Question
Dr.
I am a 40 year old female......I have a pain in my hip and hurts when I walk.....  I have been quite active over the past few years.....working out... but my workouts slowed down....I quit smoking and gained a little weight.  I started jogging in February.....had a little bit of a pain that was in the groin area and shot down my leg.  ...the pain eased up but now has found a home in my hip area.... I ran a 5k in April/ had a hard time walking but managed to run the 5k in 30 minutes.  Also accomplished the same day a 18 mile bike ride.  I don't feel the pain except in certain movements.  Walking hurts...... and walking lunges are challenging but I do.  I used to be able to do them with 10-12 lb. weights ...now justs to do with 0-5lb. is hard.  I have been going to a PT...for a month now....three times a week.  I have been active up until this past weekend ...now 4-5 days without working out and I still have pain ,...depending on my movements ( a few movements have jolted the pain ) but I actually walk without any limp.  It seems the pain is in my lower back a little bit too.....  My PT is going to refer me to a orthopadeic doctor......  Should I also see a chiropractor ????  I read that it could be periformus syndrome.....   possibly sciatic nerve .......  would love to be lead in the right direction...have not had any x-rays ....was curious on how they determine ...ligment tear....muscle tear...periformus syndrone..... any help you can provide or point me in the right direction would be greatly appreciated....... I would like to get back to my workouts and be able to walk normal and pain free......
Thank you --

Kris

Answer
Hi Kris,

First, consider a basic hip x-ray to rule out any arthritic problems (often inherited) as well as any signs of avascular necrosis (AVN) or stress fracture (since you've been jogging).   See a chiropractor, preferrably one that has better skills and credentials (sadly not all DC's are homogenously clinically competent).   A good place to start is www.acbsp.com and www.westhartfordgroup.com;  If you see an orthopedist, and you have any positive hip orthopedic signs, then the most appropriate imaging procedure is an MRI-arthrogram.  This is especially so if there are signs of hip cartilage tears (labral tears).   Symptoms of labral tears include pain and clicking/catching deep in the hip during weightbearing activities.  Forget piriformis...  this is a rare condition in its true form.  Often, the posterior hip tissues get sore and everyone calls it piriformis syndrome because they have no idea what else to call the problem.  It's one of the dumb "wastebasket diagnosis'" often used by those with a lack of knowledge of clinical orthopedics and anatomy.    Basically, you need to rule out stress fracture, labral tear, arthritis, or AVN.   Once that's ruled out, then the chiropractor can consider entities such as hip rotator cuff tendinosis or deep hip adhesion formation or deep hip joint capsule (ligament)lesion, and then chip away at these conditions.   Bye the way, the piriformis muscle is only one of six rotators in the deep hip.  Piriformis syndrome is only when this muscle compresses the sciatic nerve and causes sciatic nerve pain or paresthesias into the calf and foot...not a common condition.

'Hope this was helpful.

Dr. G'

www.drgillman.com