January 26, 2010

I got an email from a friend of mine, about someone with a peculiar hip pain. Seems this guy had a sudden onset of a popping over the outer aspect of his hip, when he twisted. This was accompanied by pain down the back of his thigh. Naturally, he was concerned. So my friend asked me what I thought.
 
Well, y’know, there are always a number of conditions that can cause a similar pattern of symptoms. But it’s an old, but true saying popular in medical circles: “When you hear hoofbeats, don’t think of zebras.” Meaning, of course, that the most common cause is usually the answer.
 
In this case, the guy probably had an acute onset of ITB (iliotibial band) tendinitis. The ITB is a thick, wide fibrous band that runs down the side of the leg, like a wide tuxedo stripe, from the pelvis and the abductor muscles at the side of the hip, overlying that lump of bone that you probably call your “hip bone,” and I call the greater trochanter.
 
If this band was injured, or irritated, perhaps by a minor bump, now forgotten, that minor injury might have been sufficient to provoke the cell-mediated, delayed inflammation I spoke about yesterday. Then, the tissues can become swollen and thicker than normal, causing the band to impinge on the underlying lump of bone (which is all “trochanter” really means). Any twisting or torsional movement would then cause the band to snap or pop over the trochanter, like plucking a banjo string.
 
The resultant pain would follow the path of the anatomy, down the side of the leg. Not uncommonly, its back edge is the most tender, hence the pain “down the back of the leg.” This can sometimes mimic sciatica, though that is usually NOT accompanied by sound effects, nor is it provoked by twisting motions at the hip. And true sciatica is often a severe, burning pain, often accompanied by numbness, or muscular weakness, or even reduced or absent reflexes in the distribution of specific nerve root(s). From the description, this man had something quite diffferent.
 
And this particular condition (ITB Tendinitis) can be double trouble, as well. Wherever the pain starts, it can also cause pain at its other end, where it crosses the outer aspect of the knee joint, to insert on the small bump of bone at the outer, upper tibia (shin bone), called Gerde’s Tubercle. 
 
So it’s not uncommon to see hip AND knee pain from this entity. That’s the probem with a long structure that crosses two joints–it can cause pain anywhere along its entire length and at both ends, as well.  

So, what to do?
 
Fortunately, the same measures are effective whatever part of the ITB is inflamed. So treatments intended for the knee ARE effective for symptoms from the hip and vice versa. Here are a few helpful things you can do for relief:
 
First, you need to avoid any activities that aggravate the structure and cause the popping. 
 
Second, relieve stress and tension on the band, by using a cane in the hand opposite the affected side. 
 
Third, rest with your hips apart (abducted). A good way to do this is to put a couple of pillows between your knees. 
 
If you must sit, do so on a pillow, or gel pad, as the greater trochanters roll backwards when you sit and if you sit on a hard chair, that can actually cause pain and just make things worse. 
 
If symptoms have just started, ice the tender area a few times a day. 
 
After the first 48 hours, switch to moist heat. 
 
Reduce inflammation short term, by using Advil or Aleve. BUT, you must take these NSAID drugs with food, to protect your stomach from side effects, which include gastritis, reflux, ulcers and bleeding. 
 
Long term, I’d recommend a high quality pharmaceutical grade fish oil, like my POWERHOUSE OMEGA FORMULA, http://www.favoriteformulas.com   which lacks any significant side effects, but has potent, proven anti-inflammatory properties. Once the “fire” is out, you can then begin gentle stretching and strengthening exercises for the ITB, like those I teach in my PAIN-FREE PROGRAM, available here at:  http://www.drbillsclinic.com/exrrcise_eliminate.html
 
As with any tendon problem, healing is slow, because the iliotibioal band is mainly fibrous tissue, which has a very poor blood supply. So slow and steady progress, without repetitive aggravation of symptoms, is the way to go. I’ve had this particular condition myself, so I know these measures work. You just need patience and “tincture of time.” Til next time, my friend, be well.  Talk to you soon.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
“The Wellness Warrior”        TM
 
(Be sure to sign up for my Podcasts at iTunes, or http://thewellnesswarrior.mypodcastworld.com)
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html 
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For conventional and alternative treatments and exercises to relieve knee pain without surgery click on http://drbillsclinic.com/avoid_knee_surgery.html 
 
P.P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html 
 
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Copyright, 2010 by William Thomas Stillwell, MD, FACS
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