Hip pain

[guy909uk]

Hi,
I am looking for some advice. I am 22 yr old male, and have been suffering with hip/groin pain for the past 12-18 months.
The pain started just over a year ago. I began to notice it at the front of my hip when running. I went to orthopaedic consultant who noted limited internal rotation. This is the most painful movement. I had some physio, stretching excercises. I also had an mri looking for a labral tear which was came back clear.
Since then I have got on with my training (rugby player and keen cyclist). The hip has not resolved and aches after training. The limited rom is still present (esp. int. rotation). When I play rugby the hip feels "stiff", especially at extension.
Previously I had a knee operation 6 months prior to the start of this pain. Lateral collateral and bicept femoris reattachment following a rugby injury, and wonder whether this is related? I do have poor flexibility, and am trying to work on this. I was wondering if anyone has experience of a similar thing, or can suggest a way of attacking this one. It is the lack of int rotation that worries me, as this is painful and restrictive. I would appreciate any advice,
Cheers
Guy909uk

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[wutti]

hi, could you please answer a few more questions:
1. how about the strength and flexibility of your adductors and gluts?
2. can you put a finger on the pain area, please descibe exactly were it is.
3. are you performing lots of crunches and other abdom. muscle exercise.
4. when does the pain comes up during exercise?
will try to help, but this a real complex area and problem which needs a lot of info.
cheers

[alophysio]

Hi,

In addition to the questions above, are you able to post a picture from behind and from the side with you in briefs or swimmers please (tight fitting) - need to see hips and pelvis etc.

I am willing to bet there is overactivity in the piriformis and probably Active extension pattern as a motor control strategy in there as well.

Thanks

[wutti]

hi, that sounds most likely. maybe tendinopathy of the adductor lungus. also wanted to ask for sportsmen hernia.
but your right, limited int.rot. and stiff hip screams for piriformis probs.

cheers

[Orihc]

hi guy from uk
Firstly, pls no photos of you half naked! ( esp with tight swimmers on )
If the hipis restricted with internal rotation, then the hip external rotators will be over-active, therefore they will need to be released.
A few things can cause the external rotators to over activate, the main caue is usually the foot. out of curiosity do you have a supinated foot type? My suggestion would be to hed on to a pod ( be very careful on which on you go too) and get some orthotics.
commonly a supinated foot type or a forefoot varus could cause the external rotators to over activate.
Good luck!
C

[alophysio]

We are physios - need to see the area to help. Otherwise we are guessing.

It is up to you guy909uk. it i what we would do in the clinic. You won't show us your face. Annonymity is assured...

Out of interest orihc, do you assess your patients down to this level? I understand that there may be cultural differences. If so, how do you get to see what you need to without overstepping the mark? As far as people from very conservative cultures have dealt with it when seeing me is that consider me a doctor or specialist in this area (pelvis/hip/SIJ) and just do what needs to be done...

This is not a criticism but a question on how do you expose the areas required?

[Orihc]

Alophysio,
can see your point. I don't de-robe any patients, unless they have very tight fitting clothes, in which case i get them to bring bike paints or shorts.
Im mainly concerned with ROM/ orthopedic/ neuro testing and functional testing procedures and do all my mucle release work through clothes
I don't see how it would help in this case!
C

[alophysio]

Hi

Thanks for replying. Photos can tell a lot about static posture. We don't have the benefit of seeing the patient nor palpating structures. Therefore, photos can tell us a lot of things.

In this case, overactive muscles in the hips would show up in relaxed standing. There shouldn't be any overactivity - i didn't really want to mention this to avoid bias from Guy909uk but i think he won't be posting any photos. Also, you would be able to see his posture rather than take his word for it - no matter how good you are, you can't get out of your own body and see it unless you have a camera/video to assist - not even mirrors are good enough because you have to move your head to see things.

From which country are you from orihc? I too do some work through clothes (saves time) but some things just need skin to skin contact - appropriate draping etc.

Thanks

[ROMinclinometer]

Cycling, while it's a great sport and one of my favorite activities, can lead to hip and low back pain associated to the shortened hip flexors common with the cycling position.

The hip flexors may become very strong but all the motion and training is in flexion.

[roycar]

work on getting internal rotation back whatever that takes. mobilisation, soft tissue release etc. then look at hip position. poor activity/overactivity in glutes/tfl. if there is decreased rom into internal rotation in a neutral hip position and in 90 of hip flexion i wouldnt personally be focusing my attention on piriformis, but we dont have that info so...

a photo of posture etc would be nice. exact area of symptoms would also be nice. but then it would be nice to be able to do a biomechanical assessment and a spinal exam too!