Hip Pain – Pinchy Hips with Iyad Salloum

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby, and we're gonna talk about hip joints. How you doing Iyad? 

Iyad: Good, Mark, how are you? 

Mark: Good. Pinch, pinchy hips. What are pinchy hips? 

Iyad: Yeah, some people get pinching sensations in the front of the hips. They feel like whenever they do certain movements or stretches that like the front of their hip kind of catches. Most commonly, they'll classify and describe it as like, oh, it feels like a pinch, and it's hard to localize. So they'll kind of say, it's somewhere deep in there.

They'll put their hand, they're like, somewhere in the middle of there. It's kind, it's hurts. So it's kinda hard for people to put a finger. And yeah, that's a pretty common presentation for people who have some soreness that's coming from the hip joint itself. And there's a variety of things that could be affected there.

So you could have somebody who develops this over time, through let's say, training, just doing a bit too much. Maybe doing things a bit in a way that is provocative for them, or it can happen slowly over time and they don't notice it and then suddenly they notice they're a little stiffer. Some people call it, oh, they describe it as like maybe my hip flexor is tight.

That's kind of one of the sensations that they feel cuz the muscle in the front of the hip gets really tense. But those are all kind of responses to a sore hip joint. So, those are kind of what what we would look at then is depending on the age and if there's any traumatic episode or not. Or how it developed, and we would assess the joint itself. Sometimes with imaging from their physician, sometime without imaging with their physician. And we would kind of determine a treatment plan based on what they're presenting with us and what they need to be able to do.

Mark: Does that the, what you're diagnosing, does that change what's possibly causing that feeling? 

Iyad: I mean, usually the way we would approach it from a physio point of view would change a small bit depending on what you're dealing with. So for example, that symptom in the front could present with sometimes buckling sensations where people feel like literally their hip is slowly giving out, not maybe coping well with certain movements. And sometimes they just say, I just feel really stiff after I run, or after I hike, I just can't feel like I could walk anymore in like really severe cases. And sometimes they'll feel it like that they're really good with a lot of things except when they do a day in the gym where they do a lot of squats. 

And then in that case, we would just look at different ways that they need to be able to move and adjust their program accordingly. So like the load management here isn't necessarily just, oh stop doing this activity. It also tends to be looking at different, let's say areas that are not addressed, areas that they're under loaded in that maybe can benefit from a bit more strength, maybe a bit better control. And then also we sometimes will change the way to do things.

Because what we are learning more and more about people is that no two hips are the same. So you and I, you know, we have different haircuts, so we probably also squat very differently. So that's kind of one of the things that you would work with somebody who's you know, can coach you through that movement and just help you find your optimal way to do it.

Mark: And is it actually changing, like, is there a specific muscle dysfunction, tendon ligament dysfunction that's going on. 

Iyad: So you can get some, usually if it goes on for a while, you can get involvement of some of the connective tissue, like the ligaments and maybe even the labrum, which is one of our things that helps provide some structural stability to the hip.

Creates labrums interesting, kind of creates a suction cup effect between the ball and socket joint, and it kind of helps create some congruency between the surfaces, so that two surfaces fit a lot better with each other. Some people when they in prolonged aggravation patterns, they will affect the labrum.

And that's kind of the progression of, of these things. And the most common thing that some people will get a diagnosis of is called femoroacetabular impingement syndrome, where you have just a let's say a ball in the socket that don't quite fit each other. So you either have an overcovered socket or a too big of a ball for the socket and the tissues in between have to respond to different stresses then. And that's where like, you know, when we come in is we would try to adjust and let's say identify certain provoking things and then maybe see if we could change it. 

So in running it would be looking at mileage, looking at let's say angles of incline looking at a different training pattern. Like if somebody's just not cross-training enough, that could also predispose them to certain things. And also, like sometimes we would do some gateway training. So we would just change a thing or two about their running style to make it a lot less impactful on that injury. So that's an example of that.

Sometimes with lifting, we would again change multiple things, like maybe the depth of the squat, the width of the squad, even sometimes just change the exercise altogether, but keep them strengthening or maybe address some of the deficits. Because you can have also muscular components to this where let's say the control is really poor. So you're just moving in a really, like, you're kind of robbing yourself of good movement mechanics, so then you feel stiffer than you actually are because you're just moving in let's say a pattern that's not necessarily the best for you in that case.

So yeah, there are muscular components and there are all also structural components, and that's like where we would try to figure out what's going on and address it that way. That's why the name has a syndrome in front of it, so it's not like one single thing that gives you the presentation. There could be a multitude of factors that kind of come into play, and you just have to look at what the person's doing and what they need to be able to do and kind of work with them that way. 

Mark: And so again, depending on the diagnosis, what's sort of the typical course of treatment then? What timeframe are people looking at to get better?

Iyad: So it depends on when they come in. So if you are just starting to feel it and you know, it's not, let's say as irritable. So it takes a long time to come on and it goes away pretty quick. I mean, that makes sense that it's not gonna take as long of a recovery time. And then if unfortunately, sometimes we see people who are like, oh yeah, like now walking two blocks becomes really tough and the hips become really sore. Well, in that case, we just have to kind of be a little more basic and a little more rudimentary with our approach. So there's definitely exercise components. There's a lot of education. And so we try to find things that actually are provocative and try to like limit those for short periods of time.

And then we also try to find movements that they can do very safely, very well, even under decent loads sometimes where we could get people lifting weights even when they're sore and doing it safely. We just have to tweak a couple of things about their program. And from there on, it becomes a goal-based treatment progression.

So if you are going back to be a hockey goalie, you need to be able to do very different things than if you're in Ultimate Frisbee, you know, field player for example, or you have to just be able to, to sprint and change direction a lot more. Meanwhile, the hockey goal is gonna need to be able to drop their knees in and collapse in a bit more quickly, especially with more fast movements and kick side to side a lot easier with their legs spread out wide.

So that's kind of where your recovery is really different and it depends on what we're trying to get you back to. But also depends on how sore you are coming in and how progressive this thing is. And obviously things like your training history and how, let's say all those things are gonna factor in to timeline. So it's really hard to give you a one number on how long it takes on average. 

Mark: Is it fair to say that the sooner you get in, the quicker your recovery's gonna be. No matter what that length of time on the recovery is. And also the more diligent you are about your following what's been prescribed, you're gonna recover quicker.

Iyad: Yeah, generally I tell people this, I'm like, you know, even if it's not a physio problem. So for example, if it's not something that like just rehabilitation's gonna help, we'll help you go seek the right advice. So, for example, if this needs something that needs our orthopedic surgeon colleagues to jump in and help out, we're able to look at things and just refer to the appropriate areas. We work closely with our family doctor colleagues. Just make sure that every client has the access that they need to deal with that issue. And most of the times people come in and see us because they worry about something need surgery, and it might not need any of that and just need some bit of a tweak in their training program.

So it's really beneficial just to figure out what you're dealing with first. And that's kind of where I tell people just go get it checked out. And if chances are it's nothing serious. But you wanna know that right away because unfortunately all hip and groin pain kind of feels pretty similar, which is like, you get random tightness in the hip flexors or the adductors or you get buttock pain sometimes. And then sometimes it's also pinchy sensation in the hip. So those are pretty vague symptoms and those are pretty commonplace and like multiple different things. So unfortunately, just pain location alone here doesn't tell us a lot.

Mark: If you're having pinchy hips or any kind of hip pain get into Insync Physio. You can book online for either office, insyncphysio.com. They have an office in Vancouver, as well as in North Burnaby. You can call a North Burnaby office to book (604) 298-4878. You have to call and book ahead. They're always busy. Insync Physio in North Burnaby. Thanks, Iyad. 

Iyad: Thank you.