MVA Client - Pain in Inginal Line

[PhilMax]

Hi first of all I am a Kinesiologist and am not looking to diagnose this client. She is a 21 year old girl, who was in a rear end MVA approx one year ago. Originally with back pain in the lumbar region, she has seen physicians, physios and chiropractors none of whom have given her or me a solid diagnosis. She experieces pain in the inguinal region. She notices the pain particularly when driving and lifting her leg from brake to gas. There is also discomfort during hip flexor stretchs (extension). She has a very low tolerance for certain exercise (ie) lungeing and appears to be severally deconditioned (weak) on her problem side (right). I've read about iliopsoas syndrome, and have cautiously incorporated foam rolling and rehab exercise as such. There has been no improvment after 4 weeks. I know this isnt a long time but i thought i'd get some feed back on my approach. Are there questions i should be asking that I have not? How about assessments? Anything and everything helps. Thanks

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[Dr Damien]

dear Philmax

i know you say you are not looking that diaagnose the problem however it doesnt sound like there can be any help without some diagnosis. so maybe you do need to have a diagnose to be able to give the best possible exercise program that helps...

the assessment will definitely need to be extensive looking at the lumbar spine, sacroiliac joint, hips...muscle length relationships, movement aggravators and easors, general posture etc...
its impossible to give you any real advice based on the limited information you have given...

if lifting her leg from brake to gas causes the pain she gets in the groinal area... the problem could be the muscle, the hip joint, the SIJ or even the back...as the movement requires some involvement of these anatomic sites...we talking hip flexion combined with abduction...
hip flexor causes some discomfort in the groin again...that sign is not specific as this could involve the hip, the pelvis, the muscle, the associated bursae ...

what you need is a systemic approach to assessing this client based on what you know that aggravates it...

for instance...hip flexion done by self and hip flexor stretch aggravate the problem so you think it might be the hip flexor muscle right?
then test your hypothesis...ask yourself what happens if i carry out the movement without getting any hip flexor activity or as minimal as possible...will that pain be there...
so passively flex the hip...any pain, if no pain...ask the client to do this actively...if the pain is there then maybe it is the muscle...ok, then resist the movement...pain worse? most likely the musscle then...you may want to resist at several angles...

assessments usually involve the mind thinking and ticking along as u unfold more information

you can ask the client to join this site and post her problems ... if this is of any help