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hip pain in 17 year old
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hip pain in 17 year old - October 18, 2006 7:07:00 AM
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gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
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My 17 year old son reported Monday night that he thought he had "pulled something" during basketball practice that afternoon. Said he was sore in his groin area, but was OK. Yesterday he said it was worse, and he did not think he could practice if it continued. Says the pain is more in the front of his right hip. Wants to have it checked out.
Complains of pain during gait with hip extension on the right. Active hip flexion is painful, unable to flex his hip against gravity in supine due to pain. Passively, range of motion appears mostly OK, with pain on passive internal rotation which is limited to just past neutral. Passive hip extension in prone is symmetrical with and without knee flexed. But he has trouble letting his hip down towards extension in supine complaining of pain.
I work more with developmental disabilities, and very much appreciate y'alls input in the past on some of these ortho situations.
Any suggestions?
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Re: hip pain in 17 year old - October 18, 2006 9:49:00 AM
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PHSPT
Posts: 119
Joined: December 1, 2005
From: Oklahoma
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What exactly was his mechanism of injury? Any new changes in BKB training? How long has he been playing competitively? any other sports?
You mention pain w practically every hip position, is the pain localized to groin only?
Prior history of hip/groin pain?
pain scale 0-10?
describe the pain dull,sharp,etc, shoots anywhere?
This info can paint a better picture for me.
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Re: hip pain in 17 year old - October 18, 2006 9:53:00 AM
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PHSPT
Posts: 119
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From: Oklahoma
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Oh yeah that age.....17 yrs old!. Any sudden weight changes, growth spurts?
Sounds like hip flexor strain, but need more info.
Thanks
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Re: hip pain in 17 year old - October 18, 2006 10:31:00 AM
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gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
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This is his 5th year playing for his school. This is the first year on the Varsity team. They just started practicing for this year, but he plays year round at church. B-ball is his primary sport. He has run track in the past, and plays recreational football, etc. Overall very active, steady weight, growth has finally leveled out. (After he outgrew me by an inch)
He does not remember any specific activity that caused the injury. He did say they were doing a lot of defensive drills where he is in the crouched stance moving quickly back and forth down the court.
No prior complaints of groin pain. He had Osgood Schlatters last year that he worked through.
Sorry about the poor description of painful positions. Basically, active hip flexion hurts the most, and stretches to the hip flexors also hurt. I also think probably hip flexor strain, but his painful response to passive hip internal rotation made me wonder if there might be something else.
He really likes basketball, so when he said he could not play like it is now, it lets me know it's significant. Hadn't asked specifically 1-10, but based on his reactions, I would guess 7-9 when he was trying to do a straight leg raise, and on passive internal rotation.
Thanks!
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Re: hip pain in 17 year old - October 18, 2006 12:58:00 PM
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PHSPT
Posts: 119
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From: Oklahoma
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gerry,
If pain is localized to groin, sounds to me like a muscular strain. Rest and ice to affected area for 2 weeks.
I doubt any stress fractures due to mech of injury.
Does he feel any locking/catching feeling in the hip? (Spec .85 Narvani et. al) This can potentially indicate a labral tear.
I am going to hang my hat on the muscle strain, and expect to see your kid back to sports in a couple of weeks!
Keep us posted.
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Re: hip pain in 17 year old - October 19, 2006 4:51:00 AM
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PTupdate.com
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Joined: October 8, 2001
From: Pittsburgh, PA USA
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Gerry, considering his age and athletic level, hip labral tear is much more suspect. The painful hip flexion, limited IR are classic signs. Adding flexion and adduction while in IR may confirm even more. Also, FABER may be painful, as will palpation to the anterior hip capsule. Over the years, many of these injuries have been diagnosed as "groin pull", and we are learning more and more that labral damage is really the culprit.
John M. Duffy, PT OCS
[URL=http://www.PTUPdate.com]www.PTUPdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: hip pain in 17 year old - October 19, 2006 6:27:00 AM
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jma
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From: NY
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A trip to the MD or an orthopedist may help confirm what is going on. Hopefully, not doing any athletic activity right now, right?
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Re: hip pain in 17 year old - October 19, 2006 6:38:00 AM
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Shill
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From: Madison WI USA
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I would not raise any alarms either. Strains happen, and if the acute pain doesnt subside when it should, within a week or two, followed by 2-6 weeks of appropriate reponses to graded activity and rehab, THEN go get it checked out.
Sometimes, because of our training, we jump to worst case scenario, but we shouldnt do this.
_____________________________
Steve Hill PT
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Re: hip pain in 17 year old - October 19, 2006 9:18:00 AM
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gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
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Thanks for all the input. I did do a similar movement to the FABER with him, and that did not bother him. Resisted hip adduction was also fine. That would make it less likely for one of the deep muscles that help with adduction, wouldn't it? I will try palpating the anterior hip capsule.
I go back and forth on waiting versus early physician visit on his injuries. I tend to be a "wait" type of person. But I'm learning that many athletes get things checked out quick so that they can grade their practicing/playing appropriately. Speaking of which, it is difficult to keep him from participating when he is able, even if it is limited participation. He said it felt better Wednesday, but did not have practice. I will see what he does this afternoon, and how he responds to it.
Again, thanks very much for the info. It reminds me I found many areas of PT interesting in school. But having spent all my time in a relatively limited area of practice, I have missed a lot of other stuff.
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Re: hip pain in 17 year old - October 19, 2006 10:20:00 AM
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ptim
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Joined: September 26, 2006
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The loss of passive internal rotation would suggest internal joint derangement.
Try looking at repeated passive hip extension and see if it changes the baseline test movements
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Re: hip pain in 17 year old - October 19, 2006 9:04:00 PM
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PJM
Posts: 25
Joined: October 25, 2005
From: Australia
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Consider L1 radiculopathy. This may account for the discrepancy between hip PROM and Active SLR by your son.
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Re: hip pain in 17 year old - October 20, 2006 12:59:00 PM
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srcase
Posts: 551
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From: Michigan
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Try scouring the hip in flexion, add, IR (add compression). This test in good for ruling out labral tears. Active and resisted SLR causes some anterior glide in the joint and can be painful with labral tears as well.
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Re: hip pain in 17 year old - October 23, 2006 4:32:00 AM
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gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
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Thanks again for all the suggestions. Took him by the orthopedist friday afternoon, just because he wants to participate in b-ball practice as much as possible. X-rays were read as normal, and he diagnosed a hip flexor strain. He said he could participate as tolerated. We went over some gentle stretches for him to do during the day and before any practicing. He is to limit activities in practice that put a strain on the hip flexors.
Internal rotation has improved since the beginning of the week.
Any other suggestions for how to keep him from further injury?
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Re: hip pain in 17 year old - October 26, 2006 10:52:00 PM
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rv36116
Posts: 216
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From: Texas
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Have him prone & perform some passive hip ext to end range... Take some baselines (mmt, rom) & perform a set of 10-12 to end range (yes, it will feel strain/painful), and check the baselines.
A sudden improvement in the baseline and you've got the direction to explore further. Try that direction 5-6 x per day spread out during the day, and come back to checking the baselines often. (easiest one for him to do would probably be simple active hip flx in sitting)
Progression of force (if ext is the direction of preference, if flexion has the sudden results, just flip flop the legs in half kneeling as described) would be to have him in half kneeling (painful leg w/a knee on a pillow, non painful leg up in front) & lunge forward, putting a stretch on the front of the painful leg in a pressure on/off routine. Check baselines again...
Should knock it out in 2-3 days esp. when he's that young.
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Re: hip pain in 17 year old - October 26, 2006 10:54:00 PM
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rv36116
Posts: 216
Joined: August 5, 2006
From: Texas
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And for the love of God, don't stick the kid with the rest/ice routine, that's back in the day of "bed rest" for the sick and elderly, PHSPT...
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Re: hip pain in 17 year old - October 27, 2006 4:07:00 AM
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PHSPT
Posts: 119
Joined: December 1, 2005
From: Oklahoma
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BTW,
No one said bed rest, dude! I said rest meaning refraing from sports for 1-2 weeks. C'mon get with it!
just playing man, :)
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Re: hip pain in 17 year old - October 27, 2006 4:31:00 AM
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rv36116
Posts: 216
Joined: August 5, 2006
From: Texas
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Really? Thanks for the tip, but I work with plenty of Orthopods who send patients specifically because they know we base our treatments on the McKenzie method, so I'd clamp down on that idea of having "no idea"...
Do you seriously think I just do this because I see imaginary results?
Let me know how it turns out gerry.
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Re: hip pain in 17 year old - October 27, 2006 5:09:00 AM
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PHSPT
Posts: 119
Joined: December 1, 2005
From: Oklahoma
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Hey,
My hat is off to the Mckenzie method, i know it works. Im by no means knocking it off, it just seems that you are trying to fit every elephant you enocunter into this tiny frame of Mckenzie.
Any time you limit yourself to any one tech or theory, you are bound to run into a wall, at which point youll have no where else to turn, b/c you have been Mckencized!!
Dont put all your eggs in one basket, open your mind to other well renowned theories. the idea that everything under the sun is deranged, is well.....DERANGED!
;)
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Re: hip pain in 17 year old - October 27, 2006 9:22:00 AM
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proud
Posts: 941
Joined: March 22, 2006
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PHSPT,
I actually feel that the McKenzie approach should be utilized as a primary assessment tool by all clinicians. It is a systematic way of diagnosis which I think is one of our more reliable assessment tools. Reliablity has historically been a weak area within the PT profession. Something that professional credibility often hinges upon is reliability.
I do however imagine that if RobPT has investigated this route, he is more than capable of traditional approaches. Most McKenzie therapists I have met are highly skilled clinically in most facets of PT assessment.
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