Search for tag: "hip pain"

Interviewer: You pulled your hamstring. You might have been playing a competitive sport, you might have been just playing something with your friends, you might have been running around with your dog, and you feel a pain in the back of your leg. It's possibly a pulled hamstring. Is that something you can handle on your own, or is it something that you really should seek help for? We're going to find out the details on how to heal a pulled hamstring today.

Travis Nolan is an athletic trainer at University of Utah Health. Travis, how does somebody know if they pulled their hamstring? What are the symptoms? Where would you feel the pain and that sort of thing?

Travis: Usually, the signs and symptoms are going to be sudden onset of pain in the posterior thigh or sort of in that back thigh musculature just below your buttocks. And so you're going to have a sudden onset of pain, most of the time sharp, very pinpoint, and local, so you can pretty much point to one spot in that area. It's not going to be your entire muscle belly. And also decrease of motion, decrease in strength in that muscle belly.

Those are some of your immediate signs and symptoms that you're definitely going to notice right away.

Interviewer: And if somebody does pull their hamstring, is that something that they can then take care of on their own, or should you really see somebody?

Travis: Most of the time, when you do have a strain or a pull, you can actually take care of that on your own. You can take care of that at home, as long as you know what you're doing and know your exercises.

And really, the biggest guiding principle through rehab with a strained or a pulled hamstring, it's going to be listen to your body. Listen to those pain levels and don't push through any kind of pain, because that is essentially your body trying to tell you, "Hey, we're trying to heal this area, and you are making it worse for us." And so you're just going to prolong your recovery and prolong your rehabilitation process by pushing through pain.

Interviewer: So if somebody has already pulled or strained a hamstring, and they've seen a professional, and they have some stretches or some exercises, and this feels much like the last time, then they could just get those exercises and stretches and proceed as normal.

If it's a first-time situation, would you really recommend going to see a physical therapist or an athletic trainer to get those exercises and stretches?

Travis: I would recommend for the first-time patients to go and get those exercises and stretches, a little bit of guidance, because sometimes those exercises, to a person, might seem a little tricky. They might seem complicated. And when patients run into that, even unknowingly, they can sort of get this noncompliance with their rehab program. It can be frustrating when you don't know exactly what you're doing.

And so when you're doing things appropriately and correctly, it's going to feel a lot better, and you're going to feel like you're actually making progress with this, and then you're not just going to maybe quit, because it's like, "Oh, man, it's not getting better. The pain is continuing."

So, yes, I would definitely recommend for those first-time people that maybe don't even know if it is a hamstring strain and maybe they're struggling trying to determine if that is what's going on, definitely go get it checked out by the right professional.

Interviewer: And those exercises and stretches, does that actually speed up the healing time?

Travis: Yes. By actually completing rehabilitation, so exercise, stretches, and using some modalities and these things you can find at home, such as ice, heat, different things like that, it is going to accelerate your healing process.

And most importantly, if you are an athlete or maybe just a recreational athlete, you will need to complete some exercises in order to build strength back in your hamstring, get the same length back in your hamstring that you had previously. Because there will be scar tissue formation from the injury, and that scar tissue formation is not only going to affect our range of motion, it's also going to affect the muscle strength and the sort of force production that our muscle is able to generate. And so, by doing rehab and exercises, you are going to return back to the level that you were previously before your injury.

Interviewer: So doing nothing, just resting, not necessarily the best idea.

Travis: No, not necessarily the best idea. Will it get better? Yes, it totally will. Will it return to the same level of function prior to your injury? Most likely not if you're just hanging out and sort of resting, and that's all you do in order to heal it.

Interviewer: And then if somebody has already been in and they pulled or strained it, and they have implemented the exercises and the stretches, how long does it generally take if you're being good about that and icing and heat to recover?

Travis: So the recovery process for a strained/pulled hamstring is quite varying, honestly. And that is probably one of the most debated things in research when it comes to pulled hamstrings and things like that. Specifically, when we're looking at athletes, there's the return-to-play timeline. It can range, honestly. And research has shown it can range from 7 to 50-plus days.

And so it really depends on the progress of the individual person. Everyone heals differently. As well as sort of the initial injury. Was it a Grade 1 hamstring strain? Was it a Grade 2 hamstring strain? And then it also all depends on sort of the level of athletics or the level of sort of recreational stuff that you're trying to get back to. That can sort of determine your return-to-play timeline, if you will.

Interviewer: And if somebody wants to have their hamstring pull looked at, the walk-in clinic at University of Utah Health would be a great option. If that's not an option, just any physical therapist or athletic trainer, would they be able to help with a hamstring pull like this?

Travis: Yes, definitely. And I know there are a lot of physical therapists that you can schedule appointments with, go see, get this checked out. And so, yes, this is definitely something that getting in to somebody, in my opinion, especially for the general population, it's only going to accelerate your healing process and your recovery time and getting back into those activities that you actually love doing.

Interviewer: When should you have your hip pain checked out by a doctor? Dr. Matheau Eysser is an orthopedic surgeon. What's your advice?

Dr. Eysser: Well, hip arthritis is a common condition that causes hip pain. Hip arthritis is characterized by wearing away of the cartilage of your hip joint. Symptoms of hip arthritis include pain in the hip joint that may include pain in the groin, outer thigh or buttocks, pain that is typically worse in the morning and lessened with activity, and some patients even have difficulty walking or walking with a limp. Sometimes the pain worsens with vigorous or extended activity and stiffness in the hip or limited range of motion. Hip arthritis symptoms tend to progress as the condition worsens. What is interesting about hip arthritis is that symptoms do not always progress steadily with time. If you are experiencing these type of hip symptoms, please see your doctor.

updated: March 17, 2021
originally published: March 13, 2019

Announcer: Seven question, seven answers. It's Seven Questions for a Specialist on the Scope.

Interviewer: It's time for another edition of Seven Questions for a Specialist. Today we have Dr. Chris Peters. He's an orthopedic surgeon who specializes in knee and hip replacement. Are you ready for Seven Questions?

Dr. Peters: I'm ready. Go.

Interviewer: All right. What's the best thing I can do for my knee or hip health?

Dr. Peters: Staying active, maintaining ideal body weight, and avoiding cliff jumping. I don't know, joining a . . .

Interviewer: What's the best thing I can do after a joint replacement surgery?

Dr. Peters: Go out and live a full, active life.

Interviewer: What's the most common knee and hip problem that you encounter?

Dr. Peters: Arthritis.

Interviewer: What's one thing you wish people knew when it comes to joint replacement?

Dr. Peters: It's not as painful a thing to go through as most people think.

Interviewer: Knowing what you know about hips and knees, you cringe a little when you see someone doing what?

Dr. Peters: Marathon running.

Interviewer: Really? Expand on that a little bit.

Dr. Peters: Well, that's not really fair, because, you know, if you look at it, marathon runners are usually super-fit. They're slight people, and they're highly conditioned, and there's actually not a lot of evidence that says running well into your 50s and 60s leads to arthritis, but it gets to the point of overuse in very vigorous athletic activity, so for instance, NFL players tremendously high rate of hip and knee arthritis. So extremely high-impact, competitive athletics, I think, is very hard on your hip and knees

Interviewer: How can I prevent common knee and hip injuries?

Dr. Peters: It's common sense, you know? And I think, to a certain extent, you can't eliminate that if you want to live a full life, you know? So I hear parents a lot of times asking me, "Well, should my kid play football?" "Should my kid not play basketball?" Well, no. We have to accept that there are some risks in the things that bring enjoyment in life, and recreation's one of those things.

Interviewer: What do I need to know about nutritional supplements that say that they will help my joint health?

Dr. Peters: Save your money. In most cases, a once-a-day multivitamin is probably all that you need.

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Dr. Miller: When hip pain is not arthritis pain. I'm Dr. Tom Miller and I'm here with Dr. Steve Aoki. He's a professor of orthopedic surgery here at the University of Utah, in the Department of Orthopedics. Steve, hip pain isn't always due to arthritis. If that's the case, what can it be due to?

Dr. Aoki: So it's interesting when I went through my training ten years ago, often times we didn't quite know what . . . we'd have these young adults come in that had hip pain. They'd have this radiating pain right in their groin region. We'd look at them, we'd look at their films, and we wouldn't see any arthritis, and we'd say, "You strained your groin" or "You pulled a muscle," and we'd send them out.

I think that what probably happened over time was they'd get disappointed, and wouldn't have a good answer, they'd go see someone else, and everyone kept telling them, "No, it's a pulled muscle or it's a groin injury," and they just weren't able to get back to their activity. So what's interesting, it's surprising that we took so long to kind of understand the young adult hip pain problems, but what we've realized . . .

Dr. Miller: Do you think that's because it just did not show up on an x-ray, like arthritis shows up?

Dr. Aoki: No, it actually, once you start looking at the films and the radiographs a little bit closer, you start looking at shape issues, and we've noticed that bone shape, whether it be the ball or the socket side of your hip joint, that the shape of the joint plays a big role in what we understand . . .

Dr. Miller: So joints are like individuals. They're different from one person to the next.

Dr. Aoki: Sure. Everyone's built a little bit differently, exactly, and that shape of your hip joint plays a role in different causes of groin pain and hip pain. So what we've gotten to understand is a concept of what we call "femoral-acetabular impingement," or "hip impingement," where the ball and the socket get a pinching with activity and range of motion.

I would think of it somewhat where there's a mismatch between the ball and the socket, where if you have a cup that's round and you have a ball that maybe didn't form quite as round as we'd ideally like it, as you do activity you twist, pivot, you squat, you force the area of the ball that's not round into that round socket, and it starts to pinch. Over time that repetitive pinching can cause discomfort and start causing hip pain.

Dr. Miller: Are there certain activities that bring this out, that precipitate this more than others?

Dr. Aoki: Yes, so what we've noticed is that in general, athletes tend to have more discomfort and shape issues in their hip joint, and that's probably a combination of the way that their hip joint formed and the shape of their joint on top of their increased activity with competitive sports.

Dr. Miller: Would it be more running, or basketball, or . . .

Dr. Aoki: It tends to me more cutting, twisting, pivoting, deep squatting type of activities. So what happens, most likely what happens and what we think is going on is that, when you are going through those early teenage years, the growth plate around that hip joint is still open, and with stress to that growth plate, we can see kind of a stimulation of extra bone in that area around that growth plate which makes the ball so that it's not as round as it ideally should be.

Dr. Miller: How common is the physical therapy to solve the problem for most athletes?

Dr. Aoki: I think it can be helpful for some people. I don't think it's one of those parts of our process that I see people get better with the pinching type pain, the deep squatting groin pain. But treating the muscular pain can be helpful, and if I can get you to a point, regardless of what's going on in your hip joint, if I can get you comfortable where you say, "It's reasonable and I can do the things that I want and it's more comfortable and I can tolerate the pain," to me that's worth sitting on it for a little while and not rushing into something surgical.

Dr. Miller: When that person finds that the pain is not getting better, or their function is not where they want it to be, what are the next steps?

Dr. Aoki: So if we've given it a chance at non-operative treatment, which includes activity modification within reason, maybe anti-inflammatories, maybe a course of physical therapy, but time if it's not getting better, then continuing with the workup of looking at the shape of the joint, maybe getting an MRI plus or minus a CT scan to look at the shape of the bones of the joint.

Dr. Miller: So you use, when you say "a scope," you mean a little device making a small incision?

Dr. Aoki: Yeah, a small incision.

Dr. Miller: No large incisions?

Dr. Aoki: Two or three incisions about the size of a button shirt hole, and then we go into the joint and we evaluate the cartilage, clean it up, repair the tissue if it's torn and unstable, and then I think a big part of this whole process is reshaping the joint, taking the ball of the joint and making it rounder so that it doesn't pinch as much into the socket side of the joint.

Dr. Miller: Now as an operator, how hard is that to do? It sounds like sculpture.

Dr. Aoki: Yeah, it's a little bit. I think a lot of what we do with orthopedics is like a jigsaw puzzle. We take broken bones and we piece it back together and it's like a jigsaw puzzle. I would look at what we do from the standpoint of hip arthroscopy and femoral-acetabular impingement, we're doing a reshaping. It's almost more like pottery. You're reshaping it and you're trying to get it to be round and ideally a shape that doesn't pinch.

Dr. Miller: That sounds like quite an art.

Dr. Aoki: I think so.

Dr. Miller: So after that surgery, then talk about the recovery.

Dr. Aoki: Yeah, recovery after it's an outpatient same-day surgery so you go home the same day. I typically put people on crutches for a few weeks, typically around four weeks where you're gradually increasing your walking and putting a little bit more weight on there as you start to tolerate. I get you started in physical therapy after a couple of weeks, mainly to have some guidance and have them work on just motion and some gentle exercises, get you on the stationary bike. I really reserve those first three months of this whole process to just get more comfortable with your daily routine, the things in life you have to do.

I typically think of that after three month process as being getting or starting to do more of the things you want to do in life, some jogging, some lighter change of direction activities. I'm not necessarily releasing you to full activity until about that four to six month mark, and at that point it's really dependent on how comfortable you are. Everyone's always a little bit different as far as how quickly they recover, and some people just don't feel ready yet at the four to six month mark. But pain's a pretty good guide.

Dr. Miller: So prior to surgery you have this detailed discussion with them about what to expect after surgery. It's not launching back into their activities that they want to do. It's a steady process.

Dr. Aoki: It's a steady process.

Dr. Miller: They're involved in that.

Dr. Aoki: Yeah, and hopefully the surgery itself is not something that you feel laid up and you feel like you're laying in bed and six months later you're ready to go. This is a gradual process of continuing to increase your activities, you're getting on the stationary bike pretty quickly, you're increasing your strengthening as you go along, as you get more comfortable. So this is not a surgery that hopefully you feel laid up or you feel like you're not able to do some function.

updated: May 20, 2020
originally published: October 25, 2016

Dr. Miller: When's the best time to get that hip replacement? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope.

Dr. Miller: Hi, I'm Dr. Tom Miller, and I'm here with Dr. Chris Peters. Chris Peters is a professor of orthopedic surgery here at the University of Utah.

Chris, the old saw was, well, at least when I trained in medical school, if you had to have your hip replaced, or your knee replaced, you ought to wait as long as possible, maybe even until the time that you're crawling, because there was some concern that the surgery was a little risky. That's not the case now is it?

Dr. Peters: No, you're right, Tom. There has been a very profound change over the last, I would probably say the last twenty years. When hip and knee replacement was first begun in the late 1960s and 1970s, those initial cases were done on people who had kind of disastrous arthritis, and they were folks who were predominately wheelchair bound.

Dr. Miller: They were the worst of the worst.

Dr. Peters: Yeah, the worst of the worst. Over time, what we have seen is that there's been a slow, steady change, and a realization that actually waiting is perhaps detrimental to overall patient health in many cases, and so I think now we realize that, for instance, if a patient's in their early 60s and has some health problems, which is common these days, diabetes, high blood pressure, and their functional status is profoundly impaired, that is they can't go out and recreate, they can't go for a walk around the block, they can't go play with the grandkids comfortably, those patients are probably better off treated with surgery earlier, rather than the old conventional wisdom of waiting as long as you possibly can.

Dr. Miller: Well, technology and techniques have improved, I would think, remarkably since the first joint implants had been done, right? So a lot has changed in terms of the functionality of the implants, and the time to recovery, and the physical therapy that's done afterwards so that people can get back to do many of the things that they were doing previously sooner.

Dr. Peters: Absolutely, and again, back in the '70s and even into the early '80s and '90s, we had concerns about implant longevity. We used to tell patients, we hoped this would last, that a hip or a knee replacement would last ten years. And what we found is that the longevity of the current generation of prostheses that we use is probably more likely 15 to 20 years. And so again, that patient who's in their early 60s is likely to see a hip or a knee replacement last the rest of their life, and they're likely to see their functional status be quite good throughout the last several decades of their life.

Dr. Miller: Now is it true the longer one waits, the kind of weaker the ligaments and muscles around that particular joint become? I would think, if that was the case, that rehabbing that area after surgery would be even harder.

Dr. Peters: Right, and what we find is that patients who wait too long come to us in what we call a deconditioned state. So we start to see deterioration in other organs, and often what goes along with that is obesity, weight gain. And many of these things can be reversed. When you restore ambulation, you restore the ability to get out and exercise. So I think patients often today are much better to have an arthritic hip or knee replaced sooner rather than later.

Dr. Miller: So Chris, when will the right time be? I mean, it's individual. Obviously it's an individual decision, but how do you advise patients?

Dr. Peters: The optimum time obviously is individualized for every patient that we see, but if a patient comes to us and they have X-ray or radiographic evidence of arthritis and can describe to us a significant impairment in their life, whether that impairment is the inability to go out and play nine holes of golf after work, or whether that impairment is an inability to go to the zoo with their grandkids on the weekend, and they're experiencing significant pain, and they've gone through a period of time using the standard medications that people use for pain, such as anti-inflammatories, if they've gone through that process and they're in that position, they're probably ready for a joint replacement.

Dr. Miller: Do you ever recommend that they do some of these other treatments such as injections into the joints of lubricants or prednisolone, something to calm the joint down before you make that decision?

Dr. Peters: Sure, there is absolutely a role for what we would call conservative or non-operative therapy. And there's evidence that, for instance in the knee, that corticosteroid injections can provide short term symptomatic relief, and we'll use those fairly commonly in patients in the earlier stages of arthritis. But once you get to significant bone on bone contact, and the whether it's in the hip or the knee, those modalities tend to be just very short term pain relief, really aren't the long term strategy for treating the patient.

Dr. Miller: They just don't last, do they?

Dr. Peters: Right.

Dr. Miller: The primary reason to do a hip replacement, as I understand it, is to reduce pain and to increase function, but it's so much more than that, isn't it Chris?

Dr. Peters: Right, and it's really a fascinating thing. As orthopedic surgeons, we start a little bit with this tunnel vision. You've got a patient comes in with an arthritic hip or knee joint and we get excited about replacing that, because we know that there's a pretty predictable improvement in pain and function when we do a hip or a knee replacement, but what we found over time is that there's incredible added benefits to the patient as well. So their overall health tends to improve.

We see patients who come in to us as a diabetic, and who are significantly overweight, and now they can get back out and exercise, they can get on their bike, they get into a Zumba class, they lose weight. Often they'll go from an insulin dependent diabetic to on to an oral agent controlled diabetic. We see we see significant improvements in overall health just resulting from the ability to be more active after a hip or a knee replacement.

Dr. Miller: So it's so much more than just improving function and decreasing pain.

Dr. Peters: Absolutely, yeah. I mean, I think it's one of those things that joint replacement surgeons didn't appreciate very much until, I would say, the last decade or so, but now we can, I think very reliably, with good literature support, tell patients that not only is their arthritic hip or knee going to feel better, but likely their overall well-being will be better.

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Dr. Miller: Your coach tells you you have a groin pull. Is that really what it is? We're going to talk about that next on Scope Radio.

I'm Dr. Tom Miller and I'm here with Dr. Travis Maak, an orthopedic surgeon here at the University of Utah and he's in the Department of Orthopedics. Travis specializes in sports medicine. Travis, talk a little bit about that whole issue around groin pain. Is there such a thing as a pulled groin muscle or is that something else?

Dr. Maak: It could be and many athletes are very used to this type of injury and being told by their trainer or their coach that you bent down or you were running and just kind of exploded off the blocks if you're a running athlete. And all of a sudden, you have pain in your groin and you're told you pulled your groin and you need to take a little bit of time off, stretch it, out walk it off, take some anti-inflammatories like Aleve, ibuprofen, Advil and when the pain goes away, you get back doing what you were doing.

Yes, there are muscles, to your point, that you can literally pull in your groin. Those are called the adductor muscles. They are on the inside of your hip. Frankly, multiple groin pulls are not common.

Dr. Miller: They're not common?

Dr. Maak: They're not common.

Dr. Miller: Contrary to what everybody hears.

Dr. Maak: That is true.

Dr. Miller: We always talk about a groin pull. For the audience, I think that a groin pull is pain on the inside of your upper leg towards the pelvis, right?

Dr. Maak: That is correct.

Dr. Miller: If it's not a pulled muscle, then what is it?

Dr. Maak: Well, a person who's prone to groin pulls and has a history of playing sports from their childhood and being told they pulled their groin, they pulled their groin, they pulled their groin and it never seems to get . . . it will go away temporarily, but then it comes back. One of the other diagnoses, which can cause this, is something called femoral acetabular impingement or FAI.

Dr. Miller: That's a big word. What does it mean? What does that look like?

Dr. Maak: So the femur, that's the thigh bone

Dr. Miller: That's the big bone in the thigh?

Dr. Maak: That's the big hole in the thigh. Acetabulum, that's the socket or the ball and the socket of the joint. So the ball is the femur, the socket is the acetabulum. Just the two bones of the hip joint. And then impingement is a fancy word for the two bones hit together.

Dr. Miller: They rub?

Dr. Maak: They rub.

Dr. Miller: When they rub, they cause pain.

Dr. Maak: That's exactly right.

Dr. Miller: Are certain people predisposed to this problem?

Dr. Maak: They are. It tends to be a Northern European type of injury or at least the way the bones are shaped. Although it can happen in any type of ethnicity or group of population. Interestingly, we also have some evidence that specific sports put people at risk for this.

Dr. Miller: Do tell, which ones?

Dr. Maak: Lacrosse tends to be a fairly high incidence of sport, football, hockey.

Dr. Miller: Now, why lacrosse as opposed to basketball or soccer?

Dr. Maak: Interesting question. We believe it has to do with the rotation with the stick. Part of this, there's a current theory that this has to do with the growth plate of the hip and small growth plate injuries that occur over time can make your hip shaped a little differently.

Dr. Miller: So if this happens, you have this pain, this discomfort. How is one reliably to separate this out from actually a pulled muscle or tendon versus you know this is a problem with the hip joint.

Dr. Maak: Sure. So the history is actually fairly classic here. So while the initial acute stabbing pain of a pulled groin can happen quickly, particularly when you're exploding off the blocks or you twister you get tackled, and then it goes away within a few days and basically you return to normal. With FAI, there's typically a subtle, continued discomfort, particularly when you sit for long periods of time. If you find yourself going to the weight gym and your coach says, get down, get deep and squat this weight and every time you find yourself not going . . .

Dr. Miller: Get discomfort.

Dr. Maak: Right.

Dr. Miller: What do you do then? What are the treatments?

Dr. Maak: Well, the first treatment is physical therapy so athletic trainers are very good at this. Many physical therapists are as well. As long as you have the diagnosis, going and learning how to lift a little bit differently, avoiding deep squatting exercises and strengthening the muscles around the hip as well as a little an-inflammatory, like Aleve, ibuprofen, Advil can help you. When those fail, sometimes other interventions can help you.

Dr. Miller: How often is this a game changer for the young athlete?

Dr. Maak: So I can tell you is if this ultimately gets diagnosed in the athlete finds himself limiting their athletic participation because they're groin hurts when it's treated, the beautiful thing, while no one wants to get surgery, if it ends up getting surgery . . . and the surgery is basically to make the ball of the hip round again, it's done with a camera. It's minimally invasive and three little, tiny poke holes. And you go in and basically reshape the ball to make it round again. It's curative, it does not return and effectively, they return to their sports at a higher level without pain.

Dr. Miller: One of the things you started out with is the potential to have this problem misdiagnosed. So what would be your recommendation be to an athlete that has groin pain?

Dr. Maak: The first thing is probably to not worry about it initially. If it's a first time you're told by your trainer that you have a groin pull, odds are you probably did. That being said, if it continues to happen and you have a one or two or three or even four groin pulls that keep happening, my recommendation would be to go get an X-ray of your hip. It's nothing fancier than a simple X-ray of your hip and you can diagnose this problem.

Dr. Miller: They could very well do that through their primary care physician?

Dr. Maak: Absolutely.

Dr. Miller: So, in summary, this groin pain may not actually be a groin pain, it could be an impingement in the actual hip joint itself and that that ought to be checked out if you have repetitive groin pains.

Dr. Maak: That's exactly right.

updated: March 9, 2022
originally published: August 9, 2016