Side of Hip Pain That Comes From the Lower Back

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. Hey everyone, it's your co-host Sebastian with the Restoring Human Movement podcast. Thanks for joining the show. If you're an active individual who wants to get back into sport or back into running, back into weightlifting, you are on the right podcast as on this show. We empower you to learn more information about what can get you back to your activity level again without a hitch and without feeling like you're going to be damaging your body for the long term.

Today, I'm covering a case presentation, and this is with a gentleman with a hip complaint. If you've been listening to the podcast today, you've probably heard a lot of other hip podcasts or case studies that we've done. This is going to be a fun one today because it's going to highlight locations of pain and how it could be a giveaway, as well as how an examination, like a good thorough examination by hopefully someone who has good experience can help you identify very quickly ways to decrease pain. This person in particular was having a onset of a lateral hip pain or side of hip pain that seemed to come down from the upper crests of the hip all the way down to the side, but the backside of the hip, it didn't go much beyond that.

It came on after running the marathon, and this is a very seasoned runner. I've been seeing him for, I don't want to say, I don't want to say a long time all the time, but I've seen him on and off for like a year, on a year off, not fully in a year, but like periodically throughout the year of managing problems for about probably 12 to 13 years now. I've known this person for a very long time. They've had a long history of actually hip complaints. It doesn't always present exactly the same way. Soft tissue care, like active release, really helped him in the past, and weight training has really helped him as well.

So this was a little bit of a different one. There was no mechanism, no pop, but the location was a good giveaway that it was actually a case of what we call spine-referred hip pain. I know it sounds odd to say because how can pain be referred from the spine to the hip? It's actually very possible. It happens in about 70 to 75% of the people I'd say that we see, and it's a dead giveaway that it's probably from the spine if there's, number one, no pop that happens, no contact to the area like a hip pointer, like helmet contact, and it's to the side, especially backside of the point of the hip called the greater trochanter, which is the bone in the side of your hip that you feel if you were to rub your fingers up and down.

Now, a lot of people would say this is IT band problems or TFL or things like that. No, this is not. IT band problems actually present only at the side of the knee as a manifestation of clicking, and it's a friction syndrome as the IT band goes over a tubercle or bony prominence of the knee and creates local irritation. I know that a lot of you will say, well, I've had it, it goes up the thigh. But I bet, I'd gamble to say you didn't actually have the actual knee symptom either. A lot of people just feel pain in the distribution of the IT band, and they think that it's that. A lot of times those ones are actually spine-referred ones too.

They're called L5 radiculopathies or L5 nerve root impingements. So this one in particular was referred from the upper lumbar spine, so it didn't travel quite as far. It didn't get to the knee, didn't go to the shin, but it's into the side of the hip. And the reason why it's a dead giveaway, especially in the absence of the popping or the contact as well, is that normally, so you can do something called a McKinsey lower back examination, which is something that some physical therapists do, some chiropractors, not all of them. It's just ones that have been educated in the protocol. And there's actually a great McKinsey low back protocol book on Amazon.

I think it's called Fix Your Own Back. If you look at the reviews on there, it's like 15 bucks. It says like 10,000 five-star reviews, and it's like raving about how good it is. Like all those reviews can't be wrong. Like they're actually very good and legitimate reviews, in my opinion. And so if you've read this book, it outlines a protocol, what we call directional preference, which tells us how to manage a spine complaint, because this is a spine book we're talking about here. Now, there's a forward touch, a lean backwards, like this is all standing. You push your hips to the side one way and side the other, kind of like you're making like a bend in the frontal plane or like in a painted glass.

And these ones, as well as rotating, are things that you can do in the lumbar spine exam. But if you take this protocol and actually you look at their other book, which is the hip book, same thing, probably Fix Your Hip, I think. This one actually, since there's so many people who have spine-referred hip pain or side of hip or back of hip or SI joint or crease of hip, they actually had to put, and I bet this is not just the first rendition they did it in, but I bet so many people buy this book, this hip book, thinking they have a hip complaint, and they read through the book. And one of the first parts of the book is, if you have pain in this distribution here, or you have provocation with things that test the lumbar spine, such as our lumbar spine book, it's a spine-referred problem and you have the wrong book.

It's as clear as day. The McKinsey Directional Preference Protocol has been used for a very long time with high success rate. I've met so many different providers who are educated about using it, with especially lumbar spine complaints, neck ones. But also, remember, the exam helps us figure out if this is actually a hip complaint, because you can do hip McKinsey series as well. A lot of you may know some of them already, like hip flexor stretches, like the half-kneeling ones. I don't know if that came from the McKinsey Protocol. It probably didn't. But when you do it as an end-rein-loney protocol, we use that for actual hip complaints, groin complaints, hip arthritis, hip impingements, some light labral tears, and actually hip capsular problems.

And so these ones are going to present in the front groin crease of the hip, deep into the crease of the hip. And also, there'll be limitations of hip range of motion, especially in flexion and internal rotation. So these can be found in a physical exam. A good examiner knows how to look for them. They can also be done in virtual examination. By the way, we do have virtual examination. If you guys don't know it already, we're licensed in multiple states. And a lot of these things can, again, you get the right person. You can decipher this information very simply. But one of the dead giveaways, again, is location.

Location, especially if there's no bruising, no pumping, it's not in the crease of the hip, and it increases with lumbar spine standing protocols or examination. So to me, that's a dead giveaway. Now, this person was under the impression it was a tightness of one of the side glute muscles as it goes into the IT band. That's a pretty common assumption. What we did to help her was something, we actually did something called an opener protocol. Now, you may be wondering, well, why didn't we use McKinsey protocol with this? We probably could have. McKinsey protocol is not just lumbar spine extension.

In fact, standing, I think I said her earlier, him. I'm thinking about somebody else. So, he actually had more pain when standing, doing extension with some of the protocol or the examination with the lumbar spine. So, I wouldn't give him extension. I wouldn't give anyone lumbar spine extension if it provoked them, especially after doing multiple reps. So, I decided to use a different treatment protocol called Neurodynamics. Neurodynamics is pretty simple. It's a low force protocol. Actually, it can get complex when you get into the weeds of it. It actually, it makes a lot of sense physiologically, mechanically.

And there's a good book out there that none of you will want to read at all because it's way too complex for lay public. Actually, it's too complex for a lot of healthcare providers. It's the Michael Shacklock Neurodynamic Solution book. It is excellent. Understanding it is hard for a lot of people. I had to read it twice, actually. And I went to his workshop twice. And I'm still learning things to this day about the protocol. But in some of the simple basic treatment forms, it is very easy to apply. And it's literally just laterally flexing the spine away from side of complaint, which is kind of like leaning away.

But the interesting thing, though, is that if you, if we look at the physical exam, standing lateral reflection or leaning away from the side of the problem provoked him. It created his pain. So we can't just have him do that. We got to do it in a more creative way, which is going to be with a hip and a knee bend. And so usually we have people lay on the side of the table, laterally flex away and just wait and find a position where they feel like they're not really doing anything. Unfortunately, one of the biggest mistakes that we see people make here at Performance Place is that people mistake feeling something for actually doing something productive.

And they find a position, they use, they alter the position where they feel nothing, including the symptom. And they alter it to one where they feel something. They're usually trying to stretch the area of complaint. In fact, I saw a gentleman just earlier today. He was actually stretching his hip in a way that he said, I can feel the area, so I know I'm doing something helpful. Well, I said, yeah, but it's increasing your pain after you're done. And he said, well, yeah, but I feel like I'm stretching the area. I said, but it's increasing your pain when you're done. So sometimes feeling the area that, that, that feeling the area of the symptom when you're doing the actual treatment is unnecessary.

I'd say a lot of times it is unnecessary, unless you're doing something like isometric loading. In that case, yeah, you'll want to feel the area, but it also shouldn't be the pain or the symptom. And so a opener to the side knocked out easily 75% of his symptoms in just this single time. I'm not saying it's going to stay away because he does have homework to do. We also did a glute facilitation exercise called Diagonal Set, which is from the DNS, Dynamic Neuromuscular Stabilization Protocols. And we use something called an Attractor State way of coaching it. And Attractor State increases the amount of tissue tone of the glute max, and it makes it stay on longer versus just doing something like a, like a flowy exercise, like, like sometimes DNS ones are.

So we blend things together here at Performance Place. There's, this is a drawing from multiple different disciplines of treatment alone. Neurodynamics is taught alone. McKinsey protocols are taught alone. DNS is taught alone. Also physical examination, actually doing things like scours tests and testing the hip and rolling out actually hip conditions is all done in school. And so you'll need to find, if you want a protocol curated like this, you're going to need to find someone who can do all those things and marry them together. I'd love to say that really skillfully treating somebody and giving them good recommendations is an art form.

Essentially, we have all their tools, which is our protocols and our education. And then there's the artistry and knowing how to fine tune it for that person. I have gotten a lot of comments over the years of people who have unfortunately had to have longstanding symptoms. This gentleman was only two weeks. Most of his symptoms are gone as of today. I'm going to see him next week and probably the next following weeks because I need to make sure to advance this so it's not just a first aid or a pain management protocol. I need to build some resiliency in that hip and also get some core support in a way that he hasn't been doing before.

And the traditional exercises he was doing are actually bothering the hip as well. And so I need to build up some resiliency so he can get back into running as well. And again, he's only had it for two weeks, but I've met people who have had problems for two years or two decades and they're in disbelief that they can actually feel better in a short amount of time like this. Yeah, generally speaking, the longer you had it, the harder it is. But don't assume one year, two years is really that long. Usually the course of treatment of about a month is enough to make a really big dent in it, even if you've had it that long.

Now, if you've had it for decades, yeah, there's more adaptation involved. There's probably some bony adaptation, some soft tissue adaptation. There's some stiffness. There's some movement patterns. Like there's things to unravel. It's not impossible to do. But I don't want to discourage you guys to say that, you know, you can't feel better sooner, but don't assume that the adaptations will change automatically. Like you will still run how you ran. You will still have compensation as you did. But pain can actually reduce very quickly. And so if you trust in the process, you may be surprised how fast it can actually resolve.

So if you guys are looking for help, we do have telehealth options. We'd love to help you, 714-502-4243, or email us or go onto our page to book that way, p2sportscare.com. All of our contact is below. I hope to see you guys next time. Subscribe to the show. Have a good weekend.