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1365 Views 4 Replies Latest reply: Nov 30, 2011 3:48 PM by jtibbscu
jtibbscu Amateur 22 posts since
Jan 23, 2006
Currently Being Moderated

Nov 17, 2011 1:43 PM

Hip pain

I've done some reading on this topic and I was hoping for some of y'alls thoughts.  I've been experiencing pretty heavy hip pain, stemming from the area right over the head of my femur.

 

If I place my hand with light pressure on my hip, and raise my leg, I can feel a noticable pop.  It seems to come from tissue over the hip joint.  It began probably 3 weeks before ny and curtailed my final preparations.  It seems to be an issue with the fascia, and occassionally on runs above 10 miles (as in the marathon) begins to manifest like itbs if I understand that correctly (although it seems to be centering on the hip not the knee).  On these longer runs,  I have felt pain from my hip down along the left side of my knee to the top of my calf.  So it seems like the fascia is irritated because it is rubbing (at the hip). 

 

Could this be the manifestation of a stability problem?  I've been nursing (not always apparent and of varying degrees) lower abdominal pain on the opposite side of my body for about a year now.  I am starting to think it could be a problem of pelvic stability due to abdominal issues.  Thoughts?   Thank you in advance.  Sorry for the rambling structure.

  • Jasko123 Legend 461 posts since
    Apr 18, 2011
    Currently Being Moderated
    2. Nov 28, 2011 4:05 PM (in response to jtibbscu)
    Hip pain

    I've had difficulty with sciatic nerve problems and I think they are more commonplace than people may think.  It is also possible that you experienced a hip injury at some point in the past that you did not even notice at the time, or you felt minor discomfort that disappeared in a few days.  This sounds crazy, but it really does happen ( mine was three years ago running on an uneven surface).  I can recommend floor excercises that focus on the abdominal region and lower-body flexibility.  There are many routines available on the Internet and most of them are similiar.  I hear my hip "click and pop" also when I do them, but over time, it really does help.  The only other thing that comes to mind is a leg-length discrepency because that influences so much and could cause all your symptoms.  It would be a good idea to check with the professionals about that..and best of luck!

  • JamesJohnsonLMT Legend 1,160 posts since
    Aug 23, 2009
    Currently Being Moderated
    3. Nov 29, 2011 7:33 AM (in response to jtibbscu)
    Re: Hip pain

    I want to emphasize three important points that Jasko brings up: (1) Leg length discrepancies, (2) running on uneven surfaces, and (3) clicks and pops from the hip.

     

    Statistically speaking, some version of a leg length discrepancy occurs in most people. Although it may not be as noticeable in the sedentary population, it can still have an impact on standing and walking. Differences of less than an eighth of an inch have been known to cause chronic pain, especially in athletes whose repetitive movements may bring them to the fore.

     

    The second point about uneven surfaces is important for two reasons. Not only does an uneven surface temporarily create the conditions of a leg-length discrepancy as the body struggles to maintain balance, but in the case of an actual leg length difference, it can be the "straw" that broke the camel's back, so to speak. The reasons for this are obvious, so I won't go in to them here.

     

    What is also helpful to learn from Jasko's post is that many people experience clicks and pops, often overreacting to them. I'm not saying they should be considered "normal," but for many people they are. This should not, however, allay your concerns about the effects of repetitive motion on a noisy joint. My guess (and it can only be a guess, not having examined you) is that after many miles and likely many years of training for distance events like the marathon, there is unequal tension in the musculature supporting your hip, resulting in the odd sounds as well as the discomfort. The fact that the pain moves around adds credibility to this assumption.

     

    Piriformis Syndrome could play a role, especially in cases of Sciatic Nerve entrapment, which Jasko also alludes to. This is of course most likely in about 15% of PS cases, due to differences in the routing of Sciatic nerve branches through Piriformis muscle. You can read a discussion here. However, I disagree with some of the conclusions made in this article, because anatomical differences alone cannot be considered separately from the other factors we have already discussed, since all combine simultaneously in the real world of sports pathology.

     

    IF you were one of those unlucky 15% with Piriformis/nerve entanglement, and one of the 10% of those with unilateral entanglement on the involved side, had a leg-length discrepancy, were athletically active and running on uneven surfaces.. this would almost be a no-brainer, but I am not one of those in favor of exhaustive testing when more practical trial-and-error solutions are available. My apologies to those who habitually use the healthcare system to tackle aches and pains due to sport, but I think clinical approaches are overused by many, though they thankfully serve to inform the rest of us.

     

    Half of these factors involve lifestyle choices, or can be compensated for by the athlete/patient, so you've probably got room to work with the "injury" a bit before it becomes too difficult to reverse.

     

    Looking through the differential diagnoses in the article, you will see suggested tests and solutions that can be performed by professionals, and this article can serve as a general guide to resources that can be fleshed out elsewhere.You could probably do some research and perform some of these tests yourself, if you have the time and confidence.

     

    In a nutshell, you want to determine what kind of sciatica pain you have. Previous experience with abdominal tightness could enter into the picture if there was resulting scoliosis of the lumbar spine, which though it might indicate potential for spinal causes, would also set the scenario for muscular compensation, including PS, as you suspected.

     

    Right now, I would evaluate the contributing factors we have discussed. Canted running surfaces like roadsides are easy to figure out. Actual leg length discrepancies more difficult, since they can be functional (due to muscular compensation) or anatomical (like mine, from a previous tibial/fibial fracture). Tests that observe hip height can be due to either cause, but also due to variations in arch height. Measurement of the height of the Anterior and Posterior Suprailiac spines of the pelvis (ASIS/PSIS) can be misleading due to variations in pelvic structure/symmetry. One simple test that bypasses some of these problems involves height measurement of the flexed knees while lying on a firm exam table. If one knee is higher than the other, depending on which is more forward, it can highlight whether the femur and/or tib/fib are longer with respect to each other, but these differences can also offset each other. All of this is somewhat academic when it's easy to try a lift in your shoe to see if symptoms disappear.

     

    In my case, a thin gel pad in one shoe took care of the aches and pains stemming from my leg-length discrepancy. Eliminating potential causes, the rest often resolves on its own. Casualties of the original problem can include spinal muscles, core muscles around and within the pelvis, hip flexors (psoas), abductors (TFL), adductors, etc. If you have gotten to the problem in time, they may heal themselves with a little r&r. In many cases, rest alone and/or elimination of the original cause is not enough.

     

    When I see the kind of symptoms you describe, and consider your health and athletic history, I think there may be issues with the abs and glutes that need to be resolved. Intrapelvic muscles like the Piriformis are often reacting to problems elsewhere that need to be handled first. There are no doubt issues with your core muscle group that need to be addressed, possibly by strengthening exercises, but certainly by palpation and Range of Motion (ROM assessment) to determine asymmetrical tightness (Physical therapy), and Massage therapy to disarm any trigger points affecting normal muscular function. The clicks and pops should respond to this. If not, there could be another underlying pathology in the joint itself, which may or may not resolve itself over time.

     

    You are pretty tough to have survived all that training leading up to your marathons, and your body is programmed to heal. These two factors give me great confidence that you can solve this nagging problem with a little experimentation, perhaps some foam rolling and gentle stretching to guarantee equal range of movement. The alternative? You can spend a lot of time waiting, worrying, and missing the athletic activity that makes you happy and otherwise healthy. Which is worse? Another no-brainer.

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