Recurring hip/pelvis/hip flexor issues for over 1 year

[Portable Mink]

Hi there!

i am hoping for some direction or help with a chronic problem I've had for over a year now. I'm not very rich so I'd like to get some idea of the best course of action with reference to getting help for my issue before I go spend hundreds of dollars.

about 4 years ago I broke my right foot but didn't realise it was broken for a year. I got a lisfranc fracture that wasn't diagnosed properly. I think I began to change the way I walk slightly putting less pressure on my big toe as I walked with my right foot, as when I walked with full pressure on my big toe, I could feel the bone separating in my foot. Not very nice.

to this day I have not had this fixed as the specialist I saw said orthotics would help and they seem to for the most part. It is hard to tell if I walk completely normal again although I think I still slightly walk on the outside of my foot.

Fast forward to last year and I have began ice skating a lot as I wish to learn to play hockey. I once skated 8 days in a row and ended up feeling like I'd hurt my groin. I let it heal for a couple of weeks but it never completely got better, or if it did, he recurred not long after. I also fractured my L2, L3 in my spine snowboarding in July last year but it was apparently on the wing and not too bad.

My pain occurs in my hip almost all the way around. I feel it sometimes down the front of my quad, in the groin, high hamstring, in the buttock and when sitting down for longish periods, It seems to migrate to my lower back. If I sit on the toilet for 5-10 minutes, when I go to stand up, it's actually hard and a bit painful to do so.

because of this pain and the fact that it often got worse between shifts when I played hockey(having to stand on the bench instead of sitting), I decided to join the gym and try to strengthen up my core. I thought it was working a bit but then the same kind of pains would continue to linger. I continually find myself poking myself in the hip and all around the base of my right leg trying to massage it almost.

at the gym I do weighted squats, dead lift, bench press and a bunch of other exercises, as well as jogging on the treadmill. Up until today I had never really felt my pain during gym work and if I had, it was no more than normal moving slight discomfort from every day life.

today however, I did my deadlift and a few other exercises and then tried to do my squats and immediately the pain shot through all the regular areas, but I could no longer do my squats. I have since been limping a bit and have pain in the very lower back on the right ride, groin, hip, pelvis etc.

i have seen a chiro a lot in the past and she has done all she can for me, I just want to know I keep getting this recurring issue. My chiro said to me once that my pelvis could be slightly turned open on the right.

Please help!
what kind of person should I see?
any suggestions? Osteitis Pubis?
treatment ididea sbc really great if I could get some thoughts from you miracle workers.

cheers,
Ben.

- - - Updated - - -

I also feel doing a really open hip stretch with knee bent gives a bit of relief. Stretching out my hip in a few ways feels like a relief even though it makes me feel it stretching.

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[physiobob]

HI Ben, thanks for your interesting post. It would be good if you add the body chart to your history as that helps us visualize more where your issues are felt.

A few questions:

1. How did you suffer the foot trauma?
2. How was the L2/L3 fracture diagnosed and what treatment did you have for that. Did you have follow-up x-rays or an MRI to check all was healed?

By the sounds of it you might have a pelvic imbalance, perhaps historic, or at least since the foot trauma. The ice skating probably just highlighted this issue rather than resulted in an injury per se. Fast forward to the snowboard accident which could have upset the pelvic alignment as well as possible implications for the restriction free movement of the nerve roots at the same levels. Note that L2/L3 supply innervation and sensation to the upper thigh area with L1 a little more around the anterior groin region. You could also feel weak in the right hip flexors and knee extensors (quads) with altered neural flow to those same areas.

The deadlift of course uses the hips and lumbar spine together as they act across the pelvis. Thus an issue here could be from one or the other or both as a result of piriformis issues. It could also just be a lumbar instability and or disc issue that is exacerbated with the dead-lift rendering the squat weak. You would really need to have someone with a good knowledge of dead-lifting and squatting to take a look at you performing the exercises and then assessing the results and alignment at that time.

I would recommend a sports physio with a special interest in lifting training. There should be plenty but a good place to start is at a sport academy near where you live. Another useful option would be to look for an assessment from someone with an interest in pelvis instability and muscle energy techniques (nordic therapy). Most good Aussie physios have interests in both those. The really need to be able to provoke the symptoms and assess at that time so a center that has access to a gym set up where you can perform the troublesome activity whilst being supervised/assessed would be ideal.

I think Osteitis Pubis is very unlikely as this is more a sprinter or hurdler issue and not one for people whose legs are keep a little closer together as in ice skating.

My gut feeling is that as sitting affects you (and the probing around looking for the focal spot to massage) it might well be that the low back is involved here, perhaps with its relationship to the pelvic musculature (piriformis).

I hope this helps you to seek out the relevant clinic for further assessment as this one is a very difficult one to give more concrete commentary on via a forum.

Let us know how you get on and the results. :-)

[Portable Mink]

Thanks heaps for your response!
1) playing footy I kicked the ball then went to ground from a tackle. My knee was on the ground and I was in a kneeling position with my foot stretched out straight so there was no gap from knee to toes on the ground. Then someone fell across my heel, effectively hyperextending my foot in a pointed down fashion.

2) my L2,L3 I had X-rays at hospital a few hours after injuring myself and let it heal, seeing my chiro a few times who obviously didn't touch my spine, rather she just watched over the muscles around the area as they settled down and then I had further X-rays a month or so later and she said it was ok.

Just to follow up, I was able to deadlift 90kg x6 reps and 2 sets tonight with zero pain. And that is normal that I feel no pain. Normally I can do the squats as well 50kg x8 x3 sets and whilst I do notice a slight tendency when I get near the bottom of the squat for my right hip to slightly turn outwards, normally there is no pain. I feel most of my pain in my general life rather than in my exercise, however today when I tried to squat 20 minutes after I did deadlift with no problem, the hip/pelvis issues flared up as to stop me in my tracks.

thanks again

[physiobob]

Thanks for the additional info. I think though that the squat movement might show a therapist your weak area in the lower position. This all still leads me to think of the pelvis and perhaps the effect it is having on the lumbar spine, even with an unstable disc as a possibility. The chicken or egg as to what is driving what can be hard to work out but a good therapist will assess and address both areas.

[kwunfu]

Exactly what Physiobob said. Your body tends to remember injuries and if you were walking awkwardly for a period of time from the initial foot fracture that can lead to muscle deconditioning on the side particularly if there was no rehabilitation or strengthening. So on occasion these muscle weaknesses may stay around and play havoc when you go back into fairly intense training ie skating 8 days in a row. This is the same with the lower back injury there may be residual muscle and biomechanic issues that have led to some loading on your lower back and thus inflammation of the nerves which can cause referral of pain. Nothing that can not be fixed with some rest and a physio that applies some hands on technique to address to muscle and joint issues as well as exercise rehabilitation. Physio bob is right, hard to say what is causing what but definitely rest from weights but keep moving i.e. walking or swimming as well as stretching (which I am sure you do? ) and see a good physio.