mid-hip pain resulting from foot injury/tip toe standing

[Curtis M]

A new client (referral) had an injury to her right foot and tip-toed for 2-3 weeks. She then reviewed severe pain in her left hip.

When I inquired as to the location of her hip pain, it was not in her gluteal area, nor was it in her psoas area ("hip pain" can cover a broad area). The area she pointed to was superior to the greater trochanter and midway between her ASIS and PSIS. She said that she had no joint pain and that it was definitely muscle pain.

She experienced no low back or abdominal muscle discomfort.

I tried working her mid-hip area (TFL?), glutes w/ rotation, her psoas, and stretched the entire hip area with her face down and face up. Worked both hips.

It seemed to me she was pointing to the TFL area, although now that I have consulted anatomy charts I wonder if she was pointing to an area posterior to the TFL.

She did not seem to get any relief from my work, and I am stumped and disappointed.

I am now wondering if the hip area was stretched and strained due to the tip-toeing and if I merely aggravated the condition and maybe I should have suggested rest instead of massage?

Prior to our session, she claimed to have no medical conditions that might be affected by massage. She did claim to suffer from migraines, although they were not bothering her at the moment and she took Advil for them when they occurred.

I kept the work very conservative due to the fact that she occasionally took Advil. During the massage she told me she had an "autoimmune condition" that occasionally caused cysts. I did not ask her which autoimmune condition she had because she seemed like she didn't wish to speak and I didn't want to bother her.

2 days after her massage, she claimed the pain was "worse than ever" and that she had a bruise in the area I had worked.

~What do you think caused her hip pain in the first place, and how would you have addressed the problem?

~How much Advil (dosage amount and frequency) would increase the likelihood of bruising, and how much pressure would be too much. I have been practicing massage for over 10 years, but have not had reviews of bruising.

~What do you do when someone discloses a medical condition after you have already worked on them?

~Any advice for how to effectively handle dissatisfied clients? I apologized sincerely and offered to provide referrals to other practitioners, and I carry liablility insurance, although I hope I never have to use it!

Thank you in advance!

 

[Lady Discordia]

It's easier said than done, but try not to beat yourself up too hard. Anytime there is an injury to the knee or foot, it can create dysfunction up into the hip and low back.

It's difficult to say what was going on with your client without physically looking at her, watching her move or performing some orthopedic testing for clues. Usually, unless there was a specific injury or a blow to an area, pain is not a reliable source of the location of the issue. (except maybe in NMT, the TrP usually reliably sends the pain to a specific area!) So, her problem could be from shortened or strained muscles in her low back, mid-back, lower legs, inner thighs, upper legs or even the other hip or leg!

Although, to keep it simple, I might have checked her quadratus as TrP's there refer into the exact area she pointed and also tend to shorten on one side when limping (But I'm not suggesting she necessarily had any TrP's either). But again, that is only from reading you post and not really looking at her or performing some testing to verify or discount. SI joint problems also can refer into that area which would make sense because of her limping.

Advil does thin the blood and although many of my clients have no bruising from it, I have seen a couple who do claim to bruise easily. Also, how do you know that is all she is taking since she barely admitted to having an autoimmune condition?

However, you did mention your client said she had an "auto-immune condition" to which it was imperative that you find out more details. Was it rheumatoid arthritis which can lead to joint pain and swelling, in this condition in an acute flareup, massage is not recommended.

Although, I make my intake interview as detailed as I can with the client's history, I have also had it happen when a client doesn't disclose information right away and sometimes not until after the session! If it's disclosed during the session, I usually stop what I'm doing and ask for more information and change the work I'm doing if needed. I will only stop if it is something really important, like a certain condition but not necessarily if they tell me of a type of accident they might have had several years ago.

But when a client comes in for relief of a particular pain it is really important that you interview them thoroughly and ask a lot of questions that can't be answered with a simple "yes" or "no".

We all make mistakes and the most important thing is that we learn from them.

 

[i gotta question]

Nice post, Kathryn!

 

[Chutch]

Excellent reply.

Thank you very much Kathryn!

 

[cbear]

Another thing to consider is the attachments for obturators internus and externus, gemellus, etc from the deep lateral rotators... those attachments where they "hook" onto the trochanteric head can get so painful you'd pray for someone to stick a needle full of painkillers into the joint itself! [personal experience speaking] Also, tip-toe walking can make the muscular floor of the pelvis a mess which can reflect itself into the hips and sometimes even into the low back [again, personal experience]

Was there tenderness or soreness over the ischium? In some of my clients complaining of mid-hip pain, there is tenderness/soreness over the point of the ischium and a release of the attaching musculature often goes a long way in relieving the problem.

Just a few ideas of where to look...

Also, with regard to the Advil, some individuals with autoimmune problems do tend to bruise easily - with or without the ingestion of blood thinning NSAIDs like Advil. Then there are individuals without any form of innate illness who bruise easily "just because" [one of my client's descriptions]...

You have to remember that you are not supposed to be "fixing" the client, merely being there to help them/their bodies heal themselves. This may be something that takes a while to resolve also....

fwiw