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1719 Views 4 Replies Latest reply: Sep 2, 2012 5:40 PM by JamesJohnsonLMT
Rheel Rookie 1 posts since
Jul 11, 2012
Currently Being Moderated

Jul 11, 2012 12:00 PM

Labral tear or herneriated disc or something different?

Looking for someone with similar situation.  Having left hip pain since dec 2011.  Was very active prior! P90x and basketball.  Lumbar spine MRI revealed l5/s1 mild herniated disc and at same time MRA revealed anterior labral tear (slight tear).   Left knee is shot now and right hammy is tight.   Ortho can't determine if pain is caused from labral tear or disc!   Traditional movement tests for labral tear don't produce pain.  Sitting is painfully (bar stool type sitting).  Gardening hurts.  Can't run.   Two weeks of pt did nothing.  Mra did relieve pain for a couple days.  I sent my mra to dr kelly in ny.   Very frustrated!!!   My other ortho wants me to get checked for hernia. My question is if the doctor can't produce pain by moving my leg around in the socket does that mean I do not lave a labral tear that produces all this pain in hip?  I don't feel like my symptoms are disc related.   No numbness running down back of leg.  It's isolated hip flexor area pain and knee pain.

  • JamesJohnsonLMT Legend 1,167 posts since
    Aug 23, 2009

    Have any of these professionals suggested there might be a muscular cause for your pain? Did they allow for the possibility that there may not be one simple explanation within their particular realm of expertise, but several? Did they hint that you might be able to treat this problem yourself without spending tons of insurance money? It is no wonder our healthcare system is the most expensive in the world.

     

    Your symptoms closely match those of strained adductors, hip flexors, hip rotators, and gluteal muscles. These soft tissues do not show up well on scans, and are rarely analyzed or treated for dysfunction in any meaningful way. If someone were to tell me they were "very active," and feeling "left hip pain since dec 2011," I might conclude that such activities were a contributing factor. While I might want to perform tests that would point to a particular missing piece of the puzzle, and congratulate myself for my sleuthing, I would certainly not want to gloss over the fact that very active people accumulate muscular dysfunction over the course of their athletic careers, that this dysfunction in and of itself hurts, sometimes a lot, and that further vigorous activity does not help at all. Sometimes, you can't pump, stretch, inject, and cut your way out of a lifestyle problem.

     

    Even your heart, the busiest muscle in your body, rests between beats. It is possible that one or more muscles in your core, acting individually or more likely in a group, whether synergistic or antagonistic, is/are not resting at all, and pulling 24 hours a day. Hold your notebook at arms length for an hour, and you can easily see how a 24-hour contraction can hurt. Yes, it happens a lot in people who push themselves to the limit in programs like P90x. This does not mean that taking a break will help, as you have found when you sit, or that rest alone will return everything to normal. Otherwise, your break in activity would have borne fruit by now. The solution will not be all or nothing, but somewhere in between.

     

    First, a word about diagnoses, and how a diagnosis can affect the pain we feel.

     

    Some months ago, a study was done of healthy subjects that with their permission, were scanned for hidden features like labral tears that are commonly blamed for pain. The study found no correlation between pain felt and these perceived anatomical flaws. Similar results have been reported for disk lesions. In other words, people who had these problems felt no pain because they did not know they had them. The average pain patient, on the other hand, will have received a diagnosis at one time or another that is based on these tests, and will tend from that point on to obsess about finally being given an answer to why they hurt, when in fact it may have nothing to do with their pain, which consequently takes on a life of its own.

     

    My purpose is not to discredit legitimate medical tests, or the attempt of an honest physician to find you an answer, but to point out the tremendous life-limiting power of suggestion these minutia have over patients. I have no doubt you are in serious pain. The job for you is to determine which pain is real, which may be a mental image of pain, and where the pain is actually coming from. I also have no doubt as to why you have pain. I'll bet basketball and P90x have at least something to do with it, but the perceived damage caused may have nothing to do with your hip, spine, or groin. It can simply be the product of one of the most common pain phenomena, referred pain.

     

    When I mentioned muscles and groups of muscles above, I indicated that your pain could come from several sources. There are a number of them that affect sensations apparently coming from a healthy hip, and here are links to a few. In addition, there are adductor muscles that can cause severe hip pain that feels like it is coming from within the joint itself, the Adductor Longus being chief among them. AL dysfunction is famous for benching athletes, including runners, since it is also a synergistic hip flexor.

  • mariaweller Rookie 5 posts since
    Feb 21, 2009
    Currently Being Moderated
    2. Jul 11, 2012 6:45 PM (in response to Rheel)
    Labral tear or herneriated disc or something different?

    Do a little research on piriformis syndrome and sportsman's hernia to see if either of those fit your pain. I had right hip flexor pain which I isolated to my right lower rectus abdominal muscle and had very tight hamstrings and butt pain that made it difficult to sit. Had to take several weeks off from running, stop doing core exercises. Did not think I was ever going to get better but I concentrated on eating healthy foods and doing the activities I could engage in pain free. It took me about 2 years but I am nearly fully recovered. I thought the hernia thing was never going to go away but I do very little core focused exercise now and as long as I avoid that, I'm okay.  No more 6- pack ( not that I really had one to begin with) but I'm back to running marathons.

    As James hinted above, I can clearly see I was overtraining at the time of the injuries.

     

    Tart cherry juice (montmarency) daily is a wonderful, natural anti inflammatory. I started that habit while injured and have continued to drink it daily.

  • KellyVinPA Amateur 11 posts since
    Mar 12, 2011

    Iliacus Dysfunction may explain my hip pain... Had label tear repaired 6mo ago and still have recurring pain in certain positions. I saw the recommended massage therapy on the Vermont website. Are there any practitioners you recommend in my area (zip 15626)? Any help appreciated.

  • JamesJohnsonLMT Legend 1,167 posts since
    Aug 23, 2009

    Kelly, I've worked in PA, but do not know any therapists in your area. The link below is to the AMTA website, which lists therapists, their specialties, and experience in order of distance from the address you enter into the locator field.

     

    http://www.amtamassage.org/findamassage/results.html?q=&l=delmont%2c+PA&searchcat=famt&PageIndex=2&PageSize=10

     

    I recommend you call and interview at least a few therapists to assess their comfort level with pelvic or core massage, before committing to an appointment. Years of experience are a plus when working in a sensitive area like the pelvis, since it implies better hands, but recent training can be more effective than what was available several years ago. In any event, most states require therapists to continue training to maintain licensure. Specific training for, or exposure to patients with a similar history will, of course, be a plus. It's a wide field, and there are great therapists without the particular expertise you are looking for. Anatomical knowledge is required of all licensed therapists, but this one is really all about the hands.

     

    Most of the MTs I checked out in your area have a substantial amount of experience in terms of practice years, but experience does not necessarily equal activity. You'll probably find the most active therapists in the Pittsburgh area. I saw one there with an impressive list of high-profile clients, who tend to give valuable feedback. However, your interview should be your most reliable guide. Therapists in rural areas are sometimes in greater demand, and can have remarkably broad exposure to a variety of problems, with no other specialists around to solve them. They learn by necessity. Refer whomever you select to the Vermont link, and ask them if they are familiar with the technique discussed in detail there. It requires practice.

     

    To help you select candidates for interview, look for specialties in at least two of the following: Neuromuscular therapy (NMT), Trigger Point therapy, Myofascial Release (R), Movement Education (various forms of this).

     

    When interviewing therapists, be aware that talky therapists may easily reveal strengths and weaknesses in their knowledge base, but some of the best therapists I have met are not very good speakers. They do their best talking and listening with their hands. Besides, it will be hard to achieve the release you are looking for in a stressful, talky environment. Make sure they can work with just the right level of effective communication. That and the hands are the most valuable tools they will have. Ask them if they are busy when you reach them, so you can allow for that when evaluating their communication skills. The busiest therapists can be very short on phone time. To be fair, schedule a moment when they can discuss your case without any competing pressure, or have them call you back when it is most convenient for both of you.

     

    p.s.: Don't trust websites alone, because like resumes', many of them are written by marketing specialists.

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