hip injury

[marylou]

Yesterday morning I caught an edge while skiing and did something to my hip. It hurts way deep in there, like under the muscle and fat, right near the hip socket. It hurts to walk, ski, stand up, and go down stairs. I can't figure out how to stretch it.

 

Any ideas as to what I've done to myself? Any suggestions besides RICE about what to do?

[iain]

yikes! maybe a 800mg loading dose of your nsaid of choice to start with! sorry to hear that.

[Crux]

Seeking advice on how to stretch a ligament/tendon injury in the hip joint? Mebbee better to just keep the joint active, thereby assuring circulation of synovial fluid to promote healing in those tissues unserviced by vascular system.

 

Bicycling works for me when similar symptoms suffered; worst remedy has been total rest, but stretching the already over-stretched seems to delay the time required for the tweaked fibers to get their composure back.

[glassgowkiss]

sounds like a hip flexor injury. taking nsaids won't do much for the condition itself, since it is muscular. as the matter of fact it usually causes weaker tissues at the end. find someone who does work with illiopsoas and knows how to treat it. it is not so complicated and usually they heal within a couple of weeks with proper tx. don't stretch it now, let it rest. just keep the hip moving. it is very uncommon to have an actual hip dislocation

[marylou]

The pain is pretty deep in there and if I were to point at it, I would either point staight in from my side, or from slighly more rearward on the outboard side of my butt.

 

I thought the hip flexor was more in the front, am I on acid?

 

GG, not sure how to seek treatment as I am a Group Death member. Is it something that would be treated my a PT, LMP, or someone else?

 

Tx.

[glassgowkiss]

your pcp can request for massage and pt from gh. he can also request accupuncture for pain control. i will shoot you pm, so we don't have to discuss the specifics of your condition on this forum. ciao- r

[Mtguide]

Gee,sorry to hear that; so early in the season,too.But--I'd strongly recommend seeing a good orthopedist;this is definitely a job for them,not a PT and certainly NOT an LMP. No fuzzy-wuzzy here,OK? There is indeed a lot of discussion about standard vs. alternative treaments,but one very important thing that modern Western medicine has going for it is absolutely unsurpassed capacity for diagnosis,and right now it's imperative to get as clear a determination as possible of what's going on inside that hip joint.Then you can proceed to make INFORMED decisions about treatment,rehab,etc.

 

From your description,it doesn't sound like this is something to screw around with,guessing at hit or miss meds,etc.Stretching an injury could further aggravate or seriously complicate the injury.The hip is a very complex and vulnerable joint.A simple x-ray,perhaps an MRI could save you a LOT of trouble.Stay off of it for the time being,don't ski,hike lift weights,or do anything that causes pain,beyond what is absolutely necessary to get around.

 

Aleve(over-the-counter version of naproxen/naprosyn sodium is extremely effective,and is preferable because rather than being strictly a pain reliever,it's essentially an anti-inflammatory,relieving the pain by reducing inflammation.It may take a while to build up in the system and take hold, but it doesn't mask pain,so you can keep aware of the condition enough that you'll know if you're doing something to aggravate it,and can stop before you cause further problems.

 

You can try icing it(one lb. bag of frozen peas,25 min. at a time,remove and allow area to fully rewarm on its own,repeat.)and see if it helps,and I would.But it sounds as if it may be deep enough that ice may have limited benefit,if any.This would be for the first 24-72 hrs. only,then alternate ice and heat.

 

Above all,please call the doctor,without further delay.Find a good sports medicine orthopedist,or one who's familiar with climbing/skiing injuries;

there are some good ones who are also serious skiers.I'm in Portland and not familiar with any in the Seattle area;but I do have an excellent one here in PDX and if you like perhaps I could get a referral from him to a good one up there. You might also try UW medical Center,they're usually state-of the art,and could at least steer you in the right direction.Best of luck ,and let me emphasize one more time,please DON'T fiddle around with this.

 

[glassgowkiss]

Gee, sorry mtguide, i think you've spent too much time at high altitudes or you are just full of shit without any help. acually pt can dx and they do better job as far as working with injured muscles. your whole post is a bunch of pseudo - scientific spray, so stfu.

aleve is not antiinflamatory.that's for one. second hip is not a complicated joint. the name proper is coxal joint btw. it's a ball and socket joint and it is one of the most stable joints in the body, virtually impossible to dislocate. pretyy much the only way it is possible is to have force applied to it while in a full squat (about as much your whole bs post is worth). it sounds muscular anyway, so what would orthopedic surgeon do anyway? (who the f... is orthopedist ?)there are simple muscle tests, that cost nothing. doesn't look like any bones were fx'd, so why would you order expansive x-ray (unless you want someone glow in the dark you kinky bastard) or mri?

icing- you are dead wrong. there is no time table for icing. you ice till the area becomes numb, so more the tissue, longer it's going to be. it's a vasoconstrictor.

just a thought on your point western vs alternative (to what anyway?) topic. just want to remind you that your trusted doctors are still prescribing cortisone shots and novocaine as a course of treatment for injured athletes. maybe you shoud read a story abour Curt Marsh and see how frigging effective these guys are- since they had to amputate his leg after a simple bone fracture. this treatment was performed by supposedly the best orthopedic surgeon in california. like i said- you are full of crap

Edited December 23, 2003 by glassgowkiss

[marylou]

Mtnguide, I appreciate your concern, but in large part agree with what ggk is saying here.

 

I did not take a bad fall, don't have really noticeable inflammation, can weight bear. I've broken more bones than most people due to low bone density (please don't drop me on a hard surface, parts do break), and there is nothing broken bone about this. It wouldn't even be of much concern except that my job can be physically demanding, and I do ski 2 or 3 days a week and need to make sure I don't create a big long-term injury out of this.

[Mtguide]

Hi Mary Lou and GGk;

 

Well, to begin with, I never said a thing about broken bones,that would be the last thing I'd be concerned about from what you describe.My concern is about the ligaments and tendons,also the cartilage and fibrous tissue around the joint capsule.I'm not sure where ggk is getting his information,mine comes from personal experience,as well as EMT,and WFR training and certification,and 10 yrs experience as a certified personal trainer.But I'm not here to argue that,simply to help you avoid any long term problem.

 

Aleve is indeed an NSAID,(non-steroidal anti-inflammatory).Inflammation is simply the immediate reaction of the body to injury,swelling caused by tearing of muscle,ligament,or tendon( or all three together)flooding the immediate area with blood serum from the ruptured tissues.Ggk is absolutely right that ice is a vasoconstrictor,but it tends to temporarily slow down inflammatory reaction(mostly white blood cells)and once removed ,fresh oxygenated blood flushing back into the injured area will speed repair.Aleve(naproxen) in the system will aid in the process of reducing inflammation while allowing repair to progress,long term.It's proven to be more effective at this than ibuprofen or steroids,and without the of weakening effects of steroids.I also agree with ggk on the bad effects of cortisone,etc.

 

Notice I also said/assumed nothing regarding dislocation; that is indeed very rare,and here again I agree with ggk.And yes,just the joint itself is very simple,but there are muscles that attach to it that provide movement forward and back,side to side,and a range of rotation in all those dynamic functions,and that's what is complex and makes the joint vulnerable to sprains,micro(and larger)-tears in the fibrous sheath around the joint capsule and the tendon- and ligament-to-muscle attachments around the joint.Also the hamstring and quadriceps muscles are large and very strong,and their tension places the socket under a certain amount of pressure which actually helps hold the joint together.Under the right dynamic circumstances, this tension/pressure can actually contribute to bruising or crushing of cartilage or even bone around the socket or the head of the femur,for instance in a windmilling fall on skis.Since you say you have weak bones ,maybe this isn't so far fetched.But these are big,heavy bones and in most people are really hard to break.Believe me,I'm nowhwere near suggesting you've actually fractured anything around there; if you had,you'd really know it, because the powerful tension of those thigh muscles causes excruciating pain in fractures of the femur anywhere along its length,particularly so the higher up the leg you go.I've pulled too many people out of collisions not to know a little about that.You wouldn't be walking,if that were the case.

 

Regarding icing/time,you can actually cause frostbite,or at least burn the skin, if ice is left on too long,and most PT's I know will advise about 25 min. or so.It is correct that a physical therapist can diagnose based on mechanical/dynamic evaluation,and that's where an orthopedist would start,too.But an orthopedist(which means,in answer to ggk's question,"who the f-ck is -orthopedist?",a specialist in orthopedics,the branch of medicine dealing with the treatment of deformities,diseases and injuries of the bones and joints)could make a further determination,based on his preliminary physical evaluation,by ordering an x-ray.And yes,things such as tiny chips of bone and cartilage, frayed or ruptured tendon,at the areas where muscle and tendon attach to the bone,can indeed be seen on x-rays,if you know what to look for.An MRI is ordered in case the doctor suspects something further, from the range of motion(too much or too little) or degree of pain,but that's not showing up clearly enough on the x-ray.Not much can hide from an MRI.But the point to remember is that it's a progessive diagnostic process, and that process,in the hands of a good orthopedist,is conservative,and goes no further than it needs to,once he/she is satisfied that they've found out what they need to.An x-ray or MRI isn't done unless it's necessary,if you have a good physician.On the other hand, a good physician will want to be thorough,and as certain as possible.A film or MRI might be expensive,yes.But compared to what? Finding the real problem and getting it taken care of promptly and effectively can be a lot cheaper than taking a chance on screwing something up big-time,long term.Your choice.

 

Finally,I'm well aware of the failings and stupidities of many orthopedic surgeons/sports medicine physicians,in particular regarding athletes in team sports.Pressure to get valuable players back into play can be ruthless and relentless at the college and pro level,and it's moving right on down into high school.The damage is inexcusable,usually for money and ego on the part of some asshole coach,athletic director,team owner or college president,and it's ended many a promising career,ruined a lot of lives.I couldn't agree more with what you say,GGK.

 

But Mary Lou, you're not in that situation,are you? If not, you can refuse cortisone and novocain,or any treatment you feel isn't positive or necessary.Once again I'll use that word "informed".You have to be an active,inquisitive,educated and wary participant in your own treatment,rehab and recovery.I'm not encouraging anyone to have blind implicit trust in "modern western medicine";what I did say is that those tools and knowledge available for diagnosis are unsurpassed,and I'll stand by that.I did not say anything about the standard medical treatment necessarily being the right or the only way to go,and I used the word "alternative" as it is being used in all medical fields right now,to denote things such as chiropractic,massage,homeopathy,kinesiology,etc.,as "alternative" medicine,alternatives to standard western medical practice of invasive surgery,drugs,etc.And many,many standard,traditional physicians practicing regular modern western medicine are incorporating more and more alternative treatment in their practice,my own orthopedist(who is a serious alpinist and skier)among them.So they're not ALL assholes.My guy has saved my knee,my back and a shoulder,all without any surgery.His diagnostic process was exhaustive,and dead on accurate.His treatment was very conservative,including referral to physical therapy,(ultrasound,resistance and range of motion training)anti-inflammatories,icing,heat massage,etc. It takes a while,but the results were worth it.All better now.

 

Sorry for the long-winded reply;I do appreciate the points GGK brought up--my intent is to simply contribute, based on proven experience,some suggestions for first care.But it did seem like STFU wasn't the most constructive approach.Best of luck with it whatever you decide,Mary Lou.

-------------------------------------------------------------------------

 

"It is easier to repair the beginning than the end..."

-Chinese folk medicine proverb

 

[Figger_Eight]

Asking medical advise on this discussion board is like asking a bunch of doctors how to climb.

[catbirdseat]

If it was me, I'd take it easy for a week, take naproxen sodium and see whether the hip was starting to feel better. If not, I'd go to the doctor.

[Mtguide]

There you go; that's really about all I was trying to say(in way too many words).And I was frankly forgetting about waiting a bit to see if it would get better,a little too insistent on seeing the doc right away.Good call,Catbird.The basic rule in medicine: "First,do no harm.".

 

Edited December 25, 2003 by Mtguide

[OLE]

I hurt my hip a good one one time, and i still feel the pain. If I were you I catch it early and see a doctor and a chiropractor.

[marylou]

Saw the doc. He's pretty sure I tweaked the upper end of my hamstring, given some ROM tests and questions.

 

Looks like it will be the typical thing with some PT and some take it easy and don't ski hard for a while time.

[Stefan]

What? You gone done yourself again?

 

Girl, you gotta take it easy on your body!

[glassgowkiss]

check your illipsoas then if it hamstring. the agonist/antagonist relationship. plus check the strenght ratio of your quads and hamstrings. maybe also your gluts are inactive? hence your hamstrings work overtime. ciao- r

[marylou]

Well, it looks like the doc was wrong....small muscle called piriformas in the hip rotator area is the cause of the pain. Gentle stretching and moderate exercise (hard to take it easy in this incredible snow we are having!) seems to be doing the trick. Hoping to do some ultrasound treatments in PT starting in a couple of days.