Continuing sharp groin pain following a total hip replacement and lower back operation for a spondylolysthesis

by Helen



3 years ago l had a total hip replacement which went well. Sadly 6 weeks post-op l fell and fractured my patella. Ever since I have had a nagging groin pain and what looks like a group of broken blood vessels on the outer edge of my knee. This area is also pretty painful to the touch but walking etc is fine.

Last year I had rods and screws inserted to relieve a spondyolysthesis at L3/4, but the pain and cramps that I am getting in both my legs, although much worse on the right, is much worse than before the op.

Could piriformis syndrome be causing all these problems? I do exercises everyday, and I was swimming up to 3 kilometres but have now limited myself to just 1km as the pain seems to be aggravated by the sport. I also walk about 10km a day.

I am awaiting an MRI and appointment with neurologist, but am fed up with continuing pain; any ideas?

Hello, Helen,
Yes, I have lots of ideas.
Firstly, that knee; it's almost certainly affecting your gait and that has a knock on effect up what's called the kinetic chain; your hip and lower back primarily.

You probably have a condition called patello femoral pain syndrome; sometimes it can be relieved by a simple set of exercises; I would start there faithfully several times a day.

Have you been back to the orthopaedic surgeon who operated on your hip? There's considerable risk that you loosened the pin in the shaft of the femur, or something else when you fell on your knee; even a stress fracture in the pubic bones. If you haven't already, ask him.

And lastly that operation on your back obviously didn't go well; it's a risky business and has affected one or more of the nerves that supply your legs. You are now getting the symptoms of lumbar spinal stenosis. Go on swimming, mainly backstroke, and start doing the gentle back exercises you'll find in the navigation bar at Chiropractic Help every morning before getting out of bed. I doubt there's much else to be done, and you don't want yet another operation to undo the damage done.

And lastly, ask someone to stand behind you and place their hands on the iliac crests; are they level, or do you have a short leg since the hip operation? It affects the sacroiliac joints profoundly. A simple inner sole in the shoe will help. There are plenty of chiropractors in France; it has one of the best educational institutes in the world.

One last thought; quite a lot of this is traumatic, but there may be a genetic component; hip and lower back pain runs strongly in families; get your children NOW to start lower back and hip exercises every day.

I hope this contributes.

Dr B

» Continuing sharp groin pain following a total hip replacement and lower back operation for a spondylolysthesis

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Aug 14, 2017
Reply to Dr. B
by: Helen

Hello again Dr. B.
I am going to see my chiropractitioner in UK next week so I will get her to check my leg length. I stopped wearing the insole about 10yrs ago, but the groin pain has been present since I broke my patella only.

The surgeon who did my hip just checked my x-ray and mobility, when I asked if the piriformis could be responsible for the pain he just said that during the operation he is nowhere near it and he thinks it is all to do with my back. He made no mention of correcting my leg length and I forgot to ask, sorry! I am not seeing the back surgeon unless something shows up on the MRI or with the neurologist.

However with very consciously doing the exercises things are improving, slowly! I do still get some cramps but far fewer and my back feels less stiff. My knee is still painful but I will keep on going.


I always say it's the direction that counts; things are looking up! Keep up those exercises for life.

Research by radiologists has shown that a short leg is associated with an increase incidence of hip and knee arthritis; and a curvature in the spine, so more trouble there. Get the right lift in your shoe; your chiropractor will advise you.

Just beware now that it's improving; nothing silly for at least a month.

Dr B

Aug 08, 2017
Reply to Dr. B
by: Helen

Thank you for your reply. My hip surgeon has said that all is well, saw him just a couple of weeks ago. I have always had a 16mm difference of leg length and used to wear an insert but l was told that this is no longer common practice and to stop( by rheumatologist ).
I have been exercising my knee more, as well as massaging the sore spot on the side, this has however given me some pain in the patella which I didn't have before!
As for swimming I always used to swim back stroke but have changed to the crawl, it is just too painful on my back now! What a wreck!😃

Hello again, Helen,
I couldn't disagree more with your rheumatologist. A 16mm difference is huge, but it may have changed since the hip replacement; a good surgeon would try to reduce that 16mm deficit. It needs to be reassessed.

You can't get 16mm inside your shoe; if it's still that much you have to have something under your shoes. All of them.

The other option is to take the inner OUT of the long leg shoe, and add an extra thicker inner TO the short leg shoe; or various combinations.

When did you stop wearing the insert? Did that coincide with the increased groin pain?

Probably avoid breast stroke and frog kick, or very gently.

Try some quad setting exercises. But I like to do it sitting with the knee bent, straightening it; you get more glide of the patella.

Did you get someone to stand behind you with hands on hips?

What did the surgeon say?

Dr B

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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 have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is 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 is doing well.

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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 is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has 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 stroll 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; he has a short leg.

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. X-rays 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 few months 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 is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year 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 could not 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 should not be treating the elderly most medical sites state but that is so much bunkum.

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