Hip pain

[rebeccaqaz]

I'd really appreciate any advice that anyone can offer. I'm a 23 year old female with pain in my left hip. I've always been very sporty throughout school playing tennis and badminton and then started rowing when I began university. I snapped my left acl and had a hamstring graft when I was 18. Admittedly I didn't really rehab the knee properly but I'm back to all sports with no problems.

In the past two years, I have encountered on/off pain in the left hip. Its almost as if the pain is caused by a flare up. The pain is most noticeable after training especially if we are doing heavy weights (squats). After really challenging squats there is pain just left of the dimple in my back and the feeling that the leg would not support the my weight. Also when rowing in the boat, after say 20mins there will be pain in my lower back. I can relieve the pain by tilting my hips backwards and there will be a cluck and the pain will go. I don't know if the two problems are related.

thanks anyone who could give me some information about what it could be.

Rebecca

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[Dr Damien]

sounds like a sacroiliac joint problem...

describe the quality of the pain in your hip and the pain in ur back each...e.g dull, unspecific,or sharp, specific, can you place ur finger on the spot where the pain is in ur hip and your back?
does the pain in ur hip happen at the same time with the pain in your back?

My theory is...you probably have a sacroiliac joint that is more predisposed into an anterior pelivc tilt (perhaps owing to a surgery that has left your hamstings weak, making the thigh muscles-rectus femoris more dominant, during a squat you need controlled concentric and eccentric contol of hamstring and quads, this balance seem affected hence your knee not able to support you weight). each time you do a heavy squat that anterior pelvic tilt is emphasized and strains, the posterior ligament of the SIJ. If the answer to the above questions are that the pain feels unspecific in ur hip and your back and that the hip and back pain occur together or that the pain on the side of the dimple of your back happens at the same time with those other patterns of pain, then this may mean a referral pain in the hip and back...

this would explain why rolling your hip backward (taking it into posterior pelivic tilt) relieves it...with rowing (depending on what angle you are sitting) the might be small alternations between anterior and posterior pelvic tilts putting some strain on these ligaments...overuse for lack of a better term...

The other theory still relates to the predisposition of a pelvic tilt anteriorly with compression of your hip flexions as they compress and elongate during flexion and extension of squatting.

Either way...you need to see a physio wherein the following can be assessed

Your lumbar spine (to rule out this as a cause)
To examine your hip to see if this is due to a joint pathology (unlikely due to your age)
your sacroiliac joint to see how the lumbopelvic biomechanics work in comparison to the other side and to see if any provocation tests/palpation will reproduce this pain you have
the length/tension discrepancy between your hamstrings and your quads..also your back and belly muscles
your general posture to see where this alignments fit in with the theory

I dont know if I have been of help or made things too complicated...but thats the hypothesis I would work on based on what you've posted


cheers

[rebeccaqaz]

Thanks very much for the information.

In response to the questions you asked, the pain in the hip is dull and unspecific but primarily across the back of my hip with sometimes pain going down the leg into the hamstring. The pain in my back is more specific over the dimple and tends to be aggrevated when doing activity whilst the hip pain is there throughout the day. Yesterday when sitting in lectures, i had shooting pain in the leg for about a couple of minutes.

Do you suggest that I stop training or is there certain exercises that I should be avoiding.

Thanks for the advice

[Dr Damien]

My suggestion is you need to be fully assessed, doing activities that are aggravating this should be a no no for now until you've got a better assessment from a physio...
you need your back, SIJ and hip examined, ur description suggests it could one of the following:
1) disc problem L5/S1 or facet joint issue
2) tight/swollen piriformis pushing on the sacral nerve
3) Sacroiliac joint problem

having pain lasting the whole day is not a good sign and should be addressed. Do that quickly and reduce the risk of further hurting urself further...

[physiofixme]

Excellent advice already given. Get a definite diagnosis from a physio and work towards a rehab programme to help resolve your problem and allow you to continue with your sport

Rachael Burke
Rehabilitate prevent perform physiofixme