Hip & Leg

Trochanteric Bursitis

Symptoms

Usually pain on the outside of the hip, there can be a small amount of swelling. The pain is usually around the point of the hip. It is often made worse when the gluteal muscles contract around the bursa. I.e. in standing and when walking up and down stairs

What is Trochanteri Bursitis?

It is caused by the inflammation of the bursa which is a fluid filled bag. The bursa’s role is to reduce friction between the tendon and the bone. If it becomes irritated it is often very difficult to settle. Normally lying on that hip will increase the pain.

Treatment

It often needs a period of rest to let it settle, during this time, hands on treatment, such as massage and fascial release on the surrounding structures can assist. Then a period of strengthening to resume normal function.

If you require more information or would like to book an appointment then please call the clinic today.

Hip OsteoArthritis

Symptoms

Often presenting as an ache in the hip or groin region. The pain is often caused by the reduction in movement, Any time a joint is held at the limit of its range for sustained periods it will ache. In this case activities such as sitting which were within the range available previously are no longer so and it is why there is an ache.

Treatment

The first goal is to improve range of motion and there are a number of ways this can be done with manual therapy, mobilisations, soft tissue techniques and exercises. You will be surprised how well joints can respond to specifically tailored exercises.

So if you require more information or would like to book an appointment then please call the clinic today.

Hamstring injury / tendonopathy

Often confused as hip pain. This pain is present on the boney bit you feel when you are sat down. The pain often comes on with running and eases as you run more, but it will often be very sore afterwards.

Any exercises that involve the hamstrings are likely to cause some degree of pain.

This type of injury is usually resolved after identifying the cause – ie. What areas are weak and asking more of this area. Treatment will consist of manual therapies and specific exercise to assist in strengthening the area.

If you are suffering from Hamstring Tendonopathy then call us at our clinics today.

Labral Tear

Overview

The Labrum is also a cartilaginous disc that sits on the edge of the joint and prevents too much motion of the femur (ball) on the Acetabulum (socket).

What Can Cause This

There is often a mechanism involved whereby you feel something happen or tear at the front of the hip. This is not always the case and it is possible to have a degenerative tear that has just occurred over time. You may notice a click in the front of the hip with certain movements.

Treatment

Usually an MR Arthrogramme scan is used to diagnose the extent of the tear. If the tear is stable and small it can often be rehabilitated without the need for surgery. Even if surgery is indicated, getting the hip as strong as possible pre surgery has huge positive effects on the post surgery outcome. Core stability and strength is also really important.

So if you require more information or would like to book an appointment then please call the clinic today.

Gluteal Tendonopathy/ buttock pain

Symptoms

Pain is often on the outside of the hip, it can be sore to lie on the effected side. You can often get pain if walking for any length of time. It can often be sore if you stand after being sat.

Treatment

There can be a number of causes for this condition. Treatment normally consists of manual therapies and rehabilitative exercises.The goal is to ensure that the pelvis, lower back and hip are moving and working correctly so that there is not undue stress placed on the Gluteal Tendons.

So if you require more information or would like to book an appointment then please call the clinic today.

Lateral Femoral Cutaneous Nerve Entrapment

Symptoms

You will often feel a tingling/change in sensation along the outside of the thigh as that’s where the nerve supplying that area runs. This nerve is a branch of the femoral nerve so you may find you can have associated hip and knee pain with this injury too.

Treatment

The goal is to ascertain where the nerve is irritated and therefore causing the symptoms. The lower back, hip and groin can all be a cause, so they will all be assessed. Treatment will involve very specific manual therapies and exercise techniques.

So if you require more information or would like to book an appointment then please call the clinic today.

Groin Strain

This is normally any pain that occurs in the groin region after repetitive actions or a specific movement, such as over stretching!

After a careful examination of the injured area to ascertain the problem a treatment plan will be developed.

Treatment will normally include manual therapies and specific exercises.

So if you require more information or would like to book an appointment then please call the clinic today.

Quad Strain

The quadriceps make up some of the biggest muscles in the body. Often a patient will report doing something they haven't before, i.e a sprint session having not run for years. This puts excessive force through the muscle, it is then not strong enough to cope and suffers a tear.

There will often be pain on any movements involving these muscles. Stairs are often painful. Moving from sitting down to standing up is also sore.

Treatment

After you have overcome the acute stage, usually 2-3 days, you will be given advice on how to start strengthening the muscle. We will also look to ascertain the cause of the injury, and then address it in order to prevent reoccurrence.

So if you require more information or would like to book an appointment then please call the clinic today.

Pubic Symphysis Dysfunction

Often the area of symptoms for the patient is not also the cause. Those patients suffering with PGP can experience pain into the sacroiliac joint (two joints at the back of the hips just below your spine). The cause in our experience is often how tight the structures at the front of the hips have become. Therefore treatment is aimed at releasing tension in the front of the hips and increasing strength in the back. Addressing mismatching of function gains more sustained relief as opposed to isolated treatment to the painful structures alone.

Treatment when Pregnant

So what are the mechanisms behind pain during pregnancy? On of the major factors is that your body releases a hormone called Relaxin. This hormone is essential in allowing the pelvis to cope with the growing baby. It causes ligaments to elongate and gain much needed space, however, this elongation then requires more help from the muscles surrounding the area to increase stability of the joints. Where your muscles are not strong enough, this can increase strain to your muscles, ligaments and joints resulting in pain. In addition to the relaxin, pregnancy will of course change the mechanics of your low back and pelvis which inherently increases stress. The combination of these factors makes this problem a common one that we see.

Buttock Pain

Buttock Pain commonly occurs with low back or Sacroiliac Joint (SIJ) pain. Pain can be deep seated in the buttock, often described as achey and nagging. It can also be accompanied by intermittent sharp or twingy pain which occurs with certain movements like sitting to standing or getting in and out of the car. Often there can also be pain radiating into the leg. This can be achey or sharp and you may also experience pins and needles or numbness sensations.

Buttock pain can be from local muscles, most commonly the Gluteal (buttock) Muscles or the Piriformis. It can also radiate from the SIJ. When it involves the “side of the hip” - the bony part of your hip that you feel if you lie on the floor on your side - then the Trochanteric Bursa can be involved too. This is common when the Gluteal Muscles and/or Piriformis become recurrently tight.

In all these circumstances, Chiropractic treatment is very helpful to reduce pain and restore function. A combination of approaches including manual treatment, taping and advice are used. Weakness of the Gluteal Muscles is very common and therefore treatment is normally combined with strengthening exercises.

If you are suffering from buttock pain, contact us now to book your appointment or to find out more information.

Sacroiliac Joint Dysfunction (SIJD)

This is one of the most common problems that we see as Chiropractors. The SIJ is the largest joint in the spine and has a huge amount of nerves therefore a large capacity to cause pain. There are 2 SIJ’s in the body - one on either side of the body. They join the sacrum to the rest of the pelvis at the base of the spine.

Dysfunction of the SIJ can be extremely painful and debilitating but rarely requires surgery. Pain will be localised to the dimple the SIJ creates at the base of the spine. These dimples appear just under the bony prominences of the ilium (large pelvic bone). This can also be very tender to press. Pain commonly radiates from here into the buttock and can go down the leg right to the foot. It may also create aching and pain across the lower back.

SIJ treatment is an area we specialise in at our clinic. We have a huge amount of experience in treating this condition and a huge amount of success from our comprehensive approach.

If you are struggling with SIJD and would like more information or would like to book an appointment then please call the clinic today.

Trochanteric Bursitis

Symptoms

What is Trochanteri Bursitis?

Treatment

This condition is often confused with Gluteal Tendonopathy and is treated in the same way. It often needs a period of rest to let it settle, during this time, hands on treatment, such as massage and fascial release on the surrounding structures can assist. Then a period of strengthening to resume normal function.

Coccyx Pain

Although it is not life threatening, Coccyx Pain is extremely uncomfortable and life impacting. Most often this occurs after a fall onto the buttocks, usually downstairs or during a sporting activity. It is important for us to know how badly traumatised the area was and so we will ask questions to ascertain this including;

Was the pain immediate or did it come on some days or weeks after the trauma?
Was there bruising or swelling after the trauma?
Did you have any difficulties with defecation/emptying your bowels after the trauma?

Most commonly when presenting with this, if you have been to the GP you will not have received x-rays as it was not deemed necessary. If you are looking to receive imaging of this area, we will assess you on an individual basis and can refer where necessary. At our clinics our approach is to assess and treat the coccyx externally. We do not undertake internal coccygeal examination or treatment. If you are looking for this treatment we recommend that you discuss this option with your GP.

External Coccygeal treatment including fascial and ligament release work, manipulation with function and active release is very effective for pain relief and symptomatic improvement of Coccyx Pain. So if you are struggling with Coccyx Pain, call us at the clinic to book your appointment or find out more.

Piriformis Syndrome

This affects the Piriformis Muscle which lies deep in the buttock. If the muscle becomes very tight it may irritate the Sciatic Nerve causing local pain to the buttock and pain that radiates down the leg. Aggravating activities include prolonged sitting, especially in lower or harder seats. Treatment is focussed on relieving pressure and irritation on the nerve and releasing tension in the tight Piriformis muscle.

We have many techniques that can successfully address these issues. Piriformis Syndrome responds well to conservative care and our approach of additional advice, ergonomics, exercises and individual lifestyle monitoring means the best and quickest results for you.

If you are suffering from Piriformis Syndrome, call to book now or ask us more.

Adductor Strain

Definition

The adductors are a group of three muscles, and all of them have a slightly different job, therefore knowing the exact way in which the injury occured helps to differentiate which one is injured. By far the most common is the adductor longus. This muscle attaches at the very top of the leg, into the groin and stretches to the inside of the thigh.

Most commonly the injury to the muscle is close to the top where the tendon meets the muscle, known as the myotendinous junction.

A slightly different injury but in a similar location is called osteitis pubis, this is inflammation of the joint that is located at the bone where the adductor longus attaches. It is important to differentiate the two injuries, as they are treated very differently. Don't fear we will be able to help you with this.

Treatment

Adductor longus

After you have overcome the acute stage, usually 2-3 days, you will be given advice on how to start strengthening the muscle. We will also look to ascertian the cause of the injury, was it a muscle weakness to begin with? Is it a pelvic asymmetry? Weak core? The list continues, but thats our role is to find that out and address it to prevent reoccurrence.

Hip Flexor Strain

The hip flexors are a group of muscles that all have the action to bring the thigh forward, they are therefore usually injured in the same way. If you have attempted to do something different in your life/training you can injure this muscles. The pain is then felt performing these movements after the injury has occurred. Exercises such as walking can be painful here.

As these muscles lie deep in the hip it is therefore unlikely you will see any bruising or swelling when the muscles have been injured.

Treatment

After you have overcome the acute stage, usually 2-3 days, you will be given advice on how to start strengthening the muscle. We will also look to ascertain the cause of the injury, was it a muscle weakness to begin with? Is it a pelvic asymmetry? Weak core? The list continues, our role is to find that out and address it to prevent reoccurrence

Labral Tear

Overview

The Labrum is also a cartilaginous disc that sits on the edge of the joint and prevents too much motion of the femur (ball) on the Acetabulum (socket).

What Can Cause This

Treatment

Usually an MR Arthrogramme scan is used to diagnose the extent of the tear. If the tear is stable and small it can often be rehabilitated without the need for surgery. Even it surgery is indicated, getting the hip as strong as possible pre surgery has huge positive effects on the post surgery outcome.

Core stability and strength is also really important, please log into the patient portal to see the types of exercises you are likely to receive.

Quad Strain

The quadriceps make up some of the biggest muscles in the body, this means there is usually a lot of force involved in injuring them. Often a patient will report doing something they haven't before, i.e.e a sprint session having not run for years. This puts excessive force through the muscle, it is then not strong enough to cope and suffers a tear.

There will often be pain on any movements involving these muscles. Stairs are often painful. Moving from sitting down to standing up is also sore.

Treatment

After you have overcome the acute stage, usually 2-3 days, you will be given advice on how to start strengthening the muscle. We will also look to ascertain the cause of the injury, was it a muscle weakness to begin with? Is it a pelvic asymmetry? Weak core? The list continues, but thats our role.....to find that out and address it to prevent reoccurrence

Lateral Femoral Cutaneous Nerve Entrapment

Symptoms

Treatment

The goal is to ascertain where the nerve is irritated and therefore causing the symptoms. The lower back, hip and groin can all be a cause, so they will all be assessed. Treatment will often involve the Neural Interface Technique (explained in the what we treat section)

Adductor Strain

Definition

Most commonly the injury to the muscle is close to the top where the tendon meets the muscle, known as the myotendinous junction.

Treatment

Adductor longus

After you have overcome the acute stage, usually 2-3 days, you will be given advice on how to start strengthening the muscle. We will also look to ascertian the cause of the injury, was it a muscle weakness to begin with? Is it a pelvic asymmetry? Weak core? The list continues, our role is to find that out and address it to prevent reoccurrence.

Hamstring Strain

Mechanism

Often the injury is caused by a sudden change in direction or speed and a sharp pain is felt in the back of the thigh, this can occur at many places along the back of the leg. Occasionally as high up as the groin.

Symptoms

After the initial sharp pain, an ache is often left in the same area. Pain is rarely felt unless you take the leg into certain positions. Often patients try and return to sport after a rest period to find they are unable to change direction or speed.

Treatment

Rest unfortunately Is not enough – POLICE is the acronym used, referring to Protect, Optimally Load, Ice, Compress, Elevate.

The key is to progressively stress the healing structure so that it returns to pre injury levels.

Anterior Knee Pain (patellofemoral Dysfunction)

There are a number of causes for this condition, it is by far the most common knee complaint according to the research.

If you are suffering from Anterior Knee Pain then call us at our clincs.

Patella Maltracking

The patella is otherwise known as the kneecap and is a "floating" bone suspended over the front of the knee by the tendon of the quadriceps muscle (at the front of the thigh). Is should glide over the front of the knee as it bends with no pain, clunking or clicking and should not pull to one side or the other. If it does any of these, this can be due to Patella Maltracking. In more severe cases, the patella can pop out of position. Most commonly it pops back in quickly, however if this happens to you, you definitely need to see someone as this movement can damage the joint.

Maltracking can occur for a number of reasons. It can be the result of trauma, soft tissue contracture, patella alta (high patella) or if the knee is moving in a way that causes twisting or bending inwards.

If you are experiencing Patella Maltracking then you should seek treatment. Firstly we need to establish how severe your case is and if it is "Functional" (due to biomechanics or soft tissue changes) or "Structural" (due to bony positions, damage or changes). This is very important to know for you to receive the correct treatment and the best care long term. Most cases of Patellar Maltracking are functional and respond well to conservative care.

Meniscal Tear

The meniscus are semicircular bands of cartilage that sit in the joint of the knee. Their job is to offer shock absorption and offer better joint congruency.

Mechanism

There are 2 mechanisms here, 1 is as a result of trauma, the other is a result of degenerative changes to the joint.

Trauma – is often a result of planting the foot on the floor and the knee receives a sudden twisting motion. There can be a click or sharp pain, but often no pain is felt, the patient reports it not feeling quite right. There is often swelling but it can take up to 12 hours for it to show.

Degenerative – there is no cause but the meniscus often becomes worn down and means the knee

Treatment

Often the correct type of exercise placed through the knee helps to settle symptoms very well. If the tear is not too extensive it can be rehabilitated. You will often find that the knee symptoms can also be a result of what occurs above and below. Therefore weakness or stiffness in the hip and ankle can also be a cause of the tear and therefore the pain. Addressing the joints above and below are required to help treat this condition.

Cartilage Tear

Usually twisting on a leg that is fixed to the floor. There is often a known mechanism i.e. the person remembers exactly when it happened but this is not essential for it to be a cartilage tear. Often there is swelling that takes about a day to come on

If you are suffering from Cartilage Tear then call us at our clinics

ACL/PCL Sprain/Rupture

Mechanism

This type of injury is usually associated with a very definite mechanism. It often occurs as a result of you planting a foot on the floor and while the foot is fixed you twist. There is often a sudden pain and the knee swells very quickly.

Treatment

PCL – often the management is conservative, i.e. not surgical. You can often get back to the activities you were doing previously with exercise therapy alone. The first stage of the recovery is to promote swelling reduction, mobility and strength of the knee. After that the exercises are progressed to become more functional. Eventually specialisiing for the activity you want to return to.

ACL – The immediate management of this injury is predominantly surgical as the role of the ACL is different to the PCL. There are occasions when surgery is not required and for further information please contact the clinic.

Post surgery please see ACL/PCL Post-surgical Rehab section

Medial Collateral Ligament Strain

This type of injury is usually as a result of sudden trauma, often landing awkwardly unlike the Anterior cruciate ligament, this injury usually involves a collision with someone, where the collision has caused stress to the outside of the knee, stressing the ligament on the inside, causing it to become damaged.

If you are suffering from Medial Collateral Ligament Strain then call us at our clinics

Baker's Cyst

This is where fluid forms in the back of the knee. It is often a symptom of a cause elsewhere, often associated to inflammation in the knee, calf and hamstring weakness. Non surgical treatment is advocated, firstly to reduce the swelling, then to find the underlying cause for the inflammation.

Osgood Schlatters Disease

The tendon of the quadriceps inserts just below the knee cap. At this point there Is a lot of tension.

This is a condition that often affects adolescents; boys more so than girls and it is thought to be associated to the way you grow as a child. Bones grow sporadically and as they do the muscles and tendons struggle to keep up, this causes excessive stress at the point of attachment. If you then perform exercise and increase the tension further it can cause pain.

Treatment

The treatment often requires activity modification. You will need to reduce the amount of activity you do initially, gain range and strength in the affected muscles and progress to level you were previously.

Medial Tibial Stress Syndrome (MTSS)

Symptoms

Pain on the inside of the shin, this is usually associated to a sudden change in exercise intensity or volume. Some of the causes are weakness in the muscles, stiffness in the foot, inappropriate footwear to name a few. Unfortunately this condition is multifaceted and the goal is to understand the underlying cause in which to solve the issue.

Treatment

Soft tissue release techniques help to mobilise the tendons that should glide and slide along the inside of the bone, which is often one of the causes for the pain. We will give you strengthening exercises for the muscles that support and stabilise the knee.

Calf Strain

If you perform a sudden movement and feel like you have been shot or kicked in the back of the lower leg, this is usually associated to a calf strain. The pain is usually felt higher than where the Achilles is, often at the junction of where the Achilles meets the muscle, known as the myotendinous junction.

There is often a large amount of pain, it will often be sore placing the foot on the floor and coming up on to your toes.

There are different grades of this injury, the severity will also dictate the time to recover.

Treatment

Initial management requires you to let the muscle rest and recover. This should only be done for the first 2-3 days. After that some very strong scar tissue would have been formed which allows you to progressively stress the area. This does not mean run on it but some very mild stretching and strengthening can begin.

If you rest a structure for too long, it heals as if it is immobile and will cause problems further down the line.

Once the scar tissue has formed manual therapies and soft tissue techniques will aid recovery.

If you require more information or would like to book an appointment then please call the clinic today.

Soleus Strain

Very similar to a calf strain but is specifically in a muscle called Soleus. There are two muscles on the back of the calf that are essential for producing force for walking and running. The Gastrocnemius and the Soleus. The Gastrocnemius spans both the ankle and knee while the Soleus is just over the ankle. This means we can preferentially load the soleus by asking the patient to bend their knee when exercising.

There are different grades of this injury, the severity will also dictate the time to recover.

Treatment

If you rest a structure for too long, it heals as if it is immobile and will cause problems further down the line.

Once the scar tissue has formed manual therapies and soft tissue techniques will aid recovery.

If you require more information or would like to book an appointment then please call the clinic today.

Tibialis Posterior Tendonopathy

This condition often presents as pain along the inside of the shin and toward the inside of the ankle. This condition is usually associated to a sudden change in exercise intensity or volume. Some of the causes are weakness in the muscles, stiffness in the foot, inappropriate footwear to name a few.

Treatment

The first ting to do is understand what has caused the issue. This will aid in prevention in the future. Initially the goal is to settle the tendon and remove the pain. As soon as you have overcome the initial stage the goal is to then strengthen the muscle with specific exercises.

The final stage is to integrate the muscle strength into functional activities such as running. It is important that the therapist treating you also assess your hips, pelvis and lower back as these areas are often related to the cause of this condition.

If you require more information or would like to book an appointment then please call the clinic today.

Tibialis Anterior Strain

The role of the Tibialis anterior is to lower the foot to the floor with control when walking. If you decide to go on a long walk and your body is not used to it you can often find the muscle is unable to cope and therefore displays pain after, this pain is commonly felt in the anterior portion of the shin with activity. This muscle can also become injured if you have a fall on the ankle the places the toes into a forced pointed position.

Treatment

If the cause has been established i.e. a sudden increase in the amount you walk, the goal is to assist the muscle in performing the task, i.e. get it stronger. In the mean time we will assess the ankle and make sure the cause of the strain is not a stiff ankle which asks more of the muscle when working.

If you require more information or would like to book an appointment then please call the clinic today.