Need help re: combo hip flexor tightness & glute/piri weakness

[Merrida]

Worked with a young man yesterday (22 y/o). I won't "be working with him" because his doc chose physical therapy for him, then a cortisone shot! (Don't get me started). Doc took XRays of his lumbar spine (not enough to see femur/hip joint, only low enough to barely fit in illiac crest). This must have been exclusively lumbar and no sacral.

NO further tests. He's complained of "hip pain" for going on 5 years and this recent XRay is the ONLY test his doctor has and is willing to perform on him. He refused this man's request for XRays of his hip to r/o possible hairline fractures, bone spurs....or an MRI to see if there's any ligamental involvement.

Anyway, he's working with a physical therapist, and is out of my bounds/hands.

He came to visit yesterday and all I did was some basic "muscle testing" type of work with him to see where his tightness was and weakness was and it's really evident his left hip flexor is shortened and tight (based on my "assessments and tests") and his left glute very weak and his left piriformis is very tight. (Note: He complains of radiating pain from his hip down his leg, the lumbar XRays r/o lumbar disk involvement or nerve impingement).

I'm still thinking his piriformis is encroaching his sciatic nerve (possibly) -- again based on stretches we did to see how tight he was and what could reproduce stimulation.

Question: Any kind of stretch he does (on his own, in PT, or with me)...."most" of them just create a tight/pinch in his left hip flexor. A hamstring stretch, a piriformis stretch, adductor/groin stretch, and hip flexor stretch (of the varities of hip flexor stretches I tried with him, in a number of positions, most of the time creates a radiating "pain" medially down his inner thigh, originating from his hip flexor region).

Even BARELY doing a hamstring stretch (meaning I lift his leg maybe 45 degrees from the ground) -- he says it "pinches" his hip flexor. (This prevents us from further stretches).

Any ideas what may cause this repeated/duplicated "bunching" or "pinching" of his hip flexor (region) even with the least amount of movement?

[threenorns]

mental issues. he's freaked himself out totally so feels the pain when he THINKS he should feel it.

[pseudonym]

speaking only from experience with similar pain/inflexibility issues (though it sounds like I am nowhere near as messed up as this fellow ) - and I don't know spit so take what I say with a good few ounces of salt but here's my take.

I think the cause of his pain is most likely lack of use. How often does he move his legs in a sideways motion ? not often is my guess. I used to get similar pinching pains in my hips when I first started Taekwondo (and the associated stretches) though I had no back condition which may exacerbate the situation.

Here's what I rekon:
The hips, when inflexible and suddenly (or even gradually) flexed, are the most painful group of muscles/tendons/ligaments I have encountered and if this is connected with a percieved (or real) back problem I can definately understand this guys reticence to 'embrace the pain', so to speak. But honestly, stretching is just stretching, as long as there is no 'partener' or external force involed to increase the stretch it is very very unlikely the body will stretch itself far enough to injure itself (according to Kurz in Stretching Scientifically). Long and short if he can force himself into the position using only his own static pressure he is not likely to hurt himself (again I have no idea how this is impacted by a back injury). So, if you're confortable (knowing all the other factors you do) I'd advise him to stretch ... a lot (and by that I mean often not necessarily hard )

My, one inflexibile guy to another tip, spend ever increasing amounts of time sitting cross-legged on the floor, this has increased the motion in my hips and lower back no end (careful if you've got weak knees though, the less flexible the hips are the more pressure is palced on the knees).

My basic conclusion: problem: atrophy through lack of use (full range movement) - common in a world of tables/chairs and forward-only movement
solution: stretch, keep it individual, non-ballistic and do not be afraid of the pain caused.
caveat: back injuries not factored into my thinking.

take what you want form these ideas, discard the clearly moronic

[smm3]

What's his "diagnosis" from the doc or the PT?

I don't think that it is sciatica due to the pain originating at the front of the hip (doesn't it usually follow the sciatic nerve?) My thinking is that he has been guarding it for so long, that it is painful to stretch. Kind of a combo of the two above replies. It's mental in that he knew it would hurt to stretch therefor he hasn't for, what, five years now. I recently had a client like this, except it was frozen shoulder. If he really wants the results, some pain will come with it, but it WILL lessen as progress comes along.

Another idea. I don't know all of the specifics but here's something out of my head. Is it through a full ROM that he has pain? Could he (since you're not working with him, maybe suggest while you watch ) try to fatigue the hip flexor through a limited, pain free ROM and that might assist in some of the stretching if his muscles can't resist.

Hope this helps!