Hip and groin pain: the back connection and when surgery fits

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. Hi, everybody. Welcome to the Restoring Human Movement podcast. This is your guest host, Dawne Costantino, and we are going to hop into a kind of a shorter format podcast today, conversation, answering some specific questions that I found on the internet that people typically have about their hip and their groin discomfort. So the questions that we'll be answering today is, how can I tell if I need surgery? What is my hip or why does my hip and groin pain worsen at certain times of the day or with specific activities?

And could my hip and groin pain be related to another part of my body, like my back or my knees? So that's what we're diving into today. I'm going to keep it short and sweet. It's actually my second round of trying to record this one because I realized as I was answering the surgery question I was ranting on because it's a hard one to answer. So I'm going to try to keep it organized and let's hop into it. If this is your first time, welcome. If it's not your first time, welcome back. Don't forget that we have all kinds of recordings on our channel that you can go back to and dive into. So much information to cover when it comes to hip and groins.

We see tons of hip and groin issues in the office. I like to call ourselves specialists at this point because the amount of experience that we've had with specifically with hips is, it's a lot. So, you know, I think when we talk about answering some of these questions, it comes from a place of experience, comes from a place of education as well. So, yeah, if you want to learn a little bit more, if you want to hear what more we have to say, YouTube or our podcast, you can dive deeper into some more about hip and groin. There's a lot of low back stuff too, which I recommend if you've been dealing with something like this for a while, go into our low back stuff as well because a lot of times they're related.

So, just keep that in mind. Let me plant that seed for you. So, yeah, I am a little bit sad right now because I'm looking outside and it's beautiful and it's sunny and I wish I was out there, but I have roosters in the backyard so I can't record outside or else you guys won't even be able to hear me. So, I'm indoors in a bedroom watching my dog snore next to me, wishing I was outside, which I'm going to go do, taking for a walk after this. So, yeah, sunny and beautiful in SoCal today. And don't forget that if you want to take a trip here and get assessed by us, we'd be happy to see you. We do virtual stuff too.

So, keep that in mind. We'd be happy to see you virtually and just kind of start a conversation and guide you down the right path. So, let's dive into the first question. Again, second time recording. So, I'm going to leave the surgery question for last. What we're going to talk about first is, can my hip and groin pain be related to another part of my body like my back or my knees? A thousand percent yes. I don't think, unless it's like a traumatic event, right? Like a, somebody ran into me on the football field, a slip and fall, something like that, where it's kind of a traumatic mechanism of injury, where it can just be a hip issue because you did maybe fall on it or slide on it or something of that sort and create injury in that area.

Most likely, if it's one of those, just like, I don't really know where this came from, kind of snuck up on me, it's usually related to globally how you're moving, usually related to other areas of the body not functioning well and this area taking on a lot of load. Even if, let's just say, I'm thinking about squatting right now, because specifically with hip and groin issues, usually groin, you're going to feel that with squatting. I think almost every groin case that I see, squatting is typically a problem for them or just painful for them. It's pinchy in that area. It's a tight hip flexor. It's stiff when sitting too long.

Like anything that's got that squat pattern. Say you were initiating a squat. You were somewhere in your second set, rep number eight, certain amount of weight, you felt it. You know, there was a moment that you felt it. I still would like to know, like, how is the rest of the body functioning? Like, why did you feel it in that moment? Like, did we just start squatting for the first time in our life and put a bunch of weight on the barbell and our tissues just weren't prepared for it? Possibly. But very, very likely there's other areas in the body that are contributing to this. I, again, don't know if I've ever seen a hip that doesn't also have a lumbar component to it or like a foot and ankle component to it.

So, yeah, the short answer is yes. What do I typically see? I actually just recorded before this a podcast about hip imbalances. So, if you're curious about that, go listen to it. It's only 18 minutes. But I usually will see that the opposite hip is not functioning very well or the lumbar spine, the low back, is playing a bigger role than you realize. Those are the two top of the list that I see more common or more often than not when it comes to hip and groin issues. What does the low back have to do with it? A lot of times it could be a referral pattern. Let's just say there might be some nerves coming out of the low back that supply into the hip that are actually more related than you realize.

So, maybe not an actual tissue of the hip involved, but just a referral pattern we're talking about. Or maybe the lumbar spine is not moving the way it should. Maybe it doesn't have great range of motion. Maybe we had an old back injury in the past when we were 18 and, you know, we finally got over it and it never came back again because we're avoiding picking things up. And so, now we pick things up in these weird ways and we're putting a lot of load into our hips. And so, now we're starting to create tissue and injury in the hips. So, we need to get you to access other areas of the body more so that there's less load in this area of the body.

So, those are the things I see more often than not. Lumbar spine is playing a role or the opposite hip is just not functioning very well. And so, this hip that's bothering you is starting to feel pain. The tissues aren't able to tolerate the amount of load that you are asking of it or the amount of activity that you are asking of it. Other things that could be contributing too is the foot and ankle. So, if there's some dysfunction down there and we're not moving well through the ankle, the body is going to find a way to still accomplish the task. So, I see that a little less often, but it's there and it's something to consider too.

So, yeah, I mean, referred pain is a tricky topic and people are typically curious, you know, is there other areas of the body that I need to be paying attention to? And I think that if you are dealing with something like this for a really long time, or longer than you would like, and you've gone to different places, you've tried different things, it's just not getting better. But what you've tried has really only been focused in the spot of pain. You've done only hip stretches, only glute exercises, maybe some core exercises. You dove back into strength a little bit, but nobody's tried to really improve the function of the movement of your thoracic spine, your ability to rotate well.

Nobody's asked you why you're not moving through your lumbar spine as well as you should. Nobody's looked at that opposite hip and said, what the heck's going on here? Why is this thing not moving? If nobody's zoomed out and looked globally, please go find somebody who can assess you like that because there might be a huge missing link you didn't even realize. You don't have to have pain in these spots like the low back or the opposite hip or the foot and ankle for them to be playing a role in your hip and groin discomfort. If they aren't moving well, passively, or you have a weird movement pattern going on that you've learned from some old injury in the past and just haven't gotten out of that compensating pattern, you can't access your range of motion in those joints very well.

We need to get you to passively move better, actively move better through those joints. And I bet you your hip's going to start feeling better too. So I hope that wasn't too long answering that question. It's just the short answer is yes. And more often than not, it's somewhere else that's playing a role. Okay, next question here. Why does my hip and groin pain worsen at certain times of the day or with specific activities? And I think this has to do more with like what tissues are involved. That's the first thing that pops into my head is like specific tissues are sensitive to specific motions.

Certain times of the day too can play a role in that. Like there might actually be simple, like so simple answer would be like disc issues. You know, if you're like a bulging disc, separate from the hip, but bulging discs, they just feel terrible first thing in the morning. Usually there's just specific tissues that are susceptible to specific things you'll learn. We learn in school, chiropractic school, that like a disc blood flow comes back. You know, when you're sleeping at night, you wake up in the morning and it's nice and filled with blood and it's pretty darn painful, especially with acute disc injury.

And so as you go throughout the day, you move a little bit more, that blood moves out of there. The disc kind of shrinks a little bit. It's not as big and full. It starts to feel a little bit better. So again, specific tissues can be sensitive to certain movements. For example, when it comes to the hip, hip impingement, cam impingement, you know, cam deformities, pincer deformities, where there's just some bony growth happening near the hip joint that's preventing certain ranges of motion, like hip flexion. Hip flexion is super important throughout the day. If we think about all the things that we do throughout the day that relate to hip flexion, sitting on a toilet first thing in the morning is hip flexion.

Getting up from the toilet, going from flexion to extension. How do we activate that? Getting out of a car is hip flexion. Going up and down stairs is hip flexion. Let's see what else is like something that would be normal activity days of living that have that. I mean, I think the biggest one is it's sitting, right? So if there's impingement going on in the hip, impingement sensitivity, or like true bony growth starting to occur in that area, then anything that requires hip flexion is going to be sensitive. And that's not a forever thing. And that's not the podcast I'm recording today to dive into how to get rid of that.

But it's to answer the question about with specific activities, that specific diagnosis is definitely not going to love a whole lot of hip flexion throughout the day. Hip flexor also too. The hip flexor is responsible for pulling the hip into flexion. It's a part of it, really. So if you're doing active things like that, like say you are an avid gym goer, you like to exercise, you're doing some hip flexor exercises, and that thing is strained and overused, then those specific activities can create pain and discomfort. Hey, everyone. It's Sebastian. I'm going to hijack the show just for a second here to tell you about an opportunity that we have called the Discovery Session.

A lot of people over the years have reached out to us from our YouTube channel because we have 150,000 YouTube subscribers at this point in time, probably more by the time you're listening to this. And we have a lot of people listen to this show and read our articles online. They're frustrated. People are frustrated about not being able to get back to full activity. They're frustrated they can't really trust their body. They're frustrated that they have not found any long-term answers or things to make them happy. And so we're here to help. We may not be the ones to actually help you, and we're okay with that, but we're hoping that if you are able to speak with us, that we can maybe give you some insight of things that you potentially haven't tried yet.

And if we know people, we'll suggest those people too. So if you want to take advantage of the Discovery Session, all you need to do is go to p2sportscare.com and find the Book Now button. It's all in there. We have virtual or in-person options. You can go to the show notes for this show and find a link that'll directly connect you to us, or you can call us, 714-502-4243. We'd love to help you the best that we can, and we're always here to serve. Now back to the show. One other thing I want to bring attention to for specific activities is nerve referral that I mentioned into the hip joint. So let's just say all the structures of the hip themselves are pretty sound.

There's no injuries of the hip. There's no big range of motion deficits there, but we have a lumbar spine, an L1, L2 nerve referral into that spot. Anything throughout the day, depending on who you are and what you do and what's creating sensitivity of that nerve, can reproduce and aggravate it. So, you know, let's say we are somebody who doesn't tolerate bending over or sitting in sloppy positions or, yeah, picking things up. We're doing this all with like a rounded spine, and that's the thing that you're sensitive to for that nerve. Although we're feeling it in our hip, we're not figuring out why the hip itself, like what am I doing with my hip that's creating this pain, and we're not paying attention to what we're doing with our spine, that could also be contributing throughout the day too.

So, yeah, that kind of like in a general way, I know it's not very specific what I'm talking about. I don't know if what I've said so far has related to you, but to bring attention to like why do specific activities bring my pain on is because there's certain tissues that are responsible for certain movements. And if that tissue is injured, when you do those movements, you're going to feel pain. And it's not avoid the movement, it's respect the threshold of that tissue right now. And that's kind of what I want to segue into is I feel like I have a lot of conversations around like, I'm really sorry you've been told to just like rest because most of the time when you're told to rest, like people think like just stop being active at all.

Like just, I don't know. I don't know why people like conclude that rest means like sit on the couch and watch TV all day and don't go for walks and stop doing all the activities that you've been doing. That is not rest. And I think it's just not described very well by whoever is prescribing rest for you. Rest is rest from the activity that is reproducing this discomfort. So let me get more specific so I can get you to understand that. Hip impingement again. Okay. We have hip impingement sensitivity. You got an x-ray, you got an MRI, there's no bony growth, there's no, you know, injury in the hip joint specifically yet.

But right now you are very sensitive to hip flexion. You go throughout the day sitting. Okay. You feel fine. You don't get up and walk very often. So you're stuck in hip flexion a lot. And then you get out from work of eight hours of sitting. You go sit in the car, drive to the gym. It's leg day. You start with some walking lunges as a warmup. And then you get into your squats and you're like, what the heck, there's my pain. Well, we've just spent however many hours in active or passive hip flexion, the thing that the hip impingement is typically sensitive to. And then we start to load hip flexion in a squat at the gym.

We just, at this point now, just surpassed our threshold of how much that tissue can tolerate hip flexion. How much that joint can tolerate hip flexion. It doesn't mean that hip flexion is bad for you. It's finding that tissue's threshold. Everybody's threshold is a little bit different. How bad the injury is. How sensitive it is. What you're asking of your body on a day-to-day basis. All of this plays a role in what you're sealing. What your capacity is. So if we pay attention to what it's sensitive to and how often we're actually doing that movement throughout the day, we might be able to find ways to not reach that threshold as quickly.

So that if the goal is to be able to squat in the gym, maybe we find more movement throughout the day, less sitting throughout the day, less hip flexion throughout the day so that you have more capacity for hip flexion in the gym. That's just one of many examples that I can use. But I think talking about capacity and threshold of these tissues is super, super important because too many times do people just stop things altogether and then feel really frustrated when they try to get back into the activity right away and it's not better at all. You've got to build your capacity back. So yeah, I want to share a couple rules of thumb.

If nobody's shared this with you, please take this and use it and I hope it helps you. Pain is a warning sign. It's not always a stop. I usually tell people if we're going to rate your pain on a scale of zero to 10, okay? 10 being worst possible pain you've ever felt in your entire life. 5 is maybe we're going to take some medication because we're getting to a point now where it's really starting to bother us. Don't let it get over a 4 out of 10, okay? So some people, the moment they start to feel any discomfort, they're going to stop the activity. But what happens if you explore it a little bit more?

You may notice it actually starts to go away and get better. Or maybe you can do two sets of squats at the gym before you reach a three and then you're like, okay, I think I just won't do that last set. You can still do the dang thing. You could still get some reps in. We're not at our full capacity, but we're not doing nothing anymore. So let pain guide you as far as what you would rate your pain as. And I've had people argue with me sometimes about just like, well, I have a really high pain threshold. I'm not comparing your pain to other people's pain. I just want you to let your pain guide you.

So don't let it get over a 4 out of 10. If you've reached a 4, you've probably gone too far. Don't push it. Let a 3 be your guide. All right, I'm at a 3. I'm probably not going to push it any more than that, okay? So then for the next few days or the next couple weeks, you now have the two sets of 10 with this weight and squats has felt fine. It's kept me under a 4. So I'm going to do that for a while and still until I don't even reach a 3 anymore. Now I'm reaching a 2 at that point. Great. Add another set or add a couple reps. Add a little bit of weight. There's many factors that we can play with there.

Maybe you can add two more reps in a week. Maybe you can add five more pounds in a week. Build the capacity back. Just pick up on what's provoking. You know, put a pin in those things. Introduce yourself to them a little bit. Find a threshold. Find a capacity. Respect that capacity for a little while. Two to four weeks. Let's say four weeks to be conservative. Give yourself four weeks of working at that capacity and then see if you could start to push it. That's a huge missing link I see a lot. Don't let pain stop you. Let it educate you. Let it guide you in what you can and can't do. And this is hard.

This is really hard to do on your own. So just reach out to somebody. Let them guide you through it. Let them give you a program to follow. It's going to be much better that way. Okay. All right. I am going to talk about this last question here, which is how do I know if I need surgery? This is honestly without even having a specific person and a specific case in front of me to answer that question for it is really hard, but I think it's one I do want to dive into as best as I can because really when it comes down to let's, let's take the, the topic of like big, bad, scary, you know, diagnoses that could be happening in your hip and grind out of the equation because that's, that's just a whole other conversation to be having.

Let's just say this is just a musculoskeletal issue, normal aches and pains, normal sprains and strains, whatever it is that usually can go, you know, get better with conservative care. It really always comes down to how much has, is this affecting you? How long has this been going on for? Be honest with yourself. Have you put enough time and energy and effort into conservative treatments to give them the time that they need to allow the body to heal, right? So I have people all the time ask me, like, it's one of their first questions on their initial visit. Am I going to need surgery? It's like, I, I need to know more first before I can even answer that question for you, but I'm happy to give you your surgical options and a referral.

If you want to go ask those questions to somebody who can look at your imaging and give you some surgical options as well. I think it's super important when you are talking about a trial of care to have all the options in front of you and you can choose what's best for you. When it comes to those that are like, they really want to try to avoid surgery. Most of the time you don't need surgery. Most of the time it's about finding what works for you. It's about respecting that tissue threshold. It's about finding a program that works well, that you can build into your lifestyle. It's about having goals that we can reach for.

So a lot of times the surgery part of it is I've done all the things I've committed myself to all the things. It's just not getting better. It's affecting my mental health. It's affecting my ability to show up the way that I want to show up to other people. I've seen an ortho. They've given me my options. They found something on imaging. They know how to repair it. I've been educated on what I should be doing before, during, and after. And I think that that's the right route for me. There's nothing frigging wrong with that. If you feel like the surgical path is going to be the path for you, there's a clear path, meaning we found something and we know what to do about it on imaging, then frigging go for it.

Rehab is still going to be a part of that process afterwards. But at least the tissue is repaired, and now you know where to go from here. But most of the time, people ask this question because they've spent so much time with pain that they feel like that's their only option. And I'm here to let you know that that's not your only option. You just haven't necessarily found the right approach and the right program for you that has gotten you, you know, through those milestones. So I'll leave it at that because I think I can rant about this question for a long time, and I don't want to get lost in thought and get disorganized here.

So just to recap really quick, when it comes to the surgery right for me, it's truly a question to have with yourself. If you feel like you're at the point in your life that you have committed to all the conservative options, and it's just, there's a clear path for surgery for you to do it, do it. And as long as you feel comfortable and safe with that. If you feel like that's your only option because you're just not getting better, most of the time that's not necessarily true, keep searching. And I have a great referral network. If you want to reach out to me, I'm happy to send you to somebody near you if I have someone.

Okay, so yeah, that's, that's a takeaway for that one. Pay attention to the activities throughout the day that are provoking your issue. Don't avoid them completely, but see if you can minimize them and slowly build it back. Okay, and last but not least, most of the time, there are other areas of the body that are definitely contributing to what's going on in your hip and groin. So make sure that you are seeing somebody who is assessing your full body and pointing out to you why your hip hurts, what's causing your pain, but there's other areas of the body that are contributing and here's a plan of attack on how we're going to get all of those things better.

If you want to come out to sunny, closed in California and have us assess you and take you down those paths, we're happy to see you. You want to start with a discovery session virtually first, just open up the conversation and see if we can help you before you even decide to do something like that. We can always do that. If you're not in a place where you can travel right now and you want to do some virtual options with us or just see if we know somebody near you, please reach out. We have a webinar. Take advantage of that webinar on our website. That'll go through things that you can try, ways to assess yourself.

Start there and hope to talk to you guys soon.