Mark: Hi, it's Mark from Top Local. I'm here with Simon Kelly. He's a physiotherapist at Insync Physio in Vancouver. One of Vancouver's favourite physiotherapist clinics, many time winners of best Physio in Vancouver. And Simon is going to talk to us today about frontal hip pain. Hip pain. This is really common. So what causes this kind of hip pain in the front of your joint?
Simon: Hi, Mark, thanks for having me. Yeah. I'll just talk about hip pain sort of a little bit globally. And again, I might bring in a certain client that I saw recently as well, like a case study. But yeah, there's a couple of things that can cause hip pain to be honest Mark.
So this guy in particular, just came in and had pain in front of his hip. No real specific injury as such kind of came on more gradually. So we dug into the history of like how it came on and then he said he had it, I think mid November. So that would have been two months ago from when we recorded this video, he took a break.
He was actually doing a lot of Nordic cross skating, which I wasn't really aware of what that was, but it's almost like you're on the little wheels. Like you're kind of skating, but on ground as you maybe you know what that is Mark? But I never heard of it being from Ireland, but he explained it in good detail, but he was doing a lot more of that and he was in a lot more rowing he was telling me.
And then he did feel the pain coming on, but he just kind of continued for awhile and he stopped and then the pain didn't go away and he landed in my office here, or in my clinic here. So, you know, the first thing, like, because it was more gradual in nature, you wouldn't be sort of thinking more like a groin strain. It might be overworked or chronic use of the groin, but we have to kind of rule out the groin, which we kind of do in clinic where you squeeze the knees together. And if there's no pain on that, you kind of pretty sure it's not a groin, but even the mechanism of injury it's unlikely to be a groin. You know, you usually get that in lots of changing of direction.
He does have a bit of changing in your direction in that actually. He further made it more detailed in how this classical, where you just kind of go straight, these wheels are, there's kind of more lateral as he described. So the lateral movement was really making it worse according to him. So that was kind of interesting to see why that was worse for him.
So he came into clinic. We had a look at the front of the, he kind of pointed to the front of his hip, not to the side of his hip and it was more painful that at night time when he was laying on that side. So that's kind of how he presented. So we cleared the groin. Obviously we did the squeeze test where the knees were squeezing together. That was all clear.
And then we kind of checked his hip flexors. So iliopsoas, that's the name of your hip flexor and then you have rectus femoris, which is actually one of your quads that also crosses the hip joint and it assists in hip flexion as well. So in the clinic here, he had a little bit of pain when he was completing that movement on hip flexion.
And when we started to palpate the front of the hip, you kind of have two bony nodules on the front of your hip. Just a little bit below that, he had a lot of pain in there. So he was also stiff in his hip as well. And he was a little bit older, he's 50 years old. So he has a bit of stiffness in his hip, but this is definitely, I think an overuse injury of the muscle called rectus femoris.
And just from lots and lots and lots of hip flexion. It was a lot of hip flexion. And then he was trying to alternate to something else which was rowing, which was also a lot of that hip flexion. It also was stretching the life out of his hip flexors as well.
So the muscle was really getting no time to kind of recover or heal, so I think he just needed a bit of education really. I think he was concerned. It hadn't gone away in two months. So my job is to get out the aggravating factors. Just tell him, stop rowing, stop, stretching the life out of his hip. And just maybe cool down at Nordic cross skating just for a week til I settle it. So that's what we done just to start.
And then we obviously just loaded up to the hip and a little bit more, but more gradually. And because it is chronic, it wasn't specific and some of the chronic stuff can take a little bit longer to heal, like it is a chronic tendinopathy. So you're probably looking at maybe, sometimes take two to three months. But if it's done right, we can introduce it a little bit earlier. So we load it up as hip flexors and we did a couple of exercises just to build up that muscle on the hip, we avoided sort of a lot of this aggravating factors for two or three weeks, and then we started to add it in gradually.
And he's actually after making a pretty good recovery now and he's happy that it's not hip osteoarthritis. So he's back doing his Nordic cross skating. Now I think he's back up to three or four times a week so with no pain. And so that was great.
Mark: Well, hopefully he puts the skis on and gets out on the snow, which is really what that's training for. I've had this injury from cross country skiing. But it was from wax failing, going uphill, hard uphill and over stretching the rectus femoris. And so, did he have any crepitus in his hip?
Simon: He didn't actually no, he had no crepitus in his hip. He was very tight in his hips now. And I'd imagine we all know you get a little bit of osteoarthritis as you get older, but certainly he wasn't symptomatic or had no clicking or popping or crepitus. That was good. I think that really eased his mind. I think he kind of thought it was the start of hip osteoarthritis. So he was kind of relieved that it was, I say, just that muscle it's important, but maybe it is better not to have hip osteoarthritis as well.
But you're right, Mark, you can get more of the acute injuries. His was more chronic from lots of hip flexion, somewhat a more, acute injuries, you know, snowboarders, when they lean back, they can really over that muscle. Kind of like what you were saying when you're really doing a lot of uphill and stretching back, you injury it that way too, for sure.
Mark: Yeah. So what was the treatment protocol? What would be more of a typical thing if somebody had this kind of overuse injury to the rectus femoris or their front of their hip?
Simon: Absolutely Mark, yeah. So what we do with him, actually, we, a lot of the time it can be just tightness in the quad muscle actually. So we just worked out that muscle with a lot of massage, some needling like IMS treatment or dry needling, it's called that because there's nothing in the needle obviously, but we just reset the muscle and make sure it's long enough. And really, again, it's all about education and just, you're overloading this muscle just too much in the amount that you're doing.
He really wanted an alternative, something alternative to do. He couldn't do it the Nordic cross skating because obviously he's probably training. Someone who does, this is usually really eager to get onto the snow and he didn't want to lose any sort of cardiovascular stuff as well. So I mentioned a little bit of biking to him and a bit of cross trainer if he could, but just really tried to limit, I avoided rowing as well, there's too much hip flexion in that.
I think he was just going to aggressive, a weekend warrior type character. So he was happy to just do a bit of bike for awhile but it was hard to reel him in to avoid the rowing and that cross skating. And then, yeah, we just loaded him up here in clinic as best he could. And yeah, he has no pain at nighttime now. And he's back doing his Nordic cross skating now. And he's looking forward to getting back into the slopes, he can do that now too.
Mark: Absolutely. So if you've got some hip pain, the guy to see is Simon Kelly. You can reach him at Insync Physio in Vancouver at the Cambie Street office. You can call to book your appointment (604) 566-9716. Or check out the website insyncphysio.com. Real easy to book right there online.
If you're in Burnaby, they have a Burnaby office, (604) 298-4878. Same thing you can book online there. Pick from whichever physiotherapists you want. You can choose Simon, he's busy and he's good at what he does. Inphysio.com. Thanks Simon.
Simon: Cheers Mark. Thanks very much.