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Hard questions: Mommy, where does hip pain come from?

Sara Shupe, MSPT, Dip. MDT is a physical therapist specialist and founder of J.O.Y. Physical Therapy Inc, a mobile and tele-health physical therapy provider servicing the Twin Cities Metro Area, greater Minnesota and WIsconsin. Sara has presented early access models of mechanical diagnosis and therapy (MDT) in the treatment of low back pain to the American Physical Therapy Association (APTA), National Association of Spine Society (NASS) and The International MDT Conference in MIami, FL. Sara lives in Eagan, MN with her 14 year old son and Dox Mix puppy.

We are too “nice” in MN to distinguish the area between the back and leg, but…(excuse the pun!)...does it hurt when you try to get out of a chair? Get on your sock and shoe in the morning? Let’s call it “hip pain” for lack of acceptable Midwestern descriptions. The likely next step in the medical pathway is to get prescribed a NSAID (non-steroidal anti-inflammatory drug), icing, and relative rest from bothersome activities. If you were so fortunate (or maybe not so fortunate when you get your bill!) to see someone in orthopedics you likely received an X-ray of your perfectly normal hip, been told you have “arthritis” and received a steroid shot into your hip. 

Steroid-Land. Everything feels right in the world again.

Until the pain comes back within hours or days.

So what’s the real problem?

Here are some of the issues listed by May and Rosedale in Physical Therapy: “poor criteria for present diagnostic labels, the questionable reliability of most orthopedic tests, and the questionable validity of commonly used orthopedic tests to identify the patho-anatomical structures they are meant to identify.” So how do we know where the problem comes from if these tests (i.e. Xrays) don’t tell us? 

An article by our colleagues Maccio et al published in the December 2018 volume of The Journal of Manual & Manipulative Therapy (JMMT) found that “a high occurrence of peripheral pain in conditions that resolved fully with spinal treatment.” In their data after pooling all pain in the arms and legs together, it was 45.9% 

“It is unsettling and concerning to report this statistic as inaccurate identification of the source of pain generation could lead to an abundance of inappropriate diagnostic tests, as well as interventions (physical, chemical and surgical) directed to the wrong structure. An orthopedic specialist was the highest source of peripheral medical diagnosis in this sample of which 71% were found to be of spinal origin.”

When the back meets the leg.

While we don’t understand the exact bio-physiological mechanism that causes pain in this area of your hip, what now know the importance of ruling out your back as the source is well known in the literature. Using a specialized form of evaluation and treatment called Mechanical Diagnosis and Therapy (MDT) to first rule out the back before performing treatments on the hip reduces the over-medicalization off treatment in the latter joint. In other words- don’t pay for a shot you don’t need!

If you have read our blog for any period of time, you know there is always Good News!

You can eliminate your hip pain by finding an MDT Provider near you at www.mckenzieinstituteusa.org or set up your mobile or telehealth evaluation today at J.O.Y. Physical Therapy Inc. today! Call 651-800-MYPT (6978) or email [email protected] or make your appointment at www.joy-pt.com

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