Hip pain on both sides and front thigh pain to the knee

Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, it's Dr. Sebastian Gonzales from the Performance Place Sports Care Podcast. And this is the place where I'm going to start answering some of these questions that I get online. I get them off of YouTube. I get them off of SpeakPipe, off of my website, p2sportscare.com. These are things that I've really wanted to answer for a long time. And if you actually look at some of the YouTube commentary that I'm giving back and forth, I really want to answer them, but I can't.

I can't answer them all, especially directly to people, because the problem is, in the medical profession, is we're not allowed to really make these comments about what it is unless we've examined you or if you're under our care. But, you know, I really think that answering, or at least going into general theory on some of these questions would be okay. And because of that, I'm taking some of these comments that I get from people, and I will not say their name because of privacy, but I'm going to go over their question and just kind of brainstorm it with everybody, because they've obviously put it on social media, and it's going to be okay to share, because they shared it themselves.

So, I plan on doing these every once in a while. We'll call them case studies. This one is on one of the more popular YouTube videos that I've put out, and this one was put out in 2013. It's called, Number 3 Most Common Cause of Hip Pain, Rectus Femora's Origin Strain. And, I mean, this was three years ago when I did this video, and there was a lot of stuff I learned since then. I mean, a lot. And I've explored the possibilities that this video could have been in reference to sports hernias. It could have been femoral acetabular impingement or hip impingement. It could be a labral tear. And I know you might not know what all these things are, but going through this podcast today, I want to explain some of these things.

And the pure intention of these videos, at least this era, these YouTube videos I made, was mainly for the intention of being able to self-palpate, and mainly to feel bony landmarks of your hip, of your knee, of wherever the region was, and know what attaches there, and know what's around it. Because part of the issue when you go into an office or a medical clinic is that we have different communication. And what we consider hip, you might not consider hip, or what we say is shoulder is actually the shoulder joint proper and not the actual spot that's kind of around the base of your neck. So I'm going to go through this question here, and if you have a question you want to submit, please go on to the P2 Sports Care website, SpeakPipe.

It will be right there in the center of the screen, where I'll make it really easy to find. And you can just leave a question, and it will be on, you don't really have to go through your phone or anything. It's just right there on the website, so you don't have to really have cell access or anything like that. So here's the question, and she obviously had some hip issues. So I'm just going to read this verbatim, or roughly verbatim, because I think there's a couple errors in the grammar. But, so I have two hip, two different hip injuries, or two, sorry, I have two different hip pains, one on each side.

I think, I think sciatic, the sciatic nerve is one of them because it is painful when I'm sitting or leaning on it. But my left leg has sharp pain in the front, almost down the knee, when I carry any weight or too long of strides. Now, the first thing I think of when I hear something like this is, I wonder how this person had two-sided pain, or two-sided hip pain. And also, I wonder if it's symmetrical. In this case, it sounds like it's not. But in the case of symmetrical pain, let's just say, someone might say they have bilateral piriformis pain, or piriformis spasm, or so on, or bilateral sciatica.

Anything that is bilateral, you have to think that there's a possibility of a central origin condition that is creating both of them at the same time. And I always like to think of it in regards to, say you have a river, a main river with a bunch of tributaries off the side, or a bunch of canals. And I always think of it with, in regards to pollution. If the main river has a ton of pollution or toxic waste in it, all the tributaries will also have it as well. There's a high probability of it. Now, what if we said all of the tributaries, let's just say there's two, just for the ease of this, since we have two sides.

So, what if both of the tributaries, or canals, had pollution in it, would we rationally think the main one doesn't have it too? I mean, it's definitely a possibility. Someone just went to the roof, or the beginning of those canals, and just started dumping toxic waste in it. But that would take two different incidences, and it's almost like flipping a coin twice and trying to hit heads twice. It's a little harder than hitting heads once. So, we have to consider the possibility of having a central condition which is causing this. And in this case, for the spine, we might have stenosis, depending upon the age of the person, which is a narrowing of some of the holes or outlets for some of the nerves and also the spinal cord itself.

Or we might have a disc injury. We might have, gosh, there's a couple things. I mean, we can say there's cancer, space-occupying lesion. There's a lot of things there could be. Now, let's just consider this is not a central origin, but there's actually two different conditions, one on each side. So, she's mentioning that there's sciatic nerve pain, and let's assume that it means in the back of the leg and thigh, since that's technically what sciatic pain is, because that's where the sciatic nerve goes. But I've heard a lot of people say the sciatic nerve, or they have sciatic pain, and it's on the front side of the leg, which that can't be.

That's a different condition. It's not the sciatic nerve, but it can still be from the back. Now, the sciatic nerve, let's just say, so she said it's on one side, and it hurts when leaning and sitting on it. That can be from pressure on the nerve as it passes down through the backside, through the butt or the hip rotators. It makes me think reminiscent of a possible peripheral nerve entrapment, or an entrapment outside of the spine, which could be like piriformis syndrome. And I'm sure a lot of you have heard conditions like that. So there is a possibility of that. In that case, she might want to probably just consider she's not sitting on a big wallet or something like that, or a really hard and dense seat, because that could always be possibilities with these conditions as well.

Anytime you smash a nerve directly, almost like a funny bone, like when you hit it, that is actually the ulnar nerve of the arm, and when you smash it, it sends that zinging sensation down your arm, so that's always a possibility. But she's talking about the left side, which has front-sided things, all the way down to the knee. So down to the knee, that could be a muscle condition, which would be the topic of that video, the rectus femoris. It can also be a femoral nerve entrapment. It can be a radiculopathy, which is an entrapment of the nerves which create that femoral nerve, but higher, up into the spine.

So, she also says it hurts when she carries any weight, which makes me think there could be a trunk issue, which, for me, this is all leaning towards a possible instability of the trunk. And, generally speaking, we could call that, I guess, core strength. And core strength, although some people have very poor core strength, it doesn't mean they have structural problems underneath. What I mean by this is that you could have, like, your abdominal air is really, or the whole hoop mechanism of the core is really weak, but it doesn't mean you have blown out disc and damaged the spine or anything yet, but you could.

Any time there's these large-scale conditions, sciatica, disc injuries, pain or numbness on the front side of the thigh, there's always a larger possibility there is damage to the spine, which could be helped with conservative care, like physical therapy or rehab. But, and there's a lot of other things, by the way. But it can also be a surgical condition. So, in cases of this, I would say an assessment would be very much in their favor. And I know that this is something I default back to a lot on these podcasts, or, sorry, on these YouTube videos, mainly because a lot of these people, if you read through these, they haven't done anything to get any help yet.

And they're asking for help on the Internet, and I've seen this through Yahoo! questions, I've seen it through Runners World blogs, or forums, I've seen it through a lot of places, and it intrigues me, it really does, that people are willing to ask for help on the Internet here with conditions that really kind of sound, some of them sound very severe. And I understand, like, they want to be heard, and they want other people to echo that they have the same thing. But really, if you want help, this isn't the place to start. And for this condition in particular, I would want to assess, is there proper flexibility, number one?

If there's not, maybe we should address that. If there's not proper core strength, we should address that. I mean, is this person sedentary? What does their daily life entail that requires them to take long strides? Are they a long jumper? What are they? What are they doing? So there's a lot of things that would, that need to be taken into consideration when developing a treatment plan for this type of person. But we have to really, really consider that there's a possibility that we would need advanced imaging as well. I'm sure a lot of you have heard about x-rays, MRIs. You probably have not heard about ultrasounds, maybe not CTs.

And there are other advanced types of imaging as well. And studies that we can do to confirm what's going on in these cases and confirm a diagnosis. So, in my opinion, in cases like this where there's a possibility of a nerve being entrapped or a muscle or tendon being irritated, I think we really have to, I mean, we can do x-rays, but, I mean, x-rays, I think, have a lot of, they have some positives, but I think they have a lot of drawbacks as well. There's radiation involved, and I know that if you're younger, and especially with unfused growth plates or you're still growing, you don't want to have a bunch of x-rays.

Pregnant ladies can't have x-rays. There's just a lot of things that, in regards to radiation, I don't think you want to be subjected to it too much. A couple of them is okay. But the amount of information that you get from them, really what we're looking for on those is fractures and bony alignment. And what I mean by that is, or mainly cortical fractures, and cortex, or the cortical surface of a bone, means the outer layer. And my typical analogy with this is an x-ray would show if, so if we took a hatchet to a wall, or just took a hammer to a wall and just busted a hole in it, that drywall right there in that hole in it would show on x-ray.

But just looking at a wall right now as I'm doing this podcast, we don't know if there's rot inside. We don't know if the joices or wood or anything in there is rotting away or fractured or broken because we can't see inside. And x-rays are kind of like that. They're not good at looking inside the bone too much, but they're good at looking at the outside. Now, if you stare at an x-ray and look, you can see you don't see a lot of soft tissues, muscles, tendons, ligaments, nerves, disc, or anything of that nature, really. We used to have a saying in x-ray class, you'd have to be on drugs to see what you're supposed to see on x-rays.

And you can get a glimpse of some things, but realistically, there are better images for soft tissues such as that. MRIs are great at looking inside the bone. If you're looking for fractures inside or if we're looking at muscles, tendons, nerves, or carlages, MRIs are the gold standard. And another advanced image too, which I alluded to, is ultrasound. Ultrasound has a lot of positives. There's no radiation involved. It is very quick. And you can see very superficial tissues very well. So, in regards to this video, the rectus femoris, or the origin, I mean, it's so close to the surface that if you stuck an ultrasound on there, within five seconds, you'd see whether there is any tendon damage or not.

If there's not any tendon damage, I'm pretty sure it's safe to say we need to start looking elsewhere for why this person has an injury. Now, ultrasound does have some drawbacks. You can't see underneath bone or inside the areas where bone is guarding even other soft tissues. Inside, in and around the hip, you can see parts of the capsule or deep sections of, like, ligaments around the actual hip joint. And you can see the hip flexor. You can see the glute muscles. You can see some of the other muscles around the hip. But you really don't get a good image of inside the joint. And certainly with the spine, especially the spinal cord and some of the nerves coming outside of it, they're guarded by bone.

I mean, that thing is just like a house of bone in there, and you can't really see past it. So, I personally never utilize ultrasound imaging for spinal issues. I hope this was helpful to everybody in just kind of seeing the thought process around these injuries. Anytime you have two sides, you have to think possible central origin. When you are claiming something is, say, sciatica, I think you need to do further research on what actually sciatica is. And I'm sure there's lots of references out there on what it is. And I'm sure I'll do a podcast or YouTube video very soon about sciatica if I haven't already.

I don't think I have. But, yes, get assessed. None of these podcasts, I guess as a disclaimer, none of these podcasts are intended to be used as substitution for actually seeing a medical provider. So, you really, really do need to go get checked out, have someone examine you, do extra imaging if they need to. And I'm sure they'll give you a great opinion. So, if you want to submit your question on to SpeakPipe, just know that it could be possibly on air here. Or if you take it and put it on YouTube under the channels or in my channel or on one of the videos, I see a majority of those. But YouTube is not very good at categorizing these things.

So, sometimes I get lost. And if I don't respond, it's probably because it's been just lost in a cluster of all these other types of comments that I'm getting. So, I really, really try to at least respond to some of them. Or, sorry, I try to respond to all the good, credible ones. And normally, in case you're wondering, the ones that I look at the most are the longer ones. So, if you're putting one-liners down, a lot of times me or my staff will just kind of skim through it. So, I hope this was helpful. And I will talk to you guys soon. Don't forget to subscribe to our YouTube channel as well as the podcast here.

And like our stuff. I really, really am appreciative of our fans who comment on things and do thumbs up on YouTube as well as put comments and ratings down on the podcast. It's really, really helpful in regards to getting the word out there and helping everybody. So, have a good day. I'll talk to you guys soon.