Hip and Groin Pain Patterns: Look at the Other Hip

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. Hello, everybody, and welcome to the Restoring Human Movement podcast. This is your guest host, Dawne Costantino, and it's a beautiful sunny day in Southern California today. It's been rainy and stormy lately, and I've been enjoying it, but I did just want to brag a little bit and share with you guys how beautiful it is outside the window that I'm looking at. I just took my dogs for a walk. It is gorgeous out there, so I'm in a great mood.

I'm recording now, and what we're going to talk about today is hips, specifically hip imbalances. We see a lot of hip and groin cases in our office, and the more and more that I see, the more and more, I'm starting to see some similar trends and patterns between each patient, and I think it'd be really, really important to kind of share this pattern with you guys, because if it relates to you or somebody that you know, it might highlight something or might help somebody really find the help that they're looking for. So that's what we're going to get into today. We're going to dive into hip imbalances.

We'll start first with how it feels, usually what these people present to me or present with how they describe it, what bothers them. Then we're going to go down into what I see on their exam and their assessment. We're not going to talk diagnoses specifically, but just kind of just these like global movement trends that I'm seeing. And then we'll dive a little bit into a case study that I think would be really important to share with you guys, too, that kind of correlates with this pattern I'm talking about. And that's it. It's going to be just a quick little conversation. So, yeah, if you guys are new to the podcast, welcome.

If you're not, welcome back. We have tons of podcasts about hip and groin. So if that's what's going on with you and you want to kind of a longer format than what I'm sharing with you today or you like what you hear today and you want to hear more, go back into the vault of all the recordings that we've made. There's so many at this point. And yeah, hop through some of those hip and groin ones. If you got a hip and groin thing, go ahead and check out the low back ones, too, because a lot of times they're very related. So anyways, let's hop right into it. What area of the body are we talking about here?

Because I have people walk in the office. They're like, my hip hurts. They point to where it hurts. And that's not at all their hip. A lot of times people think that kind of lower area of your back kind of above the butt cheek is their hip. It's not. It's a different joint. It's called the SI joint. Very related to the function of the hip, but not where we're talking about today. Specifically, I want us to kind of focus on, if you're listening, I'll describe it to you. I want to focus on more of the crease of the hip, the crease, or what some people know as their groin. When you sit down and there's the folds in the top of your thighs there, that's kind of where I'm talking about today.

More of the groin area. A lot of people that I've been seeing will describe it as a tight hip flexor. People will describe it as pinchiness in the groin. It can feel stiff and achy sometimes. It can radiate to different places. It can go down into the pubic bone, down into the inner thigh, down into the meat of the thigh, maybe even as far down as like the inner knee. It can go up into the lower abdomen, can wrap around to the backside, that upper butt cheek, maybe even the meat of the butt cheek, and also up into the low back at times as well. I don't want to dive into diagnoses too much. Some of those referral patterns are more specific to certain things like nerve issues.

Some of those referral patterns are more specific to things like hip impingement, labral tears, sporternias, all kinds of things that we can really talk about. But again, go check out those other podcasts for more details about the diagnoses that can be related to these symptom presentations. But that's a lot of the stuff that I see when people are coming in with a groin and hip issue is all of those areas can be correlated, some more than others, or can present. Typically, it's just the crease of the groin though. A lot of times people will describe it as painful when squatting, painful when lunging, painful when sitting for a long period of time, or going from sitting to standing, painful getting out of the car, going up and down stairs.

If you haven't picked up on the trend of all of these movements though, it's all hip flexion. Anything that breathes the knee closer to the chest, which is hip flexion, will create a lot of times that pinching discomfort in there, or just stiffness, or just tightness. So yeah, that's typically the presentation. Sometimes there might be popping or clicking going on. Painful popping and clicking is something you really want to get checked out sooner rather than later. It's really, really important. But yeah, and I've heard a lot of them talk about certain stretches that they've tried. Hip flexor stretch, temporary relief.

Pigeon pose stretch, temporary relief. They've tried glute exercises. They've tried core exercises. Good ones too. Watch them do it. They're performing it great. So the question is, is like, why is it still there? That's kind of why they end up in our office, right? I've tried all these things. I've seen all these people. I've had some temporary relief. I've seen some progress. I'm just not where I want to be. So here's what the assessment looks like for these people. And this is kind of where the shock comes in ultimately. Because I like to also show people, not just like go through my own assessment and just like don't describe why I'm doing things or not show them what I'm seeing.

So a lot of this stuff, they can see, you know, where the discrepancies are, where the dysfunction is. So I'm not going to go through what my whole assessment looks like, but I'll describe to you some of the more important things that I typically see with groin issues like this. We start with standing range of motion, just lumbar, dracolumbar range of motion, bend forward, bend backward, bend side to side, rotate. Most of the time, you're not going to reproduce groin discomfort with any of those. Every once in a while, you can feel some like tight hip flexor when you're bending backwards. Every once in a while, they can't go as far down to touch their toes because that is some hip flexion happening there as well.

And they'll get that, maybe just some stiffness, their exact pain. There's something in that area that'll be bothering them. 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. From there, we get into a squat. Squat tells me a lot. Every angle of the squat can tell me something a little bit different too. But what I usually see, either from the front, looking directly at them or from the backside, is that there's a shift happening. And it can look a little different on each person. The shift is usually, and again, this is the pattern I'm talking about, into the painful hip, instead of just dropping the butt straight center, they're actually shifting into the painful hip.

And they'll be like, that's my pain. That's what I'm feeling. This is what I'm noticing. And as I'm looking at them, I'm like, oh yeah, of course it freaking hurts because you're using it a lot. Like, why are we sitting into this hip so much? It doesn't, I mean, at this point, I don't have enough information to know why. It doesn't make sense, but it makes sense why that thing hurts. It looks to me like it would hurt if I use it that much. And for some reason, not using the other side evenly. So it can look like a shift or it can look like even, I don't know if you're watching the video, my hands like this is basically the bottom of the butt cheeks.

In the bottom of the squat, what you'll see is their butt cheeks aren't at like an even level. One of them might be lower than the other. That's usually the one that they're sitting into a little bit more. And that's usually the painful one too. Not everybody. Okay. Some people will shift away from the painful side, especially more in the acute phases. But I see people at all different phases, so really most of the time don't exactly know right off the bat why they're sitting into the painful hip. It's just, well, that needs to change for sure. There's some, I know, our first piece of data. So sitting into the painful hip is a very, very common trend that I am seeing in hip and groin cases.

So my question then, and what I want to dive deeper into is what's going on on the non-painful side that we are not accessing that hip as well as we are the painful side. And usually when I bring that up to people, they might actually have a story. Oh, I had an old knee injury on that side. I used to sprain my ankle in soccer a lot on that side. I don't know why. It doesn't make sense. I've never had an issue on that side. Gosh, so, so many different reasons why they may not be accessing that side as well. But it's like insanely common for me to see this in hip and groin cases. Another thing I kind of wanted to go back to for just a second is that just like overall range of motion that we were talking about too, the bending forward, backwards, side to side, rotating.

Most of the time, like I talked about, doesn't reproduce discomfort, but I'll see some pretty significant dysfunction. Maybe they can't rotate to the painful side as well as they can the other side. Their ability to bend backwards is severely limited, meaning, I mean, who knows what, but like a lot of times if we don't have other areas of the body functioning the way that they should, pain starts to set in because path of least resistance, the body is going to use where it has access to, to accomplish the task at hand. So if that painful hip is functioning pretty darn well, it's just painful, your body's going to use that hip to accomplish those tasks.

So my question is, why are we not moving well through the spine? Why are we not moving well through the opposite hip? What's going on down at the ankles? All of this stuff is questions I have going on in my head as we're assessing. So moving along in assessment, lay them down on the table and we're facing up to the ceiling and you can go through passive range of motion, passive meaning, how much range of motion can I take this person through without them having any muscle activation during? Laying on your back, we want to see how far we can, you know, flex the knee to the chest before pain comes on.

When pain comes on, what do I feel? Is it hard? Is it soft? That tells me something a little bit different. Is it tight muscles? Is it a bony end feel? Those are the questions that are going on. But usually what I see is the painful side will say, ow, but will have really good range of motion, really good function. And we hop over to that opposite hip, the one they're not sitting into in their squat very well, and that side is significantly limited. We don't have the ability to internally rotate well on that side. We might actually be able to really externally rotate better than the painful side or also external rotation is limited.

So those are two things that I can easily show the person too as they're laying down. Look at your painful hip. Ouch, right there. Yeah, but you got great range of motion. Look at this other side. Severely limited. Severely limited, moderately limited. Little bits I'm not too concerned with. I don't expect everybody to be perfectly symmetrical. But big changes or big differences from side to side and range of motion is something that I want to dive into for sure. Flip over onto your belly. Ability to extend the hip. Also kind of kicking backwards with the hip joint. I want to know how well we can passively get into that.

But then I also want to know how well these people can actively access this range of motion. This is the amount of range of motion you have in these hips. Can you access that range of motion well enough too is always a question. So we may notice, wow, that's really great range of motion you got there. Show me how well you can access it on your own. And it looks horrible. It looks really bad. I would never say that to you guys, by the way. I would just be like, that's, you know, we need to improve that for sure. That is something that's just more and more data we're gathering here where there's opportunities to improve here in range of motion, there in active range of motion, all kinds of stuff like that.

So that's typically what I'm trying to say here is what I see is the painful side is not the problem side. The opposite side is the problem side. And I'm not sure if you've been told this yet. I'm not sure if you've heard this information on the internet just yet. If I'm the first one telling you, well, there you go. Have somebody look at your other hip, have somebody or find somebody who will kind of zoom out from where the pain is presenting and really pick up on where the dysfunction is at. Pain is pain and pain can tell you a tissue that's involved. It does not necessarily tell you what got us there.

Why does this hurt? Why are we creating injury? Why are we creating impingement? Why are we, do we have a strained hip flexor? Why is there a sports hernia? All of these things, we need to dive deeper into the why. So overall movement and overall function tells us a lot. So I kind of wanted to open up your eyes to the thought of getting other areas of the body to function better so that your painful spot can actually heal. Just like a team sport, you know, star player is going to frigging fatigue out and is not going to be able to work at their full potential if the other players of the team are not working at their full potential.

So if we can build better team players, then this painful hip will or can diminish and can heal and can function better overall. So that's a little rant I wanted to go on. It was just pretty insane how often I was seeing this. The case study that I wanted to share with you guys is actually a post-surgical hip, labral repair, hip impingement repair, really great recovery. Function has drastically improved for this person, can squat better, can lunge better, has spent a lot of time rehabbing this hip before and after surgery. Assess this person, that hip is moving really good. Obviously a very successful surgery, obviously has been putting in a lot of work to help repair this hip.

And not to say that there hasn't been improvement, but it's still painful. Obviously that's why they're still in the office. It's still painful. It's still stopping this person from working at their full potential. I want to squat, but I want to be able to squat heavier or I want to squat deeper or I want to feel stronger. I want to be able to get up and out of a chair without it like really stiffening up on. So during this person's assessment, kind of what I described before is exactly what we found on this person, was sitting into the painful side more in their squat. That butt cheek was lower on that side as well.

Range of motion, just kind of global range of motion in the spine was a little limited on one side more than the other. I can't recall off the top of my head, but just like spinal range of motion needed some improvement. And then hip assessment, it was like the left hip, that hip that was painful was functioning totally fine. Right side had some pretty significant discrepancies that we were seeing. So we, in our rehab journey, have been focusing on how to get that right hip to mobilize, to open up, to have a little bit more range of motion. Another thing this person described to me was during single leg movement, like a single leg dead lifting pattern, that the non-painful side fatigues quicker, feels stronger on the left side, can do more reps, can do more weight before they start to feel that muscle fatigue set in.

And the non-painful side is the side that like pretty drastic difference we were noticing in strength and fatigue on that opposite side. So yeah, that is really important to think about. If you've been dealing with hip and groin issues for longer than you would like to, I guess, or longer than necessary, like pain and injuries are just a normal part of being human and active. But there's like a timeline that's okay. And then there's a timeline that's like, we're missing something here. So if you feel like you're in that timeline of like something's being missed, make sure that whoever you're working with is zooming out and looking at you globally, or go find someone that knows how to do that really well.

Maybe ask or request them to look at the opposite hip. How is that opposite hip functioning? If you want us to do that for you, I'm happy to, you know, or we're happy to work with you. Come take a trip to sunny SoCal. We'd love to see you. We'd see you in the office. We, if you are not somewhere where you can come and travel at this time, we can assess you virtually, maybe talk about options. We do have a really great referral network across the country. So we'd be happy to kind of point you in the right direction if necessary. And another thing that I wanted to share with you, I don't know if I mentioned it yet, but we do have a hip and groin webinar on our website.

It's free. You want to dive deeper into this. You want to assess the hip. You want some options on what you can try, some exercises, some stretches. Start there. I think it'd be great information for you to dive into and just try some things on your own at home. But whether you have improvements or not with that, I always am going to advocate for allowing somebody to guide you. I pretty much never treat myself or try to treat myself. I'll try things here and there because I know what I know, but I would rather just have somebody else tell me what to do, hold me accountable, be my advocate, take me through what you're seeing and give me some stuff to work on.

We've got something going on right now that Dr. Sebastian is helping me with. He's doing some things that I probably would have never thought of on my own. So just go have somebody look at you, have them take you through it, have them take you through a program. It's always the best bet. Yeah, reach out to us. Give us a call. Shoot us an email. Hope to talk to you guys soon.