Restricted external hip rotation & groin pain?

Hi everyone,
I need some help with a case study if anyone can help. The patient in question has her main symptom of restricted external rotation and abduction of the right hip. This was noticed after stretching following a run. She runs intermittently but not consistently and had recently done a few runs close together. She reports it feeling trapped and o/e she is very tight and limited in her movement. There isn't much pain but a few days after she noticed a sharp groin pain but this is only on certain movements (mainly taking into abduction or external rotation). Muscle power is full & functional but she does have some obvious glutes weakness bilaterally.

There was nothing to find in her lower back. I'm a little stumped as to what would cause a sudden restricted in external rotation like that. Any ideas? What tests should I do?

Many thanks in advance
Colin (physio student)

Lot of things to look at: Look at pelvic obliquity/alignment ,the femoral version and knee alignment, the hip ER ( piriformis ), the groin pain would also make me want to look at the possibility of labral impingement. What would happen if you applied femur long axis distraction then move the hip around.....If she never had this pain before running look at her running mechanics

In the real world I would start with the alignment of pelvis hip, and knee. If you correct it and the problem goes away work on muscle balance and still check running mechanics. Often what you see is the result of, not the cause of the problem. I always check labral issues for internal impingemet also.

The other thing I that always worry about with these Sx' is hip pathology which may necessitate radiographs to rule out AVN etc

Let me know how it turns out

Maybe the problem lies with her running techniques. Have you enquired whether she is performing some other physical activities besides running?

Hi Colin,
Had something similar to this myself and like you, zoned on on what appeared to be the most obvious symptom, this limitation on External rotation. Try to take a step back and look at the bigger picture, for example does the patient have "Lower Cross Symptom", You spotted the weak Glutes really well, but does she also have a weak Core and over-active hip flexors, if so try doing some "Illiopsoas Release" BUT DON'T GIVE OUT THE ILLIOPSOAS STRETCH, Trust me it will only lead to disaster!!
I too would look at her gait/run (on a threadmill if possible) so you will be able to spot a restriction if there is one. Are her QL's taking over from another muscle?..., I would take full advantage of the fact that she appears to be pretty low irritability and look closely at some of these things.
Just try not to focus too much on the lack of external rotation, as it may only be part of the picture!

Do let us know if any of this helps"!
Kind Regards,
Sarah