After teaching all day and 3 hours in a car, he had severe right hip pain that was in the groin. He’d had a similar pain in the past, but it would pass in a few minutes. This time he was limping, and it’d been several days without any letup, so he reached out to me via Facebook.
Problem/Examination
Any time he would attempt to stand after sitting for a while, his pain would be so bad that it would cause him to limp. Walking on it was painful, but jogging on it, interestingly enough wasn’t a problem. Standing didn’t seem to make it better or worse.
Pain with flexion-adduction-internal rotation (also called the FADIR test) suggested that he had a femoroacetabular impingement (FAI) a condition where part of the thigh bone near the hip pinches or abutts on the cartilage and bone surrounding the socket. Weakness and stiffness around the hip was suggestive that this had been going on for quite some time.
FAI has seemed to mushroom out of the woodwork since the early 2000s, and frequently results in arthoroscopic surgery of the hip to either trim, smooth, or repair a ring of cartilage in the hip called a labrum, and to remove some bone along the neck of the femur, leading to the hip joint, to alleviate the symptoms.
When I say this problem has mushroomed out since the early 2000s, I mean that the problem was almost unknown at the start of the century. As always, though, when imaging and surgical techniques improve, a “new” problem because the favorite thing to operate on. After all, there are findings on MRI, and pain, so what else is there to do?
Treatment
Over the past 15 years, scientists have also discovered that many, many “normal” pain-free people have the telltale signs of FAI on MRI. This suggests that although FAI is a problem that may require surgery in some cases, the vast majority of the time, this problem is treated successfully in physical therapy. The first step is to avoid the activity (temporarily) that is bringing on symptoms. In most cases, it’s sitting. Then the problem can be addressed directly by manual therapy (hands-on joint mobilization, manipulation, or stretching) to impart a quick gain in flexibility, followed by stretches and pain-free strengthening exercises to restore normal mechanics.
Outcome
Being some distance from my clinic and on the road extensively, this was treated “from a distance” with a structured home program, and just one in-clinic visit. He has no symptoms a week later, and has instructions for specific activities he can add to his regular workout routine to avoid problems in the future. He can also call back or stop in any time in the next year for help, without visiting his physician.
