I was recently called by a former patient of mine who I hadn’t seen in a couple of years. I was told by his wife that he was having pain at the groin region and that he had difficulty getting up from a chair after sitting for awhile. He went to an orthopedist who without any diagnostic testing told him he needs a total knee replacement. Through some coaxing from the patient an x-ray was taken that supposedly showed that the patient’s hip was bone on bone. He was given an anti-inflammatory. The patient was scheduled for a second opinion in a few days when the patient’s wife felt compelled to call me for my opinion of the situation.
I was able to get over to the patient and when asked to show me where his pain was he used his hand to present the pain being right in the groin region. He said that if he sits for a while and tries to stand up, he gets severe pain at the region and has difficulty getting upright. It takes a few seconds and finally the pain and tightness works out and he is able to stand although it is still difficult to remain fully upright.
These two clues were enough for me to know without question that the cause of the symptoms was not that he was bone on bone but that his hip flexors were in spasm. Here’s the logic. He said that once he stands up and waits a little time, the pain and severity of the tightness decreases. If the symptoms were from bone on bone, the bone on bone never changes therefore the severity of the symptoms shouldn’t change. If bone on bone caused pain due to a limit in range of motion of a joint, any time I am at that limited position in the joint, the pain will remain constant; not change with time. Secondly, where he pointed to was the exact location of the hip flexors. The hip flexors attach from the hip and go diagonally through the abdominal cavity and attach at the 5 lumbar spine. He was pointing very near where the attachment of the hip flexors occurs with the hip. Finally he stated that it is not when he is sitting that the pain occurs but when trying to stand up after sitting for a while. The sitting allows the hip flexors to shorten. It is when standing up that they are asked to elongate at a very rapid rate. Since they are shortened and strained, they cannot handle this quick elongation and prevent the ability to stand upright with the emitting of pain. Once upright and given the chance to slowly lengthen, they get to a length where pain is no longer emitted and function can occur although with a mild sense of tightness still exhibited.
I simply massaged the hip flexors and performed exercises to elongate the muscles and the patient’s pain was resolved. He was able to sit for a period of time and stand up unincumbered both from a limitation in standing up and having no pain.
They cancelled the second opinion and stopped the medication. I am confident that the patient will follow the exercise routine and prevent the symptoms from reoccuring. This is should prevent another orthopedist from gettng a chance to wrongly convince this guy that a hip replacement is inevitable.
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