hip pain only with certain movements

Posted by hikerguy62 @hikerguy62, Jan 14 2:56pm

61 y.r. male, always been physically active and maintained my weight (always around 150-155 at 5'7").

Hello,

Starting around June of last year I started having pain in my left hip (on the side). It only occurs with certain movements and is around a 4-5 on a 1-10 scale when it occurs (otherwise I'm pain free).

It is not a result of an injury

The pain occurs when:

I swing my leg into the car, bring my knee up to put on my pants and lift my knee up when seated in a chair. I also feel pain (around a 3) when I'm stretching by lying on my right side, bringing my bent legs up a little, then twisting my upper body in the other direction.

I'm able to do just about anything else without ANY pain - walk up stairs, squats, sandbag training walk sideways with an exercise band.

I did PT for about 4 months with no improvement. Because I felt like I wasn't making any progress, I saw an orthopedic surgeon who took X-rays that indicated I have acetabular dysplasia and secondary osteoarthritis. They also noted a positive Stinchfield test (and there's no doubt my left leg is MUCH weaker than my right).

After the ortho visit, I began working with a PT who had special training in orthopedics (OCS, FAAOMPT) and have worked with him the past 5 weeks focusing on strengthening the hip muscles and glutes with little improvement.

Just last week I went to another ortho doc for a second opinion. He saw the xrays and confirmed the diagnosis but said I wasn't in need of surgery at this time. Neither ortho doc could explain to me why I'm only having medium-level pain during certain movements.

It just doesn't make sense to me that it's due to the hip dysplasia or OA (osteoarthritis) when it's only occurring with very specific movements.

Anyone have any thoughts about this?

As you look at my xray, my left hip is to your right.

Interested in more discussions like this? Go to the Bones, Joints & Muscles Support Group.

So your hip socket is a little shallow. Hyperextension of the joint allows the ball of the femur to become slightly displaced. This is putting pressure on some nerves. The rub is causing inflammation of the acetabelum. Surgery might be advantageous at some point if the lining (labrum) of the acetabelum tears. In the image (I don't read x[rays) it looks clear that the ball joint is shallow. It also looks (to my inexperienced eye) as though the sacrum is slightly lower on that side which could distort the image.
You might get relief from a chiropractic adjustment of the SI Joint. It could change the imaging of what appears to be a shallow hip socket.
The ball of the joints functions normally within the socket with most activities.
Aside:
I have a labral tear and experience groin pain in the extension of the joint like you. And the same pain after bending. Sometimes the ball gets slightly displaced and can't reseat itself . (I don't think you have that.) Chiropractors can reseat the ball and always adjust the joint between the sacrum and the ilium. It helps but isn't permanent. If you had an x-ray of your joint with the leg raised in the manner you describe, you'd see the ball edging out instead of moving smoothly within the confines of the socket.

REPLY

@hikerguy62 @gently Has given you a great description about what is probably happening as you move. His suggestion of a positional x-ray was also a good one.
If I was being a smart aleck, I would give you the response we used to get from my Dad when we would say "It hurts when I do this" - his reply was always "Well don't do it anymore." But of course, that doesn't always make sense in our lives.
I had 2 total hip replacements before my 55th birthday due to osteoarthritis, bone spurs and shallow acetabular cups. Some years later they had to be revised due to faulty parts. Now, in my 70's, I am finding certain motions cause pain (and weakness) on the left side, so I am back to my full post-surgery and post-revision strengthening regimen. I was demonstrating at a dance class this afternoon to a friend.
Here is something to remember - 5 weeks is a VERY short time when it comes to strengthening glutes and other large muscles - they respond much more slowly than smaller muscles, and it takes even longer as our bodies age (as my PT always reminds me, you are not 20, or 30, or 40, or even 50 anymore!) I would say 3-5 months would be a reasonable time to gauge whether continued exercise and stretching helps. And then , after that it is lifelong maintenance - maybe not every day, but several times a week.

And be sure to work on staying flexible as well as strong. My PT has me on a weekly regimen of 5 days of stretching and walking or biking, only 2 days of strength training. And for every muscle stretched, its counter-muscle is always done (eg both abductor and adductor) and both sides of the body as well to try to create balance.

Have you been doing balanced stretching and exercising?
Sue

REPLY
@gently

So your hip socket is a little shallow. Hyperextension of the joint allows the ball of the femur to become slightly displaced. This is putting pressure on some nerves. The rub is causing inflammation of the acetabelum. Surgery might be advantageous at some point if the lining (labrum) of the acetabelum tears. In the image (I don't read x[rays) it looks clear that the ball joint is shallow. It also looks (to my inexperienced eye) as though the sacrum is slightly lower on that side which could distort the image.
You might get relief from a chiropractic adjustment of the SI Joint. It could change the imaging of what appears to be a shallow hip socket.
The ball of the joints functions normally within the socket with most activities.
Aside:
I have a labral tear and experience groin pain in the extension of the joint like you. And the same pain after bending. Sometimes the ball gets slightly displaced and can't reseat itself . (I don't think you have that.) Chiropractors can reseat the ball and always adjust the joint between the sacrum and the ilium. It helps but isn't permanent. If you had an x-ray of your joint with the leg raised in the manner you describe, you'd see the ball edging out instead of moving smoothly within the confines of the socket.

Jump to this post

Thanks for your reply @gently. My hip socket is definitely shallow and I can see that part of the head of the femur is resting outside the area it should fit inside.

The last ortho doc I went to did mention that it's really impossible to dislocate that joint unless there's severe trauma (such as a car accident), so that's a little reassuring I guess lol

I've worked with three chiropractors in the past and know it works, but I don't think that's a route I'll take as any adjustment they make will not help a whole lot simply because of how my hip and femur are (doc said I was born like this).

Both docs wanted me to go on Mobic (meloxicam) for a month. I picked up the prescription but still thinking about it. I told the last doc that the previous doc wanted me on the same med and after reading about all the side effects, I chose not to. His reply was "don't read the box" and "If you read the side effects of Tylenol, you'd never take Tylenol". Probably some truth to that. They both prescribed 15mg, which is the highest dose (the only other dose is 7.5mg). I'm considering quartering the pills and doing roughly 3.75mg a day for a week, then 7.5mg for a week or two and see how I feel. I'm not a fan of drugs but maybe clamping down on the inflammation temporarily would help.

REPLY
@sueinmn

@hikerguy62 @gently Has given you a great description about what is probably happening as you move. His suggestion of a positional x-ray was also a good one.
If I was being a smart aleck, I would give you the response we used to get from my Dad when we would say "It hurts when I do this" - his reply was always "Well don't do it anymore." But of course, that doesn't always make sense in our lives.
I had 2 total hip replacements before my 55th birthday due to osteoarthritis, bone spurs and shallow acetabular cups. Some years later they had to be revised due to faulty parts. Now, in my 70's, I am finding certain motions cause pain (and weakness) on the left side, so I am back to my full post-surgery and post-revision strengthening regimen. I was demonstrating at a dance class this afternoon to a friend.
Here is something to remember - 5 weeks is a VERY short time when it comes to strengthening glutes and other large muscles - they respond much more slowly than smaller muscles, and it takes even longer as our bodies age (as my PT always reminds me, you are not 20, or 30, or 40, or even 50 anymore!) I would say 3-5 months would be a reasonable time to gauge whether continued exercise and stretching helps. And then , after that it is lifelong maintenance - maybe not every day, but several times a week.

And be sure to work on staying flexible as well as strong. My PT has me on a weekly regimen of 5 days of stretching and walking or biking, only 2 days of strength training. And for every muscle stretched, its counter-muscle is always done (eg both abductor and adductor) and both sides of the body as well to try to create balance.

Have you been doing balanced stretching and exercising?
Sue

Jump to this post

@sueinmn

Thanks for your reply. I wish I could not do those moves lol I do cheat now and grab my leg as I swing it into the car and do the same when putting on my pants.

Sounds like you've been through quite a bit. Sorry you've had to endure multiple hip replacements. Seems like you're doing well now though.

Yes, I know I'm being impatient lol I will give it a 2-4 more months and see where I'm at. And I do plan on sticking with a maintenance routine whether or not this helps as having strong hip/glutes will help down the road as I age.

I DO need to get more stretching in, but my wife and I do walk around our neighborhood 5x-6x per week (I mile with slight inclines both ways). I do work both hips when I do my PT. I'll have to do some research on how to balance out the stretching though.

REPLY
@sueinmn

@hikerguy62 @gently Has given you a great description about what is probably happening as you move. His suggestion of a positional x-ray was also a good one.
If I was being a smart aleck, I would give you the response we used to get from my Dad when we would say "It hurts when I do this" - his reply was always "Well don't do it anymore." But of course, that doesn't always make sense in our lives.
I had 2 total hip replacements before my 55th birthday due to osteoarthritis, bone spurs and shallow acetabular cups. Some years later they had to be revised due to faulty parts. Now, in my 70's, I am finding certain motions cause pain (and weakness) on the left side, so I am back to my full post-surgery and post-revision strengthening regimen. I was demonstrating at a dance class this afternoon to a friend.
Here is something to remember - 5 weeks is a VERY short time when it comes to strengthening glutes and other large muscles - they respond much more slowly than smaller muscles, and it takes even longer as our bodies age (as my PT always reminds me, you are not 20, or 30, or 40, or even 50 anymore!) I would say 3-5 months would be a reasonable time to gauge whether continued exercise and stretching helps. And then , after that it is lifelong maintenance - maybe not every day, but several times a week.

And be sure to work on staying flexible as well as strong. My PT has me on a weekly regimen of 5 days of stretching and walking or biking, only 2 days of strength training. And for every muscle stretched, its counter-muscle is always done (eg both abductor and adductor) and both sides of the body as well to try to create balance.

Have you been doing balanced stretching and exercising?
Sue

Jump to this post

Sue, did you suffer this all during your youth. Do you think the short cups caused the osteoarthritis and bone spurs gradually and then by 55 it was just too painful Do you have the idea that strengthening glutes and surrounding muscles could have protected you from the first surgery. Do they correct a shallow cup or replace with a smaller femur head? And then you had to have replacement parts. Too much.
Gently means well and thanks you for your kind comment. It's best to have a response from someone with your experience. We need to see a video of your dance class demonstration. or at least a description of the strenghtening regimen.

REPLY
@gently

Sue, did you suffer this all during your youth. Do you think the short cups caused the osteoarthritis and bone spurs gradually and then by 55 it was just too painful Do you have the idea that strengthening glutes and surrounding muscles could have protected you from the first surgery. Do they correct a shallow cup or replace with a smaller femur head? And then you had to have replacement parts. Too much.
Gently means well and thanks you for your kind comment. It's best to have a response from someone with your experience. We need to see a video of your dance class demonstration. or at least a description of the strenghtening regimen.

Jump to this post

Sorry gently - this girl is camera shy, so no videos.
No, I think there was something else going on with my hips that caused the cups to be damaged, and then I abused them with years of running and sports, as well as heavy lifting in some of my jobs, and in remodeling homes and landscaping. I had a family predisposition to severe osteoarthritis which affected me as early as my 30's, but I was in denial until I could no longer walk up steps or get onto my ladies' bicycle without help. I always had extremely strong muscles due to all my physical activity , and worked with a PT many times over the years to stay flexible - I was on my feet each time the day of surgery, and walking and dancing within a few weeks.
Sue

REPLY

So, when I was exercising today, I was lying on my back with my legs bent. I was slowly raising each each foot and bringing the knee slowly back towards my chest. I happened to have my thumb slightly pressing against the area where the leg meets the hip (basically the hip joint) and noticed the second I moved my left foot off the ground, I felt the muscle (or maybe it was a tendon) really tense up (without pain though). It would remain tense throughout the whole movement. If I did the same movement on the right leg, I felt hardly any muscle/tendon tense up. There was a VERY noticeable difference between the left and right leg in this regard.

Does this say anything about the pain I'm having with certain movements? It's like the left leg is very week and is really needing to tense up the muscle to lift my foot off the ground and move my bent leg back towards my chest.

REPLY
@hikerguy62

So, when I was exercising today, I was lying on my back with my legs bent. I was slowly raising each each foot and bringing the knee slowly back towards my chest. I happened to have my thumb slightly pressing against the area where the leg meets the hip (basically the hip joint) and noticed the second I moved my left foot off the ground, I felt the muscle (or maybe it was a tendon) really tense up (without pain though). It would remain tense throughout the whole movement. If I did the same movement on the right leg, I felt hardly any muscle/tendon tense up. There was a VERY noticeable difference between the left and right leg in this regard.

Does this say anything about the pain I'm having with certain movements? It's like the left leg is very week and is really needing to tense up the muscle to lift my foot off the ground and move my bent leg back towards my chest.

Jump to this post

The best thing you can probably do is to find a Doctor of Physical Therapy whos specializes in individualized treatment. They have more knowledge of anatomy, muscles and tendons than anyone else, and can help figure out what to report to your treating physician.
Sue

REPLY
@hikerguy62

So, when I was exercising today, I was lying on my back with my legs bent. I was slowly raising each each foot and bringing the knee slowly back towards my chest. I happened to have my thumb slightly pressing against the area where the leg meets the hip (basically the hip joint) and noticed the second I moved my left foot off the ground, I felt the muscle (or maybe it was a tendon) really tense up (without pain though). It would remain tense throughout the whole movement. If I did the same movement on the right leg, I felt hardly any muscle/tendon tense up. There was a VERY noticeable difference between the left and right leg in this regard.

Does this say anything about the pain I'm having with certain movements? It's like the left leg is very week and is really needing to tense up the muscle to lift my foot off the ground and move my bent leg back towards my chest.

Jump to this post

REPLY

Looking at pics and explanations of the muscles related to the hip flexors, I'd have to say it's either the iliacus or psoas muscles. I was looking at this URL to determine what I might be feeling:
https://backmusclesolutions.com/blogs/the-ql-blawg/hip-flexor-muscles-anatomy
In the link above it mentioned two devices I hadn't come across before but might give a try. I'll try anything at this point lol
https://backmusclesolutions.com/pages/psoas-release
https://backmusclesolutions.com/products/ql-claw

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