Hip Arthritis...

My physical therapist suggested a hip x-ray a few weeks ago to rule out arthritis. Some of my quad tendon pain is apparently consistent more with hip arthritis (and isn't actually quad tendon pain). Apparently there was good reason for that, for I just learned that I've mild hip arthritis.

At least it is mild and it doesn't HAVE to progress. Will meet with my PT tomorrow after my training session to see what, if anything, we change. My doctor tells me that PT or a shot in the hip by a specialist are really my only real options. There isn't that much pain to justify some of the prescription pain relievers available that have such nasty side-effects - and a shot is NOT an option unless it should get much worse. God willing that won't happen.

Considering that I've woken up a few times recently with mild hip pain I am not all that surprised. Not happy, but not surprised. At least it is mild!

Hip injections have really helped me. I have one of the autoimmune forms of arthritis, and my hips are the only area that continues to hurt despite aggressive treatment.

The injections I've had were done by my rheumatologist who is also board certified in pain management (yay!). They're done at the hospital or an outpatient facility under fluoroscopy (live x-ray). I've never been sedated for them, but it is an option with some doctors. I got 6-8 months out of one and about a year out of another. Your mileage might vary.

I've also done PT to help. Because of the pain, I've limped a good bit over the last 5 years or so, and my musculature has changed. PT helped balance me back out and get my gait back to normal.

Also, if you haven't had a pro bike fit and talked about the hip issues, I'd suggest getting one done. I sit pretty high on my bike according to just about everyone who sees me on it, but it makes my hip happy. :)

My current bike has been fit to me well, but we didn't know about hip issues at the time. My arthritis is mild, but I do note odd sensations in that area much of the time these days - most if the time I wouldn't call it pain. It does, however, wake me in the night, though it isn't bad, just enough to wake me :(

In mid-Jan I am getting fit for a custom bike, and we will certainly take this into consideration. My physical therapy was wrapping up for my leg injuries, but my doctor has just sent over another order for more sessions. Thankfully I can use my flexible spending account in the new year to cover this - so will likely put off more visits until Jan.

I am going to put off shots until there is no choice in the matter...

Quote:

---

Originally Posted by Catrin

My current bike has been fit to me well, but we didn't know about hip issues at the time. My arthritis is mild, but I do note odd sensations in that area much of the time these days - most if the time I wouldn't call it pain. It does, however, wake me in the night, though it isn't bad, just enough to wake me :(

In mid-Jan I am getting fit for a custom bike, and we will certainly take this into consideration. My physical therapy was wrapping up for my leg injuries, but my doctor has just sent over another order for more sessions. Thankfully I can use my flexible spending account in the new year to cover this - so will likely put off more visits until Jan.

I am going to put off shots until there is no choice in the matter...

---

While it has been fit to you, you're not at the optimal set up in that your saddle is by your own admission still too low. Now I have absolutely NO IDEA whether that's contributed at all to your pain, but it is a question mark. You might ask your PT if a repetative movement in which your hip isn't allowed to fully open would cause any joint and/or muscular issues.

And as with my own hip arthritis, remember that it may have nothing to do with the pain you're experiencing or may just partially explain it.

I hear you Indy, and my saddle height is much better than it once was. I am not changing it again, however, until I can start riding a little more frequently.

My physical therapist thinks that the hip not opening fully in the pedal stroke may have contributed to the hamstring injury (especially once I started clipping in), but not the quad injuries. He isn't recommending any changes to what I am doing - he is comfortable with what my trainer has me doing and he isn't concerned that I am being too lazy :o :) I haven't ridden in three weeks due to the weather and work so at least I know that my riding position isn't contributing to anything just now :o

What is odd to me is that I get assorted leg pain when my legs are at rest - for example today when my PT was checking out my hip flexibility he was pushing on the outside of my hip and it hurt in my groin area. Or I wake up in the night with my hip aching (whichever side I am lying on) but so is a portion of my calf below my knee. I know it is just referred pain, and I do have some neurotension in my calves, but it is just odd. At least he does not think that my back is part of this at all, for which I am thankful.

So I will keep doing his stretches and exercises, keep listening to my trainer, and keep putting one foot in front of the other.

The worst of my hip pain was when I was sitting or sleeping. Interestingly, riding my bike didn't really hurt.

I don't begin to understand it all. I just know that our bodies compensate for weakness, injury and the like in some really intersting ways, some of which lead to pain. That's what made me think that your saddle being too low (if I remember your last mention of the subject, it was still an inch too low--which is a lot) might be a contributing factor as you're limiting your leg and hip's natural range of motion. Something within you might be overcompensating for that.

With that, I totally and otherwise defer to whatever Knotted may have to say! :)

When I stop doing my 3-5 mile brisk fitness walk once or twice a week, I slowly begin to get achiness in my hip joints back again, regardless of whether I'm biking a lot or not. I start to feel creaky and achy in the mornings, especially in my hip joints. (I'm 56)
When you are biking, your leg never really gets flexed back behind you, like it does when you walk vigorously. Biking just doesn't do for my hips what regular brisk walking (with long strides) does. Once I start regular fitness walks again, my hip joint aches go away again.
Just something to consider.

Quote:

---

Originally Posted by indysteel

The worst of my hip pain was when I was sitting or sleeping. Interestingly, riding my bike didn't really hurt.

I don't begin to understand it all. I just know that our bodies compensate for weakness, injury and the like in some really intersting ways, some of which lead to pain. That's what made me think that your saddle being too low (if I remember your last mention of the subject, it was still an inch too low--which is a lot) might be a contributing factor as you're limiting your leg and hip's natural range of motion. Something within you might be overcompensating for that.

With that, I totally and otherwise defer to whatever Knotted may have to say! :)

---

This certainly could be contributing, though I've been able to ride so rarely since early October that I wonder how much of a factor this could be currently. My PT thinks it may well have contributed to the original hamstring injury in September, but not the quad injury. It has been almost 3 weeks since my last ride :( Now that I feel well enough to ride, the weather is conspiring against me - or at least it feels that way sometimes. I can't remember how low my saddle still is, but I do think that it is less than an inch now.

Quote:

---

Originally Posted by BleeckerSt_Girl

When I stop doing my 3-5 mile brisk fitness walk once or twice a week, I slowly begin to get achiness in my hip joints back again, regardless of whether I'm biking a lot or not. I start to feel creaky and achy in the mornings, especially in my hip joints. (I'm 56)
When you are biking, your leg never really gets flexed back behind you, like it does when you walk vigorously. Biking just doesn't do for my hips what regular brisk walking (with long strides) does. Once I start regular fitness walks again, my hip joint aches go away again.
Just something to consider.

---

Hmmm, good point. I have no stiffness, and while my right leg is less flexible than the other, my flexibility is pretty good. I just get these strange pains, some of which is quite obviously in my hip. It isn't very bad though. just enough for me to notice. Your point about the range of motion involved in brisk walking is a good one.

Back when I was not allowed to do any cardio work at all - all I COULD do was walking, so have developed the habit of a 20-30 minute walk around the track prior to all training sessions or spinning class to help my legs warm up. I will keep this in mind and expand it to see how a good fitness walk once or twice a week might help me. Running is out of the question, so this might be a good alternative.

I do hope that Knotted reads this and gives her perspective :) I think it is a good sign that my physical therapist thinks that I've improved enough to stop seeing him - outside of a couple of sessions in January in case we want to try a couple of medication applications to the sole quad tendon that hasn't yet healed - I forget what it is called but the medication is applied directly to the skin via a patch ... iontophoresis? Something like that.

Quote:

---

Originally Posted by Catrin

I do hope that Knotted reads this and gives her perspective :)

---

I still think it's your lumbar/sacrum.

Women often have no back pain with a low back derangement. Often it's in the hip and groin, and radiates down the leg. The hip pain disappears when the back (which didn't hurt) gets "fixed".

Everyone over the age of 20 has some sort of arthritis in their hips. Imaging does not indicate causation.

I assume you saw this: http://forums.teamestrogen.com/showthread.php?t=40880
That's what I'm talking about.

Quote:

---

Originally Posted by KnottedYet

I still think it's your lumbar/sacrum.

Women often have no back pain with a low back derangement. Often it's in the hip and groin, and radiates down the leg. The hip pain disappears when the back (which didn't hurt) gets "fixed".

Everyone over the age of 20 has some sort of arthritis in their hips. Imaging does not indicate causation.

I assume you saw this: http://forums.teamestrogen.com/showthread.php?t=40880
That's what I'm talking about.

---

Yes, I saw this. If a simple x-ray would show a lumbar sacrum problem then it sounds like something pretty easily ruled out. The hamstring itself is healed, the sole remaining issue is with the quad tendon that attaches at the top of the thigh and/or the sartorial? hip flexor. There is still just a little tendinitis in one of the hamstring tendons.

My PT yesterday had me in a couple of positions with my back to see if that would affect the hamstring and it didn't. He is pretty confident that it isn't an issue, but my symptoms - for anything - are rarely as expected and he is perplexed about where some of my pain comes from.

I will talk to my doctor's office next week and request a lower back x-ray to rule it out, hopefully we won't be ruling it in...

My back and hip x-rays were normal. It took an MRI to find that I had a herniated disc - and it's a big one. I almost refused to have an MRI, I was so convinced it wasn't my back.--

You've tried a lot of things, but an x-ray won't rule out a back problem. Keep thinking positive on recovery. Even if it does turn out to be a back problem, there are plenty of threads and posts from people who have gotten through it. I'll be thinking of you.

Thanks for your thoughts on this, and I do hope that you are feeling better. My osteopath doesn't think I have a back problem and neither does my physical therapist - though of course things can certainly get missed. I am going to request an x-ray just in case, but an MRI or CT scan just isn't an option. We have to pay such a large amount of the cost for all hospital-based services as co-pays/co-insurance these days (x-rays are the only thing fully covered) that I simply can't afford it at all. I am thankful to have insurance at all but it is so bad compared to the kind of coverage we used to have at one time...

I am having problems sleeping all night. I sleep on my side, and most nights I wake up with pain in whichever hip I am lying on. Not every night, and generally only in the first few hours after I've fallen asleep. I assume this is from the mild arthritis - but wanted to know if others experience this. I cannot tell if this is muscular or joint pain.

I did get the back x-ray Tuesday, they did a series of lumbar x-rays lying down and standing. I won't hear anything before Monday or Tuesday.

I experienced that nightly before starting PT, but I'm not sure that it was caused directly by my hip arthritis. I tend to think that finding was largely coincidental.

Thanks Indy, the confusing part about all of this is, of course, the finding may have nothing at all to do with anything :rolleyes:

I have been paying attention to the pain in my legs though, and I have noticed that if I walk at least 15 minutes before other activities that things go much better. Someone here recommended working fitness walks in my schedule at least once a week and I have already started on that. The interesting thing is just how many different parts of my legs twinge and complain in those first 10 minutes or so - guess that it just part of being an active 15 year old who was sedentary for much of her life. After that 15 minutes though, there isn't a complaint anywhere :D

I do wonder if I am putting too much weight on the hip abductor machine at the gym. It doesn't hurt when I do it, but will back off a little on that weight and see if I still wake up with that pain.

During our sessions, my PT manipulates my right leg a lot to get some movement back in the joint. I typically lay prone on my back on his examination table while he works the leg into a variety of positions. It hurts at times--quite a bit, in fact. But I almost always feel great afterwards. It's kind of like intensive massage. From there, we have worked on glutes. I typcially do a series of "fire hydrants," bridges and leg lifts while laying on my stomach. I don't know if my weak glutes had anything to do with my hip pain , but I do think my lower body is working more normally. Now I just need to keep working on all of it on my own.

Quote:

---

Originally Posted by indysteel

During our sessions, my PT manipulates my right leg a lot to get some movement back in the joint. I typically lay prone on my back on his examination table while he works the leg into a variety of positions...

---

It sounds like he was able to do some good work. My pulled hamstring and quads meant that my own PT was afraid of doing too much to my leg...

Someone has advised me to sleep with a little pillow between my knees to prevent the hip pain at night - does this make sense? Something about how it opens the joint up. I do not pretend to understand but am certainly willing to try it!

Quote:

---

Originally Posted by Catrin

Someone has advised me to sleep with a little pillow between my knees to prevent the hip pain at night - does this make sense? Something about how it opens the joint up. I do not pretend to understand but am certainly willing to try it!

---

Keeps your spine and hips in neutral during sidelying so the weight of your top leg doesn't pull you into rotation.

Give it a try.

Quote:

---

Originally Posted by KnottedYet

Keeps your spine and hips in neutral during sidelying so the weight of your top leg doesn't pull you into rotation.

Give it a try.

---

Thanks, I did give it a little try last night, but don't think the pillow was quite the right size. Less pain though :) More hip pain/aches today darn it...why is the hip flexor on the OTHER leg firing up - and cold feelings in the OTHER hamstring?

Be interesting to see what that series of back x-rays show, and will experiment with another pillow tonight.

Quote:

---

Originally Posted by Catrin

Thanks, I did give it a little try last night, but don't think the pillow was quite the right size. Less pain though :) More hip pain/aches today darn it...why is the hip flexor on the OTHER leg firing up - and cold feelings in the OTHER hamstring?

---

Because you have a soft tissue pressing into the nerves. (disc, spasming muscle, or something). Spinal level symptoms that don't always make sense.

And soft tissue doesn't show up on xrays.

Quote:

---

Originally Posted by KnottedYet

Because you have a soft tissue pressing into the nerves. (disc, spasming muscle, or something). Spinal level symptoms that don't always make sense.

And soft tissue doesn't show up on xrays.

---

This is the only thing that makes sense...and sadly I have to pay 30% of MRI or CT scans, and I just can't afford that. Bummer.

Knotted - are scans the only way of finding such a thing? Would a good PT or chiropractor be able to chase down the problem?

Several studies have shown that a mechanically trained PT is nearly as accurate as an MRI when it comes to diagnosing spine and joint issues. The MDT physical therapist is about $200 in billable units for an evaluation, as opposed to $5,000 for an MRI; which is why a lot of docs will send someone for PT before going after the MRI.

But it's got to be a mechanically trained PT, or you'll end up with a lot of vague stretching and strengthening crap. An MDT PT would never let you continue beyond the 3rd visit unless you were showing significant improvement.

There are chiros who are MDT trained, but not many.

I don't know what to tell you. Your symptoms are clear and definitive. Find someone near you who knows mechanical diagnosis and self treatment. Under their care you should be massively improved within a few visits, or they should be able to clearly state what aspects are non-responsive and refer you back to your physician with clear information about what is NOT going on.

McKenzie Institute has a certified therapist locator on their web page.

http://www.mckenziemdt.org/index_us.cfm

Quote:

---

Originally Posted by Catrin

It sounds like he was able to do some good work. My pulled hamstring and quads meant that my own PT was afraid of doing too much to my leg...

---

BTW: it is impossible to "pull" both agonist and antagonist muscles of the same limb without massive trauma.

My current PT has simply been giving me hip flexor strengthening stretches and seems perplexed over much of my symptoms. I will look around for a mechanically trained PT in the area that my insurance will hopefully cover, my doctor would be happy to refer me to someone else. I get the sense that he isn't happy with what my PT is doing either - not that he isn't doing all that he can but he doesn't seem able to really help me much.

I will see what I can find, thanks for the link.

I suspect the only muscle that was actually pulled was my quad, and the tendinitis in the hamstring seemed clear. I can point to the minute that I messed the quad up, but while I had the symptoms of a pulled hamstring muscle - warmth and definitive pain right in the middle of the thing - I couldn't say when it happened. That always had me wondering, the tendinitis seems to be about gone.

Thankfully I am feeling better enough to ramp up the exercise gently - but when symptoms moving to the OTHER leg now, it is time to do something different. Thank you for the information, it is greatly appreciated.

Quote:

---

Originally Posted by OakLeaf

McKenzie Institute has a certified therapist locator on their web page.

http://www.mckenziemdt.org/index_us.cfm

---

They have someone locally in my medical network - thank you!