Hip pain in a runner, a specialist journey, and a simple solution by his chiropractor.
The other day, a patient whom we saw last year for some problems from running began to have groin pain, leg pain, and mid-back stiffness. He had been running non-stop and his problems began after completing the Philadelphia Marathon last year. His symptoms gradually worsened as he tried to begin training for a major event this fall. He is the type of competitive runner who is used to pushing through discomfort, which often is how many injuries occur in these types of athletes. Having treated thousands of runners, this is a common mindset.
He visited his primary doctor thinking his groin soreness may have been due to a sports hernia, which has been in the literature lately but is quite rare. His primary doctor who is unfamiliar with runners did not see a hernia but suggested he see an orthopedist, who wanted to begin ruling out things such as labral tears of the hip (MRI), tendonosis in the hip and wanted to send him for physical rehabilitation with a number of sessions.
The patient elected to visit us before having any tests, MRI’s or any rehabilitation first, based on his experience in the past with his own and his wife’s previous running issues.
On his initial evaluation, his pelvis was torqued (a common finding with runners who are built asymmetrically where the pelvis is distorted by the surrounding muscle) and his upper body was torqued the opposite way (a common compensation). Often this results from under striding on one side (usually due to overpronation of the foot) and then under striding on the opposite side (tightening of the lateral fascia of the leg and the hip flexors). This is a common cause of knee pain, plantar fasciitis, muscular pulls, and shoulder, and neck pain. The more the pelvis distorts, the more back pain, sacroiliac symptoms and the slower they will run since their core is now compromised.
As a clinician, it is important that we look at the mechanics of the problem first, the symptoms second and then after looking at all the clinical data from a functional evaluation, determine why the patient is having the problem and then use our professional training to help solve the problem.
What most doctors and therapists have learned is to evaluate the symptomatic part, rather than the mechanism behind the symptom. A good example of this is knee pain, which is most often caused by foot, hip, and core issues. Looking at the knee and order tests such as a knee MRI is often not helpful in resolving the problem cost-effectively because the knee is just a conduit of forces, with the kneecap being the fulcrum. We all can solve more knee problems by looking at feet, calves and hip flexor, and core stability issues first and then the knee last, using our understanding of the fascia and the musculoskeletal system to resolve the mechanisms involved. Since these are mechanical problems, they require mechanically based solutions such as chiropractic manipulation and fascial release of some sort to reliably restore the gait mechanisms that are causing the joint-based symptoms.
The patient improved markedly after his first visit the other day, with markedly reduced groin pain, abdominal soreness, and a markedly improved ability to run without pain at a faster than average pace. He will likely require 3-4 visits to resolve the episode.
Which are the best specialists for musculoskeletal problems to help a runner with hip pain?
As a sports chiropractors, we are primary conservative care for musculoskeletal conditions, an area which most primary care physicians are not as comfortable with, which is why these conditions are typically referred to specialists. Many of your patients can avoid going from test to test and doctor to doctor by sending to a primary spine physician such as a sports chiropractor first. There is a huge value to looking at the patient holistically, and then adding up the evidence to find the most effective way to treat and resolve the patient’s problem.
We also offer the unique service of treadmill evaluations to evaluate runners and their problems. There is nothing like having a video of a runner who is not responding to a particular treatment to figure out why. Often, they have developed bad habits such as hunching shoulders that can be diagnosed, and then the video can be used to instruct them on proper form. Sometimes, treatment alone cannot solve these problems, and having this type of technology available is a benefit to many runners.
Solving mechanical problems is what we do. Think of us as a primary spine provider, one who is primary care for your musculoskeletal system. We are body mechanics plain and simple that have nonsurgical and drug-free solutions. The benefit of course is that we have to resolve your problem naturally, by restoring symmetry and normal mechanical patterns in a way that surgery and medications cannot do.
Everyone wants their problems solved quickly, however, if the wrong approach is used, the results are often ineffective care, pain, frustration and of course, a huge expense. In this day of high deductible plans, who you visit first will make all the difference. In today’s health care environment, it’s your money and you need to spend it wisely. Often, people are scared of visiting a type of healthcare practitioner they are not familiar with, similar to the first time I visited a periodontist. The good news was that he helped me save two teeth on both sides of my mouth. A chiropractic physician can do so much more for what ails you because they look at you, not just your parts. Since we are the sum of our parts which are supposed to work in a functional coordination fashion, when they do not, pain and injury is often the result.
If you are concerned that a problem will be life-threatening (they rarely are), the chiropractic physician is trained to refer you to someone who can. On the other hand, seeing the wrong specialist first will often be an expensive and frustrating journey. Call us today to discuss your problem. Click here to book online.