Body Part: Hips Diagnosis: Hip flexor tendonitis
A young female patient I saw this afternoon was accompanied by her mother. She complained of bilateral trochanteric pain after sitting in class for one hour and with driving for greater than 30 minutes. Quite expectedly, dysfunctions were seen in the coccyx [tailbone], sacrum, innominate and to a large degree the lumbar spine including neural tissues in sitting. Forward bending (FB) with the pelvis blocked at anterior superior iliac spine (ASIS) measured only 30% lumbar spine flexion. When allowed to complete FB motion, patient was able to touch the floor using mostly hamstring length AND this also reproduced the bilateral trochanteric pain. After the full evaluation, and after they both received a simple summary of the patient’s dysfunctions through using ‘George the skeleton’, they showed understanding that the source of the patient’s recurrent pain in both hips in flexion-biased activities was not only the area of the hips as was formerly addressed by patient’s previous PT, but that of the whole mechanical relationships of the joints, neural, and soft-tissues in the lumbopelvic hip complex when the hips are placed in tension during sitting or forward bending. Learning from this afternoon’s collaborative training session, I prioritized treatment of coccyx, sacrum, innominate, bilateral psoas, and lumbar spine anterior to posterior glides. The post test showed increase in lumbar spine flexion to 60% and patient reported decrease in bilateral hip pain with full FB. Finally, there’s the “hook!” The mother told me that her husband (who is a dentist) has been experiencing severe low back pain and has not been getting any success with his long standing PT intervention elsewhere. She said that she will have her husband come to the Oak Brook clinic instead, to have us see him.
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