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Hip / Knee Pain

Printed From: CyberPT - Your Online Physical Therapy Resource
Category: Specialty Forum for PTs/Healthcare Professionals
Forum Name: Orthopedics
Forum Description: Discussion on Orthopedics
URL: http://www.cyberpt.com/ptforum/forum_posts.asp?TID=1562
Printed Date: May 27 2022 at 2:22pm
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Topic: Hip / Knee Pain
Posted By: troponin2018
Subject: Hip / Knee Pain
Date Posted: May 25 2018 at 11:58am
Age: 32 Sex: M Ht: 5'11 Wt: 175

Prior to injury I would run up to 5 miles daily, hike, some light-moderate strength training, climb, ski, etc.

Began having anterior and lateral hip pain just prior to Thanksgiving '17. Waited a month with not much change with rest/activity change before seeing my PCP. Diagnosed as hip flexor strain and ordered xrays, which showed no acute findings, and PT.

Began PT late December '17 through March '18. Pain went down but had pain essentially from greater trochanter to through mid lateral thigh with seated leg extension test (straight leg test negative). PT also noted a marked weakness of right hip abductors vs leg continually throughout treatment. Plan was to attack glute medius which we did.  Over time the pain crept down to my knee area (pain above and laterally, not "in" the knee). Finally, I asked if it was time to get an MRI. PT agreed and referred me out to an orthopedic hip specialist.

Hip Orthopedic MD was able to instantly tell me I had FAI, which I was able to clearly see in my first set of xrays, but I was asymptomatic (no tests for it were provocative). Also told me he never saw a Glut Med tear in a patient as young as myself and instantly dismissed that. He ordered to MRIs: lumbar spine and hip/knee/ankle. Lumbar MRI showed a small disc protrusion at L5/S1 and Hip MRI confirmed FAI but showed a possible tiny labral tear, but it was inconclusive. He first referred me out an Orthopedic Spine Specialist (OSS).

OSS determined that the disc protrusion was not the culprit and I was having no symptoms from it. Asked him about the seated hip leg extension (Slump Test bascially) and he felt the pain was from the muscles and no the spin based on associated L5/S1 weakness, numbness etc.

Back to the Hip Specialist who tells me I have FAI (but so do 75%+ of players in the NFL combine on MRI and most are asymptomatic - I pulled the study to confirm) and the labral "tear" is small and most likely just natural course for anyone. He is against FAI surgery (so am I as I have no associated symptoms). Reorders physical therapy and gives me a home based program that him and AT are working on publishing.

Back to PT we are working on hip exercises he specifically recommended and some back therapy just in case. After the first session, my PT said to try running as well. I tried 3 sessions of running (plan to start 0.5 miles and build back up), and after a warm-up and just before a half-mile i felt lateral pain on my IT Band each time. Back to PT and knee was flaring up after my last session, which the PT gave me foam rolling and stretching to do for my IT Band. Also suggested biking. Biking seems to also flare up my knee

So far what I know is it seems: 
- Lateral movements (lateral lunge on to bosu) flare up my hip (i feel it on TFL, Glute Medius area, Greater trochanger)
- Running / Biking both seem to flare up my knee tenderness
- Bending the knee from the PT exercises also seem to flare up above my knee (like quad tenonsis)

Right now I feel really stuck. I'm looking for any suggestions to talk to my PT and Ortho about to get through this.

Any and all help appreciated!



Replies:
Posted By: Ask a PT
Date Posted: May 30 2018 at 12:28pm
Hi - has the PT checked for leg length discrepancy? Also has the PT worked on releasing trigger points either manually or with dry needling at gluteus medius / minimus? The pain referral patterns you describe are often associated with those muscles.
Glute Medius Minimus Referral Pattern



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