Orthopaedic Treatment for Front Hip Pain and Lower Back Muscle Tear


Understanding Front Hip Pain


When we think about front-hip pain as the result of the hip joint, we start with the understanding that the only place that it is impossible to feel pain from the hip joint is behind the posterior femoral head-neck junction. In easy-to-understand words, in the back if the trochanter (mountain tops) are the same as the glutes insertion location (green line in picture). Pain only happens when we try to squeeze the legs together in external hip rotation, a motion that the glutes primary functioning is to stop. Inability to squeeze the legs together is very likely related to lower back or lumbar spine pathology leading to muscle weakness or muscle imbalance. If an MRI without contrast is obtained, often the doctor will not see anything from a lumbar cause unless a tear is present.

There are many potential sources of what people call “hip pain”. Most commonly, it is pain that presents near the groin. In the leg, that can be from the hip joint, but that pain can also come from the many muscles that have tendons on the inside of the femur. Other common sources of leg pain can often be called the hip but actually come from the sacroiliac (SI) joint or the lower back. Some advocacy groups that I respect working in hip preservation describe hip pain as any pain that is in front of the trochanters. Effective front hip pain treatment typically involves rest, physical therapy, and anti-inflammatory medications.

Understanding Lower Back Muscle Tear


We will discuss the causes of lower back muscle tears, which cause penetrating pain that leaves you wondering what happened to cause that kind of problem. You might have strained the muscles either from overuse, bad posture, bending improperly during lifting activities, inappropriately and repetitively bending, prolonged standing, a history of long hours driving, or suddenly straining the muscles during your daily exercise activities. Muscles are strained when the muscle is either stretched beyond its limit or forced to contract too far. When a muscle strain occurs as the muscle is stretched, the over-stretching causes more small muscle tears to form. This is the reason why you feel intense pain in the gluteus medius or front hip area, not the buttock itself, as the stretch tear process happens more extensively to affect. The size of the tear may vary, from microscopic to complete tearing of the muscle fibers. If you have major muscle tears on both sides of your lower back, this gives rise to spondylolisthesis, which is the forward or backward slippage of the vertebrae.

We managed to catch up with Mr. Shaharudin, 63 years old, who started experiencing right front hip pain. He shared his experience on conservative treatments that did not show signs of improvement. From the X-ray, it was diagnosed that he has wear and tear in the right hip joint surfaces with diffusely reduced disc space. He was then referred to an orthopaedic consultant, Dr. Siow, for hip pain treatment. Upon examination, the doctor ruled out any signs of arthritis, which was not the causative factor of his chronic right front hip pain. Indeed, it is a torn left lower back muscle. This is a common referred pain from the lower back into the front of the hip, thigh, and occasionally to the shin. He mentioned that he can consume up to 6 Panadol tablets each day for pain relief. However, consuming more tablets than necessary could cause digestive system problems, such as indigestion, in the long run. The prescribed treatment for him was tailored to his condition, and these treatments worked well. He will be able to regain his strength from his right waist to the right ankle in 2-3 weeks.

Treatment Options for Lower Back Muscle Tear


This is an injection treatment which is used to rebuild the torn muscles and tendons. The mainstay of the treatment is an ultrasound-guided needle injection of lidocaine, sodium morrhuate, and dextrose or a similar solution into the affected area. This solution, also called an irritant, causes the body to naturally produce a mix of immune, red blood, or white blood cells that help accelerate the growth and regeneration of the new muscle fibers. The process, however, may take a series of injection treatments. Surgical treatment should only be considered if conservative and aggressive options failed or if the muscle tear is severe on MRI (magnetic resonance imaging). Non-surgical treatment of muscle tears generally leads to a better outcome and is less risky as it does not involve surgery.

In mild cases, conservative treatment is recommended. Ice and heat application, physiotherapy treatments to strengthen the muscles, and the use of medications are considered for pain management. The use of anti-inflammatory drugs also may help control the inflammation and relieve symptoms. In moderate cases, similar treatments will help, including massage and acupuncture. In severe cases, a more aggressive approach is taken, including epidural steroid injections. Localized invasive therapy is also used for treatment. Prolotherapy may help those in whom conservative management had failed. Appropriate lower back muscle tear treatment includes rest, ice, compression, and gradual stretching exercises to promote healing


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