Once I heard that the pain heightened when sitting and rising, I suspected the underlying cause was a lumbar disc herniation instead of an SI Joint dysfunction or pyriformis syndrome, as those conditions are generally worse with walking activities. Since it was May and the patient was headed home for the summer, I sent her for an MRI scan of her lumbar spine, which confirmed the L5-S1 Focal Disc Herniation (FDH). The disc was pressing directly on her left S1 nerve root, explaining the left lower extremity symptoms down to her heel and bottom of her foot.
Since she did not have a directional preference exercise that could centralize her pain, I offered her an S1 transforaminal epidural steroid injection (TFESI) under fluoroscopic guidance with contrast enhancement. This provided her 80% relief of the left leg symptoms and she responded to extension in standing and prone press-ups. She continued these exercises every two hours per day for 10 repetitions. Fortunately, a Buffalo-based PT group had an office in Syracuse near where she lived. I saw her at four week intervals in June and July, and we advanced her from bridges and planks to more stability and motor control exercises to eventually soccer-specific skills.