Sports Medicine/hip problem

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QUESTION: Dear Dr. Arthur,

I don't know if you received my last response to your answer of "hip impingement and gymnastics". I answered somewhere but I think I posted it somewhere wrong. So I will give it another try!

When I received your message I was really happy. This is far beyond everything I could ever think of. When I first visited AllExperts.com I doubted that this is going to work.
You need to know, I have kind of a quirk that if I explain something, I need to do it as detailed as possible, because I am scared to miss something out that might be THE crucial point to indicate the problem, so I didn’t really dare to believe that anybody will bother to read my “story”.
I cannot express how overwhelmed I am by your message! THANK YOU!!!


So do I get it right that my pelvis kind of “moves” in a wrong way? My right hip is 0.2 inches higher than my left one, if that might contribute to my problem. My femoral head of the right side is not ideally covered by the hip socket. So it is a very very light form of hip dysplasia. That's all they could see on the x-ray. May it be a laberal tear? I'm so scared of that. I don't need to be a runner or something, just want to continue my gymnastics ( I don't train on a high level, I actually focus more on strength things like yoga and press handstands and some easy acrobatic moves. The problem is, that the strength involves so much hip flexor strength and I can't work that, because there is this sharp pain in my groin!)

The last two weeks I was sick and couldn't work out. I hoped that my hip will recover. But in training yesterday it was the same, even worse. It hurts in my groin when lifting the leg, especially when I rotate it inwards. When I actively tension the muscles in my groin/hip to pull my leg inwards, it aggrevates the groin pain. When I do a pike stretch, I feel really stiff in my buttocks, like if it was piriformis syndrome, although I always do deep tissue massage myself. When I stretch and put my leg to the side like and then roatete the hip a little, it's also a very uncomfortable feeling all around. Like in this pic: http://www.google.at/imgres?espv=210&es_sm=93&biw=1280&bih=901&tbm=isch&tbnid=I-

I somtimes even feel the strange stiff and sharp pain when I sit, or when I walk and my leg is behind me it hurts in my groin. But when I rotate my leg as far as it goes and push against it I don't have any pain, also front splits doesn't hurt, but sides splits are a little uncomfortable. When I lie down and rotate it there is a crack inside, but that doesn't really hurt. But it seems to be worse when the thing that cracks is "in the wrong position".

What should the treatment be like? Do I need to learn the right posture and how to rotate the hip correctly? I will tray to find a good Physiotherapist here!

Again, thank you for your advice! I will try to find a good Chiropratic as soon as possible and hopefully my problem will be fixed!
However this is going to turn out, your message gave me a lot of hope and some positive thoughts again!

Thank you very much, there should definitely be more people like you!

Katharina

ANSWER: Hello Katharina!

How nice to speak with you again!  I believe I addressed some of your concerns in my last letter when I said I could find only one Chiropractic physician in Vienna!  That can't be right!  Anyway, I did tell you that Physical Therapist will do nothing about manipulation......that is not their schooling.  They only know how to strengthen muscles, and possibly massage them, and I don't want anyone touching you that doesn't have the proper training techniques that you need.  At least in the US, they don't have the right training  for manipulation. Certainly, Physical Therapists have a very special type of expertise which is working primarily with the muscles, and not the structure of the body.

That said, I need you to find a GOOD manual therapist, or speak with the Chiropractic physician in Vienna about his background studies.  If necessary, we can exchange Skype numbers, and I can speak with him myself!  As far as your problem is concerned, you have a classical mis-articulation with the femoral head, and the pelvis, with some discrepancy in the low back and sacrum, secondary to the hip. Case in point, you said if you rotate the leg on abduction, you feel a lot of pain.  But, if you rotate it the opposite way, then push on it in adduction (rotated the other way), you feel no pain.  This is an indication the femur and pelvis are rotated against each other, and they need someone well educated in body mechanics to be able to re-align these joints.  No, it doesn't hurt one bit, if done by a professional, so don't worry about that.  But, it does NEED to be done so there is no further injury to the muscles, tendons and nerves that are affected by the torsion of the pelvis. I am writing this simplistically, because it is a very complicated issue, and it takes many years for a chiropractic physician to learn the intricate part of the body's engineering marvels.  It is so annoying for me to have to try to explain this when it would be so easy for me to adjust this once, possibly twice, to make this correct and you feel much better!  There should be someone there that could do this with expertise, and again, it is not an orthopedic physician, it is not a physiotherapist, but if you could find a chiropractic physician who has done his post-graduate training in sportsmedicine, that would be perfect. See if you can ask around to find if anyone would know of this type of physician, and ask if I could speak with him, OK?

In the meantime, don't do anything that will irritate this joint until we can do this together, and I can speak with them about your hip, if you want me to?  I would be delighted to discuss this, and if we can find the right person, you will be much better very fast!  By the way, I think I have mentioned this before, please, please, please do not get any steroid shots in that joint. Promise me you won't, ok?

Now, I will wait for your next letter telling me you have found someone that I may speak with, or write to, that would be willing to assist us.  Be careful not to try to stretch this leg out with the pain it causes.  Even though you were sick for two weeks, that didn't clear up any of the pain by resting it for long, so that will not work.  Don't worry, we will find something, but I am not there.....you are....so I give you the responsibility to find someone.

Take care of yourself, Katharine, and I'm glad you wrote back to me.

Best wishes,

Dr. Patricia Arthur  










---------- FOLLOW-UP ----------

right hip femur+socket
right hip femur+socket  
QUESTION: I hope that the "follow-up" question works this time.

Thank you again for your great answer. I don't know how I should express how thankful I am! I have been to two orthopedists before I asked you. The first one said it's hip impingement type pincer (he diagnosed this within 10 seconds without even touching me, I had my jacket and pants on the whole time). I went to another one who did an x-ray of my hip. He said that my hip is inflamed and I need orthotics insoles for me feet, although I already have them from the first doctor. I have an appointement with a manual therapist in 2 weeks, I really really hope he can help me!
I hope that it isn't hip impingement. If someone else rotates my hip I feel absolutely no pain. But as soon as I do it and use the muscles to do it - it kills me.

I attached an image of the x-ray of my right hip. I unfortunately haven't done an MRI recently!
Thank you again and I will keep you updated - maybe the manual therapist is willing to listen to you. I really hope so, but those people are really rare!

Thanks again!

Katharina

Answer
Hello Katharine!

It's  interesting to know how the Orthopedist work in your area!  Neither of which were able to pinpoint any specific  knowledge of Biomechanical malfunction in the pelvic area. Of course, when there is a dysfunction of one side of the pelvis causing secondary pain in the hip area, that usually means there is a rotation of the pelvis out of it's normal juxtaposition. X-rays and MRI's  can be taken until the cows come home, and they would see only what they believe is a normal hip.

When X-rays and MRI's are taken by professionals who deal with Biomechanics, they are taken so both sides can be viewed at the same time. and measured against each other for inconsistencies.  This is the major difference between Orthopedists and medical physicians.......they will never see what is causing the problem!  This is why I have been so adamant in you getting an appointment with either a Manual Therapist, or a Chiropractic Physician, who can look, or feel the difference from one side to the other.  Mind you, it is very subtle, and specific tests have to be done to pinpoint the problem.

Now we are on the right tract to finding how the hip joint is positioned in the pelvic socket to cause such pain.  The X-rays will indeed show an imbalance in the pelvis.........where the one side might be a little higher, or the ilium might have a larger  dynamic picture....again very subtle......which would indicate an apparent rotation of the pelvis which affects the placement of the hip.  I know this might be confusing to you, but don't worry because this comes second- nature to those professionals.  Hopefully, the Manual Therapist has been trained similar to this, and can find the problem to fix it.  Make sure when you have the initial consult with him, and you take a little time to ask if his training is similar to a Chiropractic Physician.  If it doesn't seem to be parallel to the Chiropractors', but seems as though it's more like Physical Therapy, say thank you, and walk out!  You must find a Chiropractic graduate someplace in Vienna who knows what to do properly.

Let me know, Katharine, so I can feel better in knowing your treatments are directed at the cause, rather than the symptoms!
Thanks again for letting me know what's happening, and I anxiously await your next note.

Best wishes,

Dr Patricia Arthur

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Dr. Patricia B. Arthur, DC, MRC, CST

Expertise

As a 30-year practicing Chiropractic Physician, my specialty was Sports Medicine. For 8 years I had the distinct pleasure of working with the USOC, and traveled the world to care for the athletes in the Pre-Olympic venues for the Summer Games. When I wasn't traveling, I had a private practice, and a hospital practice, in Kamuela, Hawai'i. Questions I couldn't answer usually dealt with pharmeceuticals. This was not my expertise, but the simple questions pertaining to familiar drugs I was able to digress, or refer to someone that was knowledgable in that field. Most Sports Medicine field injuries were familiar to me, but I always aired on the side of caution. In my office practice, I would tend to see more patients with the weekend injuries who would try to self-treat, only making the injury worse than it should have been! Nevertheless, I never took anything for granted, and so it was my conservative approach to the "cause-and-effect" mechanisms that were vitally important to the healing process.

Experience

Following my competitive nature, I knew Sports Medicine would always be a part of my life. After graduation from Palmer University in Iowa, the old adage taught at the school dealt only with the spinal column......anything connected to the spine was outside our scope of practice. To me, this was too simplistic, because the complex body also had arms and legs! From this point, I developed specific technigues which would encorporate the body as a whole rather than haphazard segments. There is nothing traumatic that happens to a single ligament, tendon or joint that doesn't effect a secondary, or possibly a tertiary element in that area. In order for that space to heal, all the factors must be addressed. Volunteering my time teaching referrees, coaches, and interested parents about the realities of probable sports injuries was worth a thousand words!j

Organizations
American Chiropractic Association; Local Emergency Response Committee; Hazardous Materials Response Team; Urban Search and Rescue Team - Operations and Planning; Federal Corps of Engineers Committee; Earthquake Advisory Board; Big Island Wildfire Committee

Publications
Papers published focusing on the importance of proper care of sports injuries; Authored medical columns for the syndicated magazine "The People's Doctor "; Published papers in professional journals on Head Injuries in Sports; Published papers on Drug Abuse in Sports.

Education/Credentials
Robert Packer Hospital - Certified Surgical Technician - CST; Palmer University - Doctor of Chiropractic - D.C.; Wright State University - Masters in Counseling/Psychology; Wright State University - Masters In Couseling of the Severely Disabled.

Awards and Honors
Selected US Olympic Physician -1988; Graduated Wright State University with a 3.75 GPA; Graduated Palmer University with a 3.5 GPA; Faculty Appointment - Palmer University Post Graduate Education; Faculty Appointment- Hawai'i/Kapiolani Community College - Skills Team Tester;

Past/Present Clients
Cincinnati Bengals Football Team pre-season training; Summer Olympic Athletes worldwide; Kona Ironman Triathletes - Finish - line physician

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