Hip and groin pain are among the more common problems I see in my practice.
‘Sports hernia’, sacroiliac joint dysfunction, adductor muscle strain, hip osteoarthritis and impingement syndrome are all common diagnosis patients present with. Before presenting to me some patients have tried cortisone shots, platelet-rich plasma (PRP) injections, stem cell injection, physical therapy and exercise.
It is not unusual to find the pain or symptoms in the hip and groin pain being referred pain from the lumbar spine, lower abdomen, and pelvis 1, 2, 3. Figuring this out is all part of making the proper diagnosis.
I will sit and talk to my patients and get a good history, provide a quality physical examination, identify pain causing generators, and come up with a working diagnosis.
Here is what the research tells us:
• The pain at the front of the hip and groin pain is commonly associated with osteoarthritis and hip labral tears.
• Rear hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication.
• Lateral hip pain occurs with greater trochanteric pain syndrome.4
• Patients may also have hip and groin back from a herniated disc without back pain.5
• I often see tight hips that cause low back pain 6
The beneficial effects of Acoustic therapy for the above conditions are often experienced after only 3-6 treatments. Acoustic therapy is safe and non-invasive.
Please call the office at 310-444-9393 for more information.
1 Tan EW, Schon LC. Mesenchymal Stem Cell-Bearing Sutures for Tendon Repair and Healing in the Foot and Ankle. Foot Ankle Clin. 2016 Dec;21(4):885-890. doi: 10.1016/j.fcl.2016.07.015.
1 St-Onge E, MacIntyre IG, Galea AM. Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report. The Journal of the Canadian Chiropractic Association. 2015;59(4):390-397.
2. McSweeney SE, Naraghi A, Salonen D, Theodoropoulos J, White LM. Hip and groin pain in the professional athlete. Can Assoc Radiol J. 2012 May;63(2):87-99.
3. Holmich P, Dienst M. Differential diagnosis of hip and groin pain. Symptoms and technique for physical examination. Orthopade. 2006 Jan;35(1):8, 10-5.
4. Wilson JJ, Furukawa M. Evaluation of the patient with hip pain. Am Fam Physician. 2014 Jan 1;89(1):27-34.
5. Oikawa Y et al. Lumbar disc degeneration induces persistent groin pain. Spine (Phila Pa 1976). 2012 Jan 15;37(2):114-8. doi: 10.1097/BRS.0b013e318210e6b5.
6. Suarez JC, Ely EE, Mutnal AB, Figueroa NM, Klika AK, Patel PD, Barsoum WK. Comprehensive approach to the evaluation of groin pain.J Am Acad Orthop Surg. 2013 Sep;21(9):558-70. doi: 10.5435/JAAOS-21-09-558.
In a recent study in the journal PMR, (June 2017) a Washington University School of Medicine team found links between the hip and the spine affecting pain and function. The key finding was that hip disease, before it was even evident on an MRI as osteoarthritis, could cause problems in the lower back.1 The hip was the true disguised pain generator in back pain patients. This is no surprise to me and my patients. Every patient in my office has had a hip evaluation if they present with low back pain. This truly is a case where the science is catching up with what active practitioners have known for years.
What is this research telling us? If you had an MRI of your hip, and nothing presented itself as obvious, then the doctor may chase something in the spine that is not causing the pain.
The link that the researchers are still missing is that tight and immobile hips cause increased dysfunctional motion in the lower lumbar spine and this causes excess rubbing and irritation in the low back.
The same team of researchers, publishing earlier in February 2017 were also able to conclude that physical examination findings indicating hip osteoarthritis (loss of range of motion and acute pain) are common in patients who also have low back pain. A patient presenting with low back pain should be examined for hip osteoarthritis).2
1 Prather H, Cheng A, May KS, Maheshwari V, VanDillen L. Association of Hip Radiograph Findings with Pain and Function in Patients Presenting with Low Back Pain. PM&R. 2017 Jun 16.
2. Prather H, Cheng A, May KS, Maheshwari V, VanDillen L. Hip and Lumbar Spine Physical Examination Findings in People Presenting With Low Back Pain With or Without Lower Extremity Pain. J Orthop Sports Phys Ther. 2017 Feb 3:1-36. doi: 10.2519/jospt.2017.6567.
You say you want to be like an athlete? Ok, then let me check the range of motion in your breathing patterns, neck, thoracic region, lumbopelvic region, hips, shoulders and feet. I don’t mind if you are slow when you run or workout. I do mind if you are stiff, because that can put you at risk for injury.
Then let me check some ‘isometric hold’ positions of your back side, abdominal side and lateral side muscles. I am more interested in you owning your own body weight then I am interested in how much you can squat, or how much you can deadlift, or bench press. I want to watch you perform body weight squats, deadlifts and perform a push up because I am interested in your movement patterns. These tests are part of a good functional assessment.
If you can demonstrate that you own your body weight in isometric holds and squats, I want you to start thinking about more STRENGTH in everything else. For my CROSSFIT patients this means using barbells, dumbbells, kettlebells, TRX, sleds, and sandbags, etc. I need you to demonstrate strength and power in every plane of movement both bilaterally and unilaterally.
I work with the general population and crossfit athletes, and give them cutting edge treatments like laser, shockwave, pneumatic cupping, and vibration therapy. I use training tips and methods from how athletes train.
Dr. Jeffrey Tucker is a Diplomate in Chiropractic Rehabilitation and a Sports Practitioner, Certified Chiropractic Soft Tissue Practitioner, PES/CES – NASM, FMS Level 1 & 2 Certified & SMFA Certified, Instrument Assisted Tools Certified and a Performance Health Lead Instructor.
I use two different types of shock wave devices for pain relief in my practice. One is a radial pulse wave (EnPuls) and the other is an acoustic wave (PiezoWave). Both carry energy that can be targeted and focused noninvasively to affect a selected region like the shoulder, hip or foot. When these devices are applied to the soft tissues, the impulses or shock waves interact with the targeted tissues and induce a cascade of biological reactions. This results in the release of growth factors, which in turn triggers new blood vessel formation (neovascularization) of the tissue with subsequent improvement of the blood supply and oxygen to the tissues. This helps healing.
Another effect of shock wave therapy is related to the stimulation of cell proliferation, tissue regeneration, and a process through which new blood vessels form from pre-existing vessels called angiogenesis.
The therapeutic effects of shock wave therapy can be used on patients who need pain relief and reduction of inflammation even in cases with diabetes, nerve pain, soft tissue injury, arthritic joint irritation, and healing of bone (2013, Qiu et al; 2013 Liu; 2013 Siegfried).
My practice is located in Brentwood, CA. I can be reached at 310-444-9393.
I have written many articles on laser and shock wave therapy and how these modalities can improve degenerative disease especially of the spine, hips, knees and shoulders.
Similar to what stem cell injections are claiming to do in the spine or joints, shock wave therapy and laser therapy also effect cells that turn up communication with the immune system and begin exchanging new cellular messages. The result of a stem cell shot is still expensive and risky whereas a shock wave session or laser session is non-invasive and safe. Both tell the immune cells to mobilize healing factors to the site of damage.
Let’s use the research to understand how these therapies work:
When stem cells get injected into a diseased joint (ex. spine, knee) the stem cells have the ability to change/morph into other cell types and multiply. They also signal the native stem cells and other growth factors to regroup and begin repairing damaged joints. Without an injection, I use shock wave therapy and laser to stimulate growth factors and inhibit molecules that have a role in inflammation.
Mesenchymal stem cell MSCs (connective tissue stem cells) suppress inflammatory T–cell proliferation and provide an anti-inflammatory effect. The treatment inhibits damaging chronic inflammation.1
If you have a bulging disc in the spine, research in the medical journal Stem cells translational medicine suggests that stem cells, without direct injection to the site of disc lesions in the spine, can repair disc lesions by changing the healing environment of the spine. This means we can use stem cell recruitment to inhibit disc degeneration and disc herniation by way of the complex interplay between stem cells and immune system cells in achieving successful disc tissue regeneration.
Using non-invasive therapy and exercise the goal is to regenerate the outer tissue of the disc and contain and lessen the inflammation around the bulge. TheraLase will bring more oxygen to the damaged disc and accelerate healing by reversing the low-oxygen (degenerative or dying) environments in the spine. Everything heals with more oxygen.
Stem cell activation is able to reduce or prevent herniation by suppressing the non-healing inflammation.2 The take home message is that non-invasive EnPuls radial shock wave therapy, PiezoWave acoustic therapy, and TheraLase laser combined with exercise and diet have unique healing capabilities. Is this treatment right for you? Contact me at my office 310-444-9393.
1 Davatchi F, et al. Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow-up of three patients. Int J Rheum Dis. 2016 Mar;19(3):219-25
2 Cunha C, Almeida CR, Almeida MI, Silva AM, Molinos M, Lamas S, Pereira CL, Teixeira GQ, Monteiro AT, Santos SG, Gonçalves RM, Barbosa MA. Systemic Delivery of Bone Marrow Mesenchymal Stem Cells for In Situ Intervertebral Disc Regeneration. Stem Cells Transl Med. 2016 Oct 11. pii: sctm.2016-0033.
Chronic Pain Patients Offered Help
If you have neck or low back pain for more than 3 months that is considered chronic pain. It will be important for you to find a doctor that combines the most recent and relevant treatments to help you. The assumption is that “Doctors want to help patients” but Doctors and patients alike often prefer subtle changes in practice and patient care. In simple terms, Doctors can be slow to adopt new technology that helps improve outcomes and patient care!
TheraLase laser therapy is a relatively new yet effective treatment that can help reduce chronic pain, however, laser devices have been considered expensive to most doctors. For doctors, purchasing a laser has become as simple as buying an old fashioned ultrasound device. For patients, there’s really only one thing you can do. And that’s to go to your doctor, and ask him or her about laser therapy.
Laser is a solution to help chronic back and neck pain sufferers – it may make the lives of many pain sufferers a lot more enjoyable and a lot less debilitating for a fraction of the cost of surgery and spinal injections.
TheraLase – a Canadian based company introduced a laser that may help prevent nerve (radicular) pain through the interruption of the lack of oxygen and blood flow (the ischemic metabolic pathway) to painful tissues; Theralase may interrupt the generation of inflammation and help decrease inflammatory chemicals that have already occurred and be causing chronic pain; TheraLaser may improve reinnervation in chronic nerve pain (radiculopathy).
What Theralase would do is essentially give doctors and chronic pain patients with mild-to-moderate musculoskeletal pain an option for treatment that is relatively inexpensive compared to drugs and surgery.
Dr. Jeffrey Tucker, a Chiropractor in Los Angeles, California combines TheraLase, hands-on massage therapy, diet and exercise as a perfect fit to help chronic pain patients. Tucker says “Laser therapy combines well with physical therapy, for increasing range of motion to stiff and painful joints and muscles, and increasing muscle strength. Doctors often move too slowly to adopt new technology that can help patient outcomes, then patient’s end up on the wrong side of recovery and health”.
Whether you are an athlete or chronic pain patient, you can never give up finding ways to improve performance and progressive thinking is crucial. The most basic drive for doctors to change is when patients go to their doctor’s office and ask about all of the new possible ways for help. Unfortunately if your doctor doesn’t work that way, you as the patient may have to take a detour from that doctor and find a practitioner using new technology like the TheraLase laser. Call 310-444-9393 if you would like a laser session,
The Zimmer EnPuls and the PiezoWave system is intended to relieve pain, improve circulation and reduce inflammation of myofascial pain. It is especially helpful for coccyx pain, tailbone pain, knee pain, low back pain, hip pain, plantar fasciitis and tendon injuries.
Other indications for the Zimmer EnPuls and PiezoWave include chronic painful muscular hardening, myofascial trigger points in the areas of the: Upper extremities; Cervical spine; Shoulder girdle; Thoracic spine and lumbar spine; Hip area; Lower extremities.
If you have tried other therapies and been disappointed or did not get the results you expected, please call the office at 310-444-9393 to experience the pain relief effects of the Zimmer EnPuls and the PiezoWave technology.
Both massage and DMS release muscle tension, body aches, and helps you to relax.
Deep Muscle Stimulator massage is a technique that focuses primarily on the deeper layers of muscle and fascia. The DMS method uses a hand-held vibration percussion device that oscillates to provide soothing pressure that gets difficult muscle ‘knots’ to release. DMS massage is for people who like massage and want a slightly more intense focused approach. DMS therapist are trained to target the taut, tender, and sore spots and hold the device to target the sore muscle and myofascial layer. The DMS massage is not painful yet it reveals the tender and sore spots.
Deep Muscle Stimulator massage eases pain
Deep Muscle Stimulator massage releases pain and increases blood flow. Deep Muscle Stimulator massage has been shown to decrease pain in chronic low back patients, shoulder pain, calf muscle tightness, plantar fasciitis, tennis elbow, tailbone pain, hip pain, and sports injuries.
Deep Muscle Stimulator massage increases range of motion
Most people don’t like stretching but if you have scar tissue from old injuries or prolonged and poor posture (sitting slumped over) you need to make the scar tissue softer and more pliable. And that’s what DMS helps to do. Muscle tissue should resemble raw meat, and not be dried out like beef jerky! The surfaces underneath the skin should slide and glide. If everything is stuck together, and it doesn’t slide and glide, it needs to be changed.
DMS helps to remix the water (circulation) with the taut and tight muscles so they can slide and glide again, releasing tension in the stuck muscles. DMS helps regain softness in the muscles, so they contract and release better to increase your range of motion.
Chiropractic manipulation does not reposition a vertebra from a misaligned position to an aligned position. Rather, it is likely that manipulation breaks up adhesions present in the joints of the spine, which improves movement asymmetries and/or stimulates mechanoreceptors – thereby reducing spinal muscle excitability, enhancing proprioception and reducing pain.
While manipulation has been proven effective for the management of acute low back pain, a prospective placebo-controlled study by Senna and Machaly demonstrates that long-term chronic low back pain sufferers respond best to maintenance manipulations performed bimonthly for up to nine months. The authors suggest the occasional (Chiropractic) manipulations may allow for the “early treatment of any emerging problem, thus preventing future episodes of low back pain.”
My sports medicine and chronic pain therapy approach of using the DMS (vibration, percussion), EnPuls (radial shockwave), Piezowave (acoustic shockwave) and massage in conjunction with chiropractic enhances the breaking up of disruptive and painful scar tissue.
- Tullberg T, Blomberg S, Branth B, et al. Manipulation does not alter the position of the sacroiliac joint: a roentgenstereophotogrammetric analysis. Spine, 1998;23:1124-1128.
- Cramer G, Tuck N, Knudsen J, et al. Effects of side-posture positioning anti-posture adjusting on the lumbar zygopophyseal joints as evaluated by magnetic resonance imaging: a before and after study with randomization. J Manip Phys Ther, 2000;23:380.
- Nansel DD, Peneff A, Quitoriano J. Effectiveness of upper versus lower cervical adjustments with respect to the amelioration of passive rotational versus lateral-flexion end-range asymmetries in otherwise asymptomatic subjects. J Manip Phys Ther, 1992;15:99-105.
- Nansel D, Waldorf T, Cooperstein R. Time course effect of cervical spinal adjustments on lumbar paraspinal muscle tone: evidence for facilitation of intersegmental tonic neck reflexes. J Manip Phys Ther, 1993;16:91-95.
- Lehman GJ, McGill SM. Spinal manipulation causes variable spine kinematic and trunk muscle electromyographic responses. Clin Biomech, 2001;16:293-9.
- Childs JD, Fritz JM, Flynn TW, et al. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med, 2004;141:920-928.
- Cleland J, Fritz J, Whitman J, et al. The use of a lumbar spinal manipulation technique by physical therapists in patients who satisfy a clinical prediction rule: a case series. J Orthop Sports Phys Ther, 2006;36:209-214.
- Senna M, Machaly S. Does maintenance spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcomes? Spine, 2011 Aug 15; 36(18):1427-37.
I practice more than just Chiropractic. I coined the term the POLITE Method
- P is for Protect you from further pain and injury; create a Plan for healing; and Prevention from future episodes
- OL is for Optimal Loading; this means adding gentle movements that don’t overload or hurt you.
- I is for Ice or Instruments (laser, shockwave, deep muscle stimulation (DMS), etc.)
- T is for Technology / Taping
- E is for Education, Eating, Exercise and Ergonomics
The “P” reminds me to tell the patient the plan to get rid of pain and inflammation and discuss prevention strategies. This includes protecting the painful area, providing education and my prescription. I explain my plan, and offer ideas and suggestions on how they can protect the spine or involved area. I explain the services I can provide to help improve posture and achieve a positive outcome.
The “OL” stands for optimal loading. This means don’t overload the tissue structures, but at the same time, don’t underload them, either. Movement is important especially for sports medicine. I provide the patient with corrective exercises they can do to help heal properly.
The “I” reminds me to talk about the instruments or implements I can and will use as part of the treatment for inflammation; not just ice, but also physical therapy modalities such as acoustic shockwave, lasers, lymphatic drainage, deep muscle stimulation and other soft-tissue therapies. I also use nutrition and a body composition analysis machine, which help to guide my weight-loss programs.
The “T” reminds me to offer Taping (kinesiology and athletic taping). Taping is just part of the treatment right now.
The “E” stands for exercise, education, eating and ergonomics. Adding these components to care has a high patient value, is quality care and helps reduce the risk of future episodes.