Expert: Dr. J. Shawn Leatherman - 3/7/2007

Question
last year in November 2006 i was involved in an accident in which i was rear-ended by a semi-truck going 40mphs. im 21 am very healthy i was very active in sports and the outdoors but after the accident ive been having a problem with my right hip. everytime i walk i can feel like a pop in my hip. also if i walk or stand for long periods of time my hip starts to feel like its buring and gets really painfull to stand. it also tends to happen when im sleeping if i lay on that side. ive never had this problem in my life, very often it will pop really loud as if someones cracking their knuckles but its much louder. it does get painfull and very annoying. my hip constantly husts 24/7 nothin really helps at all. and everyonce in a while it gets extremely painfull to where its like someones takin a match and stickin it into my joint. ive had X-rays, MRI, MRA and the only thing that showed up is that my hip is still inflammed. these were all done in the last month. i have anti-inflammatory pills that ive been taking. i did about a month of PT for my hip but it only made it feel worse. my doctors dont know whats wrong and its getting frustrating im scheduled to have othorscopic surgery on the 27th on march and im just wondering if you have any ideas of what it could be?

Answer
Dear Matt,

With the MRI, the MRA, and x-rays showing nothing more than inflammation it only leaves a few possibilities such as ligamentous instability pertaining to the actual joint capsule, an occult (hidden) tear of the cartilaginous lining of the joint space called the labrum, chronic inflammation which will continue to create pain unless halted, or a myofascial problem such as a tightened gluteus muscles or the tensor-fascia lata/ilio-tibial band which are the structures that run from the side of the pelvis down the leg to the knee.  

I know that doesn't really narrow things down, but there are more ways to do that.  If the pain is felt deep in the joint, inflammation and cartilage destruction is more likely.  If the pain feels more dull and superficial it is more likely in the myofascial structures, and therefore a deep tissue massage or vigorous active release type of manual therapy may benefit you.

What I would suggest is that you research a few manual therapy techniques such as Active Release Technique, or Graston technique to try and alleviate the problem.  www.activerelease.com , www.grastontechnique.com. If the dysfunction is allowed to stand and inflammation becomes chronic, then the neurological system is prone to pain generation rather than pain reduction which creates a positive feedback loop making the problem worse.

I would also recommend that you pose this question to another doctor on this site by the name of Dr. Scott Gillman who is certified in Graston technique and also has more training in Sports Injury than I do...hip injuries are generated more in sports than car crashes.  He may be able to add some useful information for your consideration.

I wish you the best of luck Matt.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net