One of the more common problems we see at Doroski Chiropractic Neurology in the Woodbridge, Lake Ridge, Dale City Virginia area is hip joint pain. Hip area pain is widely misused. People call hip pain anything from the actual hip joint socket to the lower back area. I have to say even chiropractors are guilty of telling a few patients your hip is up or out in reference to the SI joint. Dr John Acquavella, DC gave a great article in ACA Today on hip joint misdiagnosis.
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.
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.
Doroski Chiropractic Neurology
3122 Golansky Blvd, Ste 102
Woodbridge VA 22192
703 730 9588