Groin and front-of-hip pain: possible diagnoses and treatments

And it's really just finding ways and teaching yourself ways to just kind of maneuver around those provocative positions when it comes to FAI. So like you said, if it just means bringing our knees out a little bit wider to help prevent that impinging sensation, then that's a pretty easy win in my opinion. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey everyone, I'm Dr. Sebastian Gonzales, your host for the Restoring Human Movement podcast.

Thanks for joining the Movement Movement. This is your first time, welcome. You are way behind and you should go back to a bunch of the other episodes we have in the archives. This podcast's intention is to improve our ability to get our patients to feel better. So it's primarily targeted healthcare professionals, movement professionals, who are working with people. And hopefully the people are willing to listen to the podcast too. So we try to keep this very general communication, make sure that it's topics and wording that everybody can understand. Because we know in healthcare we have a different type of language.

And it's not really fair for everyone to be able to understand each other unless we really break things down. So we try to make things fairly simple. As you're going to see in the podcast today, we're going to cover a topic called hip impingement or groin pain. Actually, we're going to cover it as groin pain because there's many different reasons for you to have that. So it's a very common thing people have and experience. And this is going to be a very friendly one for patients. So healthcare providers, if you feel like this is useful information, please share this with your patients. Now, as we go through every podcast, it's either going to be a 45-minute to an hour-long format where it's either me talking or, in this case, you hear that there's somebody else.

This is Dawne Costantino. She's a colleague of mine. She's going to be on. We're going to talk about it together and just kind of just generally discuss a lot of things that people ask about groin pain. So first as well, before we start into there, I like to share a little bit about myself just so you guys can get to know who I am as a host. And hopefully follow me along this journey that is the podcast. We're approaching 200 episodes. So it's been a long time, and I believe that people only really follow shows if they like the host. So enjoy that, and we will get right into the content about groin pain.

Now, I'm sure this is retelling a story, but in light of what the date is, it's July 1st. We are actually very close to the worst day in the calendar year, which is July 5th. July 5th is the worst day because you're exactly 365 days away from the best day in the calendar, which is July 4th. And the way this typically goes is usually as you start to ramp up when we get into the first of the year, or at least that we usually do around my parts. So when you get into actually New Year's, you can actually start getting excited when you say July. So you get more excited. You get towards February, March, you say July.

And you get up into around June, and you say July. And then you get up into July 4th, which is the best day of the whole damn year. So remember, I call it Freedom Day. I call it Freedom Day because you can do literally whatever you want. Obviously, you can't encroach on other people's freedoms, but it's an expression of freedom. So hopefully everybody has a good July 4th, and you stay safe. Make sure that fireworks, by the way, such a—I think we should disband the fireworks whole thing, by the way. It scares dogs. I like dogs. It scares dogs. But also, too, I mean, I almost got my foot blown off a couple years ago.

Not that I lit the firework, but someone else wasn't paying attention. So be safe with the fireworks, and enjoy the best day of the entire year. Nobody has to work the next day. Nobody has to work that day. By the way, any retailer shop that is open, you should not go in there because you should almost be protesting that they're making somebody work on the best day, which is July 4th. So let's get into the content. All right. Here we go. So this is Dawne Costantino and myself. Is that right? Did I say it right? Yes, you did it. Yeah, that was—that's the best one you've done yet. I think maybe those podcasts are helping out with that.

So, okay, so we're going to talk about hip impingement. Actually, sorry, let's take that back. We're going to talk about groin pain today, like pain in the crease of the hip. Got it. Yeah. Don't worry. Let's do it. I've already introduced everything. So, yeah, this is just a section in the middle. You're waiting for me to say something, like, intriguing? I was. Yeah, I was. No, I got nothing. So, yeah, so feel free to volley these again, like all the other times I've already introduced who you are and stuff like that. So, yeah, groin pain. What's your experience with people with groin pain? And maybe why is that different than buttocks pain?

Why is it different than buttocks pain? Yeah, because I think, I guess when I'm talking about hip, like, if you say hip pain, people think sometimes either or, and they're kind of different, you know? Yeah, it's really important for us to ask people, you know, where are you talking about when you're talking about your hip? There's so many times where people come in and they're like, yeah, my hip hurts, and then they point to their butt or they point to their, like, outer thigh or they point to the actual crease, which is what we're going to talk about today. So, it's pretty important to try to figure out what exactly they're calling their hip so that we know what's going on there.

But for our purposes today, we're more talking about the front of the hip, the part, you know, if you were to go below the belly button a little bit to the right or left, like that front, front part of the hip where the hip crease is, is kind of where we're focusing on. Okay. Go ahead. Keep going. You're good at this. Oh. I'm sorry. I'm going to let you lead this one if you want. Okay. So, I think a lot, well, let's talk about maybe some of the things that we need to consider when we're talking about the front of the hip pain. So, people are coming in and they have these ideas that maybe it's their labrum or it's their hip flexor or I don't know what other kind of things they come in with.

But a lot of times it's labrum or hip flexor that they think is causing the issue and they want help with that stuff. And so, it's important to differentiate with examination and whatnot what exactly could be causing it. So, let's kind of start with, let's start with hip flexor. Okay. The hip flexor. That's a good one. So, why don't then, I'll play Dr. Google on this side then and see what Dr. Google says about hip flexor. Let's call it a syndrome. I like that you call it Dr. Google. It's so funny that you call it that. So, Dr. Google says, sudden sharp hip or sudden sharp pain in the hip or pelvis after trauma to the area.

Interesting. I think they'd say after trauma. A cramping or clenching sensation in the muscles of the upper leg area. The upper leg feeling tender and sore, loss of strength in the front of the groin along with a tugging sensation, and muscle spasms of the hip or thighs. What do you think about those? You still there? Oh, sorry. I thought, yeah, I thought you froze. No, we're good. Okay. Oh, I got more in there. Actually, I see there's more now. Inability to kick, jump, or sprint. Reduce mobility or discomfort when moving, including limb discomfort and pain in the upper leg area, which feels constant, swelling or bruising around the hip or thigh, tenderness and stiffness after being sedentary, such as after sleep.

Okay, that's all I got. Do you want to comment on any of those ones? Yeah. I mean, I think some of the things that we keep noticing is we like to go through certain symptoms that people will complain of for different issues, right? And a lot of times it's like, oh, well, these symptoms here, like, oh, constant pain in that upper area, pain with running, pain first thing in the morning. Like, there's symptoms that are common in a lot of different diagnoses, whether it be a referral pain from the low back, whether it be an actual hip flexor issue. But I think one of the things you mentioned in there is swelling or bruising and things of that sort.

So that's one of the things that we like to try to look for when we are trying to rule in or out, it actually being an actual soft tissue issue. So I don't know. How many actual hip flexor people have you seen? No, I haven't seen really many. I've seen swelling in there. But I do think swelling is partially in relationship to other things, too, where I know that someone did have swelling in that area and they end up having an actual hernia, like, you know, one with the abdominal contents. But it didn't hurt when they raised their leg, actually, I don't think in particular. But you don't find many people who actually have a quote-unquote tear there.

And their MRIs are typically normal. Their x-rays are fairly normal. But they keep searching and looking for that tear or that scar tissue or that adhesion. And they're not going to see it if they keep trying to look for an image because I know that at least from the general classifications of actual muscle injuries is there's, I think that the estimation was based upon one of the consensus statements was 70% of the things that we see are strains. There's other ones which could be part, like, partial tears or full tears, which would also have positive MRI imaging. But if you don't have positive imaging and it's still like, oh, maybe we're looking for this unicorn, you're probably in the 70% bracket, which actually includes not only quote-unquote strains, what you guys might think is strange, but also neurological tension.

Also, things like DOMS or delayed onset muscle soreness is in that same category. And it's interesting nobody freaks out about DOMS because they know it goes away in a couple of days. So there's a lot of things in that strain category. But if you don't see a positive image, there's actually, you're in luck because you can probably improve where you feel very quickly. Yeah, absolutely. I mean, even if it's a, say it's a true strain or something of that sort, or even just overuse to the tendon or just delayed onset muscle soreness, are we going to change really our treatment approach all that much?

I think if it's a true tear, we might do it like a slower approach, but we're probably still going to do some of the similar exercises that we're going to do, whether it be a true tear or not. Yeah? Yeah, I think so. I mean, like, well, I think we should regress back. If it's actually like a grade two tear or grade three tear is a detachment, we need to make that surgical. Grade two tear, like they self-resolve, but it takes a little bit more time. It's like 21 days is like where the crossbridge forms a little bit. So we have to monitor that time period a little bit more. But no, generally, it's just a little bit of a different starting point, but it doesn't really change.

Like at some point you're going to squat again, you know, in your program, it doesn't really change that. It just might, it might shift it around a little bit in regards to timeline. Yeah, absolutely. My brain's not working very well. Well, I think the one, the one that, the one that I'm looking at on the symptom list is the tugging sensation. Cause I have had a lot of people come in with, they're talking about hip flexor. They're like, oh, I know it's that because they, cause they feel that tugging. And it said, I'm Dr. Google that tugging is a thing. Um, and I think they coordinate like, okay, it, there's a muscle there.

The muscle feels like it's tugging and it's in the area of pain of that muscle. So yeah, this is, this is that, um, do you have any, have you, have you had an experience with people mentioning that tugging or like the, um, clenching type of feeling? I know dancers talk about that, uh, hip flexor gripping. I think they call it. I mean, I think it's just another way of saying just like tightness in that general area, right? Like sometimes when you're sitting around, sitting down for long periods of time, you get up and you feel just tight in that area from you being in that position for so long.

And then you get that like tugging sensation. I think it's just an AKA tight. Would you agree? Yeah. I, you know, I don't, I'm trying to, so I did have, I had groin pain twice, but one of them was actually, I remember I was thinking about it this morning cause I knew we're going to talk about this. And, um, the groin, I remember which side it was because I had to actually sit on a certain side of the booth and the restaurant we were at because it hurts so much to sit on the other side. I did like get my leg to dangle off and kind of go backwards. And it was like, it wasn't a feeling of tightness for me.

It was kind of like, I think clenching would be fair. It's like a cramp that just won't stop, you know, and you try to get away from it and it just, you just don't like, it just doesn't go away. You stand up and walk a little bit. Finally, it goes away. But when you sit, it starts to creep on you. So I guess that would be my, um, interpretation of the clenching and tugging sensation. Cause feeling a tightness is like, I just can't move versus like clenching is like, okay, it's a spasm. They just won't stop, you know? Yeah, absolutely. I mean, when I think of things like that though, I don't necessarily, this is how my brain works.

I don't necessarily think about it being that actual muscle is the issue though. Like clenching and tightening and spasming and things of that sort usually are like a, either a protective mechanism or the nerve that's supplying that specific muscle that you're feeling that tugging sensation on is usually irritated. And it's just referring into that area. Um, and so a lot of times these people, there's this idea that like, okay, sitting for too long. Well, my hips are in a flex position for a long period of time. And, and that's the reason why it hurts there. Well, we also have to take into consideration what else is going on while we're sitting.

We're probably sitting in really poopy rounded postures for a long time too, which drives irritation to the low back. And so irritation in the low back area to the nerves to that area can just refer around to that hip and whatnot. Mm hmm. Okay. So what is, what's maybe something that would, would help those kinds of people with that nerve referred, by the way, I like the poopy posture. Very, very, very telling. Poopy posture. I've been trying to be better about my curse words lately. I think I've been doing a really good job. You sound, you sound just like a kindergarten teacher now. Like a poopy posture.

Yeah. Sometimes I feel weird when I use language like that with patients who are older than me too. It's just like, okay, now round into a really poopy posture. Sounds funny. Um, what can we say? What was your question? What can we say for those people who that's what they're experiencing? Yeah. Cause some people, you know, the listeners might think, well, so she mentioned, maybe I am sitting in poopy posture and it hurts. So like, what is something that I can do to like, like what's an easy win, you know? Well, an easy win is don't sit for long periods of time. That's the first start. So I think just sitting, it's funny because these.

I'll look for it. I just, no one else can see like the camera, but like, so you're like this, you're just to the side and all of a sudden I ask a question. You're like, like straight up on the camera. Then don't sit so long. Yeah. Guys, a lot of this giggling, a lot of this giggling that's going on is just because we can see each other. And it's, it's, it's funny. Um, so one easy win don't sit for long periods of time. I mean, if you're noticing that your pain is coming with sitting for too long, I always recommend to people just put a timer on your phone. If you're working and you're sitting and things of that sort every hour or so, if you could do less than an hour, that'd be great.

But every hour or so they'll have a little alarm that goes off as you get up and just stand up. Kind of, if you're sitting in a flexed position or a rounded position or poopy posture, just go into the opposite motion, give yourself a little extension in that low back, kind of stretch out the front of the hip there. And you'll notice a huge change with just that. That's the first, first win. Good. So just doing the opposite for a little bit. Yeah. And just go opposite for a little while. Sometimes, I mean, that's one thing that we notice is we use press-ups a lot in the office and with people with this pain.

Cause if rounding is driving their symptoms to the front of the hip, just going in that opposite motion sometimes is a super easy win too. Yeah. You know, I think we should do is we should, we should go, you ever go on YouTube and you look up a physical therapist and you see Bob and Brad, you've seen Bob and Brad yet? No. Oh, you should go on, you go on YouTube and look, just look up any old thing like hip impingement and all of a sudden Bob and Brad, like 5.2 million views. There's just these, there's older PT couple that they just go through and they just BS things for 20 minutes on there and they actually have good information, but, uh, I think we could do that.

We'll just be the younger version. It basically just like, uh, it's just a podcast version and then so showing stuff and showing exercises. It'd be great. Actually share our podcast videos. Yeah. We'll do that on podcasts. It's not just audio. Sometimes I'll actually do the video too. You know, I don't get when they do that. Cause I mean, I have a friend that he said, he's like, I won't listen to a podcast. I have to watch it. I'm like, they're just talking into a microphone. It's stupid. Yeah. So sometimes it's nice to see their faces though. And the things that they do. Like Joe, I, when I listened to Joe Rogan's podcast, he, uh, he has the ones where he video records it.

It's just funny to see their faces, you know? Mm-hmm. Yeah. Okay. Well, I forget what we're, um, oh, the, just, oh, easy wins, you press ups and stuff like that. Okay. So I think that's fair. I think it's, I guess to summarize that, like, just because, you know, you're having some gripping sensation in your hip or tugging and so on, like there might be some really easy wins in store, which, uh, simply you just, whatever movement bothers it, you just do the opposite. You don't do the opposite direction with one of the, with whatever joints, maybe all of them at the same time. And then lo and behold, you start feeling better because that does happen actually pretty quickly sometimes for people.

So hit a tip flexor syndrome, which is a big one on the list. There's also hip impingement. Let me read off some symptoms, uh, from Dr. Google, uh, people with hip impingement often report intermittent pain in and around the hip and groin. This pain comes and goes with certain activities over time. The pain may become more frequent. Second bullet point, sharp pain in the groin after certain movements, such as squatting down, twisting, pivoting, uh, as particularly, uh, pivoting to the affected side, getting in and out of cars, sitting down and getting up out of chairs. Bullet point number three is a dull ache at the hip or groin when in, when at rest, particularly in, in prolonged sitting positions, walking or a workout.

I think I found an error in finally, I was looking for years for a grammar error in Dr. Google. And I think, I think I found one. So is that the one, what was it? It's like, so the bullet point is, uh, a dull ache in the front, uh, in the hip, particularly after, uh, colon prolonged sitting, prolonged walking, a workout, like a workout. It just doesn't sound right. I'm going to report them. You just don't want to be the only one with bad grammar. Dude, you have no, Sarah's editing my book right now. I think that she's the, I think she's like the eighth one. It's just so annoying that people still find things.

Um, okay. So let me address this one then, because hip impingement is something that is, it's, it's something that, uh, I knew that I, I had a lady recently that she had, she did a legitimate groin pain and it hurt more so when she was getting, when she was sitting in a chair, but also when she's getting out of a chair. And so she is like, she had her like the involved side, just the, that's the right side. Let's just say that knee just kind of drifted in, which I don't really care about the knee, but that actually turns the femur, the thigh bone in which in, in a hip flex position, it actually duplicates a test that we call, uh, Fadir's test and it's a, and also it kind of starts simulating a scours too, which are ones that are, it's part of a cluster we use for hip impingement.

And so she had pain when in that position, especially for long times. And I just mentioned, just, just get a wider with your knees. Again, I don't care about the knees, but I want to see what it does with the thigh bone. And so she's like, Oh, went away. And I said, go ahead and stand up with your knees wide. And she's like, Oh, it doesn't hurt. So in that case, similarly to what we talked about earlier, sometimes a certain movement bothers you. You just do the opposite. In this case, rotating the thigh bone inward, and it looks like knee drift inward hurts her because that's also a positive test.

Um, and then you just do the opposite, push it outwards. And then you let the area settle itself. It's not broken or damaged. It's just, it's pissed off. Sorry. It's angry. I'll go my fifth grade thing with done. It's angry. It's poopy. And, uh, you just, you give it, you give it a chance to just settle away. But that's one of my experiences with hip impingement. They're not, I don't think they're too hard to, to help people out with, but it is, it, it is something they suffer with for a very long time. Um, and I believe they eventually become labral tears. It's like just a progression of, it's just the early stage.

What do you think, Dawne Costantino? Yeah. I mean, I, I mean, my mind kind of goes to a couple of different places when we're talking about impingement. But I think one of the first ones is like a lot of times it really is just kind of figuring out what positions your body have been put through that cause this impingement pain. So like, is it because your pelvis is, you know, rotated forward a little bit more, or you seem to be one of those people that kind of dump into the low back or that like lower cross syndrome type of thing, um, that we learn about, um, and it's really just finding ways and teaching yourself ways to just kind of maneuver around those provocative positions when it comes to FAI.

So like you said, it just means bringing our knees out a little bit wider to like help prevent that impinging sensation. Then that's pretty much just, that's a pretty easy win. In my opinion, sometimes we notice, um, with people, like I mentioned with that, like anterior pelvic tilt or like the pelvis is going forward or you're dumping into your low back, just go opposite, go, you know, activate the core a little bit more, put the pelvis in a more of the optimal position for success. And those are pretty easy wins that we find with hip impingement pain people in the office. Right. And I know that it's like, I know we're, we're kind of saying that it's, it's easy and you know, here's like, I don't, I don't want people to think that we're discounting that it's not like, it's not that we don't think it's painful.

We know it's painful and it's, it's frustrating to have, and we both had things similar to this and, um, it's just, you just have to find some easy wins to get mentally over the hurdle and think that you're not broken. And then you just have to do some hard work to keep yourself out of that or else it will probably come back. Uh, it's not a scare tactic. I think it's reality is probably going to come back. And one of the, uh, predisposed, one of the only thing that is a predictor of injury or predictor of pain is past pain in that region. So, and I think it's a lot of times just because people neglect to realize that they have to build support.

It's not just about reducing pain. If they don't want to suffer and they want to be able to use their limb, then they should build some strength and protection around it. And that just takes some work. Yeah, absolutely. I think I would steal in with. Pain similar to that for a really long time when I was doing CrossFit, it was my left hip that it was constantly bothering me in the front there. And it was always with, you know, the deep squatting positions or like any squatting position I'd get into. It hurt during, but it was hurting like much, much more afterwards too. And you just said, it's just building support around the area.

So if I would just warm up differently, like activating my core a little bit better, activating my glutes a little bit better, it just really takes the strain off of that hip area. So it's just finding a way to, to activate the correct muscles with certain motions that can, can really help set that hip up for some more success. Yeah. You know, and you brought up, so you brought up CrossFit. Um, just, I just, I'm just going to bring this up just because it's probably going to be a thought on people's minds. When we're talking about building strength and building some support around the area, are we talking about things like CrossFit or bodybuilding or like strongman competitions or what should they expect as like a, like what should it look like?

What could it look like? Yeah. So when we're saying, yeah, cause I think when we're saying like we're building up strength, we're not saying that you're not strong. And we're not saying that like your workouts that you do aren't strength workouts. It's, it's tailored specifically to help with those specific areas. So yeah, maybe we can throw some, some heavy weights up and that makes us strong, but are we activating strength or are we, are we building strength in the core, which is going to help protect that area? Are we building strength in the glutes? That's going to help protect that area. I think we're isolating different areas a little bit more in the office, um, so that you can better do your sport or your, whatever it may be that you want to do.

But I do sit up. So my core is strong. Is that not what you're talking about? No, not at all. You sound annoyed at this questioning series. Do I? I'm sorry. No, I think. No, um, setups is not what we're thinking of. And we're not really thinking about any sort of like when it comes to the core, we're not doing any sort of like repetitive, anything with the core we're thinking about. Can we, can we build endurance in this area a little bit more things like planks, things like dead bugs. Can we activate that core while we go through leg motions? Is that core activated while we're going through overhead motions?

Um, so more building endurance in that specific area that, so that that those muscles are activated for over longer periods of time. Does that answer the question a little bit better? Yeah, I think so. I think, I think it's, um, I think when you say like, say when you, like when you bring up a certain topic, like, I think you should go back to school, you know, and I tell you that and you think college, and I really just mean go to a class online. You know, it's like, I think people's, sometimes their, their assumptions goes with what stereotype they have of that. So if we're talking about strength, they're like, oh, oh, I, I, and she mentioned CrossFit.

She's talking about go do CrossFit and that's not what we're saying. And, uh, they, and we, and you're right. We're not talking about just overall, just the things you're not doing. Not that they're not making you strong. You get strong by just by getting up off the floor, you know, but, um, is it tailored specific to what's going on with you? There's very strong people and there's very, uh, capable athletes, good athletes who have injuries and we see them on the disabled list all the time. So it doesn't have to do with that. It has to do with, is it strong in the area, in the areas where you're supposed to be strong for your problem?

Or are we addressing the endurance, I guess, in the core, like what she said and all your movement patterns clean and blah, blah, blah. So there, there's certain things that need, that should be addressed. If you're trying to unravel a knot in a fishing line, you know, just don't just start yanking on it. You like that analogy? Cause then that was the first analogy of the day. It's a good one. Okay, good. That one just, that one just, that was off, that was off the cuff. So I think one of the ways to try to better kind of, um, paint a picture for people who might be listening to this, like why do the core and glutes play a role?

I think one thing that they can even just do for themselves at home is just like, if you're standing up or if you were to get up and stand up and then you just squeeze your glutes together, like as hard as you possibly can and look at yourself in the mirror and see the shift in your pelvis and see how your core will turn on and see, you know, what happens in the angle of your hip, just like simply by squeezing the glutes together and activating those muscles and seeing what it does to the pelvis and hip can better, you know, paint a picture for you in a sense of why those, that area would be important for building support in the hip.

Right. Yeah. All I'm seeing right now is when I'm seated and you said, squeeze the cheeks. I am not with my hands, but I'm squeezing my cheeks and I'm just getting taller is all you can probably see the camera. Yeah. So, but no, you're right with like the, so the pelvis has actually, it's a big player mechanically even into hip impingement. And so, um, I have a general saying is when you control the ilium, you control the hip. So the ilium being those big dish like bones around the pelvis, there's two of them in the whole thing being the pelvic rim. Um, when, when you, when you control those, you actually control, uh, part of the range of motion of the hip in regards to accessing more squatting depth or knee towards face depth, which is a lot of times a provocative provision, uh, position or in movement for people with groin pain.

They just can't get their knees up or they can't squat down into a chair. So if you allow the hip to access more range by allowing the ilium to move, then, um, then you're going to be setting yourself up for some easy ones. And the glutes and the abdominal area, the core are, uh, critical players in that. So they're kind of control where that's at from above and below. Yeah. I'm working with the patient right now, actually, who, um, is complaining of that same exact hip pain in the front. And, um, one of the big easy wins for her was we just loaded that, the glute on the side of complaint. So we did some clamshells cause she had access to certain bands from home and we did clamshells on that side until she couldn't really do them anymore.

So we did it pretty much to fatigue. And before her squat, she really could only just slightly initiate it. She couldn't go down into any sort of, you know, full depth squat. And after just loading that glute, she got up and she could get almost to parallel before the pain came back on. So that was a huge win for her. So that kind of paints an idea for people as well, who are listening. I don't believe it, Dawne Costantino. I think it's going to take six weeks to feel any difference of pain or range of motion. I don't believe it. Challenge accepted. I thought I'd bring it up just because I think people think that, uh, my observation is people think that pain is going to take forever to go away.

It shouldn't, it should, it should take most people. It's going to take like two, two, two and a half weeks, like say that three weeks would actually be probably longer than you think. Um, I'd say at least 50% reduction of pain within that time conservatively. Um, but restoration of function or range of motion, um, it comes a little bit over time because she probably hasn't had that range in a while. Right. So how could you be, how can you have good control of that range or strengthen that range if you haven't done it in how many, how long has it been since she's had that? It's been a few months.

Okay. So let's just say like even a couple of years, it's like, there's enough, like your, your musculature down there won't be really happy once it gets accessed again. You know, it'll just take a little bit of time and it has to adapt. Yeah, absolutely. I don't believe it. I think you're full of shit. I think you're full of poopy. Um, um, okay. So why don't we go on to another one, which I looked up, I'm just randomly looking up hip stuff on Dr. Google again. Um, so hip bursitis, I think this is a fun one. So symptoms of bursitis of the hip, by the way, usually most people talk about the outer side of the hip symptoms include joint pain and tenderness.

You might see all, you may see swelling and feel warmth around the affected area. The pain is often sharp for a few days and maybe dull and achy later. You might notice it more getting out of a chair or bed. You might notice it sitting for a long period of time. And when sleeping on affected side, acute bursitis usually flares up over hours or days. Chronic can last from a few days to several weeks, but chronic bursitis can come and go. So, um, bursitis, what is explain bursitis to me? I don't know what it is. I don't think I've ever seen it, so what is it like a true bursitis? My understanding of like a bursitis is, so you have these like little fluid filled pockets that are, um, between tendons and bones to help for like gliding and ways that the, the tendon can glide over the bones, um, a little bit better.

And sometimes, um, repetitive movements over time can cause inflammation to that fluid filled pocket called the bursa. Um, but from my understanding of like true bursitis, it would be like pinpoint pain. Like if I were to ask you to point to it, it's not just like a general area. It's like with one finger, you could put your finger on that area and there would be swelling and pressing on that specific spot would pretty much cause like a jump sign in that person. They would want to like get up and run away because it hurts so much. Um, I've never seen a bursitis though, or a hip, um, bursitis. Yeah.

That's my understanding of one. Yeah. I think the slap sign is common too. You poke them in the side of the hip, pinpoint, they slap you. Um, the, it's like a kidney punch sign. They punch in the kidneys. Yeah. Uh, yeah, I would agree. Pinpoint, but, but also too, I think they, I think the warmth is important on this. Like if you, if you had something else referring there, it would not be a change of temperature. And, um, I think number one, my first, my, like, I don't, I see the people ask about the bursitis actually quite a bit. Um, I wouldn't, I always tell them don't, I wouldn't worry too much about it.

If it's an infection, I would worry about it. That wouldn't create the warmth. Um, or if there's a local inflammatory response, that would be warmth. But, um, number one, they, it's, it's funny. Like when people, they get their first interaction with bursitis, they think, oh no, a bursa. And I say, and they're worried about the bursa. And I said, you know, a bursa is a normal thing. It's right. It's the itis. So they actually are not aware of like, they're actually scared of the word bursa sometimes, which I understand because they haven't. How do you even think about it? So a bursa, a bursa is normally there.

Number one, number two is the itis is inflammation of it. But I do think the warmth of this characteristic, however, there was a, I'd have to pull this research somewhere, but, um, it was presented at a, I think at a symposium one time where, uh, they were mentioning that actually most bursitis cases. No, I think I'm one sec. Dawne Costantino, can you hear me? Okay. Yeah. Okay. Just pause one sec. Okay. So there was a paper, I think they reported at one of the symposiums a couple of years back where it was on what really is outer hip pain on a lot of these people. And they mentioned that most of them are actually misdiagnosed, uh, tendinopathies of the gluteal muscles as they insert into the area has it's the bursitis is just a secondary finding.

So, and I think they did that based upon ultrasound studies. That's interesting. Yeah. So it's really not as common. I used to work at this PT office actually. Um, they, they were kind of funny. They're like, what do you do with the bursitis? Nothing. Just make them rest. It'll go away. Like it wasn't like, you just don't do anything. So. Yeah. Well, I think one of the things that you would do with it, I mean, like any other approach that we take with anything else though, it's like, just let that area calm down for a little while and then like, just teach better movements so that you can prevent it reoccurring.

It's happening because, you know, some bad movements are going on in that area and it's repetitive and it's causing irritation to that specific tissue. So let it calm down and then we'll retrain the area to, you know, learn how to move better and move, move more prop, more proper. Is that a good way to say it? More proper. Less poopy. But yeah, I think it would still be the same approach, just figuring out how to calm it down a little bit. Yeah, I agree. And in the early stages too, I think it's important just to note that just because you're not doing something effortful doesn't make it not productive.

Just be okay with letting the body do a repair process. The body is trying to heal itself just like a cut and a sunburn. It's trying to settle itself down. Just give it a second. Just give it a moment. It's not going to be immediate, but it should progressively get better. So the next one, this is probably the last one, unless we can think of another, uh, hip labral tears. These ones are a little bit more menacing and I will read the symptoms on this. Many hip labral tears. Remember, I didn't write this. This was Dr. Google. Many hip labral tears, uh, cause no signs or symptoms. No, or some people, however, will have one or more of the following bullet point one pain in your hip or groin often made worse by long sitting periods or standing or walking bullet point two, a locking and clicking or catching sensation of the hip.

Number three is stiffness or limited range of motion of your hip. What do you got? So, I mean, it's funny how pretty much all of these symptoms that you keep reading for all of these different conditions all sound the same, but there's always just like one little thing that can help you cue in on, you know, if this is the true issue or not. Um, I think one thing that Dr. Google is wrong about, I mean, popping or clicking in the hip can be normal. Um, you know, a lot of times, I mean, there was like a specific soccer warmup I would do all the time where it was just like, you just lifted your knee up and you rotated it outwards and you kind of just like kept moving through that and you'd get like a little popping sensation in there, but it wasn't anything painful.

So the one thing that we need to know is popping or clicking in the hip, is it painful? And I think that that is going to be a huge indicator of a more of a labral issue, um, and catching, catching on you. If it's, you know, hip just kind of like locks up, catches on you and things of that sort, like that's more of a labral issue as well. But all of those other symptoms can be wishy-washy with other hip issues that we've been talking about. Yeah. The probably in an, when you get into an exam on it, like these people will have a, like a, like a real firm blocking point. Like you can't get them into a deep, uh, hip, hip flexion movement or bringing the knees to the chest.

It's really hard to cross their leg across their body. It's just like, it's not like it's just not stretching there. It's like it won't go. Um, cause there's something firm there in this case, maybe a labrum, maybe a bone, maybe, you know, so there's, there's definite physical exam findings. You don't need to have a image right away. Um, it's important to know on labral tears too, that x-rays won't really see much. I know the x-rays are the standard, uh, of just kind of starting the imaging process, but they're not really informative. I'll put it that way. Um, the second thing is, is an MRI is nice to see things, but it won't necessarily see inside the hip very well.

Usually you'll want something called an arthrogram, which is painful and it costs a lot of money, but usually we don't want people to do that until we've exhausted, um, rehab. Um, because in that case, when you do that, you're kind of sending someone off for a surgical consult, which isn't a bad thing in some cases, but if, especially if they're not responding, but you certainly don't want to exhaust that image too quickly because you might have to do it again. And, um, I don't think you're, if you're doing an insurance one, I don't think they're going to want to pay for it twice, no matter how much you think that you need it.

Um, but yeah, you can, you can learn a lot just off a really detailed physical exam. Your doctor should be able to do a really thorough physical exam with you and just rule in and out beyond a reasonable doubt. Is this impingement? Is it labral tear? Is it bursitis? Is it a hip flexor? You know, is it referred? Um, a skilled clinician can do that, but it will take them probably more than 15, 20 minutes of first time interaction. I think. Yeah, absolutely. I think that like with those, any of those conditions though, the one thing to just reiterate is conservative care is always the first approach, you know, give conservative care some time, give your body a chance and, you know, if it doesn't get better within at least, at least some improvement within four visits, then we might want to then send you out for some engineering and see if there's something a little more serious going on.

But with any of those conditions, like just rehabbing through it, movement is medicine, that type of approach can be huge. And if you're not progressing the way we want you to, then we'll get you to somebody who can figure out a little bit more of what possibly could be going on in there. Yeah. Okay. I'll read it. Let's just pause one sec. We keep having internet issues. Yeah. I think it's you this time. I think it is. Well, my, yeah, my thing says your internet is unstable. Give me one second. And then I'm going to have you repeat a little bit of that. So when people aren't responding, then like maybe then what's the approach with them?

So if you're not responding to conservative care or you're not progressing the way we want you to, then it's our responsibility to refer you out to somebody who can dive a little deeper into figuring out what could be causing it, whether it be, we just need to get an image to make sure there's nothing more serious going on in there, something of that sort. But either way, we're going to get you the help that you need. It's from us or it's from somebody else who has more of a specialty in that area. Sounds good. Is there anything that you think we need to cover to have a comprehensive HIP? By the way, everybody, I'm sorry for, you know, I realized with COVID that everybody is on the internet and so it really slows everything down.

So I've been trying to upgrade ours, which is just slow to do, but I apologize for some of the glitches that won't be a consistent thing throughout the podcast. But Dawne Costantino, what do you think? Do you think we need to add anything to make sure this is a really comprehensive HIP podcast, informative podcast for patients? What about HIP Degeneration? Oh, the Degenerative HIP. That's a good one. Do you want to cover that or do you want me to? Um, I mean, really, the only really mean that it's the, that's it for you. You know, it's kind of like any other type of arthritis or anything that we talk about.

Um, there's just specific things that you look for in examination to see if that's the possible causes like decreased range of motion in that area. Um, but as far as reducing pain for it and things of that sort, strength and conditioning would still be our approach and building buffers around the area and getting things to move a little bit better would still be our same approach as far as Degeneration goes. Yeah. And I think if you, if you look up a Dr. Google with this, they're probably going to say like, you know, start to move, do body weight exercises, do some stretching. It's still like general, like it's extremely general.

Like when you usually look through that kind of stuff on the internet, but I think they're right in this case where it's like, if you don't do anything, it's not going to improve itself. So there was, um, I think it was, I forget where I was looking, but they, they had a good saying with this is that, is that your, your, your knee has been, or that like the, the joint has been unprepared for many years. And let's just say if you had a past, usually Degeneration will happen with some type of past past injury, past trauma, especially in the upper extremity, but in the weight bearing joints, it's a little bit more common, but you'll see more on one side than another, if you had past trauma to the area.

And so it's not uncommon for people to just not put weight on that side or not use that side or maybe the side. And then next time they try to do a movement there, it spikes up, becomes painful, and then they don't use it again. So, uh, sometimes the area is just generally unprepared for movement and that's why it hurts again. So it's not always the arthritis or the Degeneration, which is the painful thing until it becomes a problem. Uh, I think this was Dr. Dr. Murray had said this, I asked him about stenosis. I said, when is a stenosis, when is, when is stenosis or arthritis of the spine a problem?

He's like, it's not a problem until it's a problem. I said, oh, that's wonderful. I like that answer. So probably the same thing goes for the hip as well. Yeah, absolutely. And if it's range of motion that is, you know, scaring people away from it, there's always ways and means to showing you different ways to move so that you can still get up, be healthy, move around and, you know, still have an active and healthy lifestyle, even with what we sometimes blame or even with arthritis, which is what we, we usually use as an excuse to not be active or healthy. It doesn't need to be that way. Right.

Okay. Anything else you think we need to add? That was a good addition. You might have some good original ideas here. Let me check my list. I made a list. I mean, there's like more serious things that we don't see as often. I don't know if you would want to go into that, if you want to just stick to the more common things that we talk about. I think we, you can list them if you'd like. We don't have to talk about them in too deep, too much detail, but I mean, if we're not going to, I think if we're not going to be able to treat them, I think we should just say that we refer them on. Yeah, I think that the importance is that when people think that it's something more serious going on in the hip, it's our responsibility in our history and examination and diagnosis to rule out those things.

And if we have any sort of inkling or red flag that goes up that we think that that could be the potential cause, then we will get you to somebody that, you know, could help you with that. Yeah, I agree. I know that the, one of the last people that I did a virtual with, they, I just like, I think they, they had a, they had a little bit of a concern of like, ah, virtual, I don't know. I don't know. Like I got to do it in person and I'll say, look, I'll tell you what, you know what the first step is just fill out the intake form. If you fill out the intake form and I see something that like tickles my fancy in a bad way, then I'll, I'll call you back and I'll say that we should do this in person or I'll refer you somewhere else.

But a lot of times, like you get a lot of like the information from the history. And you'll get a lot of, I mean, you get a lot of good and a lot of bad, I guess there's no bad information, but you'll, you'll figure out whether the person should, is really that complex or not. Are the problems that complex? But I think the first thing is just, just write the list down, do an intake, you know? Definitely. Okay. So I think that covers everything. Do you want to mention our, if people, if people want to help us, Dawne Costantino's got the information. She's better at this part. So you just tell us what to do.

What do we do? We've heard this whole podcast. I'm so tired of the easy win. Just tell me what to do. Oh man. So we have tons of approaches right now. We have, we are open in our office. If you guys are in California and you're Huntington beach, we are still taking patients and we can help you in office. You just got to give us a call and we can set you up. But for those of you who, you know, maybe don't want to come into the office or, you know, don't have the ability to, we've been putting together programs, online programs and ways and means that you can work around some of this pain and introduce, you know, activity back into your life while dealing with this discomfort.

We offer virtual sessions. If you want to work one-on-one, we can set that up and chat about it. But we also just offer the programs online, which takes you through a lot of the exercises and a lot of the education that we would give you in office anyways. It's, it's all built into one little small app. So tons of options and ways to treat this issue. You just have to give us a call and we can chat about what the next best approach would be for you. Perfect. It's like you've done it before. All right, cool. Thank you for helping. This was easier. Dawne Costantino, thanks for being on with me. It's always easier to discuss things rather than just like pitch it as a solo.

So again, this is Dawne Costantino. She works with me. She's a colleague of mine. She does a very good job. She makes things simpler than me. So she's a, she's younger, she's a younger doc than I, but she's catching on very quickly and she already knows much more than I did when I was exiting programs. So if you guys are looking for help, please reach out to us directly. That's info at p2sportscare.com. Again, info at p2sportscare.com. We do offer a lot of great free advice on YouTube and Instagram. And I know we've had people over the years who say, hey, you know, like email me emails and say, hey, what's this one exercise for this?

And we're like, well, look, you can look on the YouTube channel. There's literally 500 videos on there. So if you're willing to look and dig, I'm sure there's a lot of stuff in there that will actually probably get you to what you're looking for. But if you're looking for guidance, it costs a little bit of money. So we're not going to lie. That's how we stay in business. Got to put food on the table. So if you're interested in our direction, just contact us, info at p2sportscare.com. And thank you for being part of the movement. I'm thankful for everybody who's listened to the podcast over the last about almost 200 episodes.

I've learned a lot over the years and I've met a lot of great people. And the only way the podcast continues to grow is by you promoting it. So do me a favor, scroll down on your thing. And if you say, hey, look, I like this episode, send it to somebody who has groin pain or send it to somebody, another healthcare provider. So I'm just looking to expand and improve our profession as a whole. And I think the only way that I can do that is behind this microphone because it's scalable. So thank you for being part of the movement and I'll see you guys next week.