Sports Medicine/Hip pain

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Question
Dear doc,
I have been having problems with my hip and back for quite some time.  I have visited a couple of doctors who have mostly described my back pain as deriving from muscle tightness, poor posture and weak glutes.  The ,more recent pain in my hip pointer area has been going on for a few months.  If I apply pressure to the iliac crest I feel a lof of pain.  It s a sharp pain.   Running makes it worse, and so does squatting.  Abdominal work, leg raises, and even coughing hurts. I've tried to do research on my own and mentioned it to the doctors who seem to think it all stems from the same problem.  I wonder if you have any suggestion.  I've been trying to stretch, do yoga, take Advil .   Thank you very much for any assistance you can provide

Answer
Hello Francesca!

I wrote a rather long letter to you explaining the anatomy that is causing your pain, and why this area is affected.  Apparently, my letter was diverted to who-knows-where, and I am terribly sorry for that. To make things easier and faster at this point, let me just surmise what I feel is the problem, and why you have the pain.

If you have had regular x-rays, or an MRI, a specialized Radiologist would have seen the problem.  But usually, xrays are seen on a one-dimensional plane, and many things are missed in Biomechanics.

By conjecture, the things you mention are findings that are very common for folks who are physically active.  The doctors that proclaimed you had bad posture, tight muscles, and weak glutes, just were not familiar with the multitude of biomechanical processes of the body.

When one experiences pain in the hip.......usually one-sided....it is a matter of an injury/fall/slip, etc., that has affected the juxtaposition (correct position) of that particular joint.  In your case, it has been going on long enough to affect the muscle fiber innervation of the gluteals, and causing tightness in the muscles.  Actually, the muscles in the body are there to protect the bones and joints, and when there has been an interference of the normal neurological signals to the muscles, they spasm and tighten up to protect that area.....hence the doctor said they were "tight".  With weak glutes, the nerves cannot overcome the tightness in the surrounding muscles to strengthen the glutes.  It's a balancing act. When you press on the  Iliac Crest of the painful side, you increase the pressure of the irritated nerve(s) which innervate that area.  If you were to press on the opposite side, you would feel less pain on the affected side because you are releasing the pressure on those nerves. I know this might sound confusing, but it is really very simple, especially after studying biomechanics and anatomy for many years.

The body is balanced normally, but when there is a dysfunction anywhere in the skeleton, it will tell you.  For your symptoms, it clearly involves the lower spine (L2,3 mostly), but generally the whole lumbar area, and the spinal nerves which come out of the vertebra at the disk level, travel down their own path, and innervate their specific, predestined areas.

The symptoms you are expressing tells me what level is primary, and what area is secondary. Also, the Ilium (both) are out of their normal juxtaposition, so one Ilia is turned outward, and the other one is inward.  It is not something that is necessarily visible, except if the doctor were to place his/her hand on top of the Ilia while you stand feet together, and many times the Ilia are not at the same level.  Or the same thing can be done on an exam table, where you can lie on your stomach, feet over the end of the table, face down, and the feet will be different lengths.  Another good example of a diagnostic tool would be the pain felt when you cough.  A cough/sneeze will cause momentary pressure in the spinal cord, which will cause pain in the affected part of the spine.  (Your doctors should have picked up that very important diagnostic neuro test!).  Nevertheless, a routine examination should have been done along with a history, tendon reflexes, muscle tests, and radiographs to rule out everything evident or obscure.

My suggestion for you would be to find the best Chiropractic Physician in your area by asking friends, neighbors,etc., for suggestions........DO NOT USE ADVERTISEMENTS!!.........and make an appointment with that doctor.  If he doesn't do the things I've mentioned in my letter concerning the History, physical, films (or take your xrays if another doctor did them), and he will explain what the procedure is to fix this problem.  No, it does NOT hurt, and there is nothing to be afraid of.  You should go maybe three times over a 10-day period, and make sure he/she doesn't schedule you multiple appointments over a long period of time.  You won't need them, and you should feel much better after the first appointment.

If you have any questions or concerns, please don't hesitate to contact me.  Thank you for writing me, and I will look forward to your reply.

Best wishes,

Dr. Patricia Arthur  

Sports Medicine

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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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