Thursday, September 27, 2012

Pinching hip pain during lower abdominal stabilization exercise

Wow!  Am I behind in posting.  I'll probably go crazy with a blast of posts that I have wanted to get on here for quite some time...but try and space it out for those (faithfully) checking in with me about "whatever" in PT today.  :-)

So, I recently had a patient with R pinching hip pain (probably proximal IT band/TFL area) while performing, what I call, level i Pilates Leg Loading Test.  He hadn't complained of this pain in the past nor upon arriving for his PT treatment that day.  I quickly thought around my box (with my current DPT intern at my side)........................here's my clinical reasoning (which happily made sense to my intern as well):
     Question 1. When does someone get IT band discomfort?
          Answer 1 (I thought of first). IT band syndrome where VMO weakness accompanies glute med weakness.
     Question 2. What can cause a pinch?
          Answer 2. trigger point
Therefore, treatment: accompanying trigger point release to an unknown trigger point at glute med.  Result, no pain with reproduction of same Pilates Leg Loading Test i and abolished trigger point in glute med that the patient was not aware he had.......................happy patient.

I love it when thinking around the box comes up with a successful, efficient answer to the current mechanical problem.  Does anyone else have some "thinking around the box successes" they would like to share?

Here's a picture of the exercise I am referring to: the patient lays in hooklying with neutral spine and maintains 40 mm Hg on a blood pressure cuff placed under the small of his back for visual feedback while lifting 1 foot at a time just a couple inches off the table while maintaining neutral spine (or 40 mm Hg on the blood pressure cuff).

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