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Chiropractic Help, Issue #11 - Groin and thigh pain
December 07, 2009
Dear

GROIN and THIGH PAIN

THE HIP

I receive so many questions at CONTACT concerning groin and thigh pain, that I decided this month to dedicate a page to the subject.

The first question that needs to be answered is: Is your hip stiff? Lying on your back, pull your knee to your chest. Gently rotate your hip. Does it feel inordinately stiff? Does it hurt in the groin, or on the side of the hip? Compare it with the other hip. Perhaps compare it with your spouse / friend's ... hip. Someone of a similar age.

If it has a very hard and stiff feeling, then we call it a hard end-feel and may well be associated with two fairly common conditions.

  • The first, in the younger person, is a condition with a very long and tedious name: Femero Acetabular Impingement Syndrome or FAIS for short. It's thought to be a congenital, probably hereditary, hip defect in which there are small growths where they shouldn't be. Usually you wouldn't recognise it as a problem initially, because it's always been stiff. You think it's normal. Until it starts hurting in the groin, often in the twenties and thirties, sometimes even as a teenager. If not carefully managed, we are now fairly sure that it leads on to the second ...

  • Hip arthritis. This is usually but not always found in the older person. Plain and simple hip arthritis. Except it's never simple, nor is it plain. One of the characteristics of hip arthritis is that it often causes pain radiating down the front of the leg towards the knee. This quite often leads to a misdiagnosis, either of a knee condition, or a Femoral nerve condition and suspected spinal hernia or stenosis.


  • Femero Acetabular Impingement Syndrome Case File >>

  • More about FAIS.

  • HIP ARTHRITIS.


    "Thinking beings have an urge to speak, speaking beings (should!) have an urge to think."

    Hannah Arendt



    INGUINAL HERNIA

    There is in my mind much doubt about just how common an inguinal hernia is. If you have a lump in the testicle, and if you can feel a bulge in the groin when you bear down, then yes ... personally I treat an awful lot of people with groin pain, and not too many have an inguinal hernia.


    HIP DYSPLASIA


    In FAIS there is "too much coverage" of the ball of the femur, causing the restricted movement, even in a young person. In hip dysplasia there is "too little coverage". Clinically, both cause pain in the groin, but in HD the range of motion of your hip will be greatly increased over normal. Because you were born with it, the chances are that you too won't recognise it as abnormal. It is often associated with a painful click. It's usually bilateral.

    Both hip dysplasia, and the following condition, capsulitis, have what we call a soft end-feel.

    CAPSULITIS

    The ball of the femur is held in place with some very strong ligaments, which form a sort of bag around the hip joint. These ligaments, like any ligaments (say, in your ankle) can be strained and sprained in sport, in falls, in overuse, causing pain in the groin.

    The capsule also maintains the fluid that sloshes about inside joints, lubricating the cartilage. This 'synovial' fluid contains a very special substance called hyaluronic acid that coats the cartilage cells and enables them to bind water molecules. It's this water-binding property of cartilage that makes it smoother than ice, literally, and gives it its shock-absorbing qualities.

    Loss of movement in any joint decreases the cartilage nutrition, leading to what is widely accepted in the scientific community and known as immobilisation arthritis. This is really what chiropractic is about - finding fixated, subluxated joints and restoring normal biomechanics to prevent the onset of immobilisation arthritis.

    IMMOBILISATION ARTHRITIS >>


    MERALGIA PARESTHETICA

    When I studied Chiropractic, back in the last millennium!, there was no mention of MP. Perhaps that was the day I cut class and went skiing! Remember, as one wag put it, fifty percent of all doctors, and chiropractors too, graduated in the bottom half of the class!

    Seriously, though, when I first used to bump into this condition, it was considered untreatable, even by medical means. It is unresponsive to even the strongest medicines, and nerve blocks only bring temporary relief. So I accepted what the bofs said. Big mistake!

    Faced with patients on a regular basis with a painful nerve pain on the side or front of the thigh, I started to take an interest in this condition. And low and behold, Meralgia Paresthetica responds extremely well to Chiropractic treatment. It does require something more than the adjusting the spine and pelvis though.

    Treatment of Meralgia Paresthetica

    The standard medical treatment at emedicine is:

    * "When the pain is severe, a focal nerve block can be done at the inguinal ligament with a combination of lidocaine and corticosteroids. This should temporarily (bold mine) relieve the symptoms for several days to weeks. Ultrasound guidance for the blockade may be beneficial in patients with regional anatomical variations.

    * Neurogenic pain medications such as carbamazepine or gabapentin typically are not as helpful but may be beneficial in rare patients. If medication of this type is required, then surgical decompression should be considered."

    Chiropractic care of MP

    The Chiropractic protocol that I have developed is particularly successful. The pain is usually reduced by a half with a week or two, sometimes in a day or two, but may linger in small amounts for a month or two. I wish I had the time to research this, so that my claims can be something more than one of the many unproven anecdotes that abound in all of health care.

    That protocol involves:

    1. Careful evaluation of the mid to upper lumbar spine for subluxations.

    2. Likewise subluxations of the sacrum or ilium.

    3. Painful crossfriction where the Lateral Femoral Cutaneous Nerve emerges from the inguinal canal, followed by alternating ice and heat. The treatment hurts, and bruising may occur.

    4. Various rehab exercises.


  • Read more about MERALGIA PARESTHETICA ....


    LUMPS and BUMPS

    The groin is of course very occasionally the site at which swollen lymph nodes may be found. Usually the sign of local infection, they can be sign of things more serious. You can expect your chiropractor will examine the area for "medical" conditions too, with an appropriate referral. FIND A GOOD CHIROPRACTOR


    Love to read? Greed is the subject of numerous letters I receive at Chiropractic-Help.com. This is how one writer expressed it this morning:

    "How do I know if he is only fixing it half way to get more money out of me?"

    How indeed! This is the subject of one of the chapters from Bats in my Belfry by Dr Bernard Preston, now thinly disguised as also the webmaster at Chiropractic-help.com!

    The chapters starts:

    Greed

    BATS IN MY BELFRY

    Chapter 13

    Life is not inherently fair, at least not from our human perspective. Some people, poor people we would say, seem to get a double portion of pain. Danny McFie was one of them. I had known the McFies for some years, not particularly well as they were fortunate enough to have healthy bodies or, at least, so we thought ...

    This story relates to probably the most painful experience I have ever had in my own professional life ... the kidnapping of a child ... read on at this link. Greed

    Below is the cover of Bats in my Belfry which you can order by clicking on the picture.

    Enjoyed the story? I think not, but in any case, instead of a bottle of wine for your Chiropractor this Christmas, how about buying a copy of Frog or Bats, reading it yourself!, and passing it on to him/ her on the 24th. As you can see from reading Reviews, both Chiropractors and non-professionals like you love my books.

    Hurry though, if you want it in time for Christmas.


    Nutritional corner: HUMMUS

    The chickpea (aka Garbanzo bean) is the most popular source of vegetable protein world-wide. It's cheap, easy to make in your own kitchen, but the peas do have to be soaked overnight.



    Personally, I make Humus every week. Sometimes a double amount of Hummus if we're having guests, or a single amount of Humus otherwise. You can spell it both ways!

    Click here for more info about Hummus.

    PERTHES HIP

    A last thought on the hip. If you child starts to limp and complain of pain in the groin, please take him or her IMMEDIATELY to your Chiropractor. There is a nasty condition called Perthes Hip. If your child doesn't get weight off that hip immediately for a period of about two months, it's almost guaranteed he or she will have the first hip replacement before 35. Yes, I have two patients whose Perthes was written off to "Growing Pains" by their medical doctors. They both had the first hip replacement before 30! Both are now in early 50's. One has been on crutches for 10 years after three hip procedures, and the other at 54 is in a wheel chair after four.

    Growing pains doesn't exist! and this is one you mustn't miss.





    So delic with Eggplant. Lowers your cholesterol too. More Eggplant recipes ...

    Eggplant /Aubergine /Brinjal

    Roast Vegetable I love the eggplant for it's easy to prepare properties. Just throw some slices of virtually any veg into your roast veg mix, smother with olive oil and pop into the oven. Nothing could be easier.

    The eggplant has proven cholesterol lowering properties.


    Until next month then. Promise not to fill your Inbox with information overload.

    Oh, and a very blessed and happy Christmas to you and yours.

    Should you have found this email helpful, feel free to forward to family and friends. Your doctor?! Our readership is rising in leaps and bounds, but for the considerable work put in, I would prefer it to go to 5 000 people!

    Yours in Better Health. Read a book today, preferably one of Bernard Prestons!, play a game of chess or bridge, or Sudoku, and save your mind. And go for a walk. MENTAL and PHYSICAL exercise have now been proven to greatly reduce the incidence of Alzheimers, the worst disease of them all.

    Chiropractic-Help.com

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