Groin and upper thigh pain

Groin and upper thigh pain are common complaints at the chiropractic coalface. Femoro acetabular impingement syndrome and hip dysplasia are not infrequent causes.

I have had cause to stop and ponder the significance of these discomforts recently. First it was the privilege to give a lecture on hip pain to a group of healthy students. Six out of 24 had quite serious groin and buttock issues.



In 2014 I did a locum in Holland where a great many of the patients are elderly. A fair proportion have had total ball and socket replacements. The number of people suffering from very painful sacroiliac joint, side of the hip, groin and upper leg pain is quite staggering. Disturbed nights, difficulty walking and considerable anguish are the order of the day. 

There's an assumption that all one needs is an operation, and the problem is cured. Whether it's hip or lower back, or any other surgery for that matter, it's best not to conclude that the knife will fix your pain, any more than chiropractic can permanently relieve it.

Most of these conditions need exercises, care, and on going treatment no matter which professional you consult. Certainly an operation is not necessarily the cure you were hoping for.

Interestingly yesterday I met a urologist of about my age; he told me that he spends his time trying to persuade older folk to expect and accept some problems, and not look to surgery to cure them.

So, upper leg pain is a very common complaint at the chiropractic coalface; sometimes there are strong radiological signs, but often they are disconcertingly minor, and written off as an incidental finding.

Just as important as that seen on the radiograph are the physical findings. If there are gross changes in the range of motion, whether the patient has pain or not, degenerative changes will develop with time if exercises are not started.


Femoro acetabular impingement syndrome

Femoro acetabular impingement syndrome involves an underlying pincer or cam deformity in the hip, often missed by radiologists, or is mistakenly called arthritis; it's a major cause of groin and upper thigh pain.


These deformities limit the movement, often when pulling the knee to the opposite shoulder, with pain in the groin; and untreated are the precursor to premature degenerative changes in the hip.

What is surprising is how very small pincers seen on x-ray can cause such a marked loss of flexibility in the hip, even in young people; the medical community thus write them off, but I believe them to be very significant; stiffness comes first, often unrecognised, and pain only later.

Groin and upper thigh pain are frequent symptoms, and together with stiffness of the hip and loss of internal rotation, and other movements depending on the deformity, are the signs of an impingement syndrome.

Today, I've just treated a lady who has had disabling groin and upper thigh pain for over a year. After just six chiropractic treatments of the sacroiliac joints and hip she declares she has 85% better. True, the pain recedes much faster than healing occurs, and so the 50 percent less pain rule applies, but she is ecstatic.

Patrick's faber test where you lower the knee into the lotus position is often limited in the groin, or side of the hip. It also stresses the sacroiliac joints so is a useful part of the diagnostic examination. You can do it at home.


Hip dysplasia

Hip dysplasia causes the hypermobility that also results in groin and upper thigh pain, and often severe tenderness of the inner adductor muscles.

Even worse are the femoral nerve lesions from the upper lumbar spine that radiate to the side of the thigh, groin and upper leg.

Hip dysplasia must be differentiated from hypermobility without osseous abnormalities; the latter is not a precursor to arthritis, but it still causes upper leg pain.



Most common of all, in the elderly, is a severely fixated sacroiliac joint.

Cases of intermittent claudication can also cause groin and upper thigh pain; a blocked artery in the pelvis limiting the flow of blood to the leg. Only smokers seem to get it. Like angina, they only get the ache when exercising.  

I'm convinced the early diagnosis of many of these conditions could greatly reduce the number of total hip replacements being done.

Oh, and two hip replacements that have been a total disaster consulted me in that one month in Holland. 

To succeed with these conditions, I have found that only by working in the lumbar spine, sacroiliac joint and in and around the hip joint is what relieves the pain.

A lifetime of gentle hip exercises is a must. 

Use the search function in the navigation bar to find more information about all these conditions.




The two common conditions causing groin and leg pain, both are pre arthritic, are hip dysplasia and femoro acetabular impingement syndrome.

What's confusing is that both can exist in the same hip.

The former, hip dysplasia, has too little coverage of the ball with the result that the range of motion is greatly increased.

In FAIS the coverage is increased in one form, called Pincer. The range of motion is decreased; in fact it presents very like hip arthritis, but in the young person.

Both, untreated, lead on to premature hip arthritis. If you start to get groin and upper thigh pain, don't ignore it; it's trying to tell you something.

Both require gentle daily exercise; both demand an acceptance that you can't run marathons. The hip simply won't be able to take as many steps in a lifetime as a normal one.


Chiropractic

Chiropractic management of these groin and upper thigh pain conditions demands careful analysis to work out what is the primary cause; could it be in the main a short leg? Or is it a referred pain from the spine down one of the branches of the femoral nerve? Perhaps it could even be a Maigne's syndrome affecting the superior cluneals.

Patrick's faber test may be positive, but is the limitation in the hip or the sacroiliac joint?


It takes a careful and thorough chiropractic examination to decide whether this is referred femoral nerve pain to the upper leg, or a condition within the pelvis.

No doctor should always be running late, that's just bad management by the reception, but occasionally it's almost unavoidable.



Groin and upper thigh pain

Groin and upper thigh pain are frequently caused by a hip abnormality such as dysplasia or FAIS.



› Groin and upper thigh pain


Disturbing letters

Chiropractic Help gets a lot of correspondence from folk world wide suffering from various maladies that haven't been solved by Medicine, and often frankly by Chiropractic too.

It's a toss up whether more of them concerning tingling in the arms and hands, or groin and upper thigh pain. Both are miserable conditions that often defy a simple diagnosis and treatment.

Obviously I cannot examine these folk, and frankly you should view anything you read on the internet with a certain amount of scepticism; but if you are suffering from insufferable pain, then perhaps you too might like to pop your question.

Just because of curiosity you might like to view some of these disturbing letters.


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What Other Visitors Have Said

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upper thigh pain and tightness  Not rated yet
Pain used to go away after moving around and stretching, now it seems to be worse after walking. The upper thigh muscle feels very tight when walking …

Hip arthritis; correct diagnosis? Not rated yet
Pain started June 5th, 2016 while running, thought stress fracture, had two xrays 6 weeks apart, both state mild hip arthritis. Had MRI, still mild hip …

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



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