Hip injury

[galapogos]

Hi,
I've been having a hip injury for a few months now. It was diagnosed as a SI joint misalignment and/or a hip rotator injury(probably both) by 2 different people(1 rehab specialist and 1 doctor in sports medicine). I also apparently have pronation distortion syndrome among other possible imbalances.

Anyway, the symptoms are:
- pain in right glute area
- pain happens on unsupported trunk flexion(eg when I bend forward to wash my hands on the sink, put on my pants, wear my socks/shoes, do barbell rows or conventional deadlifts)
- pain doesn't happen on supported trunk flexion(eg dumbbell rows over a bench or eccentric abdominal braces)
- pain happens on unsupported hip rotation(eg when I try to do clamshells without my feet supported. however, not much pain when doing fire hydrants)

What I've been doing on my own has been the following:
- Self myofascial release with a foam roller, concentrating on the glutes, piriformis, hamstrings, calves(Gastrocnemius, peroneus), adductors, hip flexors, IT band
- SMFR with tennis ball(glute, soles of feet)
- Stretching of the tight areas(calves, piriformis, hamstrings, hip flexors)
- Activating the areas(glutes mostly) with drills such as supine bridges, mini band walks, warrior lunge, high knee walks, pull back butt kicks, cradle walks
- Limiting the lifts that cause pain to lower loads(squats, deads)
- Substituting the lifts that cause pain to other types(deads to sumo deads/pull-throughs, BB row to DB row).

Despite all these changes I'm not getting much better. I'm wondering if there's anything else I should be doing or NOT doing. I will be going for my first physiotherapy tomorrow but somehow I don't have a lot of faith in conventional physiotherapy.

TIA.

[galapogos]

Anyway here's the essential info
1. When did the pain begin?
Started late last year, then after a week or 2 of laying off the heavy weight it sorta healed. Came back again around Feb 07.
2. What were you doing at the time? Or did the pain come on gradually over time?
The pain started out as a mild discomfort/tightness, then gradually became worse. Happens while lifting weights(deads and rows especially). The straw that broke the camel's back was this heavy deadlift set that I did some time in Feb 07.
3. Where, anatomically, is the pain?
Around my right glute.
4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting?
Not sharp but not dull either. It feels deep.
5. Is the pain constant, or intermittent, or only on certain motions?
Only on certain motions
6. What motions make your pain worse?
See above post under "symptoms"
7. What, if anything, makes your pain better?
SMFR/tennis ball work(if I manage to find the tender spot) gives immediate but temporary relief.
8. Does your pain radiate to any other part of your body?
Doesn't radiate, but other than the glutes sometimes I feel it at the top of my right thigh as well as tightness around the outside of my right thigh.
9. What things could you do before, that you cannot do now because of your injury?
See above post under "symptoms"
10. What is your main concern regarding the pain and its consequences?
Reduced performance on my weightlifting, interference with daily activities, chronic pain!
11. Have you ever injured that part of your body before? If so, how?
Never before late last year
12. Is your pain getting worse over time? And if so, how much worse over what time period?
No. It's gotten better since Feb, but now it's stuck at a point where it's not getting any better.

[UConnJulie]

Where do you live? I'm guessing outside the States since you used "physio" instead of PT ...
It could be referred from a facet joint in your lumbar spine ... and I'd guess that your "core" isn't as strong as it needs to be ...
Your physio should do a complete exam, including passive joint mobility in your spine ... and various muscle strength tests ...
If you've been doing stretching and foam rolling and that hasn't helped, it obviously needs a different treatment ...
Ask your PT/physio to check your lumbar spine ...

[galapogos]

Yes I'm actually in Singapore.

Just got back from the physio(to me PT is "personal trainer" ). She did passive joint mobility tests and some muscle strength tests like you said. She didn't check my lumbar spine today but said it'd be done the next time in 2 weeks. Anyway, she just prescribed me some stretches and some hip strengthening exercises on the cable machine and adductor/abductor machine(urgh).

[UConnJulie]

Actually, legally, in the States anyways, only physical therapists can use the designation "PT" ... that's why personal trainers who are certified use "CPT".

Sounds like your physio knows what to look for ... keep at it and see what happens.

[galapogos]

I'm sure she's pretty good...but I was kinda disappointed by the adductor/abductor machines. I'm not a big fan of machines or isolations, but I guess in certain situations(such as rehab) they have their place. I was kinda hoping there are some other bodyweight/free weight exercises I can do to strengthen my adductor/abductors instead. I was thinking maybe lunges or bulgarian squats? I've read Jane Fondas are also often prescribed. Also, she didn't think it was neccesary for SMFR with a foam roller/tennis ball, but I'm gonna do it anyway.

[UConnJulie]

Sometimes they are necessary for isolated weakness. I'm sure she will progress as appropriate. I wouldn't "tweak" what she's given you just yet.

[galapogos]

OK. I guess I'll do as she says. Just hope she doesn't have me do one legged squats on a bosu ball with a body blade or something...

[UConnJulie]

She might ... many of those "techniques" that have crossed over into personal training started in rehab for very specific purposes.

[galapogos]

Hi,
Another question...I've been performing the hip adduction/abduction strengthening exercises that I've been prescribed with a cable machine. The abduction isn't a problem, but for adduction, I feel like my opposite glute seems to be working a lot more to stabilize and keep my body straight than the adductors of the leg that I'm supposed to be strengthening.

[UConnJulie]

Yes, that's the point ... the leg you are standing on is forced to work in ways it normally avoids.

[galapogos]

Hmm, I was under the impression that I should be strengthening the adductors/abductors of my problem leg, which is my right leg. However, when I'm doing the cable abductions, my left glute seems to be taking over. You're saying that's ok?

[UConnJulie]

Yup ... you should probably do the exercise on both legs ... to work the right glute when you are moving the left leg.

[galapogos]

Thanks for the advice! I'll keep going at it then. I find that cable adduction is a lot easier than abduction, but on the traverse adduction/abduction machine the opposite seems to be true...