Identifying the source of symptoms can prove challenging in patients with hip pain. Is it referral from the lumbosacral region, hip osteoarthritis, or something else? Our chiropractic education has honed our ability to identify spinal dysfunction, however sometimes we become diagnostically biased and overlook other potential problems.
Consider these clinical pearls regarding hip osteoarthritis:
- Groin crease pain and significantly limited passive internal rotation of the hip are classic findings for Hip OA.
- Referral of pain below the knee may follow the distribution of the saphenous nerve in up to 47% of cases. (1)
- Radiographs are indicated for the assessment of hip pain in those over age 65, in cases of severe pain, or in those with a history of: trauma, osteoporosis, cancer, corticosteroid use or alcohol abuse. (2)
- Hip OA patients should be strongly encouraged to participate in a water-based exercise program.
Check out this short video demonstrating a chiropractic exam with 4 simple tests to help differentiate local origins from lumbar referral in patients with hip complaints:
…and peruse the ChiroUp condition Protocols for lumbar facet syndrome, SI dysfunction Hip OA, Greater trochanteric pain syndrome, and Femoroacetabular impingement to learn more about the current “best practice management” for these disorders-including evidence-based exercise prescription.
1. Khan, A.M., McLoughlin, E. Hip Osteoarthritis: Where is the Pain? Ann R Coll Surg Engl. 2004 March 86(2) 119-121
2. Margo, K., Drezner, J., Motzkin, D. Evaluation and Management of Hip Pain: An Alogrithmic Approach Journal of Family Practice Vol 52(8) August 2003
About the Author
Dr. Tim Bertelsman
DC, CCSP, DACO
Dr. Tim Bertelsman graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board.
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