Expert: Dr. J. Shawn Leatherman - 12/14/2006

Question
hi, when i sit down  (as normal) and bring my knees together but my feet still apart and lean forward (bringing my chest to my kness)  i have pain in my hip. but if i sit down as normal and lean forward without putting my knees together then i have no pain. it has been like this for a couple of months and recently my thigh feels numb on the same side of the hip. My physio its a hip joint problem but did not specifically tell me hwat it is.  thank you for your time

Answer
Dear Gurpeet,

The first thing that comes to mind when reading your question is that the position you are performing in the chair is fairly extreme.  It requires good flexibility and most people wouldn't be able to do it.

You need to realize that all movements in the lower legs will have an effect on the movement of the hip joint.  while seated the joint is already close to 90 degrees of flexion.  Then by approximating the knees you are adding a measure of internal rotation to the hip joint.  This will induce compressive stress on the internal cartilage of the joint, while stretching some of the outer components (ligaments, tendons, muscles)  this position is within the normal limits of the joint, but while moving the torso downward to meet the knees you further increase hip flexion to approximate 170 degrees, increasing the joint stress.

There are some likely candidates for the pain you feel.  Deep joint pain can be the result of many things, but the most likely would be a tear or derangement of the cartilage inside the joint space, degeneration of the joint, or a congenital anomaly which could be a slight malformation of the bones (femur head/acetabulum of the pelvis.  Pain not deep in the joint, but peripherally, could easily be the result of the strain and/or compression on outer joint structures such as:  the glute muscles or the Tensor fascia Latae ( fibrous band on the outer hip).

The only true way to evaluate this is with a musculoskeletal evaluation of the area to include functional testing of ranges of motion, orthopedic tests of the hip, and palpation of the affected musculature for any imbalance, muscle spasms, trigger points, adhesions, or contractions.  Any chiropractic physician can perform this evaluation, or any medical doctor.  They just need to take the time to evaluate the area with a hands on approach.  If the examination finds nothing, x-rays may need to be taken to evaluate the internal joint itself, but this really sounds more like a functional problem than a structural problem.

Concerning the numbness on the same side, cutaneaous nerves that supply sensation to the skin can be compromised at the origination site in the low back, or peripherally from compression in the tissues.  It is quite possible that the position you have described could compress and irritate the peripheral nerve on the affected hip.  Likely sources for your hip numbness are the Lateral Femoral Cutaneous Nerve, and the Lateral Branch of the Subcostal Nerve because they supply sensation to the outer hip and thigh.
 
If the pain is minor, and you are able to function without compromise, other than the described position, I would eliminate that position and start stretching the affected hip...The Illiotibial Band, Glutes, and Tensor Fascia Latae.  Monitor your symptoms and if anything gets worse, then I would suggest that you schedule an appointment for further examination.

Respectfully,
Dr. J. Shawn Leatherman