A 30-Year-Old Woman with Six Months of Right Hip Joint Pain

A 30-year-old woman began experiencing discomfort in her hip Joint after exercising for the first time in a long while six months ago. Currently, due to increased pain, she has come to my clinic. Her symptoms include discomfort and pain that spread from the right hip to the front of the groin area. When she walks, there is a slight sense of discomfort, and while sitting at work, she constantly experiences a persistent dull ache. As a result, she has recently started to feel discomfort in her right buttock and lower back as well.

After walking for a while, she starts to feel discomfort in the groin area, which gradually spreads to the hip joint. Although there are no symptoms like numbness, she mentioned that the constant discomfort in her hip over the past six months has been mentally exhausting.

After playing futsal for the first time in three years, she began to feel discomfort in her right hip. As the discomfort persisted, she decided to visit a hospital. The doctor said, “Let’s take an X-ray first.” After the X-ray was taken, the doctor mentioned, “There doesn’t seem to be any issues with your bones, so I’ll prescribe some patches. Would you like some painkillers as well?” She was prescribed painkillers and patches, but her condition didn’t improve. She went for a second visit but was told the same thing, so she concluded, “There’s no point in continuing to go to the hospital.”

She then searched online for similar symptoms and decided to try visiting several massage and Osteopathy(Seitai) clinics. While this approach was more effective than taking medication, the discomfort returned the next day, and after a few days, she was back to the same state as before.

She had never tried chiropractic care before and, wondering how it differed from other treatments, searched for options on Google Maps. She found my clinic, was impressed by the positive reviews and well-designed website, and decided to give it a try.

[Initial Symptoms]

Interview:

After playing futsal for the first time in three years, the symptoms in her hip gradually worsened and have now become chronic. She had never experienced this kind of condition before, and after the progression described above, she decided to visit my clinic.

While the pain is not excruciating, the constant discomfort has been causing her significant mental stress.

Currently, she also feels pain and discomfort in the groin area, and when walking, the front of her hip joint experiences a strong sense of discomfort.

Visual Inspection:

During the consultation, while she was seated and discussing her symptoms, I noticed that she was unconsciously leaning to the left.

When lying down in a supine position (facing up), her right toe was noticeably pointing outward.

Static Palpation:

The tension in the right hip abductors is significantly high, while the adductors show reduced tension. In the supine position, there was a noticeable difference in the height and shape of the buttocks.

Motion Palpation:

There was no pain provocation during lumbar flexion and extension movements, and the range of motion was normal.

Supine Hip Range of Motion Test: Discomfort was noted in the groin area during flexion. Similar discomfort was also provoked during external rotation and abduction.

Standing Hip Range of Motion Test: Discomfort occurred in the buttocks, hip joint, and groin area across all ranges of motion, including extension.

Additionally, during the test of the unaffected hip (the left side without symptoms), pain was induced when the entire body weight was placed on the right leg, and a noticeable lateral shift of the pelvis to the right (the buttocks drifting to the right) was observed.

Orthopedic Tests:

Trendelenburg Test: (+)
Patrick’s Test: (+)
Laguerre Sign: (+)

Thomas Test: (-)
Nachlas Test: (-), but the quadriceps did not stretch.
Ely’s Test: Right (+)

Muscle Strength Examination:

The quadriceps, quadratus lumborum, adductors, and hamstrings all demonstrated normal muscle strength, with a rating of 5/5.

The gluteus medius and minimus, as well as the iliopsoas on the right side, showed slight muscle weakness with a rating of 4/5.

[Treatment Content]

The symptoms of this individual were likely caused by a groin ligament injury sustained while playing futsal. Although there was no specific diagnosis given at the hospital, it is believed that the symptoms are consistent with groin pain syndrome. (Note: In Japan, chiropractors do not have diagnostic authority, so this is a hypothesis.)

Groin pain syndrome can arise from various underlying issues, which is why it is referred to as a syndrome.

Based on the above test results, the hypothesis was that the most likely cause among the syndrome’s various factors was related to the groin ligament, and treatment was started accordingly.

Upon checking the range of motion in the right hip joint, significant discomfort was observed during hip external rotation, indicating the need to relieve the stress on the groin ligament.

・Treatment was administered to restore the flexibility of the groin ligament, which attaches from the pubic area to the anterior superior iliac spine.

・Given the observed hip external rotation abnormalities, it was inferred that the pelvis may habitually be positioned in an outward-opening manner, so correction was made to internally rotate the hip joint and adjust the posterior and lateral displacement of the pelvis.

・Relaxation of the muscle groups responsible for hip external rotation, such as the gluteal muscles, the lateral head of the quadriceps, and the tensor fasciae latae, was performed.

[Prognosis]

First Visit: After administering the above treatment, the patient’s condition was reassessed. Although there was a recurrence of symptoms during passive testing (where the examiner moves the patient’s limbs while the patient relaxes), the symptoms had disappeared after the treatment. The patient subjectively reported significant improvement. Since follow-up was necessary, the patient was advised to return in one week, and the visit concluded.

Second Visit (One Week Later): Although there was no discomfort during normal walking, the symptoms recurred after playing futsal two days before the visit. Pain levels similar to those observed previously were noted.

The treatment was similar to the previous session, with the addition of knee joint treatment. Tension in the popliteal muscles and the mobility of the patella were worse compared to the unaffected (left) knee, so these were included in the treatment.

Due to the recurrence of pain, the patient was advised to return in one week.

Third Visit (One Week Later): The patient played futsal again, but the pain was minimal, and the discomfort had improved. The same treatment as the previous session was administered, and pain reduction was observed even after futsal. The patient was advised to space out visits to every two weeks and monitor the condition.

Fourth Visit (Two Weeks Later): Pain in daily life had disappeared. The patient played futsal twice before this visit, and pain reduction was satisfactory.

If the pain before starting chiropractic treatment was rated 10, it had decreased to about 3-4/10 after playing futsal.

The treatment plan was adjusted to expand the focus to the lumbar and thoracic regions, aiming to improve overall body flexibility and range of motion. The treatment is ongoing.

It is judged that it may be appropriate to transition from chiropractic treatment to a monthly maintenance phase. Future progress will be monitored.

[Practitioner’s Opinion]

The symptoms of this individual were typical of groin pain. Groin pain often occurs in sports like soccer, which involve not only the trunk but also extensive use of the hips, pelvis, and knees (and ankles). A common risk in these sports (as with many others) is the sudden, unpredictable changes in direction (such as abrupt shifts or twists), which place significant, momentary stress on the hips and knees. This can lead to strain on the ligaments, tendons, cartilage, and the joints themselves, often resulting in injuries. In acute cases, this manifests as inflammatory responses, causing intense pain at rest or during movement.

Fortunately, the symptoms in this case were not inflammatory, allowing for a relatively proactive treatment approach from the beginning. For individuals with such symptoms, chronic tension often creates further joint mobility restrictions and can lead to a “negative loop” where other muscle groups also become tense.

While it is necessary to relieve the tension in the surrounding soft tissues through treatment, this alone does not address the root cause. It is important to thoroughly analyze why the tension in the right-sided muscle groups becomes excessive and how this affects joint mobility to achieve fundamental improvement.

The patient continues to visit for treatment. Although the symptoms are almost completely resolved, this does not guarantee that similar issues will not recur in the future if the same lifestyle is maintained.

Regularly addressing the physical and mental burdens accumulated daily is a fundamental approach in chiropractic care. While self-care is crucial, it cannot address everything, so incorporating regular professional care is essential for maintaining a healthy daily life.

If you are experiencing hip or lower back pain, pubic pain, or post-sport pain, please visit Spine Chiropractic, located just one minute from Exit 6 of Bashamichi Station and ten minutes from JR Kannai and Sakuragicho Stations. I am committed to contributing to your health with knowledgeable and skilled chiropractic care.