I hear it all the time in my office and I am guilty of
misusing it as well. Hip pain. Patients present to my Woodbridge, Dale City
VA Chiropractic office with what they call “Hip Pain”. I often go along with it until I understand
the area they are complaining of.
Chiropractors are well versed in joint injuries and they can diagnose
all of them and treat most of them. Here
is some info from the ACA on hip pain.
When the hip joint is spoken of, it is typically thought of
as a vague area that may encompass anywhere from the iliac crest, the
sacroiliac joint or the point at which the femur articulates with the
acetabulum. The latter is the actual hip joint. Lower back pain that radiates
more laterally to the pelvic area over the acetabulum, groin, and upper lateral
thigh is not necessarily definitive of an L4/L5 disc syndrome. Pain in this
region may also be secondary to a facet syndrome. Sometimes, pain to the lower
abdominal and groin region may be a part of the symptomatology presented by a
patient. The differentiation between the L/4/L5 disc and facet syndrome is that
the disc with the radiculopathy will generally follow a known dermatome, while
a facet syndrome follows a dermatomal pain pattern. Doctors of chiropractic
usually find and treat articular lesions of the sacrum, ilium or lumbar spine,
for a period of time, without cessation of symptoms or improvement of these
complaints. One other consideration would be for a tear of the labrum in the
hip, which may result in pain in the SI joint, gluteus area and even anterially
into the groin.
Complaints in these more lateral areas are often due to a
problem in an area that many doctors don’t check—the femoral head. The femoral
head may need to be assessed for the need for manipulation or mobilization.
This in turn may cause deep pelvic muscle spasms, which may become chronic. I
believe that every day activities, from subtle movements like turning in bed to
more repetitive activities like bearing more weight on a pronated foot time and
time again, may cause misalignment to the femoral head. This area should be
checked and adjusted for recovery, in my opinion.
Drawing upon an example from personal experience: I would open
the car door and throw my right leg into the car and then sit down. I would
experience a subtle “click” in the acetabulum area, followed by pain and
irregular walking gait, pulling of the leg when weight bearing, causing deep
spasms of the upper thigh and lower abdominal muscles, pulling the leg forward
instead of pushing the leg forward, as in a normal walking gait. This caused a
transition of weight-bearing muscle function to muscles not usually used in
normal walking. (A compensatory walking gait is developed.) This caused me pain
and spasm in adjacent muscles.
All too often, I believe that this problem is missed or
misdiagnosed, resulting in unnecessary surgery, hip replacement, repetitive
chiropractic adjustments, physical therapy and muscle massage, and none of them
address the underlying cause of the condition.
Examination for Hip Joint Dysfunction
Place the patient in supine position, with your superior
hand holding the ilium to the table with light A-P downward Force (near the
ASIS) to ensure the ilium will not rise off the table during motion of the leg.
Holding the ilium on the exam table, grasp the ankle and rotate the foot
medially. The big toe should touch the table. Full rotation indicates no hip
joint dysfunction. If the ilium rises off the table during this action, this
indicates improper function of the femoral head/acetabular articulation.
Corrective Procedure
Ascertain (through the examination described above) the side
of restriction. Place the patient in lateral Syms position (Syms is performed
by having a patient lie on the left side, left leg extended and right leg
flexed) as in a side roll. Place your superior hand under the armpit of the
patient, holding the humerus and ribs, with your inferior hand reaching over
the patient cupping the femoral head. Proceed with the side-roll-type procedure
with this exception: The inferior hand (cupping the femoral head) is driven
directly forward (anterior).
If correction has been obtained, the leg now should move
freely in a medial direction smoothly and completely, with immediate
Improvement of pain. Occasionally the patient may experience residual muscle
soreness. Over the course of my practice, I have found that these patients have
a tendency to walk around for a while with a displaced femoral head and a
compensatory walk, the surrounding muscles are sprained and inflamed, and
soreness may continue for days until the patient returns to a normal walking
gait. Generally, I find the quicker the patient returns to a normal walking
gait, the quicker the syndrome is alleviated. I feel it is important to
re-address with the patient what is a normal walking gait and this may lengthen
the post-correction period.
3122 Golansky Blvd, Ste 102
Woodbridge VA 22192
703 730 9588
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