Hip pain in dancer

[Quickstart]

Hi. I am looking for some help problem solving with a patient who is a 55 year old ex-professional ballet dancer with hip pain. Her pain is intermittant and has had gradual onset over the last few years, recently increasing in frequency and intensity. She sometimes notices an ache in her hip which can progress to a sharp pain at the post aspect of the hip with prolonged walking (>2hrs and with up/down grade). The only specific motion that can reproduce the pain (which is sharp, post hip, but difficult to palpate) is "frog pose"...laying supine with the soles of the feet touching and hips in ER, ABD, and FLex. However, standard FABER position with the ipsilateral foot resting on the contralateral thigh is pain free with full ROM and tolerates over pressure. Her x-ray is clear, no sign of arthritis. No MRI has been done. IT band is very tight, but other hip ROM is good. Knee ROM is full. Pelvic alignment appears normal. She has a gait deviation on the ipsilateral side of externally rotating after midstance--as she moves through stance phase and her heel lifts it twists inward.

Any ideas?

I must admit I need to clarify exactly where she is feeling the pain. From the sounds of things, it sounds less a 'true hip/groin' pain and more a gluteal/lateral thigh/SIJ/Lumbar spine pattern. Is this correct?

Have you cleared any lumbar/sacral pathology? In particular I would be looking at her SIJ, as her gait pattern seems to indicate some form of dysfunction or block. I'd be trying some SIJ OP's in that 'frog position' to see if it made a difference to her pain levels or her biomechanics.

The only other thing that I was thinking of that could be another cause was a posterior labral tear. But then it depends where exactly she is feeling the pain.

Interested to hear more about this.

Cheers,
Quickstart.