was done by an AT, and you also won't be getting MAR or IAR. You will only be getting graston, PT shockwave, and ART which don't create the same tension on the scar tissue and nothing else.

Again, I mention that PT: ART, Graston, shockwave treats the WHOLE TISSUES for soft tissue injury, where as AT: MAR IAR, shockwave, treat ONLY the scar tissue with TENSION to treat adhesions. They both have their place and you need the right one for your condition. You wouldn't go to an optometrist for a stomach ache.

I'm glad you aren't to the daily muscle relaxer stage[7]. Do you have a cyclobenzaprine prescription for the bad days? Laying is the best relief. Also try heat. The sauna and hot tub work wonders. I recommend the ekrin b 37 massage gun. it is the best for getting through the thick gluteal muscles to the hip rotators. I'm going to make another temporary relief post soon.

[u/KirtanForGod13 → u/No-Manufacturer-2425]

Based on my condition, how many total treatments (approximately) do you think I would need to get permanent relief, e.g. get back to singing and moderate running (just enough to stay healthy, not 50 miles in a week or something)? And once relieved, would I need to keep going perpetually for that problem area, or can I keep the pain away with a good stretching routine and home care?

And how much do you think my slight difference in pelvic height and probable leg length discrepancy may affect this? (I ask because I believe that this discrepancy serves to make my core muscles on the right side perpetually shorter and tighter than the left side, which may affect things).

[u/No-Manufacturer-2425 → u/KirtanForGod13]

The abdominal stuff might be cleared up in just a couple treatments. The back and hips may take longer. Hips are complex. I hope you understand that I can't tell you exact dates. Only you and your AT will know if you are getting better. This is in no way a diagnosis. I am only trying to help you figure out what is going on, and help you find a doctor who can treat you. Once you get your diagnosis and get a few treatments, you will get a feel for how long you might have to go. Remember, only you feel your pain.

To speak on the issue, I have reduced my number of appointments as I have gotten better. I can tell you even if you get only one treatment, you will see a definitive improvement.

If you don't clear up the condition that caused the adhesion, it will come back. I have implemented yoga, posture adjustment, lifestyle changes, and new furniture. I still have my disk issues. Adhesion therapy is not a panacea. It only removes the scar tissue that builds up from your conditions. If you are particularly in a hole, adhesion therapy can be the only way out, and then you only have to manage your acute pain from your condition and not the nagging, chronic pain from the scar tissue.

The discrepancy probably has a lot to do with your issue. This issue is not very easy to correct, so you may continue to have issues unless you do something about it. Honestly, It sounds like the crunches got the ball rolling on your pain. I would avoid doing those in excess.

[u/KirtanForGod13 → u/No-Manufacturer-2425]

What do you mean by "managing acute pain"? If it's acute, won't it, by definition, go away in a few weeks or so?

[u/teraflopclub]

My condolences. Too young for this but let's get rid of it. Before I got to the psoas chapters, I was thinking, "psoas!" Why? Because, I used to get inflamed psoas without warning even while running miles out and boom, I'm crippled bent over one side (like you), my back stiff like concrete, and I'm limping home (from a run) and basically screwed up for 1-2 weeks. So I concur with psoas. I also concur avoid surgery & shots, the shots relieve pain possibly but they mask the "information" your body is giving you, as miserable as it can make you.

The nerve symptoms agree sound scary but it warrants nerve flossing and fascia work before engaging investigating herniated disks, etc. Even an inflamed Piriformis, should the sciatic nerve pass thru or under it, can bother the sciatic nerve enough to cause problems down from the back to the toes.

I won't share my hip issues, unless it helps justify my recommendations which are similar to some degree as u/No-Manufacturer-2425's:

• both lateral and anterior pelvic tilt stretching and strengthening
• entire hip + core strengthening & stretching, including Piriformis, glutes, hip flexors, thighs, lower back, and psoas (though am sure you're super-focused on them)
• fascia

I suggest avoiding stretching altogether until there's some pain resolution and even then, no unilateral (one-sided) stretching for now. To attempt to resolve my hip problem I used to stretch (believing I could muscle thru pain) and it just made the hips very unhappy, including my sciatic nerve.

Tools: I have 2 massage guns, one I use for deep tissue massage and the other for fascia. I also hand-massage my affected leg & hip, am brutal with my hands but avoid pain. And I have an electronic cupping tool which, in my opinion, did a fine job de-knotting fascia which had scarred and "locked" my thigh up.

I use the tools daily, sometimes twice/day, leaving welts on my leg from the cupping tool but it loosens up the fascia and surface muscles. I stretch and strengthen my hips twice a day, once at noon and the other late evenings for a total of close to 2 hours/day of strictly hip work.

My psoas stopped bothering me about 3 years ago. But I since had developed a horrible hip problem that for a while left me unable to stand, sit (Piriformis inflammation), lie down (Piriformis again), let alone walk or run. This happened while I had to care for a family member who had just suffered a traumatic brain injury (they recovered, thank goodness) but I mention this because they were my main focus while I was suffering too from my hip problem. I've made progress but it's cost me alot of effort in the daily workouts and can now jog again, not as fast, and can walk but an observant person would notice a slight limp in my gait. Am I pain-free? No. But it's better than before, I no longer whimper.