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This is an excellent exchange of information ladies and gentlemen. Now we are moving out of the box and thinking and observing.
As Charles noted the decrease of internal rotation of the hip is the first sign of a significant hip lesion that often results in a hip replacement. As some of my other colleagues noted the patient will have ankle dysfunction on the ipsilateral side of the lesion involving the talus, cuboid and calcaneous. Category ll is also present with iliofemoral.
Just for the sake of observation see if you notice these things. Have the patient sit down. Now have them stand up. Do not let them move from that position and look down at the patient's feet. Are they even or is one leg in front of the other? If the patient stands for a while do they list to one side?
Typically on the side of the IT band complaint they ipsilateral leg will be forward and the patient will list to the side of the lesion in the body's own attempt to stretch the IT band. You will also find a frozen hip capsule on the involved side.
On the other side you will find ankle weakness and poor coordination. I believe or postulate that since the other side is uncoordinated due to weakness that the body transfers the weight to the opposite side in an attempt to stabilize the sky scraper above the small non-functioning ankle. That transfer of weight to one side of the body is what has caused all the lesions of the kinetic chain of the involved extremity.
The opposite side will be painfree and why not... the person is hardly using it. The involved side is overused and basically doing all the work. The abductor magnus of the involved side will be in spasm if not splinting. Just looking at origins and insertions you can see that all the muscles are shoving the femur into the acetablum which will eventually erode the joint.
Just an observation and a little thinking. Maybe I am very interested in this subject because after playing collegiate football I suffer with chronic hip pain, low back pain, it band, iliofemoral and talus subluxations. My father had his hip replaced and his father had both his hips replaced. I DO NOT WANT A HIP REPLACEMENT. At 30 if I ran then the next day I could barely walk because my leg would give out under me. Now I am 39 and can run again.
My previous blog identifies what worked for me. Definitely cat ll, iliofemoral, talus adjustments, femoral head adjustments, pigeon stretch from yoga and other hip stretches from yoga and the Egoscue Method for condition 2 and the hip protocol. But the thing I have postulated lately was the opposite silent ankle strength and coordination problem.
Just some thoughts and observations.
Best of luck,
Dr. Joseph P. Wood
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