Pelvic and Lower Back Pain: Causes and Solutions

Pain in the pelvic region near the lower back?

Hello Doctor, I have been experiencing pain in my pelvis and lower back for over four months.
The pain occurs mainly when I bend over or exert myself, and I hardly feel anything otherwise, although sitting for long periods also makes my back sore.
This is something I never experienced before.
I have visited the orthopedic department of a major hospital three times, a rehabilitation clinic once, and had chiropractic adjustments twice, but none of these have helped.

During my first visit to Chang Gung Memorial Hospital's orthopedic department, I was checked for scoliosis (the doctor said a 10-degree curve was not a concern), and I was already experiencing pain at that time.
An X-ray was taken, and the doctor suggested that the pain could be alleviated with more exercise.
I then went to the rehabilitation department for treatment (heat therapy, electrical stimulation, and ultrasound), and I was prescribed muscle relaxants, but none of this worked.
Later, I visited another major hospital, and the doctor, after listening to my description, also recommended more exercise, mentioning that the pain might return after a while.
I kept asking if it could be cancer, and he said that if it were cancer, the symptoms would not fluctuate and would typically worsen over time, and I also do not have any nighttime pain or similar symptoms.
After some time, I felt that exercising did not make much difference, so I returned to Chang Gung to see a doctor again, this time the department head.
Initially, he wanted me to have an X-ray, but then he found my records from two months ago (the visit for scoliosis), and he said the X-ray results were normal.
When I asked if it could be bone cancer, he assured me it was not and advised me to do more sit-ups! However, I have a question: can an X-ray really detect tumors in the spine or pelvis? The doctors keep telling me to exercise more, but I already exercise quite a bit; I just spend more time sitting and studying since I am a student.
I can do 36 to 38 sit-ups, so my muscle strength should be sufficient, right? Could my situation be due to a muscle strain or something similar? Thank you, Doctor.

HAHA123, 10~19 year old female. Ask Date: 2017/02/19

Dr. Shi Guozheng reply Orthopedics

Typically, lower back pain is related to improper sitting posture and insufficient strength in the muscles around the lumbar region, including the back muscles and abdominal muscles (core muscle group).
When studying, it is important to maintain correct posture.
Additionally, using a cushion for support can help avoid slouching or lying down while reading or watching TV or using a computer.
Engaging in regular physical activity is beneficial.
If the pain persists, it may be advisable to consult a rehabilitation specialist for some therapeutic treatment, which could potentially lead to improvement.

Reply Date: 2017/02/19

More Info

Pelvic and lower back pain can be a complex issue, especially when it persists for several months and does not respond to conventional treatments. Based on your description, it seems that you have already undergone a thorough evaluation by multiple healthcare professionals, including orthopedic specialists and rehabilitation experts. The fact that you have had X-rays that showed no significant abnormalities is reassuring, as it suggests that there are no major structural issues such as fractures or tumors.

Understanding the Pain
1. Muscle Strain or Sprain: Given that your pain is triggered by bending or exerting yourself, it is possible that you are experiencing a muscle strain or sprain. This can occur due to overuse, improper lifting techniques, or even prolonged periods of sitting, which can lead to muscle fatigue and discomfort.

2. Postural Issues: As a student who spends a lot of time sitting, you may be developing postural problems that contribute to your discomfort. Poor posture can lead to muscle imbalances and strain on the lower back and pelvic region.
3. Core Muscle Weakness: Despite your ability to perform a good number of sit-ups, core strength is not solely about the number of repetitions you can do. It involves the coordination and strength of various muscle groups, including the deep stabilizing muscles of the abdomen and back. Weakness in these muscles can lead to instability and pain.

4. Nerve Compression: While less likely given your X-ray results, nerve compression can also cause pain that radiates from the lower back to the pelvis. This is often associated with conditions like herniated discs or spinal stenosis, which typically require more advanced imaging (like MRI) to diagnose.

Recommendations for Relief
1. Physical Therapy: Since you have already tried some forms of rehabilitation, consider a more tailored physical therapy program. A physical therapist can assess your specific movement patterns and develop a personalized exercise regimen that focuses on strengthening your core, improving flexibility, and correcting any postural issues.

2. Ergonomic Adjustments: Evaluate your study environment. Ensure that your chair and desk are ergonomically designed to support good posture. Use a chair that provides lumbar support, and consider standing or using a balance ball for part of your study time to engage your core muscles.

3. Regular Movement: Incorporate regular breaks into your study routine. Stand up, stretch, and walk around every 30-60 minutes to prevent stiffness and promote blood circulation.

4. Strengthening Exercises: In addition to sit-ups, include exercises that target the entire core, such as planks, bridges, and pelvic tilts. These exercises can help stabilize your pelvis and lower back.

5. Mindfulness and Relaxation Techniques: Stress can exacerbate muscle tension. Techniques such as yoga, meditation, or deep breathing can help reduce stress and promote relaxation, which may alleviate some of your pain.

Regarding Your Concerns About Cancer
Your doctor’s reassurance that your symptoms are not indicative of cancer is important. Generally, cancer-related pain tends to be persistent and progressively worsening, often accompanied by other symptoms such as weight loss, fatigue, or changes in appetite. The absence of night pain and the intermittent nature of your symptoms further suggest that it is unlikely to be cancer-related.

Conclusion
In summary, while your pain may stem from muscle strain, postural issues, or core weakness, it is essential to continue seeking appropriate care. A tailored physical therapy program, ergonomic adjustments, and regular movement can significantly improve your condition. If your pain persists despite these interventions, further evaluation, including advanced imaging, may be warranted to rule out any underlying issues. Always communicate openly with your healthcare providers about your symptoms and concerns to ensure you receive the best possible care.

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