After this past weekend activities, my left hip hurts when I run she said
How are things doing today I asked? She responded, not so good today. I went biking with my husband and then went out for a long 3 mile walk when the left hip began to get real sore again, you know; where that bump is. Are you sure it is not just the buildup of calcium like another doctor suggested she asked. I assured her that there was more to this than what she thought, because the calcium buildup was a symptom, rather than the problem. She was distressed because there was marked improvement of her condition over the past month, and she suffered with it for six months now. It prevented her from running with her husband and she wanted so desperately to do the half marathon with him a few weeks from now.
Realizing her distress, and since she was my last patient in the Scotch Plains office, I said she was not leaving until we tested this out thoroughly and vastly improved the current situation. Initially, she had difficulty getting up from a deep knee bend. She would lose her balance as she went down, and her right hip noticeably dropped back, causing the loss of balance.
On the table, I noticed her left calf was tight and bound up behind the knee and the firing pattern in the right hip was poor, showing poorly coordinated of movement, and she tightened her stomach when trying to push against me. Working on the calf and the tightened abs as well as the right hip flexors improved the firing pattern. I retested her deep knee bend. She was more capable but still had poor balance.
Back onto the table again, I checked her for other muscular problems and had her rotate seated against my resistance. She had marked difficulty on the right which typically indicates right shoulder or upper body coordination issues. I worked on the shoulder muscles and her lats and retested this, seeing improved coordination of movement. I then had her deep knee bend slowly again. There was a marked improvement in stability and the left hip pain was reduced to mild soreness.
She then got on my treadmill and took it up to 5 (about 10:30 minute mile). This is a slow pace for a woman who was about 5’6″ and she looked like she had some problems keeping up with the treadmill. I always look not only for stride in the lower body but also for upper body movement as well. Both seemed not to open up but she had a symmetrical gait. She reported no pain while running at this speed which was great, since she was unable to run due to the left hip pain.
Again, on the table I tried to troubleshoot, looking for something that would shorten her stride and cause a breakdown in the gait mechanism. While on her stomach, I lifted her left hip into extension and noticed a marked restriction while the right side was quite unrestricted. After working on the hip flexors on the left, while on her stomach again, I could now extend her hip fully, now noticing the other side was restricted in comparison. I did the same on the other side until I was satisfied that both sides were open.
Back on the treadmill again, she took the speed up to the same level but something markedly changed. There was a noticeable improvement in the way she swung her arms and her stride opened up. She also looked more comfortable. She said that after having these areas worked on, the treadmill was less work and that she was no longer fighting to keep up with it.
What can we learn from her experience, and what did I learn as her health care provider?
1. Sometimes, it takes more than a 10 minute visit one on one to figure out why an area hurts.
2. The area of pain quite often is the symptom, not the problem. In no part of this story, did I work the area of pain which was her hip.
3. Treadmills are quite helpful in diagnosing a gait issue.
4. Figuring this out is by the process of treat and test and treat and test, using the process of elimination. Treating a problem that is poorly understood will yield poor results. The process of treat, test and treat again will tell both me and the patient if we applied treatment to the right area.
5. The paradigm for treatment under the current insurance systems does not economically allow doctors to spend adequate time, in many cases to figure out mechanical problems like these. As a result, the doctor must be motivated to do this for the sole benefit of the seeing the person improve. I do this because I love to see people overcome obstacles.
What do you think? As always, I value your opinion. Email questions directly to firstname.lastname@example.org