Hip, groin, inner thigh, psoas pain - which doc would be the best to diagnose and treat?

[Dr_Doolittle]

Backstory:

In the late winter/early spring, I got a Hip Hook

The Hip Hook by Aletha

I have extremely tight QLs, I get trigger point injections into them twice a month, have done dry needling, roll on a foam roller, lie on tennis balls and plastic prongs to dig into them - used to get myofascial trigger point therapy until it got too painful (and I have a LOT of trigger points and musculoskeletal pain in general!)

Anyway, I thought this might help release some various tight areas, so tried it out for a week or two, but instead of getting relief, I started getting sharp pain in my psoas and hip and groin area - obviously stopped using it!, but the pain continued.

I have a DO who I go to for pain issues (she does the triggerpoints), and she adjusted me - she also does adjustments and cranio-sacral work - and had me do a “knee squeeze” to realign my pelvis. She said my psoas is “angry” and was reacting to the attempted releases by tightening more.

I did the squeeze religiously, but it didn’t seem to solve the problem. I get deep tissue massage about once a month (which DOES help!, indicating that a good bit of this is muscular like most of my pain!), but I can’t get in with my “guy” because he is so booked up. That’s what happens when you are incredible good. (Damn him.) HE said it’s a muscle in my thigh (internal adductor?)

I have been worked on twice by a woman who does adjustments on horses and humans; she said my S/I was wonky as well as my psoas - after she worked on me I WAS better - but it was temporary!

I am sometimes in so much pain I can barely walk, other times it loosens up (usually after I take my pain meds and Robaxin and do my stretches), but this is not resolving - I still limp, it still “twangs” with pain (and stairs are difficult), and continues to plague me. It hurts most when I’m dismounting, and it has an impact on my riding because it’s in the upper inner thigh and hurts when I put my “thigh pit” against the saddle/horse. I get tired from the limping and it’s screwing with my pelvis in general because I feel subtly misaligned. (I also do frequent Feldenkrais lessons/exercises which do help!, but I am unable to do some of them on that right side now.) It doesn’t help that it’s my right, driving leg and lots of time in the car makes it worse!

I’m not sure where to go next with this, but I NEED a full DX, palpation, range of motion tests and an exam so as to get to the root of the problem! So…A different DO?? An orthopedist? Thoughts?

(I thought about a chiro but I did the whole chiro thing for almost 20 years and they all insist that you just keep coming twice a week until the end of time; I’m not willing to do that and they may not be able to fix the issue anyway.)

TIA for any help or suggestions!!!

[Critter]

I would probably start with a good sports med Ortho that will do thorough diagnostics. If it’s not 100% a musculoskeletal issue, there could be a nerve component and you might need Neuro…but a good ortho would be able to do the differential and refer out of they feel it’s not something in their area of diagnosis. After that, find a good PT and maybe pain management.

[PaddockWood]

Your post is interesting to me because PRIOR to my hernia dx (cystocele) I periodically had pain most often R hamstring (and tight) and here and there mild discomfort all around my middle area - SI to hip, to tight IT bands.

Since my dx and getting many sessions of pelvic floor training and now doing 2x/day exercises is I have no pain anywhere or tightness UNLESS I do a long day on my feet and working. I can’t lift more than 25 lbs anymore (unless I want to have surgery) and work hard not to.

I wonder if you went to a pelvic floor specialist (found mine through a urogyno practice) what they’d think of all your symptoms and yes, they’d do testing.

And, when I do have pain it’s much like you describe. Perhaps you too have a hernia brewing?

[Dr_Doolittle]

Thanks for the input! Highly doubt this, since it was directly related to the hip hook - after I used it on and off for about a week, I started having this very specific tightness and pain, originating in the area where I used the hook, and right below it. I have a feeling I’m just misaligned and am compensating because I have extremely tight muscles in general.

I do core strengthening exercises every day, do at least 90 minutes of various stretches (this is after I do my cardio), use a foam roller, stretching bands, Physio ball, etc. I have found Feldenkrais to be very helpful! It “retrains the nervous system” with gentle movements (awareness through movement), and realigns you, loosening up tight spots and helping with asymmetries.

A friend of mine saw this post and recommended a sports chiropractor she uses who has many different modalities, so I think I’ll give him a try. Then a sport orthopod.

Wish me luck! I’ll update if any of this stuff helps

[Simkie]

It very much sounds like you need to see a good orthopedist. Having had hip issues, this screams hip to me, but there are other things that can cause these symptoms, too.

Find the best person you can. Experience, skill & talent varies just so hugely. A large referral center with a top notch hip team will probably get you a lot further, in a lot less time, than your neighborhood generalist ortho.

[Sdel]

I have these pains. So far my only recourse to reliable pain relief has been staying very aware of my biomechanics for everything I do.

Are you sure it is specifically the psoas and not trigger points in another abdominal muscle?

[Dr_Doolittle]

It could be, But my feeling is that the angry psoas is where it originated. My DO suggested injecting the bursa, which I have a feeling would be too excruciating to bear.

I have fibromyalgia, and pain issues in general – am on tramadol and Robaxin.

It’s sort of hard to figure out exactly where the pain is coming from, but it has definitely become limiting – feels like it’s in the groin area, and there are thigh muscles deep in there. I only say “hip“ because my glutes on that side are also tight, and it is limiting my motion on that side. So kind of a cluster of issues in that general area that are causing pain.

[Simkie]

@Dr_Doolittle

It’s sort of hard to figure out exactly where the pain is coming from, but it has definitely become limiting – feels like it’s in the groin area, and there are thigh muscles deep in there. I only say “hip“ because my glutes on that side are also tight, and it is limiting my motion on that side. So kind of a cluster of issues in that general area that are causing pain.

This absolutely sounds like a hip stability issue to me. The surrounding muscles spasm because they’re trying desperately to stabilize an unstable joint.

[Sdel]

I have the same pain issues. It is from the three 1 inch “knots” in my rectus abdominus muscle. It’s caused by over-stretching the psoas and rectus muscle.

Try the following: lay on your back with your knees bent 90 degrees and feet propped on an chair. It should shorten the psoas muscles and allow them to relax.

Also, lay on your back across a pillow so your back is arched over the pillow. Release the point 2 inches from your belly button, under the hip and the one in the thigh. Apply heat and ice while you are lying across the pillow.

On your belly, bend your legs 90 degrees, so your feet are facing the ceiling. Then move them side to side like they are windshield wipers. You can also push up onto your elbows to deepen the stretch. All of these should release the pelvic floor so it can relax.

Also, how much are you working the glutes?

[Dr_Doolittle]

Interesting.

Will try these!

Low back is very tight so will have to be careful, my glutes are probably not as strong as I would like them to be, but a few months ago I bought a machine called the DB method - it strengthens the glutes, quads and core without putting stress on the low back or knees - both of which are problem areas for me. It has definitely helped! I would use it more, but then I’m dealing with this issue

[Dr_Doolittle]

Interestingly, the one where you release that spot two inches from your belly button sounds exactly like what the hip-hook was supposed to do - and caused an opposite reaction of tightening that area which started this whole problem.

[Sdel]

Lay off the core and focus on glutes for a bit. They are the opposing muscle group and a lot of the instability is weakness in the opposing group.

Since I started doing these I am mostly pain free.

[Sdel]

The psoas has three points. It’s very deep by the belly button. I was under the impression that the hip hook was supposed to access the area under the hip bone and not the belly button.

[Dr_Doolittle]

Thanks for all this, and to everyone for the input! Lots of food for thought

The hip hook had a couple of different positions (different psoas muscles), but the one I just did in your post does seem to be a little closer to the belly button?

I did all three exercises and it did loosen things up a bit!

[Sdel]

The hip hook might be too severe at that location. Keep in mind, at the belly button point, the psoas is closer to your spine than the front of your body. You have to go through several other muscles and organs to release the tension there.

[PaddockWood]

I have another story in my past speaking of misalignment. Started having tightness just in my L s/i area and really annoying. Went from doc to doc and surgery was suggested, injections etc. A friend suggested I see her chiro and that woman put up my MRI and xrays and determined I should try sitting on an ischial lift (just under my L seat bone) and do you know from that very minute all my symptoms went away.

And I sat on it for years whenever I was sitting - including shims in my breeches.

After several years I started noticing I didn’t need it and it’s been some 10 yrs at least since then.

Isn’t that crazy?

[RMJacobs]

@Dr_Doolittle

My DO suggested injecting the bursa, which I have a feeling would be too excruciating to bear.

Are you worried about injecting the hip bursa because of the amount of pain you are already in, or just that you feel it would be horribly painful no matter what? I get hip bursitis quite often, and when it won’t resolve by my usual methods (biking and using heat on it), I’ve gotten the bursa injected. It has always been a reasonably easy injection and brought immediate relief.

I’ve also had shoulder bursas injected. That was a little more painful, and didn’t help nearly as much as the hip bursa injections.

Rebecca

[S1969]

I started to quote all the areas that you are having problems with but there were so many.

If I were you, I would find a new doctor - I’d suggest a sports doc and get some initial diagnosis and ask that person for the best recommendation…I’m thinking PT, not chiro. A chiro is not a bad addition to a PT, but by itself is not likely to be enough. You have some kind of major misalignment or imbalance going on. For all the treatment you are receiving, someone should be making this better and teaching you how to avoid issues, so something is not right here.

I would stop just about everything until you get a dx because I suspect what you’re doing is contributing. If you’re doing 90 minutes of stretching and workouts/day and it’s getting WORSE - you need to stop and reset - no DB method machine, no hip hook, etc. - these are bordering on “gimmicks” anyway.

What else are you doing - how often are you riding? If often, I would also try to connect your trainer and/or saddle fitter to your PT once you get one.

[2tempe]

Re hip bursitis - was diagnosed with this many years ago. Sports med dr told me to do the following:

1. Whenever sitting at desk, table, driving car, etc I should sit like a guy - knees well apart.
2. If I sleep on my side, place a firm pillow between my knees.
3. Do not sit “indian style” on the floor - or anywhere else.
4. Use a mounting block…
   crazy as this might sound, it fixed me for good. 25 years later I have a host of lumbar issues, but no hip problems!

[Dr_Doolittle]

Lol, thanks – good advice – I already do all of those things!

I’m 65 and have been dealing with pain issues for a long time, so I’m hyper aware of how I move, hip hinge to bend down, support myself with my core and thighs, use lumbar support when sitting, and protect my knees.

I also wear a lumbar support back brace, but only for riding and teaching my dog classes because I have to be very active and mobile (and to support my back), but don’t want to weaken the muscles by wearing it too much. i’ve been researching this stuff for quite some time and have developed a lot of work arounds so that I can function! I’m still very active, do agility with my younger dog, teach and coach a number of horse students, and compete regularly in eventing. This latest “issue” is frustrating, because even though I do many Feldenkrais lessons to keep myself loose and symmetrical, this has thrown a spanner into the works. I have an appointment with a sports medicine orthopedist on Wednesday morning, so I will update this thread when I get some feedback from him! Thanks to everyone for weighing in

I’m no longer using the hip hook, of course! After it resulted in this problem, I emailed the company and they graciously returned it and refunded my money.