Hi there,
I 've had a patient today who's presentation was a bit tricky and I could do with some guidance.
She is in her 50's and has a 1 year history of anterior thigh pain (initially on right side, now on left).
The pain moves down the front of her thigh, onto her knee (generally, no specific point on the knee).
Her pain then moves into her calves and she reports decreased sensation in her left foot.
Nil pain with all lumbar movements or on palpation, no history of back pain.
Core: weak
Hips: reduced range of movement and positive quadrant test antero-medial aspect of the hip.
Antagic gait.
Increased Lumbar Lordosis.
Anteriorly tilted pelvis
Hip flexors tight ++++
Some calf cramps at night.
neural integrity tests all normal bar dorsiflexion strength reduced on left side.
onset: insidious, started not so bad, increasing
aggs: crossing legs, walking, running (unable)
eases, sitting down
daily pattern: nil pain or stiffness on waking up, pain gets worse through the day with activity.

I guess I was thinking it was hips and going to focus on that, I've already given her some core stuff to do.
I'm just not sure if I'm ignoring half her symptoms because I really don't know what's going on with her calf and leg.

My plan was to see if some manual work releasing her hip flexors eased her pain. To work more on the core and to strengthen/stretch any muscle imbalances around the pelvis. She may have torn her labrum, I'm hoping more that she is simply irritating it with poor biomechanics around the hip/pelvis.

Any advice would be much appreciated!!


ps: Don't know if this is applicable, but she spoke of a recent hysterectomy 2012/3 where she underwent an extended period (many months) of bed-rest, no other significant past medical history.

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