Hip Pain

There is nothing great about greater trochanteric pain syndrome. Nothing at all.

~ Dr. Robert Speirs DC ~ Leave a comment

Your hip typically has about six small fluid-filled sacs called “bursa” that act as cushions between tendons and bone. One of the most common causes of hip pain is a condition called, “hip bursitis” which means that one or more of your bursas have become painfully inflamed. The broader (more accurate) diagnosis of “Greater trochanteric pain syndrome” (GTPS) describes an uncomfortable collection of problems affecting the outermost portion of your hip. GTPS can include swelling of one or more of the fibrous tendons that attach your muscles onto your hip – a condition called, “tendinitis.” In addition to bursitis & tendonitis, GTPS may originate from tightness in the muscle that travels over your hip en route to your knee- resulting in compression and irritation to your hip.


Greater trochanteric pain syndrome is most common in middle age to elderly adults and is 2-4 times more common in females. Sometimes the problem affects both hips at the same time. Approximately 1/3 of patients with GTPS have lower back pain. Patients who have arthritis in their hips and knees are more likely to suffer from ongoing complaints.

Your symptoms probably include a persistent pain on the outside of your hip, buttock, and upper thigh. Your discomfort may be aggravated by sitting with your leg crossed, arising from a seated position, prolonged standing, climbing stairs, and high-impact activities, like running. Sometimes patients find it difficult to sleep, since lying on the painful hip usually increases symptoms.

For adults, x-rays may or may not be needed to confirm the diagnosis, but children and adolescents usually require films to rule out more serious childhood diseases. Be sure to tell your doctor if you notice that you have a fever, leg numbness, pain radiating significantly beyond your knee, or pain in the front of your groin crease (the area where you leg meets your pelvis.)

Conservative treatment, like the type provided in this office, is successful in about 90% of cases. If you have acute pain, you may need to temporarily limit or discontinue activities that increase your discomfort. Using ice or ice massage at home may help. Some patients find temporarily relief by applying sports creams. Very commonly, patients with pain on the outside of their hip suffer from weakness in one of their buttock muscles, called the “gluteus medius.” When this muscle lacks strength, it is unable to protect your hip during normal activities, like walking. Research has shown that strengthening your hip has a dramatic effect on your progress.

Athletes should avoid running on a banked surface, like the crown of a road or indoor track. Be sure to reverse directions each mile if you run on a circular track. Avoid running on wet or icy surfaces, as this can cause increased tension in your hip. Runners with a “lazy” narrow-based running gait will benefit by increasing their step width to minimize stress on their hip. Cyclists need to make sure that their seat is not positioned too high. Overweight patients should consider weight reduction programs.

Pes Anserine Bursitis; What Is It?

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The term “pes anserine” is Latin for goose’s foot, and describes the appearance of three tendons that converge and insert on the inner portion of your knee. The pes anserine bursa is a fluid-filled, friction-reducing cushion, sandwiched between these tendons and your leg bone.

Injuries or irritation can cause the lining of the bursa to produce too much fluid, resulting in painful swelling. Patients with knee osteoarthritis are likely to have chronic irritation of the pes anserine bursa. The condition is more common in overweight patients, diabetics, and females. Runners and athletes in sports that require rapid side-to-side movements (i.e. football, soccer, tennis, etc.) are more likely suffer from the condition. Swimmers who do the breast stroke commonly suffer from pes anserine bursitis.
Symptoms include pain on the inner side of your knee, just below the joint. Your pain is probably worse when you stand up or walk stairs. Discomfort increases during activities that require side-to-side movements (i.e. tennis, dancing). Be sure to tell your doctor if you notice clicking, popping, or locking of your knee, excessive thirst, excessive urination, fever, or pain & swelling in your calf.

In addition to the treatment provided by our office, you may find relief by applying home ice or ice massage for 8-10 minutes. Having flat feet places additional stress on the inside of your knee, so patients with fallen arches will benefit from arch supports or orthotics. Overweight patients will benefit from a diet and exercise program.

Trigger points in the iliopsoas muscle

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This muscle originates on the bodies and disks of T12-L5 and the inner ilium. It inserts on the lesser trochanter of the femur. The psoas flexes the hip when the spine is fixed. When the leg is fixed it extends the lumbar spine increasing lumbar lordosis. This Muscle is often chronically shortened due to inactivity and sitting posture. When trigger points are present they will refer pain primarily to the lower lumbar area and the sacrum as well as into the anterior thigh. Trigger points in the iliopsoas muscle can mimic appendicitis.

Pulled Hammie! Man Down!

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Your hamstring is the group of muscles in the back of your thigh that flex your knee, i.e., moving your heel toward your buttock. The term “strain” means that a muscle or its tendon has been stressed beyond its limit and has frayed, much like a rope that has been pulled too hard. Your hamstring may be “pulled” or “strained” when it is forced to contract beyond its capacity, like during running or from excessive stretch. This tearing leads to bleeding, bruising, swelling, pain and loss of function.

The symptoms of a hamstring strain may vary from mild discomfort to severe pain, depending upon the amount of tissue that has been torn. Over 90% of hamstring strains occur abruptly with a tearing, burning or popping feeling accompanied by immediate pain below your buttock. Your symptoms will likely increase when straightening your leg, walking or flexing forward. You may notice some bruising that starts near the site of injury. Be sure to tell your doctor if you have notable pain in your lower back, if your pain extends into your calf, if your pain worsens with coughing or sneezing, or if you have a rash on the back of your thigh.

Hamstring injuries are more common when your muscles are tired from activity and happen more frequently as we age. Having excessive tightness or weakness in your hamstring, having quadriceps that are significantly stronger than your hamstring, having too little core strength or poor running form also predispose you to injury.

Nearly all hamstring strains can be successfully managed with conservative care, like the type provided in our office. Your healing period will vary based on several factors, including the specific region of your hamstring that has been injured. Tears that involve the part of the muscle closest to your ischial tuberosity (the bones you sit on) take longer to heal than those that occur further down the muscle.

Initially, you should use ice or ice massage over the injured area for 15 minutes at a time, up to once per hour. Our office may advise you to use an ACE wrap or compression bandage to help limit swelling. The use of NSAIDs for hamstring strains is controversial, as some research suggests this may delay healing. Patients who have more severe injuries may need to use crutches. While you are recovering, you may need to limit some activities, like running and jumping and instead, cross train by stationary cycling or swimming. You are more likely to strain your hamstring in the future and recurrent injuries may take twice as long to heal as the initial injury, so be sure to allow yourself adequate healing time, consistently perform your exercises and warm-up properly prior to activity.

My abductors are weak, what does that mean?

~ Dr. Robert Speirs DC ~ Leave a comment
One very important job of your hip muscles is to maintain the alignment of your leg when you move. One of the primary hip muscles, the gluteus medius, plays an especially important stabilizing role when you walk, run, or squat. The gluteus medius attaches your thigh bone to the crest of your hip. When you lift your left leg, your right gluteus medius must contract in order to keep your body from tipping toward the left. And when you are standing on a bent leg, your gluteus medius prevents that knee from diving into a “knock knee” or “valgus” position.
Weakness of the gluteus medius allows your pelvis to drop and your knee to dive inward when you walk or run. This places tremendous strain on your hip and knee and may cause other problems too. When your knee dives inward, your kneecap is forced outward, causing it to rub harder against your thigh bone- creating a painful irritation and eventually arthritis. Walking and running with a relative “knock knee” position places tremendous stress on the ligaments around your knee and is a known cause of “sprains”. Downstream, a “knock knee” position puts additional stress on the arch of your foot, leading to other painful problems, like plantar fasciitis. Upstream, weak hips allow your pelvis to roll forward which forces your spine into a “sway back” posture. This is a known cause of lower back pain. Hip muscle weakness seems to be more common in females, especially athletes.

You should avoid activities that cause prolonged stretching of the hip abductors, like “hanging on one hip” while standing, sitting crossed legged, and sleeping in a side-lying position with your top knee flexed and touching the bed. Patients with fallen arches may benefit from arch supports or orthotics. Obesity causes more stress to the hip muscles, so overweight patients may benefit from a diet and exercise program. The most important treatment for hip abductor weakness is strength training. Hip strengthening is directly linked to symptom improvement. Moreover, people with stronger hip muscles are less likely to become injured in the first place. The exercises listed below are critical for your recovery.

Meet the Hip Cycle. You can thank me later.

1. Side lying with back and shoulders against a wall so you can’t roll back.

2. Bend your bottom leg and put the sole of your foot against the wall to be more stable.

3. Start position is with your foot directly in line with your hip. Do not let it get any lower than that. The highest point of your foot needs to be the bump on the outside of your ankle.

Do 5-10 reps of each of the following without rest between exercises twice a day. The goal is 20 reps each.

a. 6″ leg raises in abduction
b. Knee up to chest (90* knee and hip)
c. 12″ leg raises into abduction
d. Bicycling (knee up to chest, extend knee and sweep back to start with leg straight)
e. Clockwise circles
f. Counterclockwise circles
Good luck.

Trigger points in the piriformis muscle

~ bryancobb ~ Leave a comment

The piriformis muscle is a small muscle deep to glute max and lies over top of the sciatic nerve. It originates on the anterior sacrum, and inserts on the greater trochanter of the femur. It’s main action is to laterally rotate the femur. When trigger points developed in this muscle they will refer pain into the sacro-iliac region, across the posterior hip and down the leg. This muscle can also be a cause of sciatic nerve irritation if it gets tight, causing “sciatica” symptoms.

Piriformis Syndrome; a real bummer.

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Piriformis syndrome results from compression of the sciatic nerve as it passes underneath a muscle in your buttock called the piriformis. Your piriformis muscle attaches from the lowest part of your spine (sacrum) and travels across to your hip. The muscle helps to rotate your leg outward when it contracts. In most people, the sciatic nerve travels deep to the piriformis muscle.

When your piriformis muscle is irritated or goes into spasm, it may cause a painful compression of your sciatic nerve. Approximately ¼ of the population is more likely to suffer from piriformis syndrome because their sciatic nerve passes through the muscle.

Piriformis syndrome may begin suddenly as a result of an injury or may develop slowly from repeated irritation. Common causes include: a fall onto the buttocks, catching oneself from a “near fall,” strains, long distance walking, stair climbing or sitting on the edge of a hard surface or wallet. In many cases, a specific triggering event cannot be pinpointed. The condition is most common in 40-60 year olds and affects women more often than men.

Symptoms of piriformis syndrome include pain, numbness or tingling that begins in your buttock and radiates along the course of your sciatic nerve toward your foot. Symptoms often increase when you are sitting or standing in one position for longer than 15-20 minutes. Changing positions may help. You may notice that your symptoms increase when you walk, run, climb stairs, ride in a car, sit cross-legged or get up from a chair.

Sciatic arising from piriformis syndrome is one of the most treatable varieties and generally is relieved by the type of treatment provided in this office. You may need to temporarily limit activities that aggravate the piriformis muscle, including hill and stair climbing, walking on uneven surfaces, intense downhill running or twisting and throwing objects backwards, i.e., firewood. Be sure to avoid sitting on one foot and take frequent breaks from prolonged standing, sitting and car rides. You may find relief by applying an ice pack to your buttock for 15-20 minutes at a time, several times throughout the day.

Trigger points in the gluteus minimus

~ bryancobb ~ Leave a comment

The gluteus minimus is a small but important muscle that lies deep to the gluteus medius. It originates on the gluteal surface of the ilium, and attaches on the greater trochanter of the femur. It’s main actions are to abduct and medically rotate the hip. Trigger points in this muscle refer pain into the buttock and down the lateral and posterior leg, mimicking sciatica. This muscle should be the first to be examined if a straight leg test turns out negative.

Lower Crossed Syndrome

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Your posture plays an important role in your overall health. Poor posture leads to chronic strain and discomfort. “Lower crossed syndrome” is poor posture that results from excessive tightness in your lower back and hip flexor muscles with weakness in your abdominal and buttock muscles. Patients with lower crossed syndrome often have a “sway back.” Patients who sit for prolonged periods of time are at greater risk of lower crossed syndrome.

This postural problem commonly leads to painful conditions involving the back or hips. Successful treatment of lower cross syndrome involves stretching excessively tight muscles, strengthening weak muscles, taking frequent breaks from sitting, and modifying your workstation to be more user friendly.

Foot Over Pronation

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Flat-Foot-Arch-Before

The normal walking or running cycle begins with your heel striking the ground. As you transfer your body weight onto the front part of your foot, the arch of your foot naturally flattens slightly. This is called pronation.

The tissues that help maintain the arch of your foot are exposed to tremendous stress and may eventually break down. The loss of the normal arch of your foot results in a condition called “overpronation” or flat feet. This condition most commonly develops over a long period of time from repetitive stress.

Overpronation by itself is not painful, but the problem often leads to secondary problems, which may be painful. Plantar fasciitis, foot pain, shin splints and problems in the knee, hip or lower back are all related to overpronation. Patients who carry excess weight are more likely to develop this condition.

To help support your foot, you should wear shoes with good arch supports consistently. In some cases, specially molded orthotics may be needed to help support your arch.