19 yrs old, 6 years of hip problems.

[Eleanor]

Sorry for the long post, but I thought I should explain everything.

When I was 13 I got up suddenly one morning and my right Hip clicked (painfully). I was taken to hospital where I was x-rayed but was then told I just had growing pains and the click was normal.

A year later I was getting regular pains in both of my hips, went to the Doctor who told me it was growing pains.

Turned 16 and demanded that something get done about the pain, as it was getting worse and flaring up approximately once a week. I was x-rayed again but no problems showed up on them.

I was x-rayed again at 17 because the pain was frequent enough for me not to be able to walk/stand long for long periods of time. I was also having a burning pain that would shoot accross my pelvis whenever I sat down.

At 18 my Doctor finally sent me to a wonderful physio, who showed me some basic strengthening excersises, but these exercises would often leave me with a tremendous pain in both my hips. She sent me on to an Orthopaedic who said I should continue with excersises and if I continue to have flair ups, steroid injections or surgery. Turns out my muscles are too short/stiff/generally non stretchy at the front of my hips and around the inside of my thigh and front of my thigh (something that the physio described as a silverside layer of skin?) and right roud my buttock (where I also got burning pain).

I am now 19. I don't want steroids, I want to know what this is. The pain is now every single day and it isn't just in my hips. It travels down both of my legs and into my ankles on the worst days, aching in all of my joints and muscles. Usually, both hips DO NOT hurt at the same time. The right side is definately worse. Bad flair ups are approximately once a fortnight and leave me in bed for up to 2 days. I take Ibuprofen 400 (prescribed), but these no longer get rid of the pain.

Please, if anyone has any idea why I get this and what this is, I would really appreciate knowing what else (appart from steroids/surgery) would help. It is even effecting my relationship and work.

Kindest regards
Eleanor

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[Eleanor]

Oh, I should also mention that I am hypermobile... ? The physio noticed when I stood and my knees push back. My mother is hypermobile also (and 6" tall), but has no problems other than clicky knees whenever she bends down. My knees also click quite frequently.

[Canuck Physio]

Sorry for the long post, but I thought I should explain everything.

When I was 13 I got up suddenly one morning and my right Hip clicked (painfully). I was taken to hospital where I was x-rayed but was then told I just had growing pains and the click was normal.

A year later I was getting regular pains in both of my hips, went to the Doctor who told me it was growing pains.

Turned 16 and demanded that something get done about the pain, as it was getting worse and flaring up approximately once a week. I was x-rayed again but no problems showed up on them.

I was x-rayed again at 17 because the pain was frequent enough for me not to be able to walk/stand long for long periods of time. I was also having a burning pain that would shoot accross my pelvis whenever I sat down.

At 18 my Doctor finally sent me to a wonderful physio, who showed me some basic strengthening excersises, but these exercises would often leave me with a tremendous pain in both my hips. She sent me on to an Orthopaedic who said I should continue with excersises and if I continue to have flair ups, steroid injections or surgery. Turns out my muscles are too short/stiff/generally non stretchy at the front of my hips and around the inside of my thigh and front of my thigh (something that the physio described as a silverside layer of skin?) and right roud my buttock (where I also got burning pain).

I am now 19. I don't want steroids, I want to know what this is. The pain is now every single day and it isn't just in my hips. It travels down both of my legs and into my ankles on the worst days, aching in all of my joints and muscles. Usually, both hips DO NOT hurt at the same time. The right side is definately worse. Bad flair ups are approximately once a fortnight and leave me in bed for up to 2 days. I take Ibuprofen 400 (prescribed), but these no longer get rid of the pain.

Please, if anyone has any idea why I get this and what this is, I would really appreciate knowing what else (appart from steroids/surgery) would help. It is even effecting my relationship and work.

Kindest regards
Eleanor

Hello, sorry to hear about your lack of help.

Firstly, the Truth is it is very difficult to analyze muscle dysfunction. Quite simply, all the endocrinological, neurophysiological, and neuromusculoskeletal studies in the world still can't tell us for sure exactly what it is that goes on in muscle, fascia, tendons that results in our problems.

The reality is it is likely a combination of factors, including muscle imbalances, biomechanical mal-adaptations, genetics-nutrient/environment interactions (by this I mean although we have genetic variability, our genes are still influenced by the foods we eat, sunlight producing vitamin D, the air we breath, the other electromagnetic, and physical energies that influence us), and our health-fitness status.

If you have hypermobility Truely, then you may require more intense muscular balance, strengthening, lengthening than the average person. You may be susceptible to poor posture more easily and dramatically, and you may as a female be experiencing and be more prone to experiencing pain in the joints or soft tissues due to hormonal fluctuations that influence pain perceptions.

I recommend you find a very enthusiastic physiotherapist to help solve your problem.

[Eleanor]

Thank you for replying to me.

I didnt realise that so many different factors could play a part in muscles... The physio did recommend Pilates 3 times a week, saying that it lengthens and strengthens the core muscles. I just cant find the time/money for a gym membership

Thanks anyway. Will look into physio

[Quickstart]

It is unfortunate to hear that you have been putting up with this for so long. It is obviously very hard to try to make a diagnosis without being able to actually examine you, but can I ask a few questions to get a bit more detailed information from you?

a.) When you say 'hip' where exactly do you mean? In you groin, on the outside of the hip, more to the back near the buttock?

b.) When you were thirteen and your hip clicked for the first time, how severe was the pain? How long did it take to settle down? Did you have any weakness associated with the pain?

c.) Is the pain with you all the time? Are there any activities that make it worse apart from prolonged standing/sitting? Which part of the pelvis would the pain shoot across? When you say you get aching down the legs, exactly where does the pain travel? Is it a generalised ache all over, or more to the back of the legs/side/front? Do you get any tingling/numbness in the legs at all?

d.) Did your physiotherapist look at your spine at all? Did they doublecheck that there isn't a lumbar spine involvement in your pain?

e.) Which exercises (basic strengthening) were you give to do? Which flared you up the most? Do you still do them?

As far as pilates is concerned, it is a great idea to help strengthen up your core, particularly if you have hypermobile joints -- as your limbs require a nice stable core if your muscles want to work effectively. As a physiotherapist, and as someone who also has gross generalised hypermobility, I would advocate it strongly -- regardless of your hip problem. If your physiotherapist is trained in clinical pilates, then they should be able to set you up with a simple mat-based pilates programme that you can complete at home. All you really need is a yoga mat and yourself.

[Eleanor]

a.) When you say 'hip' where exactly do you mean? In you groin, on the outside of the hip, more to the back near the buttock?

Exactly on the front as you look at me standing up. The area that dips in a little, I don't know how to explain it, it forms the nook then I sit down, right on the fold. The pain is also very very prominant in my buttock area, and the physio mentioned that there were knots in this area. This is also the area where I get burning pain.

b.) When you were thirteen and your hip clicked for the first time, how severe was the pain? How long did it take to settle down? Did you have any weakness associated with the pain?

Severe enough for me to be taken to hospital, although it didn't last for any more than 5-10 minutes. I couldn't put my full weight on that leg for the rest of the day.

c.) Is the pain with you all the time? Are there any activities that make it worse apart from prolonged standing/sitting? Which part of the pelvis would the pain shoot across? When you say you get aching down the legs, exactly where does the pain travel? Is it a generalised ache all over, or more to the back of the legs/side/front? Do you get any tingling/numbness in the legs at all?

The pain is with me, in varying degrees, all day every day now. Activities that make it worse are walking or lots of bending/lifting. I sew for a living so often rock on the chair, which also encourages the pain, especially in my right leg.

The pain shoots accross the front of my pelvis, from left to right. It's a hot, burning/stabbing pain.

The pain travels down the back and outer side of my legs and aches at every joint it meets, it mostly reaches my knees, then my calves but rarely travels right down to my ankle. I get numbness/pins and needles in my toes/feet.

d.) Did your physiotherapist look at your spine at all? Did they doublecheck that there isn't a lumbar spine involvement in your pain?

She did look at the base and top of my spine where she found no problems.

e.) Which exercises (basic strengthening) were you give to do? Which flared you up the most? Do you still do them?

We started off with an excersise where I lie on my back and swing one leg out gently at a 45 degree angle, I had to do this with my buttock muscles though, really using them to pull my leg around. Also an excersise where I lift my pelvis up slightly using same muscles. The other excersises I was asked to do regularly was to lie on my front and kick my legs as if I was swimming, and dips on one leg with weights.

Sorry I don't have names for these, I was just told what to do.

Thank you so much for taking an interest, I'd love to hear your thoughts.

[Quickstart]

I will preface this post with the following disclaimer: This is only an educated guess based solely on your reported symptoms, and is no way a definitive diagnosis.

With that out of the way, it sounds like you may have Janda's distal crossed syndrome. I will try to explain this as best I can.

Hypermobility is a significant factor for the development of musculoskeletal injury and postural dysfunction. When joints move more than they should it puts exaggerated stresses on other joints, ligaments, muscles and tendons when they try to hold 'normal' alignment'. The picture below highlights posture commonly found in hypermobile individuals.



You might be able to see that there is an increased arch in the small of the back with the hip bones jutting forward. Essentially what you are doing is not using the muscles around your pelvis and lower back to keep you in alignment. You are hanging off the ligaments of your lower back, hips and knees to keep you upright. While this is an effective way of keeping you upright, it will cause problems to the strength and length of your muscles. Because your pelvis is tilted forwards, the muscles that run across the front, and where you are getting your pain (Iliacus and Psoas) get tight. See below for these muscles.



You also get tight across the muscles in the small of the back, and weak in the abdominals and gluteals (because you are not using them to stand/sit properly). This posture also puts stress on the joints and ligaments of the spine, which may explain your numbness/tingling in the feet. The tightness in your Iliopsoas (Iliacus + Psoas) is most likely causing the majority of your symptoms, but the other factors can contribute too.

You need to start a stretching programme for your tight muscles, strengthening for your weak muscles (ie pilates and gluteal exercises) and postural correction (which could include taping, exercise or bracing). Your physio could also try some manual techniques to aid you to help you lengthen these muscles and guide you through a progressive core-stability program.

If none of these treatment options work then another option could be getting more comprehensive diagnostic imaging, like an MRI or ultrasound, done to clear any other abnormalities. But, again, without a comprehensive assessment this is merely postulating.

[Eleanor]

I cant thank you enough. Even if that isn't what I have at least I know a little more about my body. I do jut my hips forwards when I stand and my knees are always pushed back. I never knew bad posture could end up so badly :s

I will definately start some sort of excersise regime and slowly build up my strength.

Thank you so much for the images too. The physio did mention the muscles but couldn't explain them as thoroughly as the images and I could never remember their names.

So, excersise is the way forward. Thank you for clearing this up for me.

(once again, I understand this is just speculative, but it does seem to make a lot of sense to me)

Oh, and are the clicky hips part of this, or or do they click because of something else?

[Quickstart]

The hip clicking can technically be explained by this particular problem. When that muscle gets tight, the tendon is more prone to flicking quickly over one of the bony bits at the front of the pelvis. This frequently causes pain and can cause a sensation of something moving in the front of the hip.

There are other causes of the clicking hip of course.

One is the iliotibial band (ITB) that causes snapping on the outside of the hip. The last is that there is something disrupting the internal mechanics of the hip -- like a piece of bone, cartilage or something else. If the exercise programme does not work, then I would advocate a CT/MRI to just clear something like that.

Hope you find some relief from this.

Cheers,
Quickstart

[alophysio]

HI,

I would agree with the other two physios who posted excellent answers above.

My thoughts when thinking about the problem as i was reading was that you have a combination of overactivity and underactivity with postural changes leading to lots of compression on your hips.

Janda was mentioned above. Shirley Sarhmann would be another. Peter O'Sullivan would be yet another physio who have clinical models that deal with these issues.

If it is any help for you, i see lots of these types of "growing pains" in my clinic...exercises and stretches are definitely the way forwards.

Good luck