Jogger with Hip Problems

A 29 year old male. He suffers from tightness and discomfort in the hip and greater trochanter area which started seven months ago after a training regime for a 5k jog. 

He described the discomfort as being stiff and tight and covers a small area around the hips. The discomfort is triggered by long walks and can last for a few days afterwards. A hot bath improves the condition. The discomfort today is mild (1/10) but can occasionally be moderate (5/10). 

Client works full-time in an office.

Consultation
The primary complaint is tightness and discomfort in the hip/greater trochanter area on the left and right. This condition started seven months ago and the client has had no treatment for it. The condition started after a training regime for a 5k jog and may have been triggered by not stretching muscles enough after training. Client received a short treatment from a physiotherapist immediately after the race and it was noted that client was very tight down the iliotibial bands, left and right.

Treatment 1
Treatment includes seated, prone, supine and side-lying positions.
Muscle Energy Techniques (MET’s) -L anterior innominate in Semi-Simm’s, Pubis, piriformis, sidebent and rotated lesions L4 and T12, psoas release
Mobilisations (MOB’s) – passive and resisted range of motion for hip, mortar and pestle, L lateral femoral head, traction, lifting ilium for lumbars, lumbar roll, lifting shoulder for lower thoracics
Myofascial release (MFR) – iliac crests, hamstrings, iliotibial bands, tensor fasciae latae, gluteal group, adductors, quadratus lumborum, tissues between iliac crest and lower ribs

After treatment
Client feels much ‘loose’ after treatment and really enjoyed it.

Treatment 2
Client felt very loose in the pelvis and hip area after the last treatment. He ran for a bus and did not feel any discomfort in his hips or legs. There was no difference to his sleep pattern. Today, client feels uncomfortable and tight in the middle of the sacrum and just below the umbilicus , traveling around both iliac crests. There is no pain and it started this morning. Hands and feet are warmer today though toes very cold.

After treatment
Client felt energised and much looser in the pelvis and trunk after treatment.

Treatment 3
Client still feels ‘loose’ in the areas that were worked last time (around hips, gluteals and lower trunk) but now feels tight in the upper thoracics and neck. Still feeling tight in the L gluteus medius area. He has also noticed he has not suffered from pins & needles in his hands or feet for the past two days – this is a major improvement for him! He has also noticed that skin tone in the extremities has improved too.

During Treatment
*tissues between iliac crest and lower ribs looser and no discomfort felt *spontaneous release in L hip when resisting abduction *gluteus medius very tight at first but eased off with a mixture of myofascial release and resisted range of motion *iliotibial band was very tight – hotspots found but no trigger points. Separated the fascia from biceps femoris and rectus femoris *tensor fascia latae and gluteus medius very crunchy and gritty *L pectineus very sore and crunchy, right into pubic bone *quick check of hamstrings found no tightness or discomfort *L psoas major tight *much more movement in lumbars than previously *L quadratus lumborum tight *spring test found guarding in mid thoracics (T2-T7) *T11/T12 still clicking when mobilising *thoracolumbar fascia extremely tight *felt T6 realign during seated mobilisation *no other rib lesions found *client enjoyed myofascial release of erector spinae group *very little movement in sternocostal area when inhaling and exhaling *pectoralis major very tight on both sides *1st rib lesion did not correct supine, corrected using seated position *palpated neck area – scalene’s and sternocleidomastoid feel solid and I would like to work on this area at the next treatment.

Post Treatment
Client feels very energized and ‘loose’ in the hip and pelvis with no discomfort with L abduction of hip and flexion of trunk has increased.

Advices
*Healing crisis – client may feel nauseous/headachy over next 24-48hr period as the body rids itself of toxins. This is perfectly normal and may, or may not happen *Muscles may be sore and tender next day due to muscles being stretched/re-aligned. Again, normal and should pass over 24-48hrs *Water increase essential to help body rid itself of toxins – 2 litres p/day is necessary for the body to work efficiently *Rest and relaxation is important after a treatment to encourage the body to reach homeostasis *Stretching muscles regularly will help relieve tightness and discomfort – stretches for psoas major/hip flexors, adductors, abductors, quadratus lumborum, chest/pectoralis major all taken from The Concise Book of Muscles by Chris Jarmey *Refer to GP regarding cold/numbness/pins & needles in hands and feet *Alexander Technique is very useful for improving breathing and posture (look on internet) *Regular massage for body maintenance, improved breathing, better circulation, relaxation and ‘feel good’ factor *Another treatment next week to relieve muscle tightness and restore mobility in upper thoracics & chest and neck muscles and cervicals

Conclusion
There has been a definite reduction in muscle/fascial tightness in the hip, pelvis, lumbar and lower thoracic areas and treatment has improved joint mobility and helped to realign individual vertebrae. Continuing to work on the relevant muscles with myofascial release will lengthen and strengthen them which will, in time, improve mobility further. Continuing to use mobilisations and muscle energy techniques will help keep joints supple and improve the range of motion. Regular treatments will help prepare client for training again in the future which will help prevent injury. Further treatments will include more work to the thoracic area and to the chest and neck to relieve fascial restrictions, open out the ribcage and help improve breathing and posture – imperative for this client because he suffers from asthma and is a smoker. The client has become more aware of his own body and has realised that an exercise program will improve his circulation and will help him feel good about himself. He is more willing to take responsibility for his own health and is keen to carry on with regular treatments.