Nothing slows you down like pain in hips. But sometimes hip pain causes may not be coming from the hip and it takes an experienced physician to tease out answers.
First, though, this is one of those blog posts that I need to make full disclosure up front. I’m going to be biased. There. Now we can move on…
As a practicing chiropractor, patients come into our office with all types of complaints. Only rarely do they present with textbook-like cases that are as clear cut as putting together an IKEA desk (ok…so maybe a little easier than following that little guy scratching his head…).
The point is, the value in chiropractic treatment is that we understand the pain that our patients experience. We understand that just because it hurts HERE does not mean that HERE is where the problem is. This knowledge comes from years of study in school (chiropractors get FAR more education on the musculoskeletal system than any other physician out there) and is honed with years of clinical practice.
This is why the patient who has been getting epidurals for a year to treat her “sciatic” pain was better in 2 visits with a heel lift and some work on the hip in our office.
This is why the patient who was told they have a disc problem (because it was found on an MRI that shouldn’t have been ordered in the first place) really just had joint dysfunction in his back that was better in 2 chiropractic treatments.
It is why a long term patient who’s MRI of the shoulder led her to 2 surgical recommendations, but I explained that what she really needed was a quick steroid injection to control the inflammation caused by a vaccination.
This is why chiropactors shine at treating musculoskeletal pain. And sometimes, our diagnosis is not really ironed out on the first visit. I usually tell patients that, if they REALLY want to know what is causing his or her pain, I recommend autopsy.
It is common for a patient to present to our office with low back, hip and leg pain. Believe it or not, far too commonly a diagnosis can’t be made with clear cut certainty. An MRI can be a very bad idea here (and what do we order? A lumbar MRI? A hip MRI? Xrays?). The answer? Diagnosis made by clinical response to treatment.
I think it’s a hip, so I treat the hip for a visit or two. Disc problem? We start a protocol of Flexion Distraction. Sacroiliac joint dysfunction? Soft tissue work, stretching and chiropractic manipulation. If the patient gets better, I was right. If the patient doesn’t get better, time to move to the next likely diagnosis.
That’s why they call it “practice.”
But what about that 5 minute consultation with the orthopedic or neurosurgeon (after waiting in the waiting room for 2 hours past your appointment time)? If it takes me, a seasoned chiropractor who thinks he’s pretty good, several visits to pin down more exactly what is going on with a patient, how can it possibly be done in 5 minutes?
It can’t. And maybe this is why surgical outcomes are so unpredictable. I can’t tell you how many times I’ve had a patient undergo some type of surgery for something that clearly was not causing the pain.
So why all this rambling?
Of course it has to do with this particular study looking at arthritis in the upper lumbar spine and hip pain. Researchers looked at the presence of self reported hip pain and the presence of arthritis in the upper lumbar spine in over 2800 patients aged 55+. Here’s what they found:
- Those with disc space narrowing at L1/L2 (the top part of the lumbar spine) had double the likelihood of hip pain in the last month for men.
- For women, the increased risk was 70%.
- For reported chronic hip pain in men, the likelihood of having disc space narrowing at L1/L2 jump to 2.5 times more likely.
- Disk space narrowing at the lower levels (L3/L4/L5/S1) was not associated with hip pain.
What does this mean?
It means that if you have hip pain, you need to see a provider who understands the way the body works (hint, hint, wink, wink). If not, you may get that hip replaced when it wasn’t the problem.
But heck–hip replacement surgery these days is a cake walk, right…?