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Jan 12th, 2014
James asked The Guru for the following Physiotherapy Advice:
Dear Six Physio
I’m 47 years old and due to restricted finances have been juggling hip and leg flexibility problems on my own for many years – getting some varying opinions from physios when I can afford it and lately, undertaking exercises using a foam roller, etc. that tend to keeps things at bay, but never really curing anything.
My left side is the worst and it’s possible that I suffered some sort knock or trauma to this side when I was younger in all of the sports I undertook from skiing, to rugby and windsurfing.
The main issue I have at the moment though is that my left quad seems to be painful (deep in the muscle) when I lift my leg towards my chest. I’ve been trying to exercise the thigh, seated using an elastic band – lifting the leg against the resistance. This is very painful deep in that muscle. None of these pains though, I could pinpoint as being in the joint itself – irritation or pain always seems to be thigh or glute. Foam rollers loosen these irritations but never cure them.
A real illustration of my imbalance is when I crouch down into the sprinter’s ‘On Your Marks!’ position. On the right, my chest comes down to touch the top of my right thigh. On the left, however, there is a distance of about a foot between my chest and the top of my left thigh and I can hardly touch the floor with my fingertips! It’s quite painful – again the pain deep in that thigh mainly.
I could say to hell with it and ask my GP for an x-ray, but I’m wondering if I have an issue with the quad muscle itself rather than a trashed hip joint.
Many thanks and I hope to visit you when I’ve saved enough pennies! Moorgate probably, as I’m based near Southend and first station in London for me is Fenchurch Street.
The Guru Responded:
….I wonder if we ever windsurfed together at East Beach or off Thorpe Bay YC!
I think the relevant bit is that you’ve suffered for years, had no real trauma and have failed at different various physical interventions.
I think you may have an either, or cause. The symptoms – where your feel it, is at the moment just a smoke screen to keep you from finding out why.
You either got an FAI (femoral acetabular impingement) which is structural – bone growing from the thigh bone or hip or a functional FAI which is not due to bone growth but the way you move (there may be labral issue too, this is a cartilage like the knee which sits in the hip joint to improve its congruity). Nothing to do with how strong or flexible you are, but more to do with the quality and control of your movement around your hip, pelvis and importantly your back.
The “on your marks” bit is pretty tell tale for symptoms, but don’t be tempted to stretch and stretch as they extra flexibility and lack of control with cause more impingement and symptoms later….
Great place to start is an X-ray as it’ll show bone or not, it won’t show soft tissue (labrum) which is via MRI.
Totally understand the £ issues so do keep in touch – Im sure we can show you what’s wrong and what you’ll need to do.
Well it is possible we could have windsurfed together! I’ve only sailed East Beach once, though, and it was pretty good albeit very choppy. I’ve sailed more on Canvey Island (with those tricky tides!) and on the south coast.
Thanks for the details in your email – at last I feel like I’m getting the information I need! I’d like to make some plans to work with you, so I wonder if you are able to give me an idea of the rough plan of action… do I need to first come in for a consultation and then you refer me if necessary for an X-ray/MRI, or is that something I need to do with my GP? I suspect you have your own requirements for the type of X-ray/MRI.
If I have an idea of the procedure and outline costs, I can plan to put some money aside and then come in perhaps in the spring or summer to get moving on this. In the meantime, I can do some some light jogging, foam roller exercises and spinning to keep me from getting out of shape.
How does all of this sound?
Many thanks again… I’m really impressed with the information!
The Guru Responded:
Take the path of least resistance – go to your GP and request some form of imaging. X-ray is cheaper and quick and is a start. MRI is miles better but expensive and possibly will involve a lengthy wait on the NHS. These guys http://www.vistadiagnostics.co.uk/ at Waterloo are priced really well.
At least with an X-ray you will know if there is boney involvement, or not – it can give a more accurate and predictable outcome.
To come and see one of my guys is £78 for the initial hour – they’ll be able to tell you much more about what will needed to be done, and it’ll give you an opportunity to really understand the what’s and why’s. At a poke in the dark guess less than £400, which will invoke hands on manual therapy to get you moving better and specialist rehab physio to teach you how to keep moving better with stability, control and latterly strength. There will also be a comprehensive home program too. I’d set aside a 6 – 8 week period to start to feel a significant difference.
With regards to what to do between now and then, I’d foam roll and think about doing some Pilates. Jogging will (most likely) make the cause worse and so symptoms will follow. I think that you’ve most likely got a relatively unstable (but pain free) lower back, running make this worse. Spinning, same as UNLESS you rally concentrate on form.
Try stretching your mid back like this (see image). Roll up a towel, like you’re heading for a swim. Put this in the floor and out a pillow at the top like a capital “T” shape. Now lie on your back on the towel, head supported, knees bent up and hang out for 10 minutes. It can hurt and should feel like your lying on a rolled towel. Try to stand tall and avoid slouching (and standing too stiff like a sgt major!)
Does this makes sense?
Thank you very much for the tips. They have pilates session at the local sports centre on Canvey Island, so I’ll go for that and I’m already doing the back stretch exercise you mention. It’s interesting that you’re linking the back to all of this as, before I started foam rolling my glute on the affected side, I had serious muscle pains on that side under the rib cage. It’s all connected I guess!
I’m not sure how I’m going to keep fit aerobically as the local pool’s out of action and I guess rowing machines are no good either?
I reckon with the travel required, initial consultation and ongoing treatment, I will need around £500, so I will start to save in a separate account for this and get in to see you as soon as I can. I’ll also go along to see my long forgotten GP and get an X-ray that I can bring along. MRI as you say may be required later, but I’ll cross that bridge when I come to it.
Very much looking forward to working with you on this with you, as I have already learned a lot without you even examining me!
When I’m ready, do I just email you like this and which one of your centres should I be visiting to do you think?
James then added:
Sorry to pester you again, but following my last email, I just wondered if you know what may be best for aerobic exercise up until I can come and see you? I don’t think from your emails that running or spinning is ideal, so I’m a bit stumped seeing as the local pool is out of action.
When I get an Xray from my GP, I’ll book up to come and see you and I’m looking forward to it.
Many thanks again,
The Guru Responded:
The issue is not what you’re doing, but how you’re doing it. Running/spinning is fine as long as your form is great.
I’m not sure though with what you’ve said if you’ve got enough control or the ability to move better to allow you to exercise aerobically well enough. The harder you try, the more strength you call up or the more endurance is required the worse your posture and control will be……
Many thanks. I’ll get the Xray of my hip organised from my GP and come in to see you. If there’s something specific I need to be asking for, just let me know.
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