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Ujala suffers from persistent PGP

Apr 19th, 2016

Thank you for your advice.

I am 27 years old and have suffered with progressively worsening clicking hips since my late teens. During my 10th week of pregnancy I developed severe SI joint pain which was understood as PGP related to pregnancy. However, the SIJ pain persists 2years after delivery. In addition to the SIJ pain I have been experiencing worsening hip pain. This is worst in my right hip, at the end of the day or after activity. Sometimes I am unable to sleep because of the pain. It is a gnawing pain in my groin radiating down my medial anterior thigh. I also get pain laterally and posteriorly and it feels as though my femoral head hurts- i feel this posterior, mediallly. Also get get coccyx pain too 🙁

So basically my entire pelvis hurts, but the worst is the hip pain.

My main concern is hip dysplasia but i know there could be endless other differentials.

I have been to various physios and exercises make the pain worse. My gait is not normal I internally rotate my legs when walking and have been advised to use medial arch supports. I have been told that my pains are because of weak, unstable muscles. I have had no investigations.

what do you think the most likely diagnosis is based on history and what investigation do you recommend?

Thank you Ujala

Apr 19th, 2016

The Guru Responded:

Hi Ujala

 

That’s just not fair!

 

You’re a young Mum and need to be fully fit and able – I’m sure there is a pretty reasonable management pathway out there for you.

 

Interestingly (for me not you!!) you’ve tried some Physio and rehab and it’s made you worse – this is either because you were doing the the right stuff for the wrong body bit or you were doing the wrong stuff for the right body part! Either way making you worse shows that your symptoms are mechanical and easily changeable.

 

You’ve got a plethora of symptoms and a probable diagnosis of persistent PGP.

 

For me a diagnosis doesn’t tell me “why” you’ve got it, just as your symptoms will have a very single, simple cause.

 

You need to find the cause of the why. You’ve very likely got weak and unstable muscles, but you need to know why, as getting stronger and more stable just won’t cut it. Just as many people have dysplasia hips, but yet suffer no symptoms.

 

I think you’ve got “simple” mechanical, loading issue.

 

You need to move better through bits that have remained stiff since you’ve given birth – your thoracic spine springs to mind (carrying a baby, pre and post partum) feeding, lifting, changing etc. You compensate by moving your lower back more. The body detects this overload and demands that the supporting muscles increase their protective tone, which increase the load through your pelvic girdle.

 

Do the simple things well. Get more thoracic range, but not at the detriment of cheating through your lumbar spine. Don’t be tempted to stretch your gluts/piriformis/hip flexors – they are not tight, but protective of your back. Learn to get better control of your gluts by allowing your thoracic spine to move more.

 

Changes won’t happen over night and you’ll need a decent physio type person to hold your hand and coach you along the way, but you will get to where you want to go as long as you change the cause and not just chase your symptoms

 

Good Luck

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