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Try this... - September 20, 2007 5:46:31 PM
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pappawheelie
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Has anyone found that the remedy to a case of "hip flexor strain" was by addressing the lumbar spine?
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RE: Try this... - September 20, 2007 10:02:19 PM
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Sebastian Asselbergs
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Yeah, when it WASN`T a hip flexor strain`.....
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RE: Try this... - September 25, 2007 11:45:26 AM
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pappawheelie
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Right. Do you remember the client's presentation? And what type of dysfunction did you discover in the lumbar spine?
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RE: Try this... - September 25, 2007 2:37:08 PM
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Sebastian Asselbergs
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Pain in the anterior hip when extending the leg under load (a step-through motion). Orignal "injury" was not clear - noticed while playing ball-hockey. Abduction tests (knee extended, flexed, hip neutral extended and flexed) were clear, Thomas test was clear, resisted flexor tests in supine (with stable spine) were clear. However, when the patient allowed lumbar extension to occur on the resisted flexion test in endrange of hip-extension - pain. Tested it with active stabilisation L-spine - strong and painfree.
So, a bit of mobilisation on the L2-3 levels and re-test the one positive test - now pain free. Repeat eval was still fine - no pain.
In the past - before this one-, I had to occasionally resort to manips, or MET pelvic work - always with success for these.
This was the last one I saw - in 2001 I think. I am treating fewer and fewer sport injuries and this seems where most "groin" injuries occur. The incidence has fallen off dramatically.
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RE: Try this... - September 25, 2007 2:47:33 PM
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Sebastian Asselbergs
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BTW, I have long given up on defining the "type of dysfunction" in the spine. Those used to be part of a palpatory exam in the ortho world - and have been found somewhat wanting in their reliability and "accuracy.
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RE: Try this... - September 25, 2007 4:22:16 PM
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pappawheelie
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Thanks for the reply.
I've been receiving numerous clients diagnosed with either hip flexor strain or groin strain--I guess someone wants me to learn something about this!
Right now I'm stumped with a lady who was sent to me with the diagnoses "hip flexor strain". I've been thinking it was an oblique strain, but now I'm not so sure. What gets me about her presentation is the fact she experiences most of her pain when she transfers from sitting to standing; the longer she sits, the worse her discomfort ( I find this a to be a common report of people who have lower back/SIJ issues). She does have significant pelvic obliquities, plus mild hypomobility at L2/3 and I'm now focusing on her lumbar spine and pelvis.
If you have any thoughts on her case I would like to hear them.
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RE: Try this... - September 25, 2007 4:54:41 PM
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pappawheelie
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From: Vermont
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I classify disfunctions into either hypermobility or hypomobility.
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RE: Try this... - September 25, 2007 5:54:02 PM
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bonez
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my experience in the sporting world especially the contact sports is that upper lumbar and SI issues are often related. Acute injuries to muscles in this area should be painful on resisted testing.
Suprisingly enough this does not always happen and in those problems tx to the affected jionts often resolves them. Don't forget to try a SI belt as it will improve those that might relate to increased joint irritation.
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RE: Try this... - September 26, 2007 10:42:27 AM
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pappawheelie
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I suppose it's important not to over-look the obvious: pain with resistance can incriminate contractile tissue, however, SA pointed out that sometimes, without adequate stabilization, resistance testing can provoke joint pain.
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RE: Try this... - September 27, 2007 5:32:00 AM
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Sebastian Asselbergs
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pappawheelie, I forgot to ask: is the hip clearing test negative? Occasionally, hip joint issues mimic groin problems. And your lady's pain going from sit to stand could indicate that. Also: the labrum can be a nasty cause of hip/groin issue.
And using hyper- or hypomobility is rather diffuse in my opinion. What is "normal" in a given patient? Have you tested her pre-injury to know what her normal is? The segmental mobility is greatly variable from upper to lower levels, and from person to person, AND very hard to precisely determine....
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RE: Try this... - September 27, 2007 8:54:56 AM
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pappawheelie
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Yeah, her hip checks out fine, although I will re-test next visit. And I'll be honest by saying I'm not totally confident I can diagnose a labrum tear. Looking at my notes the most consistent motion that reproduces her pain is sidelying on her left and rotating her trunk to the right (knees and hips flexed). Pain is located at the iliac crest, anteriorly, about two inches superior to the ASIS.
As far as hyper/hypomobility, I also find it to be very subjective and variable throughout the spine. And variablity in passive movement does not necessarily imply abnormality, or dyfunction. But as far as assessing passive intervertebral mobility, what else is there? And what criteria would you use for mobilization of a joint?
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Labral tears - October 4, 2007 2:18:45 PM
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Martin
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As far as confidence / diagnosing a labral tear, don't worry, it's difficult for everyone, as the tear locations are so variable. I think even MRI has poor sensitivity for acetabular labral tears. Sahrmann and Lewis have a good article in PT journal on these from 1/06.
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RE: Labral tears - October 8, 2007 8:18:35 AM
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Sebastian Asselbergs
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I was away for a week. Is this what they call a "hip flexor strain"?!? Pain above the ASIS? Wow. You must have rolled your eyes....
Don't forget the little cutaneous nerves that pop out from under the fascia over the iliac crest all over the place - mostly cluneal nerves - and they can get irritated at their fascial exit point. Also, thoraco=lumbar junction problems can refer to antero-lateral areas at the crest.
Lastly, IF it was a muscle strain of the oblique, time and relative rest would have solved it....
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RE: Labral tears - October 8, 2007 9:49:24 AM
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pappawheelie
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Relative rest and time did not help and her condition deteriorated. In addition, she began to report similar symptoms on the contralateral side--that's what prompted me to post this thread. Currently, she is better since our focus shifted to her lumbar spine and pelvis. I'm thinking the T-L junction may be the culprit, and just hope she continues to improve.
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