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Hip Pain & Disorders

Back Clinic Hip Pain & Disorders Team. These types of disorders are common complaints that can be caused by a variety of problems. The precise location of your hip pain can give more information about the underlying cause. The hip joint on its own tends to result in pain on the inside of your hip or groin area. Pain on the outside, upper thigh, or outer buttock is usually caused by ailments/problems with the muscles, ligaments, tendons, and soft tissues surrounding the hip joint. Hip pain can also be caused by diseases and conditions in other areas of your body, i.e. the lower back. The first thing is to identify where the pain is coming from.

The most important distinguishing factor is to find out if the hip is the cause of the pain. When hip pain comes from muscles, tendons, or ligament injuries, it typically comes from overuse or Repetitive Strain Injury (RSI). This comes from overusing the hip muscles in the body i.e. iliopsoas tendinitis. This can come from tendon and ligament irritations, which typically are involved in snapping hip syndrome. It can come from inside the joint that is more characteristic of hip osteoarthritis. Each of these types of pain presents itself in slightly different ways, which is then the most important part in diagnosing what the cause is.

Comprehensive Guide to Recovery from Osteitis Pubis Injury

Comprehensive Guide to Recovery from Osteitis Pubis Injury

Athletes and physically active individuals who participate in activities, exercises, and sports that involve kicking, pivoting, and/or shifting directions can develop pelvis overuse injury of the pubic symphysis/joint at the front of the pelvis known as osteitis pubis. Can recognizing the symptoms and causes help in treatment and prevention?

Comprehensive Guide to Recovery from Osteitis Pubis Injury

Osteitis Pubis Injury

Osteitis pubis is the inflammation of the joint that connects the pelvic bones, called the pelvic symphysis, and the structures around it. The pubic symphysis is a joint in front of and below the bladder. It holds the two sides of the pelvis together in the front. The pubis symphysis has very little motion, but when abnormal or continued stress is placed on the joint, groin and pelvic pain can present. An osteitis pubis injury is a common overuse injury in physically active individuals and athletes but can also occur as the result of physical trauma, pregnancy, and/or childbirth.


The most common symptom is pain over the front of the pelvis. The pain is most often felt in the center, but one side may be more painful than the other. The pain typically radiates/spreads outward. Other signs and symptoms include: (Patrick Gomella, Patrick Mufarrij. 2017)

  • Lower abdominal pain in the center of the pelvis
  • Limping
  • Hip and/or leg weakness
  • Difficulty climbing stairs
  • Pain when walking, running, and/or shifting directions
  • Clicking or popping sounds with movement or when shifting directions
  • Pain when lying down on the side
  • Pain when sneezing or coughing

Osteitis pubis can be confused with other injuries, including a groin strain/groin pull, a direct inguinal hernia, ilioinguinal neuralgia, or a pelvic stress fracture.


An osteitis pubis injury usually occurs when the symphysis joint is exposed to excessive, continued, directional stress and overuse of the hip and leg muscles. Causes include: (Patrick Gomella, Patrick Mufarrij. 2017)

  • Sports activities
  • Exercising
  • Pregnancy and childbirth
  • Pelvic injury like a severe fall


The injury is diagnosed based on a physical examination and imaging tests. Other tests may be used to rule out other possible causes.

  • The physical exam will involve manipulation of the hip to place tension on the rectus abdominis trunk muscle and adductor thigh muscle groups.
  • Pain during the manipulation is a common sign of the condition.
  • Individuals may be asked to walk to look for irregularities in gait patterns or to see if symptoms occur with certain movements.
  1. X-rays will typically reveal joint irregularities as well as sclerosis/thickening of the pubic symphysis.
  2. Magnetic resonance imaging – MRI may reveal joint and surrounding bone inflammation.
  3. Some cases will show no signs of injury on an X-ray or MRI.


Effective treatment can take several months or longer. Because inflammation is the underlying cause of symptoms, the treatment will often involve: (Tricia Beatty. 2012)


  • Allows the acute inflammation to subside.
  • During recovery, sleeping flat on the back may be recommended to reduce pain.

Ice and Heat Applications

  • Ice packs help reduce inflammation.
  • The heat helps ease pain after the initial swelling has gone down.

Physical Therapy

Anti-inflammatory Medication

  • Over-the-counter nonsteroidal anti-inflammatory medications – NSAIDs like ibuprofen and naproxen can reduce pain and inflammation.

Assistive Walking Devices

  • If the symptoms are severe, crutches or a cane may be recommended to reduce stress on the pelvis.


  • There have been attempts to treat the condition with cortisone injections, but the evidence supporting its use is limited and needs further research. (Alessio Giai Via, et al., 2019)


Once diagnosed, the prognosis for full recovery is optimal but can take time. It can take some individuals six months or more to return to pre-injury level of function, but most return by around three months. If conservative treatment fails to provide relief after six months, surgery could be recommended. (Michael Dirkx, Christopher Vitale. 2023)

Sports Injuries Rehabilitation


Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in urology, 19(3), 156–163.

Beatty T. (2012). Osteitis pubis in athletes. Current sports medicine reports, 11(2), 96–98.

Via, A. G., Frizziero, A., Finotti, P., Oliva, F., Randelli, F., & Maffulli, N. (2018). Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature. Open access journal of sports medicine, 10, 1–10.

Dirkx M, Vitale C. Osteitis Pubis. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:

Understanding Pelvic Pain in Women: Causes & Treatments

Understanding Pelvic Pain in Women: Causes & Treatments

For women experiencing lower back and pelvic pain, could understanding symptoms help in the diagnostic process, treatment options, and prevention?

Understanding Pelvic Pain in Women: Causes & Treatments

Low Back and Pelvic Pain In Women

In women, lower back and hip pain that radiates to the front pelvis area can have a variety of causes. The pain can feel dull, sharp, or burning. The main causes of lower back and pelvic pain in women fall into two categories. (William S. Richardson, et al., 2009)

Musculoskeletal and nervous system

  • Related causes of pain affect how your muscles, nerves, ligaments, joints, and bones move.
  • Examples include sciatica, arthritis, and injury.

Other organ system-based

Causes may stem from the following:

  • Acute/chronic conditions or infections
  • Kidneys – stones, infection, and other ailments or conditions.
  • Reproductive system – such as the ovaries.
  • Gastrointestinal system – inguinal hernias or appendix.

Musculoskeletal and Nervous System Causes

Musculoskeletal and nervous system-related causes can be from injuries like a fall or practicing unhealthy posture.

Overuse Injuries and Trauma

Frequent use and repetitive movements can lead to overuse injuries to the muscles, ligaments, and joints.  :

  • Exercises, sports, and physical activities that require repetitive twisting and bending.
  • Lifting, carrying, and placing objects that require movements that are repeated regularly.
  • Trauma from vehicle collisions, accidents, falls, or sports accidents can inflict acute and chronic bodily injuries, like strained muscles or broken bones.
  • Depending on the type of trauma, healing and recovery time and treatment vary.
  • Both types of injuries can lead to numbness, tingling, pain, stiffness, popping sensations, and/or weakness in the legs.

Mobility Problems

Over time, a decreased range of motion and mobility in muscles and joints can cause discomfort and pain. Causes include:

  • Long periods of time spent in the same position.
  • Sitting for extended periods.
  • The pain often feels dull, achy, and stiff.
  • It can also lead to muscle spasms characterized by quick episodes of sharp and intense pain.


  • Posture while sitting, standing, and walking affects the body’s range of motion.
  • It can affect the nerves and blood circulation to the back and pelvic region.
  • Prolonged unhealthy postures can contribute to lower back pain and muscle strain.
  • Posture-related symptoms can feel achy and stiff and lead to quick episodes of severe or intense pain, depending on the position.

Sciatica and Nerve Compression

  • A bulging or herniating vertebral disc most commonly causes sciatica and pinched or compressed nerves.
  • The sensations can be sharp, burning, electrical, and/or radiating pain along the nerve pathway.


  • Arthritis inflammation causes swelling, stiffness, pain, and the breakdown of cartilage that cushions the joints.
  • Hip arthritis causes groin pain that can radiate to the back and becomes more intense when standing or walking.
  • Thoracic and lumbar spine arthritis, or degenerative disc disease, are other common causes of back pain.

Sacroiliac Joint Dysfunction

Renal and Urinary Causes

Kidney Stones

  • Kidney stones are the build-up of minerals and salts, which form into hard stones in the kidneys.
  • When the kidney stone begins to move to the bladder, pain symptoms will present.
  • It can trigger severe back and side pain that radiates to the pelvic region.
  • Other symptoms include – a change in urine color, pain when urinating, nausea, and vomiting.

Kidney Infection and Urinary Tract Infections

  • Urinary tract and kidney infections are also causes of lower back and pelvic pain in women.
  • They cause fever, continued urge to urinate, and painful urination.

Gynecological Causes

Pelvic Inflammatory Disease

Infections, known as pelvic inflammatory disease, occur when sexually transmitted bacteria spread through the vagina, womb, fallopian tubes, or ovaries. Symptoms include:

  • Pain during intercourse.
  • Bleeding between periods.
  • Vaginal discharge.
  • Pain in the lower abdomen or groin.
  • Fever.

Ovarian Cysts

  • The cyst can be a solid or fluid-filled sac on the surface or within an ovary.
  • Small ovarian cysts are unlikely to cause pain.
  • Large cysts or those that rupture can cause mild to severe pain.
  • The pain can occur during menstruation or intercourse and present acutely in the back, pelvis, or lower abdomen.

During Pregnancy

  • Back pain and discomfort in the pelvis area are common.
  • As the body adjusts, the bones and round ligaments in the pelvis move and stretch, which can cause discomfort.
  • Symptoms are usually normal but should be discussed with a healthcare provider during check-ups.
  • Pain in the lower back and groin can be a sign of miscarriage or labor – including preterm labor.

Sexually Transmitted Infection

  • Sexually transmitted infections, like chlamydia or gonorrhea, can cause lower back and groin pain.
  • Other symptoms can include – painful urination, vaginal discharge, intercourse pain, and bleeding between periods.

Yeast Infection

  • A yeast infection – overgrowth of the fungus candidiasis.
  • A common vaginal infection with symptoms including – itching, swelling, irritation, and pelvic pain.

Other Causes


  • When the appendix becomes blocked, infected, and inflamed.
  • In most cases, a major symptom is pain that starts near or around the belly button.
  • In other cases, it can start in the lower back and radiate to the right side of the pelvic area. (Johns Hopkins Medicine. 2023)
  • Associated pain can worsen over time or when coughing, moving, or taking deep breaths.

Other symptoms include:

  1. Upset stomach
  2. Nausea
  3. Vomiting
  4. Loss of appetite
  5. Fever
  6. Chills
  7. Abnormal bowel movements – constipation and/or diarrhea. (Johns Hopkins Medicine. 2023)

Inguinal Hernia

  • A groin hernia is referred to an inguinal hernia.
  • It involves soft tissue and part of the intestine, pushing through weak groin muscles.
  • Pain presents in the abdomen, lower back, or pelvis, especially when bending or lifting objects.


  • Inflammation in the pancreas.
  • Infection, bile stones, or alcohol can cause it.
  • One symptom is abdominal pain that radiates to the back.
  • The pain becomes worse during and after eating.
  • Other symptoms include nausea, vomiting, and fever.

Enlarged Lymph Nodes

  • Lymph nodes lie in the internal and external regions of the iliac artery in the pelvis.
  • These can become enlarged by infection, injury, and, in rare cases, cancer.
  • Symptoms include pain, swelling, redness, skin irritation, and fever.

Enlarged Spleen

  • The spleen is located behind the left side of the rib cage.
  • It filters the blood and supports new blood cell creation.
  • Infections and diseases can cause the spleen to become enlarged.
  1. An enlarged spleen – a condition known as splenomegaly – causes pain in the upper left part of the belly and sometimes the left shoulder and upper back.
  2. However, some individuals with an enlarged spleen experience abdominal symptoms – not being able to eat without discomfort. (Mount Sinai. 2023)


  • Depending on the cause of your pain, a healthcare provider may be able to diagnose it with a physical exam and by asking questions about your condition.
  • Other tests may be needed to find the cause, particularly blood work and imaging (X-ray or magnetic resonance imaging).


  • Treatment of symptoms depends on the cause.
  • Once a diagnosis is made, an effective treatment plan will be developed and contain a combination of therapies:

Lifestyle Adjustments

  • For injuries caused by muscle strains, joint sprains, overuse, and smaller traumas, pain can be resolved with:
  • Rest
  • Ice therapy
  • Over-the-counter pain relievers – acetaminophen or ibuprofen.
  • Braces or compression wraps can help support the body and alleviate symptoms during healing and recovery.
  1. Exercises to improve posture
  2. Paying attention to form when lifting objects
  3. Stretching can help ease the pain.


Medications can be used in a variety of ways to help in the treatment of lower back and pelvic pain. If an infection is the cause, medications will be prescribed to remove the infection and resolve the symptoms, which can include:

  • Antibiotics
  • Antifungals
  • Antivirals

Medications may also be prescribed to help manage pain symptoms and may include:

  • Medication to relieve nerve pain
  • Muscle relaxants
  • Steroids

Physical Therapy

A physical therapist can help to correct problems with:

  • Posture
  • Decreased mobility
  • Walking gait
  • Strengthening
  1. A physical therapist will provide exercises to help increase and maintain strength, range of motion, and flexibility.

Pelvic Floor Therapy

  • This is physical therapy that focuses on the muscles, ligaments, and connective tissues in the pelvis.
  • It helps with pain, weakness, and dysfunction in the pelvic area.
  • A treatment plan will be developed to help with strength and range of motion in the pelvic muscles.

Chiropractic Care


  • Some more severe conditions could require surgery.
  • Ovarian cysts, hernias, and other infections sometimes require surgery to remove infected or unhealthy tissue – ruptured ovarian cysts or appendicitis.

Recommended surgeries can include:

  1. A hernia repair.
  2. Hip replacement.
  3. Gallbladder removal to prevent recurring pancreatitis.


Not all conditions and diseases cause lower back and pelvic pain. Symptoms can be prevented and reduced by adopting lifestyle changes. Prevention recommendations can include:

  • Staying hydrated.
  • Using proper bending and lifting techniques.
  • Eating healthy foods.
  • Regularly engaging in some form of physical activity – walking, swimming, yoga, cycling, or strength training.
  • Maintaining a healthy weight.

Pregnancy and Sciatica


Richardson, W. S., Jones, D. G., Winters, J. C., & McQueen, M. A. (2009). The treatment of inguinal pain. Ochsner journal, 9(1), 11–13.

Kurosawa, D., Murakami, E., & Aizawa, T. (2017). Groin pain associated with sacroiliac joint dysfunction and lumbar disorders. Clinical neurology and neurosurgery, 161, 104–109.

Johns Hopkins Medicine. Appendicitis.

Mount Sinai. Splenomegaly.

Santilli, V., Beghi, E., & Finucci, S. (2006). Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. The spine journal : official journal of the North American Spine Society, 6(2), 131–137.

Understanding Iliopsoas Syndrome: Symptoms & Causes

Understanding Iliopsoas Syndrome: Symptoms & Causes

Individuals suffering from hip, thigh, and/or groin pain could be experiencing iliopsoas syndrome. Could knowing the symptoms and causes help in diagnosis and treatment?

Understanding Iliopsoas Syndrome: Symptoms & Causes

Iliopsoas Syndrome

Iliopsoas syndrome encompasses several conditions that affect the inner hip muscle and can cause hip and thigh pain. The muscle helps to bend the leg toward the body.

  • The condition is usually caused by overuse injuries and commonly affects individuals who perform repeated hip flexion movements, like cyclists, gymnasts, dancers, runners, and soccer players. (Liran Lifshitz, et al., 2020)
  • The term is often used interchangeably with psoas syndrome, iliopsoas tendonitis, snapping hip syndrome, and iliopsoas bursitis. However, there are clinical differences.


Symptoms include: (American Association of Hip and Knee Surgeons. 2020)

  • Tenderness in the hip and groin area.
  • Hip or groin clicking or snapping that can be heard and/or felt during movement.
  • Pain and/or stiffness in the hip and thigh area.
  • Pain that worsens when bending the hip – walking, climbing stairs, squatting, sitting.
  • Movements that involve bringing the knee toward the chest can worsen the pain.


The iliopsoas muscles are hip muscles on the front of the hip. They are made up of the psoas major, the psoas minor, and the iliacus. Small, fluid-filled sacs/bursae are within the hip joint between bones and soft tissues. The bursae reduce friction and provide cushioning to help the tendons, muscles, and other structures move smoothly over the bony prominences.

  1. Iliopsoas bursitis happens when the bursa, which is located between the iliopsoas tendon and the inside of the hip joint, becomes inflamed and irritated.
  2. Iliopsoas tendonitis/hip tendonitis happens when the tendon that attaches the thigh bone to the iliopsoas muscle becomes inflamed and irritated.
  3. Iliopsoas bursitis and tendonitis are commonly caused by overuse injuries and intense activities like cycling, running, rowing, or strength training.


  • Healthcare providers can diagnose iliopsoas syndrome based on symptom history and a hip examination.
  • Imaging tests – MRI and X-rays may be used to rule out other injuries or conditions like muscle tears. (Paul Walker, et al., 2021)


Most mild cases of hip bursitis and hip tendonitis can be managed using the RICE method (American Association of Orthopedic Surgeons. 2020)


  • Avoid putting weight on the hip for a few days after the injury.


  • Apply ice immediately after the injury to bring the swelling down.
  • Use a cold pack for 20 minutes at a time, several times a day.
  • Do not apply ice directly on the skin.


  • Wrap the area in a soft bandage or use compression shorts to prevent further swelling.


  • Rest as often as possible with the leg raised higher than the heart.

Medical Treatment

  • Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen sodium can alleviate pain and reduce inflammation. (Paul Walker, et al., 2021)
  • Steroid injections can be used if symptoms continue or come back with additional injections administered as necessary. (Paul Walker, et al., 2021)
  • After pain and swelling subside, physical therapy may be recommended, as well as mild exercises to gradually improve hip strength and flexibility. (Paul Walker, et al., 2021)
  • A healthcare provider may recommend surgery in severe cases where pain persists, and conservative treatments don’t provide enough relief.
  • However, this is rare due to muscle weakness and nerve damage risks. (Paul Walker, et al., 2021)

Hip Labral Tear – Chiropractic Treatment


Lifshitz, L., Bar Sela, S., Gal, N., Martin, R., & Fleitman Klar, M. (2020). Iliopsoas the Hidden Muscle: Anatomy, Diagnosis, and Treatment. Current sports medicine reports, 19(6), 235–243.

American Association of Hip and Knee Surgeons. Iliopsoas tendonitis/bursitis.

Walker, P., Ellis, E., Scofield, J., Kongchum, T., Sherman, W. F., & Kaye, A. D. (2021). Snapping Hip Syndrome: A Comprehensive Update. Orthopedic reviews, 13(2), 25088.

American Association of Orthopedic Surgeons. OrthoInfo. Hip strains.

MET Treatment Strategies To Reduce Pelvic Pain

MET Treatment Strategies To Reduce Pelvic Pain

For individuals with pelvic pain, how does MET treatment strategies reduce muscle weakness in the hips region?


The pelvis’s main job is to ensure that the person’s body weight is distributed evenly for everyday movement within the upper and lower body. At the same time, the core muscles, ligaments, and joints surround the skeletal structure of the pelvis, which provides normal function while protecting the vital organ systems within the pelvic region. When normal or traumatic factors start to affect the body’s pelvic area, many individuals will often mistake the pain for low back pain, and the core muscles surrounding the pelvic bone can become weak and lead to pelvic pain. At the same time, normal factors like improper posture can cause anterior pelvic tilt and develop into other musculoskeletal disorders with overlapping risk profiles. When pelvic pain affects the lower extremities, it can also lead to reproductive issues that can cause even more stress to the individual. Luckily, many people opt for non-surgical treatments to reduce pelvic pain and its associated musculoskeletal condition by strengthening the weakened core muscles and reducing muscle weakness. Today’s article examines how referred pain symptoms affect the pelvis and how non-surgical treatments like MET therapy can reduce muscle weakness correlating with pelvic pain. Additionally, we communicate with certified medical providers who incorporate our patient’s information to reduce muscle weakness associated with pelvic pain. We also inform them that MET therapy can help mitigate the referred pain-like symptoms related to pelvic pain. We encourage our patients to ask amazing educational questions for our associated medical providers about their pelvic pain. Dr. Jimenez, D.C., incorporates this information as an educational service. Disclaimer


Referred Pain Symptoms Affecting The Pelvis

Have you noticed that you are taking more frequent trips to the bathroom and that your bladder still feels full? Do you experience muscle stiffness within your lower back or pelvic region from excessive sitting at your desk during work? Or do you notice that you are experiencing weak core muscles affecting your workout routine? These scenarios are associated with pelvic pain and can cause issues within the lower body extremities, affecting the person’s performance when doing normal activities. Pelvic pain is a multifactorial musculoskeletal disorder that can affect the corresponding body systems to induce referred pain. (Grinberg, Sela, & Nissanholtz-Gannot, 2020) Pelvic pain can cause referred pain to the gastrointestinal, pelvic musculoskeletal, and nervous systems, which then causes anatomic malfunction to the pelvic floor muscles. Pelvic pain can easily be mistaken for low back pain since the lumbar spine creates stressors for the muscles surrounding the pelvis.



When the pelvis is affected by mechanical stressors associated with the lumbar spine, it can cause pelvic dysfunction and causes the individual to be unbalanced when in motion. At the same time, the pelvic muscle structures will be overworked, leading to hip and joint destabilization, causing them to be weak. (Lee et al., 2016) When the pelvic muscle structures begin to destabilize, it can lead to sciatic nerve entrapment to the lower extremities, which leads to overlapping risk profiles for musculoskeletal disorders. When the surrounding pelvic muscles begin to entrap the pelvic nerve roots causing radiating pain down the legs. (Kale et al., 2021) However, there are ways to reduce referred pain affecting the pelvic region and restore muscle strength.


Sciatica, Causes, Symptoms, & Tips- Video

Since pelvic pain is a multifactorial musculoskeletal disorder that can lead to the development of referred pain to the lower body extremities, many individuals often think it is low back pain or sciatica. Referred pain is when pain affects a body location instead of where the source originated. Not treated immediately causes nerve entrapment, muscle weakness, and chronic pain within the reproductive and urinary organs. Many individuals seek non-surgical treatments to alleviate the pain and restore muscle strength to the body’s pelvic region. Non-surgical treatments like MET(muscle energy techniques) can help restore muscle strength to the pelvis through soft tissue stretching. Pain specialists specializing in MET therapy, like chiropractors and massage therapists, use hands-on maneuvers to relax, elongate, stretch, and massage the affected tight muscles and reduce any tender points that may have developed over time. (Grinberg et al., 2019) MET therapy can help stretch the pelvic stabilizing muscles. It can be combined with physical therapy and chiropractic care to realign the body and reduce nerve entrapment caused by pelvic pain. Check out the video above to learn more about the causes of sciatica and how non-surgical treatments may be the answer to alleviate pain.

MET Treatment Strategies For Pelvic Pain

MET therapy can reduce the effects of pelvic pain by including soft tissue manipulation methods to use controlled isometric and isotonic contraction to improve the normal physiologic function of the surrounding pelvic muscles and decrease pain and help stabilize the alternating structures within the pelvic region. (Sarkar, Goyal, & Samuel, 2021) MET therapy can also encourage self-regulating influences to reduce pain within the pelvic area, resulting in a greater range of motion. (Chaitow, 2009)


MET Treatment Reducing Muscle Weakness

MET therapy can also be part of a personalized health plan that can help restore muscle strength in the core and stabilize muscle within the pelvis. The positive effects of the combination of MET therapy and exercise, it can be more effective in reducing pain while improving physical function. (Hu et al., 2020) This allows the pelvis to realign itself and help stretch the shortened muscles. MET therapy can help restore low extremity function and improve a person’s quality of life. (Danazumi et al., 2021) MET therapy is an excellent way to stretch out tired muscles and restore pelvic function, as it can make individuals more mindful of their bodies while reducing the chances of pelvic pain associated with musculoskeletal disorders reoccurring again in the lower extremities.



Chaitow, L. (2009). Ligaments and positional release techniques? J Bodyw Mov Ther, 13(2), 115-116.


Danazumi, M. S., Yakasai, A. M., Ibrahim, A. A., Shehu, U. T., & Ibrahim, S. U. (2021). Effect of integrated neuromuscular inhibition technique compared with positional release technique in the management of piriformis syndrome. J Osteopath Med, 121(8), 693-703.


Grinberg, K., Sela, Y., & Nissanholtz-Gannot, R. (2020). New Insights about Chronic Pelvic Pain Syndrome (CPPS). Int J Environ Res Public Health, 17(9).


Grinberg, K., Weissman-Fogel, I., Lowenstein, L., Abramov, L., & Granot, M. (2019). How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome? Pain Res Manag, 2019, 6091257.


Hu, X., Ma, M., Zhao, X., Sun, W., Liu, Y., Zheng, Z., & Xu, L. (2020). Effects of exercise therapy for pregnancy-related low back pain and pelvic pain: A protocol for systematic review and meta-analysis. Medicine (Baltimore), 99(3), e17318.


Kale, A., Basol, G., Topcu, A. C., Gundogdu, E. C., Usta, T., & Demirhan, R. (2021). Intrapelvic Nerve Entrapment Syndrome Caused by a Variation of the Intrapelvic Piriformis Muscle and Abnormal Varicose Vessels: A Case Report. Int Neurourol J, 25(2), 177-180.


Lee, D. W., Lim, C. H., Han, J. Y., & Kim, W. M. (2016). Chronic pelvic pain arising from dysfunctional stabilizing muscles of the hip joint and pelvis. The Korean Journal of Pain, 29(4), 274-276.


Sarkar, M., Goyal, M., & Samuel, A. J. (2021). Comparing the Effectiveness of the Muscle Energy Technique and Kinesiotaping in Mechanical Sacroiliac Joint Dysfunction: A Non-blinded, Two-Group, Pretest-Posttest Randomized Clinical Trial Protocol. Asian Spine Journal, 15(1), 54-63.


Hamstring Injuries Could Be Implementing Other Issues

Hamstring Injuries Could Be Implementing Other Issues


How do non-surgical treatments compare with traditional surgical treatments to improve mobility for individuals with hamstring injuries? The hamstrings are muscles in the lower extremities that provide mobility to the legs and stabilize the pelvis. Many athletes rely on their hamstrings to perform strenuous actions such as sprinting, jumping, squatting, and kicking during sporting events. However, the hamstrings are also very susceptible to injury. Athletes who repeatedly overstretch their hamstrings can experience muscle strain until microscopic tears form, which is common. Similarly, individuals who sit for long periods can also experience hamstring issues. When individuals are not physically active, their hamstrings can become weak and shortened, leading to symptoms such as muscle pain, trigger points, and strain on the accessory muscles. Hamstring injuries can also cause other issues that affect the lower body extremities. This article will explore how hamstring injuries affect mobility and how non-surgical treatments help people regain mobility. We work with certified medical providers who use our patients’ valuable information to treat individuals suffering from hamstring injuries and inform them about non-surgical treatments to regain mobility. We encourage patients to ask essential questions and seek education from our associated medical providers about their condition. Dr. Jimenez, D.C., provides this information as an educational service. Disclaimer


Hamstring Injuries Implementing Other Issues


Do you experience stiffness in the back of your thighs when warming up before exercising? Are you feeling radiating pain from the side of your hips and glutes due to prolonged sitting? Or do you tend to limp, affecting your gait and walking? Many people are unaware they are overexerting their hamstrings, which can cause pain. Those who engage in sports or work sedentary jobs may over or underuse their hamstrings, affecting their flexibility and mobility to the lower extremities. According to research studies, hamstring injuries are the most common non-contact muscle injuries caused by two mechanisms of injuries: stretch-type and sprint-type. Sprint-type injuries associated with hamstrings occur when the muscles are overexerted due to maximal or near-maximal action, causing muscle fatigue. To that point, hamstring injuries can also affect a person’s walking mobility. 


Running without properly warming up the hamstring muscle can cause muscle fatigue. Stretch-type injuries associated with the hamstring muscles involve combination movements that include extreme hip flexion and knee extension. These injuries can also mimic sciatica, leading people to believe their sciatic nerve is acting up. However, treatments available can help reduce the pain associated with hamstring injuries and lengthen the shortened muscle to reduce pain.


Best Lower Body Stretches To Increase Flexibility-Video

If you want to reduce the pain associated with hamstring injuries, incorporating RICE can help prevent it from becoming chronic. This involves gently stretching the affected muscle to avoid cramps and pain while increasing flexibility. Hamstring injuries can also be linked to other chronic issues, which can cause inflammation in the surrounding muscles. Studies show that conditions like piriformis syndrome can cause nerve entrapment in the hamstrings, resulting in radiating pain down the leg that mimics low back pain and sciatica. As previously mentioned, hamstring injuries can limit mobility and be linked to chronic conditions. Thankfully, non-surgical treatments can help reduce pain and provide relief. Check out the video above to learn different stretches that can help reduce pain in the lower body and increase flexibility.

Treatments To Restore Mobility


If rest, ice, compression, and gentle stretching do not provide relief, incorporating treatments for hamstring injuries to restore mobility can benefit many individuals. Seeking the help of a pain specialist, such as a massage therapist or chiropractor, to create a customized plan/program is recommended. There are various approaches that pain specialists can use to regain mobility and treat hamstring injuries.


MET Therapy

Many chiropractors and massage therapists incorporate MET (muscle energy techniques) therapy to gently stretch out the shortened hamstring muscle and help restore joint mobility in the lower extremities. In “Clinical Applications of Neuromuscular Techniques,” written by Leon Chaitow, N.D., D.O., and Judith Walker DeLany, L.M.T., stated that MET is crucial in stretching and strengthening the hamstring muscles through isometric contraction. At the same time, additional research studies reveal that the MET technique allows the hamstrings to have a greater increase in hip flexion ranges. MET therapy also helps strengthen the accessory muscles surrounding the hamstrings to restore mobility.


Spinal Decompression

If hamstring injuries are caused by nerve entrapment, then trying out spinal decompression can help restore mobility to the hips and lower extremities. According to “The Ultimate Spinal Decompression,” written by Dr. Eric Kaplan, D.C., FIAMA, and Dr. Perry Bard, D.C., stated that spinal decompression is safe and gentle on the spine as it provides gentle traction on the spinal disc to reduce pain and increase disc height. When hamstring injuries are associated with nerve entrapment, it could result from a herniated disc that aggravates the nerve root and causes referred pain to the hamstrings. Using gentle traction on the spine can help alleviate the pain caused by the aggravating nerve and reduce pain in the hamstrings. Many individuals can incorporate these treatments to reduce hamstring injuries and regain their mobility back to their legs.



Chaitow, L., & Delany, J. (2002). Clinical application of neuromuscular techniques. Vol. 2, The lower body. Churchill Livingstone.

Gunn, L. J., Stewart, J. C., Morgan, B., Metts, S. T., Magnuson, J. M., Iglowski, N. J., Fritz, S. L., & Arnot, C. (2018). Instrument-assisted soft tissue mobilization and proprioceptive neuromuscular facilitation techniques improve hamstring flexibility better than static stretching alone: a randomized clinical trial. Journal of Manual & Manipulative Therapy, 27(1), 15–23.

Huygaerts, S., Cos, F., Cohen, D. D., Calleja-González, J., Guitart, M., Blazevich, A. J., & Alcaraz, P. E. (2020). Mechanisms of Hamstring Strain Injury: Interactions between Fatigue, Muscle Activation and Function. Sports (Basel, Switzerland)8(5), 65.

Kaplan, E., & Bard, P. (2023). The Ulitimate Spinal Decompression. JETLAUNCH.

Vij, N., Kiernan, H., Bisht, R., Singleton, I., Cornett, E. M., Kaye, A. D., Imani, F., Varrassi, G., Pourbahri, M., Viswanath, O., & Urits, I. (2021). Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review. Anesthesiology and Pain Medicine, 11(1).


Vehicle Crash Hip Injury: El Paso Back Clinic

Vehicle Crash Hip Injury: El Paso Back Clinic

As one of the most load-bearing joints in the body, the hips nearly affect every movement. If the hip joint is involved in a vehicle crash, the space in the joint/hip capsule can fill with fluid, causing joint effusion or swelling, inflammation, dull-immobilizing pain, and stiffness. Hip pain is a common injury symptom reported after a vehicle crash. This pain can range from mild to severe and may be short-term or last for months. No matter the level of pain being experienced, action must be taken quickly to avoid long-term damage. Individuals need high-quality, patient-focused care from experienced specialists as soon as possible to get on the road to recovery.

Vehicle Crash Hip Injury: EP Chiropractic Rehabilitation Team

Vehicle Crash Hip Injury

The hip joints must be healthy and work as effectively as possible to stay active. Arthritis, hip fractures, bursitis, tendonitis, injuries from falls, and automobile collisions are the most common causes of chronic hip pain. Depending upon the type of injury, individuals may experience pain symptoms in the thigh, groin, inside of the hip joint, or buttocks.

Associated Injuries

The most common injuries that cause pain in the hip after a collision include:

Hip Ligament Sprains or Strains

  • A hip ligament sprain or strain is caused by overstretched or torn ligaments.
  • These tissues attach bones to other bones and provide stability to the joints.
  • These injuries may only require rest and ice to heal, depending on the severity.
  • Chiropractic, decompression, and physical massage therapies may be necessary for realignment and to keep muscles flexible and relaxed.


  • Bursitis is an inflammation of the bursa, or the fluid-filled sac providing cushioning/material between bones and muscles.
  • It is one of the main causes of hip pain after an automobile collision and requires immediate medical attention.


  • Tendonitis is a type of injury that affects soft tissues like tendons and ligaments, as opposed to bone and muscle.
  • Tendonitis can result in chronic pain and various discomfort symptoms in and around the hip area if left untreated.

Hip Labral Tear

  • A hip labral tear is a type of joint damage in which the soft tissue/labrum that covers the hip’s socket gets torn.
  • The tissue ensures that the thighbone head moves smoothly within the joint.
  • Damage to the labrum can lead to severe pain symptoms and affect mobility.

Hip Dislocation

  • A hip dislocation means the femur ball has popped out of the socket, causing the upper leg bone to slide out of place.
  • Hip dislocations can cause avascular necrosis, which is the death of bone tissue from a blockage in the blood supply.

Hip Fractures

  • The hip bones can be broken down into three parts:
  • Ilium
  • Pubis
  • Ischium
  • A hip fracture, or broken hip, occurs whenever a break, crack, or crush happens to any one of these parts of the hip.

Acetabular Fracture

  • An acetabular fracture is a break or a crack outside the hip socket that holds the hip and thigh bones together.
  • A fracture to this body part is not as common because of the location.
  • Significant force and impact are often necessary to cause this type of fracture.


If any of the following symptoms after a vehicle crash are experienced, it could be a hip injury and should be examined by a medical professional. These include:

  • Soreness or tenderness at the site of injury.
  • Bruising.
  • Swelling.
  • Difficulty moving the hip/s.
  • Intense pain when walking.
  • Limping.
  • Loss of muscle strength.
  • Abdominal pain.
  • Knee pain.
  • Groin pain.

Treatment and  Rehabilitation

A doctor or specialist should always evaluate hip problems and pain symptoms. With the help of a physical examination and diagnostics like X-rays, CT Scans, or an MRI, a physician can diagnose and recommend treatment options. Treatment after a vehicle crash depends on the severity of the damage. For example, hip fractures often require immediate surgery, while other injuries may only necessitate medication, rest, and rehabilitation. Possible treatment plans include:

  • Rest
  • Pain, muscle relaxants, and anti-inflammatory medication.
  • Physical therapy
  • Massage therapy
  • Chiropractic realignment
  • Spinal decompression
  • Exercise therapy
  • Steroid injections
  • Surgery – after surgery, a physical therapist can help stretch and work on muscles around the hip to gain mobility and flexibility for a complete recovery.
  • Total hip replacement

Our team collaborates with the necessary specialists to provide the complete care needed to experience full recovery and healing for long-term relief. The team will work together to form a comprehensive treatment plan to strengthen the hip muscles for better support and increased range of motion.

Movement as Medicine


Cooper, Joseph, et al. “Hip dislocations and concurrent injuries in motor vehicle collisions.” Injury vol. 49,7 (2018): 1297-1301. doi:10.1016/j.injury.2018.04.023

Fadl, Shaimaa A, and Claire K Sandstrom. “Pattern Recognition: A Mechanism-based Approach to Injury Detection after Motor Vehicle Collisions.” Radiographics: a review publication of the Radiological Society of North America, Inc vol. 39,3 (2019): 857-876. doi:10.1148/rg.2019180063

Frank, C J et al. “Acetabular fractures.” The Nebraska medical journal vol. 80,5 (1995): 118-23.

Masiewicz, Spencer, et al. “Posterior Hip Dislocation.” StatPearls, StatPearls Publishing, 22 April 2023.

Monma, H, and T Sugita. “Is the mechanism of traumatic posterior dislocation of the hip a brake pedal injury rather than a dashboard injury?.” Injury vol. 32,3 (2001): 221-2. doi:10.1016/s0020-1383(00)00183-2

Patel, Vijal, et al. “The association between knee airbag deployment and knee-thigh-hip fracture injury risk in motor vehicle collisions: A matched cohort study.” Accident; Analysis and Prevention vol. 50 (2013): 964-7. doi:10.1016/j.aap.2012.07.023

Assessing Hip Flexors With MET Therapy

Assessing Hip Flexors With MET Therapy


The hips play a crucial role in maintaining stability and mobility in the body. However, incorrect actions can lead to misalignment and pain in the hip muscles, causing discomfort and affecting other muscles and joints. This article focuses on the hip flexor muscles and how assessing them with MET therapy can reduce pain and restore hip mobility. We utilize and incorporate valuable information about our patients to certified medical providers using MET therapy to relieve chronic muscle pain associated with the hip flexor muscles. We encourage and refer patients to associated medical providers based on their findings while supporting that education is a remarkable and fantastic way to ask our providers the essential questions at the patient’s acknowledgment. Dr. Alex Jimenez, D.C., comprises this information as an educational service. Disclaimer


What Are The Hip Flexor Muscles?


Do you have any pain in your hips? Does shifting your weight from one side to the other help relieve the pain? Do you feel pain shooting down from your hips to your legs? These symptoms may be due to pain in your hip flexor muscles. Research studies reveal that these muscles support other muscle groups like the trunk and legs, allowing for proper muscle activity when lifting your legs straight during functional tests for the hips and pelvis. The hip flexors in your hips consist of six muscles that aid in stability and mobility:

  • Psoas Major
  • Iliacus
  • Rectus Femoris
  • Sartorius
  • Adductor Longus
  • Tensor Fasciae Latae

Additional studies have revealed that the hip flexor muscles are crucial in supporting the lower back and maintaining stability. These six muscles aid in hip movements such as deep flexion, adduction, and external rotation, among other functions. The relationship between the hip flexors and the lumbar spine is particularly strong. However, if these muscles become tight, it can negatively affect performance and lead to other issues.


Hip Pain Associated With The Musculoskeletal System

Hip pain can be caused by tight hip flexor muscles, which can be affected by various factors such as health issues, injuries, or environmental factors. Research studies have shown that lower extremity injuries can reduce performance and cause pain-like symptoms associated with the musculoskeletal system. Tight hip flexors can be caused by prolonged sitting, incorrect lifting, or repetitive actions, leading to stretched or shortened muscles and the development of nodules. This can contribute to musculoskeletal disorders and uneven hips. Various treatments are available to realign the body and strengthen the hip flexor muscles.


Non-Surgical Solution: Chiropractic Care- Video

Do you struggle with instability while walking or find yourself leaning more on one leg than the other? Perhaps you experience constant hip pain. Misalignment in the hips caused by environmental factors can lead to instability and pain-like symptoms associated with tight hip flexor muscles. These issues can cause musculoskeletal disorders that overlap and result in spinal subluxation. Research studies mentioned that it could be difficult to diagnose hip pain because it often presents as referred pain from the lumbar spine or knee joint. This means uneven or tight hips could cause low back or knee pain. Treatments are available to reduce hip pain and gently stretch flexor muscles. The video above demonstrates how chiropractic care can offer non-surgical solutions to realign the body and relieve stress in the surrounding muscles.

Assessing The Hip Flexors With MET Therapy


If you are experiencing stiffness or pain in your hips due to tight hip flexors, you can improve your mobility and prevent future issues in several ways. Studies have revealed that physical therapy involving RICE (rest, ice, compression, and elevation) can help restore muscle strength and range of motion. Soft tissue treatment combined with physical therapy can also be effective in restoring hip mobility. In their book “Clinical Application of Neuromuscular Techniques,” Dr. Judith Walker DeLany, L.M.T., and Dr. Leon Chaitow, N.D., D.O. explain that Muscle Energy Techniques (MET) can gently stretch the hip flexor muscles and restore mobility and range of motion in the hip joint. MET therapy can lengthen tight hip flexor muscles, reduce referred pain, and improve the hip’s function.



When the hips and the muscles around them start to cause pain that spreads to the rest of the body, it can lead to uncomfortable symptoms that cause people to shift their weight to compensate for the pain. This can happen because of environmental factors like sitting for too long or overstretching the muscles, which makes the hip flexors tight and can lead to pain in the hips and lower back. However, physical therapy combined with muscle energy techniques (MET) can help relieve the pain and realign the hips with the body. These treatments let the body naturally heal the affected muscles so that people can be pain-free.



Ahuja, Vanita, et al. “Chronic Hip Pain in Adults: Current Knowledge and Future Prospective.” Journal of Anaesthesiology, Clinical Pharmacology, 2020,

Chaitow, Leon, and Judith Walker DeLany. Clinical Applications of Neuromuscular Techniques. Churchill Livingstone, 2003.

Konrad, Andreas, et al. “The Influence of Stretching the Hip Flexor Muscles on Performance Parameters. A Systematic Review with Meta-Analysis.” International Journal of Environmental Research and Public Health, 17 Feb. 2021,

Mills, Matthew, et al. “Effect of Restricted Hip Flexor Muscle Length on Hip Extensor Muscle Activity and Lower Extremity Biomechanics in College-Aged Female Soccer Players.” International Journal of Sports Physical Therapy, Dec. 2015,

Tyler, Timothy F, et al. “Rehabilitation of Soft Tissue Injuries of the Hip and Pelvis.” International Journal of Sports Physical Therapy, Nov. 2014,

Yamane, Masahiro, et al. “Understanding the Muscle Activity Pattern of the Hip Flexors during Straight Leg Raising in Healthy Subjects.” Progress in Rehabilitation Medicine, 16 Feb. 2019,