lifestyle

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.

Trigger points in the iliopsoas muscle

~ bryancobb ~ Leave a comment

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.

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.

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.

What Is Upper Crossed Syndrome?

~ Dr. Robert Speirs DC ~ Leave a comment

Your posture plays an important role in your overall health. Poor posture leads to chronic strain and discomfort. “Upper crossed syndrome” describes poor posture that results from excessive tightness in your shoulders and chest with weakness in your neck and mid-back. This combination forces your shoulders to roll inward and your head to project forward.

To help understand how upper crossed syndrome causes trouble, think of your spine as a telephone pole and your head as a bowling ball that sits on top. When the bowling ball is positioned directly over the top of the upright post, very little effort is required to keep it in place. If you tip the post forward and the ball begins to roll over the edge of the post, significantly more effort would be required from the muscles trying to hold it there. This effort results in chronic strain of the muscles of your neck and upper back.

The chronic strain is uncomfortable and may also lead to neck pain, upper back pain, headaches, TMJ pain, and ultimately- arthritis. This postural problem is exceptionally common in computer workstation users. Correction of this problem is accomplished by stretching the tight muscles, strengthening weak muscles, and modifying your workstation.

Trigger points in the gluteus medius muscle

~ bryancobb ~ Leave a comment

The gluteus medius muscle plays an important role in hip and pelvic stability. It originates on the gluteal surface of the ilium, deep to the gluteus Maximus. It inserts on the greater trochanter of the femur. It’s main actions are to abduct the hip and to assist in internal rotation of the hip. It also maintains pelvic stability during walking and running. Trigger points in this muscle will refer pain into the sacrum, the iliac crest, and down the lateral hip and into the thigh. This muscle is often a cause of lower pack pain.

Trigger points in the gluteus Maximus

~ bryancobb ~ Leave a comment

The gluteus Maximus is the buttock muscle. It originates on the gluteal surface of the ilium, lumbar fascia, sacrum and sacrotuberous ligament. It inserts on the gluteal tuberosity of the femur and the iliotibial tract. Extension and lateral rotation of the hip are it’s main actions. This muscle is heavily involved in activities like ice skating and is a common area to develops trigger points. When trigger points do develop they can refer pain in a crescent pattern from the gluteal fold to the sacrum. Trigger points can also refer pain deep into the buttock itself making it feel like other deeper muscles are involved. These symptoms can sometimes be mistaken for s.i. Joint problems.

SI Joint Dysfunction. Nothing FUN about it.

~ Dr. Robert Speirs DC ~ Leave a comment

Your sacroiliac joint is the mechanical link on each side of your hip that connects your legs to the rest of your body. The joint has a limited but very important degree of mobility. Symptoms develop when one or both of the joints loses normal motion. When a joint becomes “restricted”, a self-perpetuating cycle of discomfort follows. Restriction causes the muscles to become overworked, leading to tightness, compression, inflammation, pain and more restriction.
Sacroiliac problems can happen as a result of repetitive strenuous activity or trauma- like a fall onto the buttocks. Other causes of sacroiliac joint problems include, poor posture, having one leg slightly longer than another, having an altered gait, having flat feet or scoliosis, or having pain somewhere else in your legs. Pregnancy is a common trigger for sacroiliac joint problems due to weight gain, gait changes and postural stress.

Sacroiliac joint problems often begin as a focal discomfort in your back just below the belt line, slightly to one side of center. Your pain can travel into your buttock or thigh. Symptoms are often worse by standing on the affected side. The pain may become more apparent when you change positions- like exiting a chair, car or bed, or during long car rides. The pain is often relieved by lying down.

To assist with your recovery, you should avoid any activity that provokes pain, like standing on the affected leg or prolonged sitting.

The Dreaded Lateral Ankle Sprain

~ Dr. Robert Speirs DC ~ Leave a comment

“Ligaments” are made up of many individual fibers running parallel to each other and bundled to form a strong fibrous band. These fibrous bands hold your bones together. Just like a rope, when a ligament is stretched too far, it begins to fray or tear. “Sprain” is the term used to describe this tearing of ligament fibers.

Sprains are graded by the severity of damage to the ligament fibers. A Grade 1 sprain means the ligament has been painfully stretched, but no fibers have been torn. A Grade 2 sprain means some, but not all, of the ligaments’ fibers have been torn. A Grade 3 sprain means all of the ligaments’ fibers have been torn, and the ligament no longer has the ability to protect the joint.

Ankle sprains are the most common soft-tissue injury and will affect up to 20% of active people at some point in their life. Most ankle sprains occur because you have “rolled your ankle” inward. Sprains on the outer side of your ankle are much more common than sprains on the inner side. People who have suffered a prior ankle injury are more likely to suffer subsequent ankle injuries.

Ankle sprains cause pain and swelling over the outside of your ankle. Walking may be difficult, and bruising is common. Be sure to tell your doctor if you experience numbness, tingling, or a dramatic cold sensation in your foot, as this may indicate more significant injury.

Ankle sprains can be successfully managed but will require some work on your part. You can help reduce swelling by elevating your ankle by lying or sitting with your foot elevated or by using an ACE wrap for compression. Applying ice or ice massage for 10 minutes each hour may help relieve swelling. Depending upon the severity of your sprain, you may need to wear an ankle brace to help protect you from further injury. If walking is painful, crutches may be necessary.

Initially, a period of rest may be necessary in order to help you heal. Mild Grade 1 sprains may allow return to sport in a couple of days, while more severe injuries may take six weeks or longer to recover. Surgery is rarely necessary.