Let’s take a look at this case example.
Shirley is a 54-year-old woman who fell and had chronic pain in the back of her hip. She had seen multiple doctors, physical therapists and chiropractors, obtaining only temporary relief. Patients like Shirley who complain of hip pain are often told they have pain coming from the hip joint. An x-ray is usually taken showing some arthritis, which would be common for her age. Based on little else than the report of hip pain and the x-ray, the patient is frequently scheduled for a hip replacement without ever confirming that it’s her hip joint that is causing the pain. Isn’t hip pain always from the hip joint? To investigate the possible cause of Shirley’s hip pain, we have to take a look at the hip, pelvis and low back.
The hip joint is connected to the pelvis and the next joint up the chain is called the SI Joint (short for sacroiliac joint) followed by the lumbosacral spine. All of these joints are close together. Pain from any of these joints can cause patients to complain of “hip pain.” The hip joint proper tends to cause more groin pain, and patients with SI joint problems tend to have more pain in the back of the hip near the PSIS area. Lumbosacral joint problems can cause pain to both of these areas. Truth is, either the hip, the SI joint or the lumbosacral joint can cause pain in the back or front of the hip, so how do we tell which is causing the complaint of hip pain? To start, a thorough and comprehensive evaluation of all 3 structures is necessary to determine the source of the pain. If it is still unclear as to the primary trigger for the pain, some medical doctors are trained in performing diagnostic numbing injections. Under x-ray guidance (fluoroscopy), these specialists inject numbing medicine into the SI joint and hip and low back. In this example, injecting the hip only minimally helped her pain, while injecting her SI joint took away 70% of her pain making the SI joint the most likely culprit.
Now that we know what is causing her pain, we need to determine the best approach to treating her condition.
Fusing the joint surgically with screws has been used, but fusion usually just transfers forces to the joints above and below leading to future problems. Most pain management physicians would either consider repeatedly injecting high-dose steroids into the joint or an SI joint radiofrequency procedure. High-dose steroids can damage the joint. Radiofrequency is where special needles or catheters are inserted to ablate the nerves that take pain from the joint. However, these small nerves also provide proprioceptive input to the muscles that stabilize the joint, so nuking them could mean less active muscular stability. In addition, this would only address the joint pain and not the pain she was having from the enthesopathy muscle areas. Instead you want to look for a treatment that would be regenerative rather than ablative (build up rather than destroy), tighten the ligaments to help the passive instability, and address the areas of muscle/tendon enthesopathy.
In this situation we decided to co-treat Shirley using chiropractic care, low level laser therapy and prolotherapy. I am happy to report that after 4 weeks of chiropractic care and 2 prolotherapy treatments, pain was down by 75%.
At Stanly Wellness Center, we are eager and ready to help you and your families achieve your best health possible. If you are looking for help with your health or you know of someone who is suffering with poor health, call the office of Stanly Wellness Center at 980-355-7600 and schedule a FREE 15-minute consultation with Dr. Patrick Ess to see how he can help. Dr. Ess will not waste your time or money. He will let you know if he can help you, and if he can’t, who in the community can.
Our office specializes in nutrition, detoxification and neurological correction. You can also refer to our website at www.AskDrPatrick.com for more information. We accept most major health insurances including BCBS, Aetna, Humana, UHC, Medicaid and Medicare.
Stanly Wellness Center is located right on Main St (24/27) in Locust and is situated across the street from the big blue Locust Monument building.