Tag: Hip Pain

Piriformis Syndrome

  • Piriformis syndrome is a common diagnosis for pain in the buttock. It is often attributed to issues related to the sciatic nerve but that’s not really the cause. In more than 80% of cases it has to do with some kind of trauma or repetitive motion not an anatomical difference of the piriformis muscle and sciatic nerve.
  • Chip Review @ (17:35): Yaokin – Mr. Cabbage Taro – “Sauce Flavor” (Hugh Thank you to Steve-O)
  • Trivia question of the week @ (15:12): How much poop does a rhino make in a single defecation?
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Brief overview of the episode:

Piriformis syndrome is the literal pain in your butt. Other symptoms include low back pain, numbness, difficulty walking, pain with sitting/squatting/standing/bowel movements and tenderness. Sometimes this is called deep gluteal syndrome, extra-spinal sciatica or wallet neuritis.

The reason that the piriformis muscle is so famous is because it can have a unique arrangement with the sciatic nerve. There are 6 other muscles in this area that can also play a role and that is why primary piriformis syndrome makes up less than 15% of cases.

Secondary pirifomris syndrome is by far more common. This is usually due to some kind of trauma, muscle holding, gait patterns or other issue further down or up the kinetic chain. That will then present as pain in the buttocks.

Women are affected 6x more than men. This seems to be due to an increased q angle as this impacts the relationship between the quadratus femoris and the OS Coxae.

Most people you experience piriformis syndrome will get better with short-term activity modification and exercises. Surgery is not often recommended even in cases of primary piriformis syndrome.

Other episodes you might enjoy:  

Lumbar Strain: Episode 123

Lateral Shift: Episode 106

Sciatica: Episode 34

Hip Flexor Strain

  • In this episode: Hip Flexor Strains are fairly common. They typically occur with sports that involve kicking, skating or lots of change of direction. They can be traumatic or chronic. Chronic injuries are most common with endurance activities like cycling and running.

  • Chip Review @ (12:30): Private Selection – General Tso’s Chicken

  • Trivia question of the week @ (10:52): In which year was the Tour de France first held?

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Brief overview of the episode:

            Hip flexor strain is a fairly common sports injury. Sports that involve kicking and skating are frequent elicitors as well as endurance sports like cycling and running. The most common symptom is pain in the front of the hip.

            Other symptoms can include pain with hip flexion or extension, weakness and tenderness. The most commonly bothered hip flexors are the iliopsoas and the rectus femoris muscles.

            Recovery time can range from a week to a few months. The severity and cause of injury are big factors. More chronic overuse strains are going to take a little longer on average. Minor sudden injuries will recover more quickly. It is important to limit irritation as much as possible initial and slowly return to the activity in a graded fashion.

Other episodes you might enjoy:  

Stress Fractures: Episode 43

Greater Trochanteric Bursitis: Episode 28

FAI/Hip Labrum: Episode 21

 

Ganz Osteotomy

  • In this episode: Ganz Osteotomy also known as a PAO (peri-acetabular osteotomy) is a type of hip surgery that works to increase the depth of the hip socket. This is usually done as a result of hip dysplasia and is often discovered when an adolescent athlete has torn their hip labrum.

  • Chip Review @ (17:36): Stacy’s Pita Thins – Garlic & Herbs (Thank You Michael Seeb)

  • Trivia question of the week @ (15:38): What is the longest continental mountain range in the world?

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Brief overview of the episode: 

              Ganz osteotomy is a hip sparing procedure that is done to correct hip dysplasia. In our practice it is most often discovered in adolescent athletes that begin to experience hip pain without a known cause. Often the hip pain is from a torn hip labrum and there is usually femoral-acetabular impingement present as well.

            The Ganz procedure, also known as peri-acetabular osteotomy, will move the relative position of the hip socket (acetabulum) so that it better covers the femoral head. This procedure involves separating the socket from the rest of the pelvis, re-orienting it and then using a few screws to hold it in place until the bone heals.

            Often times the Ganz is done in conjunction with femoral osteotomy as well as hip labrum repair/reconstruction. These procedures are sometimes done all during one surgery. Recovery time is upwards of 1 year.                       

 

Other episodes you might enjoy:

Stress Fractures: Episode 43

Stress Fractures: Episode 43

Core/Abdominal Wall: Episode 35

FAI/Hip Labrum: Episode 21

 

Pelvis Fractures: Episode 76

  • In this episode: There are several kinds of pelvis fractures. Most can be broken into two sub-headings, stable and unstable. The mostly commonly treated pelvis fracture at our clinic is an avulsion fracture.

  • Chip Review @ (09:20): Yummies – Zambos –Salsa Verde (Thank You Khem)

  • Trivia question of the week @ (08:04): – Which African nation has the most pyramids?

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Brief overview of the episode:

           The pelvis is made up of 3 bones; sacrum, coccyx and hip bone. The hipbone is made up of 3 bones that are fused; ilium, ischium and pubis. This results in a structure that looks like a ring.
            Because of this ring structure often times a fracture to one area of the pelvis will be accompanied by a 2nd fracture. Causing an unstable fracture that needs to be corrected surgically.
            A stable fracture can also occur. Often times not requiring surgery. The most common of which is known as an avulsion fracture. This is when a tendon/muscle pulls of a piece of the bone. It is most common during the teenage years but can occur throughout the lifespan.
            Unstable fractures of the pelvis are caused by high velocity mechanisms. Motor-vehicle accidents, falls from height or crush injuries. Avulsions typically occur as sports injuries, overuse, or slips and falls.
            Recovery times vary greatly. Typically stable fracture can heal between 6-8 weeks. Unstable fracture can take a good deal longer 10+ weeks because surgery is almost always necessary. Also due to the high velocity nature of unstable fractures there are usually additional injuries sustained beyond the fracture(s).

 

Other episodes you might enjoy:

Iliotibial Band Syndrome (ITBS): Episode 9

Stress Fractures: Episode 43

Shoulder Pain: Episode 4

 

Joint Replacement: Episode 33

  • In this episode we discuss joint replacement broadly. We cover the 3 primary joints that get replaced, Shoulder, Hip & Knee. Then touch on some of the lesser-known joints.

  • Chip Review: Paqui – Haunted Ghost Pepper compliments of Becky & Dustin

  • Trivia question of the week: Which city was the first to reach 1 million inhabitants?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

Today we are discussing joint replacement. The large version, all versions. All joint replacements. Covering them as a whole. And reviewing the Paqui Haunted Ghost Pepper chips compliments of Becky and Dustin. Thank you Becky and Dustin for trying to kill us. The bag says “Freakin’ Hot” on it so… Actually right now they are melting through the tissue we put them on. I’m not kidding. They are really red.

 

Hey we had fun in Chicago. We did. For those of you who listened to last week’s episode, we realize that the quality was not all that good. But boy was it fun. Now we are back in our friendly confines.

 

Joint replacement, there are 3 main types. Shoulder, hip and knee. Those are all the same type just at three different joints. Yeah, yeah, yeah, those are the main ones. Correct. There are some, elbow, ankle relatively new, toe, finger, thumb have been around for a long time. They don’t really fit the… They are not common. The stuff we are going to be talking about.

 

I’ve seen a couple ankles, they are different. Tend not to do very well. They are still in the experimental phase I think. Plus it’s an alternative to fusing the ankle. So I guess it all depends on how you define function. Do I want my ankle fused or do I want to see if the ankle replacement will give me some relief.

 

Shoulder, probably the most uncomfortable of the group. Huh? When you have the shoulder replacement. I think the knee is more uncomfortable. People with knee joint replacements complain all the time of pain. I think the knee is hardest. I think having your shoulder replaced, up by your head, trying to sleep, all that throbbing early on, it gets better sooner. Most of these people can’t lie down, they sleep in a chair, they sleep in a reclined position. Which is advisable at first. They are all uncomfortable.

 

Hip is the easiest. By far and this is not based on our experience this is based on our clients experience. Over the course of the last 30 years hip replacement is by far the easiest. People recovery really well, really quick. Regardless of the approaches.

 

For additional episode recommendations check out:

Knee Pain: Episode 2

Shoulder Pain: Episode 4

Hip Pain: Episode 15

Sacroiliac Joint Dysfunction: Episode 27

  • Sacroiliac joint dysfunction is controversial. The joint itself is not really mobile and therefore does not act like other joints.

  • Today’s Chips: Tim’s Cascade Snacks – Hawaiian Ginger Wasabi. Thank you Steve Kovisto!

  • Trivia question of the week: What American city is considered the birthplace of the potato chip?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

 

 

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Today we are going to be covering SI Joint dysfunction. Oh that is a controversial topic. And we are going to be reviewing Tim’s Hawaiian Ginger Wasabi compliments of Steve Kovisto. Why did you say Steve’s. Not Tim’s. It’s the brand name, the brand name is Tim’s. No it’s Hawaiian. No it’s Tim’s. Ok, That does not make any sense. You are right that does not make any sense. They are special. Ok. Looking forward to it. SI joint dysfunction.

 

What is your take on it Christiaan? The SI joint is a pseudo-joint. It’s kind of misnamed isn’t it? It’s very misnamed, it’s where several bones come together. Yeah but It’s not like any other joint in the body that is a nice smooth congruent surface that is designed for movement. That’s true. The SI joint was designed for a lot of things but movement was not one of them.

 

The articular surfaces, if you even want to call them that, are basically course and have ridges and depressions. They are almost like 2 interlocking ridges. If you were designing that for movement you would do a bad job. I almost said a bad word. The best way to think of it is to take your knuckles and stick them together. That is kind of what they look like. Yup, which would provide a ton of stability. Yes, That is what we are looking for. Mobility not Stability.

 

The joint itself has about total of 3 degrees or less of translation which accounts to about 2mm or less of movement. That is not a lot. If you know millimeters that is less then a 1/32 of an inch.

FAI/Hip Labrum: Episode 21

  • FAI (Femoral Acetabular Impingement) is becoming a common diagnosis. This is a bony change that causes the hip labrum to tear and fray. Both cause pain and loss of sport ability.
  • We review Kettle Brand Spicy Queso Potato Chips, compliments of Judy Kay.
  • Trivia question of the week: The Bullfinch Pub in Boston is better known by what name?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.
  • Thanks for listening!!

 

Today we are going to be covering hip labrum pain, hip labrum tears, hip labrum reconstruction, femoral acetabular impingement (FAI), which all full under the same heading. Then we are going to be reviewing Kettle Brand Spicy Queso Chips, compliments of Ms. Judy Kay.  Thank you Mrs. Kay.

 

So we are going to start with labrum tears. So the labrum sits around the outside of your hip joint. It helps to deepen the joint; it helps improve stability around there. It is also chock full of pain fibers. It is kind of like a gasket. I learned that from Dr. Parker. You learned gaskets from Dr. Parker?

 

When you have irritation to that you will feel pinching, you will feel pain.  Most of the time pain with either be in the front of your hip or into your groin.

Very common with people who are super flexible or single limb athletes as we call them if you do a lot of j ump, pushing off or landing on one leg. This is a pretty common injury. Although I think it is often, and this is speculation on my part, miss diagnosed. I has become one of those fade diagnosis. Everyone with anterior hip pain, now all of a sudden has FAI.

 

A lot of that has to do with the fact that there is now a surgery for it. The surgery is relatively routine. That has only been in the last 10 years. I remember treating a your lady 20 years ago. For hip impingement and there was not really any surgery at the time that could be done for it other then a complicated open procedure or a potential joint replacement. Neither one of those was a valiant option at the time. So we treated it conservatively and low and behold it got better.

 

We definitely see that a fair amount where you have a small tear and not need surgery. Even if you get diagnosed with a labrum tear, see it on imaging. If it is small enough you can treat it by stabilizing the joint. Treating it with physical therapy working on strength, balance, stability and range of motion.

Hip Pain: Episode 15

Hip pain has many causes that change throughout the life span. Hip pain in a teenager often has a totally different cause then hip pain in middle age or as a senior citizen.

  • In honor of Halloween we are reviewing: Zapp’s Voodoo potato Chips
  • Trivia question of the week: What is the northern most point of the British Empire?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to get additional information related to hip pain throughout the week.

Today we are discussing hip pain, fairly broadly. Talking about some of the common diagnosis we see there. And we are going to do a nice review of Zapp’s Voodoo potato chips. Sounds Yummy. I’m pretty excited. Who brought these in? You did? Yeah I did. Yeah Yeah, I got these. I’ve had them before they are delicious and tasty.

 

Most hip pain that we see is going to fall under two categories. Does it cause groin pain? Or does it cause outside of the hip pain? So those two areas have pretty different causes. Yes. Outside of the hip is going to be much more common with bursitis, muscle strain, perhaps physical trauma some kind of bruising. We tend to see it a lot when people have a limp and they start counter balancing or changing the way they walk. It’s called Trendelenburg (https://www.physio-pedia.com/Trendelenburg_Gait). Nice, you get this overuse irritation on the outside of the hip and that could be tendonitis or bursitis or a variety of tendons.

 

A lot of that is treated similarly in terms of physical, manual therapy to the outside of the hip. Modalities to the outside of the hip. Working on, above all things again, glut med strength and external rotator group strength and that is going to cover most of your hip pain that you feel on the outside of your hip. IT band is another big one.

 

We also have groin pain. Groin pain is much more indicative of joint wear and tear. So that is going to be osteoarthritis changes in there. Or we are going to see something of the soft tissue pathology in there. So FAI, which is femoral acetabular impingement. That is a topic that is going to need it’s own show to fully cover. But to kind of briefly cover.

 

It’s one of those diagnoses that has kind of become very popular lately since they have been able to treat it with a scope now. So it is actually a surgical problem. 20 years ago if somebody had a hip impingement problem, you just kind of rode it out until you could get a hip replacement. Now it is something that is treatable. FAI femoral acetabular impingement syndrome is something we see a lot in single limb athletes. Athletes who tend to land or jump off of one leg; dancers, cheerleaders, volleyball players. Like Christiaan said it’s a topic that will require a session of its own because there are so many different ways to diagnose and treat conservatively.

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