Understanding hip and groin pain diagnoses

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show's for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. This is going to be Understanding Hip Diagnosis for Hip and Groin Pain.

We're going to cover a lot of different things today that you guys have probably been looking through with Dr. Google. And so we're going to check out a lot of the different diagnosis and some basics about what they entail. And we'll even cover what most of you probably have been experiencing. So yeah, so I thought we'd cover some of the diagnosis today. You haven't taken a look at that list of things we might cover? Yeah, it was a long list. Yeah, it's a long list. It's like, he wants to cover that in like 30 minutes? No. I mean, there's ones that... So this is based upon like a... So I wrote a book with a lot of the diagnosis in it, as well as some things surrounding it, some things that might work and so on.

And I know it's long. It's like 90 pages long. So I know it's a lot, but I thought we can just cover some of the basics of it. Does that sound good? And if anybody wants to learn more, they can go see somebody or buy the book. There's a link in the description, by the way. Okay. Which one do you want to... Do you have a list there right now? Um, I can pull it up. I had like a couple like things jotted down, but yeah, we can start with... I think like everybody always thinks they have FAI. Let's start with hip impingement then. So femoral acetabular impingement. What have you learned to be true or maybe some fallacies surrounding hip impingement?

What have I learned to be true? Yeah, like... Go ahead. I'll let you talk. Okay. Well, I was... I was... I think I was going to like... For clarification, you were talking like symptom-wise like true or... So we can... So that's a good point. So a lot of things we're going to talk about today actually have a very similar symptom presentation. It's going to feel like there's pain in the front of the hip. Sometimes people might not call it actually the hip. They'll call it the groin. Sometimes they'll feel it with things like sitting and tying their shoes and crossing their legs and crossing their leg across midline and sometimes sitting wider helps.

And so there's a lot of different things or symptoms or symptom patterns that you could have with some of these things. And this is just a list of... We call these a differential list. It's a differential diagnosis list of possible things that you could have, but we don't know for sure unless we test you. And so with that in mind, we'll talk about each one a little bit in turn and we'll get through as many as we possibly can because the list is like 10 things long right now. Yeah, it's pretty long. Hip impingement is a good starting point since a lot of people have been told they have hip impingement or FAI.

So what do you know about FAI? What do you want to cover first? I think a lot of people, you know, they just think like, yeah, they can't cross their legs. They have, you know, pain in the front of their hip. They think like, oh, they can't squat, you know, with their feet or their legs narrow. Then they think like, oh yeah, I've got, you know, impingement in my hip. But that can maybe be true, but it all depends, you know, on everything getting checked out. So specific tests. Is there anything you can tell testing wise or do you need an image to do so? Or is that what? Oh, I mean, you could go a little bit of both, right?

If you wanted to look at, you know, true impingement, you could go and look at an image. But then you could also say, well, you know, they could have that, you know, impingement or like there's, I guess we could talk about the two types of FAI, you know, cam impingement or pincer, like reasoning. And then you could maybe see that on image. But I mean, as far as like symptoms go, they're all going to present the same. Can you actually, I don't even know, can you see a pincer on an x-ray or just you can see a cam? Yeah, you could definitely. I mean, I think you can see both. I can't remember off the top of my head because the pincer is just kind of like the cup, right?

So if the cup lip is a little bit further or the roof of that is a little bit further, then I would imagine you could see it on imaging as well, right? It's just like they take the measurements. Well, I was in the impression that pincer is a little bit, I mean, obviously there can be the, there's the bowl. So they call it the acetabular cup, but there's the rim that could be kind of protruding, but also too, that could be arthritic. So what's the difference between pincer and arthritic really? I was in the impression there's a little bit more of like soft tissue, like type of cartilage issue going on with pincer than there is with cam, but I guess I didn't even think about it until this moment.

Yeah, yeah. I think there is like with the pincer one, you're more likely to have like the articular cartilage wear down, but that could be like arthritic as well, right? So I don't know how you'd be able to tell, is it, right? Is it like a true pincer or is it actually arthritic, right? And then that's just kind of, I don't know, but yeah, cam would be like on the thickness of the neck of the femur. So how like, you'd definitely be able to see that on, you know, or like a bump on the end of that, like neck of the femur. Yeah, so it's more like, like it's a cam gear. It's kind of like an oblong.

I know Mary Lou likes vehicles. She likes cars. Yeah, yeah. It's funny. I was totally thinking about that. It's like a camshaft. It's like a lobe on a camshaft. It's not a cylinder. Yeah, yeah. That's a good analogy. It works for my brain. Yeah. So yeah, apparently you can see things like, I think crossover sign is one you can see on an x-ray, maybe. But also too, I think it's important to notice that people who have positive x-ray evidence or x-ray evidence of things like cam don't always have pain either. No, that's true. So that's why it's like, you can get an image, but it doesn't necessarily tell you if that's causing the pain, right?

Yeah. I always think about impingement too versus, because that general area, like I feel like the two major things, which we should probably talk about this next one, or this one next, is hip flexor type of pain. They're like, well, it hurts right here. Is it my hip flexor? Well, it hurts when you approximate the hip and the torso or the thigh and the torso. So I'd imagine that whether we're doing it actively or passively, and it hurts both, like someone does it for you or you do it for yourself, it doesn't really matter. But it's almost like you're sticking your hand in a door. It's like you're pinching, you're pinching something.

You're not, it's not like it's a tendon overworking if it's passively, especially. Yeah, kind of getting pinched mechanically in there, maybe. Yeah. How many hip impingement cases have you seen, personally? I don't think I've seen a true hip impingement myself yet. So explain that then, because that'll be, that's probably a good talking point. Okay. Yeah. So what I mean by true, you know, impingement is these people might have signs of impingement, you know, maybe that internal rotation or crossing that leg over, right, gives them pain or they go to like cross their leg and they can't quite have their knee to the table if they're like laying on the, on the table, right?

And that's painful, but then you can find other things that would cause that pain to go away after you retest it. And if it changes, then, I mean, it's not a true impingement. Right. It's kind of like masking as an impingement. Oh, it's like a, it's like a masquerade of impingement. So, so then if you, so you still have signs of impingement because you still have the x-ray that shows that there's impingement, but it doesn't hurt because things that you're doing are in positions that you take and decrease your pain. Is that what I'm hearing? Yeah. So what's that mean? It could mean a lot of things.

It could be, it could be referred pain, right? Which you'd have to rule out some other stuff. It could be other area, you know, other things in the area that's causing that pain. But yeah, that's all stuff that you kind of have to test out, right? Mm-hmm. So I'll keep asking them some target questions since it seems like it's really easy right now too. So what do you mean by test out? Test out, are you talking about like the assessment test? Well, so how would, so everybody listening here, they're like, so we're talking about these theoreticals of like, well, true hip impingement, fake hip impingement, how do I figure it out?

Like what, like you're saying an image helps, but it doesn't help. Like I want to know where to go from here. Got it. Yeah. So, I mean, like we said, if you had tried to bring your foot onto your opposite knee and lay it across it, like you're making a figure four. So you make that figure four and that's painful, right? And so that would be one of the tests that you might use to help rule in or rule out hip impingement, but then you might check and see if some other activity changes that, like maybe a bracing technique, right? Or changing the position of their low back. And if that changes the sensation or the pain that they're feeling, then you might wonder, okay, maybe this isn't a true impingement.

Does that make sense? Yeah. So I'll usually kind of deem it as, I call it a differentiating test. And so if Mary Lou moves her finger and her hip impingement symptoms go away when she's figure four, then this is not hip impingement. You know, if Mary Lou blinks her eyelashes like because she's got big caterpillar eyelashes. She doesn't. I don't know about that. Yeah. But if you did and all of a sudden your hip impingement goes away, this is not hip impingement. It's something else. We don't know. We don't know what it is, but it's not that. Yes. But also too, like if you're doing something like a corrective exercise or some type of core work, like you said, and your symptoms go away, that means that, I mean, yeah, you could have quote unquote hip impingement, but at the same time, there is a loading strategy you can do to load share.

Like you're making it so the hip doesn't have to do so darn much. And so it basically means you're a rehab case, at least in my book. Yeah, yeah, absolutely. And that's going to lean more toward not a true impingement, right? Yeah, I know. I've seen, I've seen a handful of true impingements over the years and I keep that there. There are ones that like I do the strategies you're talking about and it seems like it'll work, but there are cases where it doesn't work and I go back to it again. I'm like, damn it, this is truly a hip impingement. Is this a labral pathology even? Like is there something deeper like local structure that is actually frayed and torn and beaten up, you know?

And I found a handful over the years, they were much harder to treat than the ones that you're discussing. Yeah. But everybody kind of presents in a very similar way when they first come in though, whether one or the other. Yeah, so it's a little bit harder in the beginning to figure it out. Yeah. Something to probably note here that we can knock off a lot of things on the list right now if we're talking about young kids, like, you know, 10, 12, 8-year-old kids that come in with hip pain. I know Mary Lou got a bunch of these in school. Do you want to talk about a little bit of these kind of big, big ones?

So I think like the population you're talking with like young boys or young kids, you're probably referring to more of the skiffy is like the, what they call it, right? Slipped capital epiphysis. And so, yeah, if they had that, you know, skiffy in their hip, then that would be something alarming more serious. But if they, they would have a lot of other symptoms that go with it, not just that pain. So they might actually have like knee pain, I think is the biggest one, right? Knee pains kind of correlates with that. So they might not even have hip pain. They might have knee pain, you know, and they might have a traumatic event, but it's not necessarily, you know, true that it's correlated with it.

Could just be a high intensity of like sports and activity for them. Yeah. And so there, the, you said epiphysis, I always said epiphysis, but yeah, so that's the growth plate is still open. So as long as you're, you know, kid is still open and growing, they could have something like this. And so growth plate fractures are nothing that you want to steer away from and ignore. So that's one that like kids generally shouldn't have any hip pain. And as Mary Lou mentioned, they might even present with loss of hip range of motion, but knee pain. Their hip might not even hurt. And so these are things that need to be investigated further, especially for kids under, I'd say generally about 14 years old or so, and they're having some ache and pain.

Kids generally don't make things up. There's also an odd one, which we cover a little bit in the book. It's leg cap hearth disease, which is avascular necrosis of the femoral head. Nothing you want to mess with either. We don't even treat it. And those are the types of bony death of the femoral head to the thigh bone head, which can create hip pain. And this is always a good reason to get checked out. But for the moment, since we can't comment too much on those, but they're things that we screen for, let's go back on to something more fun then. Which is... Yeah. Well, I'd say at a side note, if they had something like that, you might not find any position of relief for those types of things, right?

So that might lead you to believe like, hey, I can't get comfortable and get this pain to go away in any, you know, position, then that'd be like a red flag for us, right? To say, hey, yeah, probably something else going on, not a, you know, impingement. Yeah, like we had a younger individual that came into our office too that we were working with that they had hip pain, they were young for it, they were about 13, but they can make their hip pain go away with sitting and laying down on their belly, like it would immediately go away. And so, at least it's a good sign that things are transient and they're changing, but if they weren't responding to care and they had no position of comfort, like Mary Lou just said this is kind of like, I'm not quite sure, do people like to x-ray those people or is it MRI?

Because I know there's an age where it's like, I don't want you to x-ray my kid, you know? Yeah. Are you familiar with what they would recommend for imaging on those? I think they definitely, for Skiffy, they definitely want to image that. I mean, yeah, it's still young, but they're not going to be like babies, right? I mean, you're looking in that teenage age group, so maybe even starting as young as like 8, 10, and then up to like 16, 17, you know? But, so yeah, you're definitely going to want to x-ray them if you think there's, you know, slipped capital or cap, cap. It's always hard to say.

It's a long one. Capital epiphysis or epiphysis, if you will. But yeah, I don't bring up the imaging because I've actually had parents come in and they're like, yeah, I don't want to image my kid or like their primary care won't want to image the kid and I'm like, well, there's something to look at, you know, like we should investigate this. So it's always like a, sometimes it's a battle about what, what image is safe for the kid at that age. You mentioned things like not being able to find a position of comfort. Fractures and dislocations might be in that boat too. We should probably mention that fractures, if you're a, especially a female runner and you don't eat a lot of food and you run a lot of miles, you should be considered of possibly hip fractures as well, even in the absence of trauma.

Yeah. Or the geriatric population, right? It's a little bit more common. They usually have trauma associated with that though, right? Or do they? Yeah. Some type of fall, you know, but, and I think it's. Go ahead. Well, they fracture the neck or the head or both? I think it's the neck. Do they? Yeah. Yeah, that's a hard one after that. Have you had someone you worked with that had the post-fall fractured? No, not myself. No, they're tough. You got to get them walking again real soon or else it's hard to get them independent. Yeah. So I'll give you a choice what you want to cover next. Hip labral tears or sorry, hip labral pathology, hip flexor or snapping hip.

Let's go labral tear because I think that's a good one. People always, you know, they think, oh, if they have a labral tear, then, you know, it's causing all their pain. Okay. Well, I'll let you lead the show if you'd like to. She's, by the way, this is, Mary Lou is going to be on YouTube. She's going to be ML the anatomy gal. So she's going to have to start leading the conversation soon anyways. Yeah, yeah. So if you do want to start pestering me the questions, you can as well. Until then, I'm going to start pestering you. Okay. So hip labral pathology, then what are your first thoughts about it?

Because listeners might not know what it is at all. So the labrum is like a cushion in that ball and socket joint, right? So think of just like a shock absorber in there. And it's got to go all the way around the head of the femur, right? The leg bone. And then it can get tears. It can, you know, let's, I like Dr. Horgan's analogy. I don't know if you, did you have them? Yeah, we did. I did. You did? Okay. So his analogy was like, oh, like imagine a fence and then you had like, you know, somebody broke the fence or the post got pulled up from the fence and think of like the labrum as the fence and you got like a, you know, a break in the fence kind of a thing.

So it's supposed to help keep it in place. Okay. So you're talking, he's talking about his goats, his goat farm. So I had this goat farm that like the fence it got pulled up from the bottom and the goats got under the bottom and then it also was a split in it. So they got out the front. Is that what you're talking about? Yeah, kind of like that. Either way, a split in the fence in the perimeter is not good for your goats. No, you want to keep them in. Got to keep those goats contained. Okay. Yeah. There. I know that when I was in school, we really didn't go too much into the locations of the fence, which are the most common.

I think anterior lateral is the most common. But there was all these other odd ones. It was like, you know, the goats always went for the front fence. They knew it, but they're kind of like raptors in Jurassic Park. They figure it out. You can't get out the front, so they start going at the back. So there's other types of labral, there's other varieties, right? Yeah, yeah. There's, I think you're right, the anterior lateral, but then there's also the posterior, right? So you might have in the posterior labral tear more pain with extension, right? So kicking your leg back behind you, I think, would be more painful versus like the anterior one where it might be in like a deep squat where you're like flexing your leg would cause more pain.

So it's any time that the thigh bone approximates towards the direction of the fence that it starts to bother. Yeah. So it's like it's catching in there? Mm-hmm. So it seems like it feels like hip impingement again so they can mirror each other? Yeah. Yeah, I think that's still one of the symptoms, right? You'll still have it like pain in the front and you would feel popping and clicking with that, you know? So it might feel like it is literally catching, like you can't get past that movement versus in impingement you won't have that. But with a labral tear you might actually feel like it's clicking and catching on something inside.

I like it when you showed the catching and not going past the movement, you actually moved your hands up and shook like you were trying to get past your spot. Catching? I'm working on my animation, right? Yeah, I can't wait to see all the videos that are coming. Yeah, so I think that is a, I know when I was in school again, they kind of really forced down our throat the idea of the clicking and popping, you know, but they also noted that the clicking and popping had to be associated with pain, the person's primary complaint, not just clicking and popping. Did you hear anything different or is that kind of like the thing, differentiating between impingement and labrum?

No, I mean, I think, yeah, it still stands as, you know, we were taught like, yeah, you have to have painful clicking and popping. So similar to like in the knee, the meniscus, right? Like you always say painful clicking, popping. So same thing for the labrum. It should not only be clicking, but it will be painful with that movement versus pain-free clicking. It's not a problem, right? Kind of like the snapping hip you're talking about is one of on our list. Yeah, yeah. You ever had, I mean, you mess with someone that has the clunk, they can stand and they can just pop their hips and just clunk it?

Yeah, it sounds painful even when I hear it. I don't want to hear that clunking sound. It doesn't hurt, though. I remember this one girl, like she's like, watch, I can do it. And you can see like the side of her thigh just kind of like right around like her hip bone area. You can see it just kind of move. And it's like this thing looks like it's coming out of socket, but you're smiling. Yeah, yeah, it can't be good. Yeah. So I guess moral story of that is doesn't always hurt to click and pop, I guess. I'm sure you've had patients before that ask you like, but I feel this clicking and popping in my hip.

Is this normal? Should I be concerned? Is this a thing? You know? Yeah, yeah, definitely. I've had people ask me that over the years. And I think it's totally okay as long as it's not painful, right? So it can click, but if there's no pain, then there's nothing wrong with it, you know? Yeah, I would agree. I think it's really normal to feel, to pay attention to the clicking and popping when you're in pain. But if you're not in pain, you just don't think about it. My shoulder pops all the time. It's not dislocating, but it grinds. I throw a baseball fine. There's no problem. I can play pickleball and I can backhand that pickleball.

Yeah, that pickleball party. We got to get it going. I can't wait to do this pickleball party. Yeah, I don't know what's funny is I was just thinking that though. I'm like, my shoulder clicks all the time when I'm playing, but it doesn't hurt. I don't worry about it. So when someone gets in the kitchen, do you yell a certain thing? No. They call it the kitchen, right? Like, get out of my kitchen. What's right next to the net? Yeah, you're talking about right there in the no volley zone? Yeah. I thought they called it the kitchen, or am I thinking about basketball right now? I don't know. I think of kitchen, like, I was thinking of basketball, right in the hole, right?

In the key? Okay, I'm going to look up. Yeah. It says, yeah, it's called the no volley zone, but I got it. Maybe I don't know the slang, right? I'm not that cool. Yeah, it's called the kitchen. Some people call it, it looks like pickled, no volley zone, drop shot, flapjack, kitchen, falafel, or pickle ball portal. Falafel? Did you say it's called the falafel too? The falafel. But I definitely see the kitchen, so yeah, don't put it in my kitchen. Got it. Okay. Now for a quick pause before we keep going. Hey, everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar, and you've been dealing with some ache, pain, or stiffness that keeps coming back no matter what you do and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working, and we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity.

The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. So we might as well go on snapping hip syndrome since that's a good route to go with all the sounds. What do you think about it? It seems like it's a dancer thing. that they get the diagnosis. I remember how I met your mother had this episode where they were talking about how Marshall got dancer's hip. I think at that time it was in iliopsoas bursitis. What do you think about snapping hip syndrome? If it's not painful then it's okay if it's clicking but dancers tend to also be hypermobile. They're stretching all the time.

Maybe it's just clicking a little bit more because it's not as stable in that area. How do you stabilize it? Some glute exercise, some squats. I could think of lots of things. Right? Okay. Actually, that's a good thing. There's so many things to cover. We'll circle back to one more later, maybe two. Since this is a good tangent, we've discussed a couple things like labral tears and hip impingement and now snapping hip. We've alluded to some ideas that people can do, but you directed right at it. You're trying to do some stabilization for the hip. What do you think about hip treatment? What are some things people could try at home?

Maybe some things you've seen that have worked or hasn't worked? You can definitely try doing glute exercise simple one that a lot of people know is doing a glute bridge. Put a band around the knees and do some glute bridges until your butt is on fire. Some people call them hip thrusts. That would be a good starting point that I feel like is a basic exercise that a lot of people are familiar with. Yeah. I find that a lot of people doing things you mentioned squats tends to work pretty well for people but if they're having the actual hip pain when they're doing it I find that starting them from something like a one foot box maybe or a handful of books is actually better so they can relax in the position so they don't pinch their hip up before they actually rise yeah that's definitely a good starting point and I think yeah that's a good point to make like not too deep on that squat you don't really need to be going you know all the way down trying to get your butt to the ground type of thing right so just keep it shallow keep it slow yeah well at some point you know they'll have to they'll probably get that back I believe hip pain or at least impingement anyways just kind of remove it for a week or so and then go to the depth that you can tolerate and rep those things out yeah or just changing the position right modify the position of the squat I mean you don't have to all squat with your feet facing forward it's okay to change position everybody's hip sockets are built a little bit just from one of your instructors so they were talking about how one of the colleges had one of the football teams had all like a handful of football players they lost from hip problems like hip impendent labial tears and so on did I show this story yet I don't think so okay so they had like it was football team so it was how many people on the football team like what 30 40 so anyways they screened all these people with is it Clark's test is the face down kind of rocking thing no it's not Clark's is it Clark's where you're kind of rotating the leg yeah and you're looking for like the antiversion retroversion you're basically looking for like hip position or at least normal abnormal for normal for the person and so they deemed the and so for those people they modified the strength conditioning programs so that it wasn't provoking their problem because I think they found that they were actually creating the hip pain with the strength conditioning program and just creating problems for the athletes so they couldn't play football and so they implemented that strategy where they customized the weight training program for those individuals and then they stopped losing so many people to hip injuries just by changing the problem I'm assuming all they probably did was what you just mentioned is they just change their foot position or change the depth of the squat yeah I mean and that's a good point right a lot of times you can just give your body slightly different movement modify it let it rest and you know your body will heal over time too right so yeah so I think there's one more thing we should probably cover is just a general overview you already mentioned a referred pain we mentioned label tears hip pathology some big bad scaries and I know there's probably a lot of arthritis oh we didn't cover arthritis yeah that's a biggie so there's two more things we should cover then I'll let you take the lead on arthritis then since you brought it up okay yeah with arthritic pain I mean I think the biggest thing you would look at is your range of motion right it's going to be limited in both active and passive right so you might just think like oh okay I can't get into that position but maybe somebody else picks up your leg and then they can get into that position okay then maybe it's not arthritic right I think that's a good sign but also the age is going to be important so you know you're not going to have arthritis in a teenager right so it usually is going to take some time to build up in there well what do you think about the people who are like 40 years old and they've been told they have arthritis is that like a death sentence there or like you know no definitely not I think that's kind hair of the spine like I think that's gray hair of the hip you're going to start to get a little bit of arthritis in there wear and tear I think it's natural it doesn't necessarily cause pain right yeah so I think like you know what you mentioned before with you know passive active range of motion someone doing it for you versus you doing on your own is a good PT MD ortho chiropractor whatever they can figure this out for you like it shouldn't be a big mystery like if they move like there's I remember the first time I felt hip arthritis or knee arthritis there was like a skipping feeling I'm like oh shoot like this feels like I can feel there's something physically obstructing the area like there's something going on and then at that point you can do an image and then you see whether it's so severe or not that you have to it's going to be an uphill battle for this person in a rehab facility but you know I remember there was a guy that came in like a couple months back he was told he needed a hip replacement and he was 60 years old and he had an image of his pelvis which showed both hips hip hurts you and he said the right and I said your right hip looks like the hip of a 30 year old the left hip looks like you're 50 but yeah like it doesn't look that bad I'm like and they told you what like you're supposed to have a hip replacement I don't see any signs of any arthritis anywhere in this right hip wow or if there was it was so small I need to be on drugs to see it it's like his left hip his other hip should have been the painful one if anything at all but even then it looks like a fairly normal hip for the age and activity level so I forget why I got in the rant but yeah we were talking about the active passive range of motion thing but yeah I think that's an important point yeah you're always good at bringing me back to the center thanks yeah there's so many things that can be symptom generated and so this individual he's 60 years old and he's like you know like it's very believable he could have some like larger amount of arthritis but he didn't and a good exam can tell you beyond reasonable doubt like it's like dude your hip feels it feels like butter in a hot pan you just can't it just hurts like why why do we got to go to a hip replacement on you yeah but if you do need a hip replacement I hear they are pretty good at them now so true they cannot actually cross their legs over again now right where before they would tell them like oh you can't cross your leg because they thought it would pop out or something I don't know oh really yeah I just I know so I used to work at nifty after 50 which is like a gym back in the day and so it was working with you know older people and that population tends to have the hip replacements and anyway they had told me like when they did the hip replacement before if it was they would have like the scar on the side so then they would tell them like okay you can't cross your legs anymore and you know and I was cross your leg because you know it sounded like they're afraid that it would you know kind of you know be in the wrong position or something but now I guess where they the way that they do them is different and then they have a the incision is in a different place yeah I think it's a little bit more cosmetically friendly now but yeah I remember the same there was there was certain range of motion that the person can't do usually the person is very keen on it anyways but I don't know if it was a fearfulness of movement or there was a danger of the prosthesis moving I remember the first individual I ever saw he had two hip replaced different hips and he was like a I remember he was this white cowboy hat and he was and so he I said how do your hips feel he was like great and so he was wearing cowboy boots too and I don't know if his lifts in his shoes or not but he put ass to grass when he squatted down and he was I almost imagined him doing that you know that dance where they squat and kick and stuff he was so spry he probably could have done that he just loved the replacements but yeah so he was really happy but I know not everybody needs it either yeah the other thing I think would be important to know if you know with hip arthritis is that a lot of times people won't even notice it until it's like at a point where okay it's feeling like it's totally stuck and their hip might not hurt them but they end up getting knee pain because their knee is trying to like compensate for that lack of movement that they now have in their hip right yeah I agree and yeah they can so they can get stuff other parts of the chain sometimes their back can hurt too I know we found in the clinic a couple times people with knee pain if you just expose their hip to some other range of motion their knee pain goes away too so the hip is a big player and just how the rest of your body feels too before we move to tight muscles around the hip is there anything else you want to cover on arthritis since I know it's a passionate topic for you no do you have arthritis at the hip no at least I don't think so maybe I need an extra I see some I see some gray hair so what about muscle tight muscles around the hip because people are going to probably been a lot of places with their TFL and hip flexor and hamstring and glute meat so is right like I feel like the so is always gets blamed for everything in the hip right that pectineus muscle and the high adductor in that paramedalus holy crap the paramedalus so what about all these tight muscles in the area I mean you can have tightness but it's usually not the tightness that's causing the pain right usually there's something else underlying that's causing the muscles to be tight maybe as a protective mechanism even you know so your body doesn't want to go into more movement because it would cause pain so the muscles are trying to guard but I don't think that I think the muscles get a bad rip you know for they're tight and this is what's causing my pain yeah you know I'm just thinking about have you ever found a torn pyramid allis pectineus iliopsoas glute mead have you ever found tears in any of those like actual evidence of tears no not that I've ever seen I mean you know you'd probably have to be doing a lot of I don't know maybe hardcore kicking or something I don't know to even you know to get an actual tear in those you know those muscles yeah I found people that had torn rectus femoris like the two joint muscles like rectus femoris the hamstrings like I feel like they're more dynamic and then get tears associated the other ones obviously can hurt and feel tight but I don't think I've ever found real hard evidence of it actually being a tear yeah well and those muscles you're mentioning are really deep that I feel like they're more those deep stabilizers and you know like you said they're not going to be as dynamic so yeah by the way I smell cornbread cooking downstairs I smell something there's something going on down there yeah I can't wait like if I end this podcast early it's because I smell the cornbread or something going on down there I won't be offended that's okay yeah I gotta go I might like some cornbread too yeah I think yeah the the muscles around the area it's like the tightness associated with let's just say hip impingement hip labral tears they both have associated muscle tightnesses that happen around it right I've never found avascular necrosis of the hip I found possible slip femoral capital epiphysis and I think there was spasm around that one but I don't know about I would imagine avascular necrosis is the same thing right yeah so the muscles are protectors including the piriformis so just just a note on those things because it's going to be super common it's really distracting because people just treat those things up and they don't actually get to the root of the problem Mary Lou before it's cornbread time is there anything you want to cover about hips that you think people need to know I don't I mean we've covered a ton but I mean I would just recommend if you're going to somebody specifically for your hip that they look at all the other surrounding areas that can be you know affecting the hip right not just the hip itself so I think that'd be a good point to bring up yeah and I think a good comprehensive exam of your hip requires the person to actually put their hands on your leg it's more than just an image is nice but it's it's it's not part of the puzzle or sorry it's just part of the puzzle if I said that cool so yeah so if if everybody wants more information too as I mentioned I did I'm going to put a link in the description for very I guess very long for me to write anyways but it's 90 pages or so of a book we might change the title but Mary Lou I don't know if I told you this title I really like it understanding hip diagnosis and how to not let Dr.

Google guide you to failure I like it so it boils things down goes to pain in the hip out of the hip referred to the hip some things we discussed already as well but also some of the big picture things like how pain can be your friend as well as joint by joint approach to the body and neuromuscular control and suggestions as well but if you are around Orange County I bet Mary Lou has a place you can go I think everyone should visit Mary Lou she's stellar when it comes to hips wouldn't want to give your contact information yeah definitely so I'm located in Tustin California and so if you want to reach me you can email me at revamped active chiro at gmail dot com or give me a call 949 994 1304 how do you spell revamped r-e-v-a-m-p-e-d I like it okay and you do virtual stuff too yes absolutely okay cool well thanks for being on I'm going to link some stuff in the description for Mary Lou as well I know her pretty well she does a very good job with hips and as you can see she's tolerant of bad jokes and so if you have bad jokes she would love to see you thanks for having me on yeah thank you all right thanks Mary Lou for being on everyone that was Mary Lou Garcia Dr.

Mary Lou Garcia she's in Tustin I've known her for quite a while she does an excellent job like I said before so if you do have any issues go ahead and contact her as well if you're looking for that book I useful information because there's a lot of bad it's confusing information on the internet and so I tried to organize things in one place for you guys so you get an idea of what to do next what works for different types situations I know we didn't cover fully what a rehab approach or a treatment approach would be for these types of things but it can be very simple it doesn't have to be super complicated simple things do work if you do them well and if you get examined to figure out what your diagnosis is first so until then you're kind of guessing a little bit and there was those odd ones that we had mentioned in the podcast that are ones that obviously we can't treat and they might have to be addressed in different ways so getting an examination a good examination by someone who can physically examine you as well as look at images anything you have is a link in your podcast player there you'll find any free resource that we mentioned in the show any guest links and a link for a free discovery call with us we're licensed to work with our outdoor active people via telehealth across many states in the U.S.

at this point in fact we cover almost half of the population in the U.S. and we add more states every year thanks for listening. Subscribe to the show and we'll see you in the next one.