This topic contains 2 replies, has 2 voices, and was last updated by Brandon Cohen DC, CSCS September 16, 2019 at 3:18 pm.
August 31, 2019 at 2:26 pm #7918
Brandon Cohen DC, CSCSParticipant
I have 5 cases with similar presentations right now, and it is troubling as I sometimes fancy myself as an expert in these matters.
Sex: M (see, this one’s different)
Location: lateral and anterior hip, lateral thigh to the knee. Left sided lumbar spine (started during 3rd course of PT consisting of a lot of exercises)
Quality: tight, ache, feels swollen (in lateral thigh)
Intensity: Current 2/10, average 3/10, worst 5/10
Provocative: Increased activity, running more than 500 M, going u p stairs, walking more than 2 miles on flat, walking downhill (any distance), hip flexor stretches. Sleeping on the left side or lying supine produces pressure and pain in the anterior left hip. Driving.
Palliative: Rest (has not run over the past year.
Onset: 3 years, started with running
Recreation: currently none, previously up to 30 running miles/week.
Other: known depression, works as freelance photographer, stress 8/10 (Let’s drop this in the fastmap!)
F/S: 100, M: 30, P: 50
SLR: 96%R anterior thigh and leg tension +braggards 91%L post thigh tension +braggard’s
SHF: 100%B anterior hip pinch on the right, no sx on L.
QLF: 70% no sx
KHE: 91%R 100%L mild ant thigh tension.
SLPF: 100% post thigh stretch.
Lunge: B. adduction mild, no sx
TFL stretch: modderately decreased (I don’t have a way to measure other than feel and comparing the opposite side) produced pain in the lower left-sided lumbar spine
TFL strength: weak and pain in the lateral thigh and hip on the left.
IT band at vastus lateralis 2
L. proximal TFL tendon 3
B. lumbar erectors 3
L. SN at SG 1
1. IT band/vastus lateral adhesion
2. hip joint pathology
4. Lumbar disc
Treatment started reasonably, we made some good changes in tissue texture. He had a lumbar disc flare 2 weeks into treatment (good thing I told him about the disc issue in the ROF), so we shifted gears from the hip to the lumbar spine for a while.
He made good progress, running up to 2 miles without pain. Ran 3 miles and everything blew up and reports feeling just like before treatment.
His primary complaint is the lateral hip and thigh. We have ordered MRI to evaluate the hip. This was done pre-FASTMAP, so I’m not sure what the metabolic component might be. Hopefully, we get the MR this or next week depending on the primary.
#helpSeptember 16, 2019 at 10:38 am #7987
Sounds multi-layered to me.
My diagnostic hypothesis would be:
1. Lumbar disc with scl. referral
(+) – location (all locations fit), all provocatives (including lying on side and supine), driving, low back flares, QLF, “extension” based movements (i.e. hip flexor stretching, TFL stretching, walking downhill, KHE symptoms)
2. Hip pathology AND/OR ITB adhesion
(+) – “feels swollen” although this could also just be “inflammation” or possibly Referral?, palpation of ITB, ITB strength
Good job in increasing capacity 400% (500 m to 2 mi)
I would have started with QLF and then ITB and ordered Lumbar mRI. Curious what everyone else says.September 16, 2019 at 3:18 pm #7990
Brandon Cohen DC, CSCSParticipant
I went the other way, started with the hip and ITB, and then QLF. I agree there is a lumbar issue and hip issue.
It seemed more hip related to me, so I started with the hip MRA for a couple of reasons, but a major one is that he now reports pain more in the hip than then side of the thigh. I went back and forth between starting with the hip or the lumbar spine and decided on hip first, but still do not have images in hand.
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