Ida Rolph, the Yogi Berra of myofascial structural integration therapists, says “It is where it ain't.” What she means is that location where you feel pain can often be a symptomatic referral from an origin with a different anatomical address altogether. Yes that was triple A alliteration and I’m just getting warmed up, and THAT was two baseball jargon references for Mr. Berra. Stay with me kids, I move quick…
Hip pain generally presents one of three ways; in the front, on the side, or in the back, specifically the medial glute area. If you have hip pain this is important because it tells us a lot about the root cause of that pain and how to treat it. Again this is generally speaking.
Hip pain that presents from the backside is typically muscular in origin and can impact the sciatic nerve. We will pass on that for today. Hip pain that presents in the front is what we call “true” hip pain, and here you probably want to see a doc and get an x-ray. We are definitely passing on that for today. But hip pain that presents on the side is a hobbled hipped horse of a different color (yes, that was a shameless triple H alliteration and if there was such a thing as a triple H ball club I would be the Yogi Berra of Medical Exercise Specialist bloggers, but alas…)
The iliotibial band is an incredibly thick, strong, stubborn strip of fascia that runs from the hip (iliac crest) and glute area to the knee cap and tibia, hence the name. Tight IT Bands can do terrible things to knees and hips and backs and feet and checkbooks and moods and marital bliss and really ruin your day.
Case in point – mystery lady comes in to our facility with her husband. She has not slept through the night for six weeks, complaining of hip pain that presents on the side. She sees an orthopedic surgeon, who tells her she has an impinged nerve in her back and needs surgery. She comes in with no appointment as she was in the neighborhood having just had her preoperative anesthesiologist meeting, because she is going to have surgery on her spine to fix her hip pain.
She sits down in a chair as we talk. I sit down on the floor next to her chair as we talk. Based on the information she has given me I stick my elbow in the side of her leg. Later the fire department was able to extract her from the ceiling tiles (now I keep my own ladder) and her husband was impressed with the velocity at which she shot out of the chair, but the point was made. Mystery woman had a bad case IT Band Friction Syndrome. I worked on her for five minutes. Honestly; five minutes. The next morning she called to report that she had slept through the night pain free for the first time in six weeks. She cancelled her surgery. The cautionary tale here is this – I see that same scenario, or variations on it, maybe a dozen times a month. Even Yogi Berra would agree that that is no joke.
Andy Baxter is a Medical Exercise Specialist and author of Racing Yesterday, www.racingyesterday.com