Hip and Thigh Pain

Sudden onset of hip and thigh pain can be very disconcerting. You go to bed at night with nary a problem and wake up in the morning barely able to walk.

Placing weight on the leg is excruciating and you're looking for a stick or crutch to enable you to walk. What to do is of course always the question? One factor may be whether you have medical insurance or not.

As a rule of thumb I don't recommend rushing off to the doctor or chiropractor for a snivel or little ache; but this is something else. You're actually quite disabled. If you've had several previous episodes as in the case below, you can be less concerned.

More than likely something happened the previous day. Perhaps you went to the gym or stumbled on the stairs, but thought nothing of it.

Have you had upper leg and groin discomfort before is a question your chiropractor will likely ask; and does granny walk with a limp and a stick? Is your hip sometimes stiff in the morning? Do you ever have difficulty putting on a shoe.

Of course, if you are a senior then arthritis is a possibility but sudden onset like I've been describing is not a feature.

Radiation via the femoral nerve from the mid lumbar spine, through the groin and to the side and front of the thigh is certainly one factor that needs to be considered in the differential diagnosis. Almost invariably there would be distinct lower back pain; and bending movements of the spine provoke the hip and thigh pain.

The sacroiliac joint too can often provoke hip, groin and thigh pain; only a careful examination can distinguish between these various syndromes.

It's interesting that at a conference of the fifteen top spinal medical specialists in the world, they concluded that less than fifty percent of the time were they in agreement over the diagnosis of lower back and leg pain; and so it is. In the chiropractic world there is often a fair amount of umming and ahhing when faced with hip and thigh pain.

We now present such a case when both the sacroiliac joint and a pincer deformity in the hip are both seen to be the villains of the peace.

Hip and Thigh Pain

A 47 year old woman had a five year history of intermittent right lateral hip pain that radiated to her thigh and knee; there was no significant low back pain, nor was there a family history of hip arthritis. She was taking 15 dual anti inflammatory drugs per week, at least one week in the month; for hip pain, but also for headaches.

On examination, there was reduced flexion and adduction of the hip with pain in the groin and lateral hip. Internal and external rotation of the hip were relatively normal, but with slight hip pain. Fabere tests was negative.

There were no xrays, but the presentation was consistent with a mild case of a hip impingement syndrome.

Fortunately both her headaches, coming from her jaw joint not her neck interestingly, and the hip responded very quickly to chiropractic treatment.

Femoro Acetabular Impingement Syndrome

Pincer deformity

Recently after a particularly vigorous aquacise class she again developed very severe hip and thigh pain. This time she was barely able to walk; the sharp stabs started the morning after the workout in the pool.

The presentation again was not dissimilar to the original, only far more severe, and with strongly positive sacroiliac joint tests to boot.

Xrays which I now deemed to be necessary show a very small pincer deformity, entirely consistent with the presentation of very limited and flexion and adduction of the hip. It's not a very good quality film.

Again the hip responded extremely well to mobilisation of the hip, chiropractic adjustments of the SIJ and deep soft tissue therapy in and around the hip. Such that after three days she was adamant that she was returning to the aquacise class, very much against my advice, I might say. Happily she was not worse after a gentle workout in the pool; in fact, if anything a little better.

Now five days later she was determined to go for a ten kilometre run; an exercise junkie.

It's an interesting question; is your doctor always right when she or he strongly disapproves of something you plan to do? No, not always, but usually. You should have good reasons to ignore their pleas for a little sanity.

In this case the doctor was right! After four kilometres she again has severe hip pain and still had to finish by hobbling another six kilometres. It's back to square one.


Degenerative joint disease certainly is one of the main causes of hip and thigh pain; but the onset is steadily increasing stiffness and a deep ache, often in the groin. Eventually putting on shoes and cutting toenails becomes difficulty.

Osteoarthritis in the hip is frequently one of the sequelae of two conditions:

  1. Femoro Acetabular Impingment Syndrome, with stiffness starting in the younger person; the socket is too deep and has a Pincer or CAM deformity.
  2. Hip Dysplasia, with increased range of motion and sometimes a hip that subluxates easily; it just pops in and out. The socket is not deep enough.

Both these conditions need daily exercise long before they become arthritic; just like you would brush your teeth to prevent cavities. Neglected both dysplasia and FAIS become arthritic much earlier in life.

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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.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

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