Acute Low Back Pain and Chronic Hip Pain

[00:00:00] Welcome back to Untold Physio Stories. I'm your host, Dr. E, with Minor Manual Therapy and Edge Mobility System.

[00:00:05] I wanted to give you a quick case of a patient that I'd seen several times in the past, most recently for hip and low back pain.

[00:00:15] But the first time I saw him was probably maybe 15 years ago. I was still in a normal HMO-based practice,

[00:00:23] but I believe it was in my clinic when I was working with Dr. Terry Rose at Rose Physical Therapy in Williamsville, New York.

[00:00:34] So this patient at that time had gone snow tubing and he hit like a bump or a mogul or a ramp or something,

[00:00:43] flew off his tube and landed on his hip, fractured his hip, ended up with surgery.

[00:00:49] He came to see me about a year later or so. He was really stiff, really weak, did lots of strengthening.

[00:00:55] And if I remember correctly, because I was still doing a ton of manual therapy at that time,

[00:01:01] even though I was into a pain science and more active message, did a ton of ISTM, hip mobilizations, got him back on track.

[00:01:09] He was successfully discharged after maybe a month or so with full function and still working on strengthening.

[00:01:18] But he got back to working out and doing his very physical job.

[00:01:22] So fast forward, you know, 10, 15 years later, and I'd seen him a couple times, mostly for low back pain,

[00:01:31] sometimes for that same hip stiffness or weakness.

[00:01:35] And I just mostly seen him maybe two or three times or two or three months ago.

[00:01:41] So in the previous times I had seen him, he'd always got better with repeated loading.

[00:01:46] He was still pretty strong.

[00:01:48] He didn't really need strengthening at this point because he actively went to the gym, did a lot of deadlifts and leg workouts and stuff.

[00:01:56] But this time was a little bit different.

[00:01:58] He said he had acute low back pain and his hip had been bothering him.

[00:02:02] So his low back pain still went away pretty rapidly.

[00:02:07] He was slightly shifted.

[00:02:08] I did some side glides with him.

[00:02:11] He was able to tolerate those well.

[00:02:13] He comes in next time.

[00:02:15] He says, you know, my back is better, but my hip is still bothering me.

[00:02:18] Now, my bias is that 80% to 90% of most hip issues can be solved pretty rapidly unless it's true weakness and something like a gluteal tendinopathy.

[00:02:30] But they can be solved very rapidly with repeated lumbar loading.

[00:02:34] McKenzie's X-Paw study or the extremity pain of spinal source basically shows that a high percentage of hip issues are arising from the lumbar spine.

[00:02:44] Sometimes like a higher percentage of shoulder issues are arriving from the cervical spine.

[00:02:49] So I was kind of surprised, especially because his low back pain was better, that his hip was still bothering him.

[00:02:55] And he came in and he said, you know, I was better until I went back to work and I started walking all around.

[00:03:03] And he wasn't sure if it was just the walking or if it was his job or what.

[00:03:08] He works as an electrician, does a lot of walking and heavy steel-toed work boots.

[00:03:13] And these things don't have the greatest support inside unless you actually take out your insoles and replace them with something better.

[00:03:21] So, you know, I just loosened up his hip, did some distractions, belt distractions, some mobilization and movement type treatments.

[00:03:30] He felt a lot looser.

[00:03:32] That distraction made it so that he was able to walk upright.

[00:03:38] But he was also walking mostly.

[00:03:41] He came in and he was wearing his work boots and walking was painful.

[00:03:47] And he kind of listed to the same side of his hip pain.

[00:03:53] So when I retested him, he was wearing his sneakers and he said that walking felt much better.

[00:03:57] And he didn't have that list.

[00:03:59] That list could have been due to hip pain and antalgia, antalgic gaits.

[00:04:05] But in this case, it turns out that it was actually his work boots.

[00:04:09] When I went to go look at his work boots as opposed to his shoes, his shoes were newer.

[00:04:13] They didn't have nearly as much wear.

[00:04:15] His work boots were probably at least three or four years old.

[00:04:18] The upper part above the sole or above the heel actually had on the involved side a significant crease on the lateral border, meaning that he kind of like compresses to that side.

[00:04:33] His heel also on the lateral aspect was significantly worn.

[00:04:38] So not only does he weight bear more on the lateral side, but his shoe or I'm sorry, the upper part, the leather part tends to compress a lot.

[00:04:52] And when I watched him walk in that, he had that same antalgic gait and it hurt.

[00:04:57] And when I changed him to his normal shoes, the discomfort was still there from walking up and down a little bit in his work boots.

[00:05:06] But he no longer had that list because the shoe was much more supportive.

[00:05:11] So I thought this was interesting mainly in that it was mostly generated that antalgic gait was kind of what was causing him to list, go into a little bit more hip flexion, hip abduction, and thus also unload his lumbar spine.

[00:05:26] So even though side glides made him better, the amount of walking that he does in those work boots obviously does not compensate for the amount of side glides he can do to offset.

[00:05:37] You know, he was emptying his cup not as fast as it was filling up essentially.

[00:05:44] He just bought a new pair of work boots.

[00:05:47] And other than the break-in period, he said that walking around at work is fine and now he has neither hip pain nor low back pain.

[00:05:56] So definitely make sure that when you see people and they have antalgic gait in their particular footwear, always examine the footwear.

[00:06:06] And I know that to some of you guys that will actually seem kind of like redundant as you probably work that already into your exam.

[00:06:17] I say I do that, but probably not as often as I should.

[00:06:20] But in this case, in particular, if they have alternative footwear and they are not wearing the same footwear, they don't bring the footwear into their office that is the same that they have at work.

[00:06:35] You should probably look at both and have them walk around in both and see if there's a difference.

[00:06:40] So happy new year.

[00:06:41] And we're bringing 2024 to a close.

[00:06:46] Untold Physio Stories is going to continue into 2025.

[00:06:50] Hopefully we'll have more awesome cases and stories.

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[00:07:02] And as always, you guys have a great day.