Sara Shupe, MSPT, Dip.MDT is a physical therapist specialist that has been practicing for almost 2 decades in the Twin Cities Metro Area of Minnesota. Sara is the Founder of J.O.Y. Physical Therapy Inc. which provides high-value, convenient mobile and telehealth PT to Minnesota and Wisconsin. Sara’s work on early access to specialized physical therapy in the treatment of low back pain won an innovation award and has been presented at the National Association of Spine Society in CA and Idaho, the MDT Conference of the Americas, and The American Physical Therapy Association of MN. Sara lives in Eagan with her teenage son, and Dox mix puppy.
One of the most beautiful things about Minnesota is the fall landscape. What beauty! The array of colors come just in time for reduced humidity and the major migration of the state bird- the mosquito! Looking forward to some hiking? Or troubled by pain on the outer side of your leg or groin? 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 middle-aged hip and been told you have “arthritis."
For all of us fluent in Latin, that translates into "swelling of the joint," and is a too-often-used-bucket term for decreased space between the two bones that make up your hip joint. The problem is that decreased space is expected with age (100% of spines after 60 years of age are "degenerated"), and has NO indications of pathology (another translation for the non-scientific reader: "problems that require medical intervention") or indications of how to treat it.
None. Nada. Nil. Nine.
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 (JMMT 2019).” 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%. If you ONLY looked at the hip, the number rose to 71%.
“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.”
The Answer: The Spine.
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 (another translation: using medical intervention for something that can be self-healed) of treatment in the latter joint. In other words- don’t pay for an X-ray you don’t need!
enJ.O.Y. the colors of fall without hip pain!
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 https://pms.therapysites.com/providers/54999/request