Non-radiographic axial spondyloarthritis or nr-axSpA and non-radiographic ankylosing spondylitis/AS are related. However, non-radiographic axial spondyloarthritis can present AS symptoms with active inflammation of the spine and sacroiliac/SI joints, causing back and hip pain but does not reveal joint damage on X-rays or MRIs. Injury Medical Chiropractic and Functional Medicine Clinic can explain what it means to have non-radiographic axial spondyloarthritis, how it can be managed, and what to do to prevent it from turning into ankylosing spondylitis.
Non-Radiographic Axial Spondyloarthritis
Non-radiographic axial spondyloarthritis means there are early AS symptoms but have not developed enough joint inflammation or damage to show up on an X-ray or other form of imaging. Early evidence of joint inflammation includes blurring of the joint edges and localized regions of joint erosion. It can be difficult for physicians to see these subtle changes on an x-ray.
Ankylosing Spondylitis
Ankylosing spondylitis, or AS, is a form of inflammatory arthritis that affects joints in the spine and elsewhere.
It is a chronic, inflammatory, autoimmune disease.
Medical research is still ongoing to determine the exact cause, but a genetic component is believed to be contributing factor.
Around 85% of individuals with ankylosing spondylitis have inherited the HLA-B27 gene, which is associated with multiple autoimmune conditions.
In the early stages, individuals will present lower back pain around the sacroiliac joints or the joints that connect the spine to the pelvis.
Later stages have more obvious X-ray findings, like the fusing of the sacroiliac joints and the lower spine that takes place over time.
Joint inflammation can progress, causing permanent joint damage and spine rigidity.
Most individuals with the condition can manage their symptoms with NSAIDs, chiropractic care, physical and massage therapy, and range of motion exercises.
Stage 1
There is no evidence of spinal inflammation on x-rays.
MRI provides more detailed images of bones and may reveal bone marrow edema or accumulation of fluid in the structures of the spinal bones and joints.
Individuals with non-radiographic axial spondyloarthritis, you are here.
Stage 2
There is visible inflammation of the spinal joints on the x-ray.
The sacroiliac joints between the spine and the pelvis are the most affected.
Stage 3
Chronic inflammation of the joints has caused bone loss and permanent joint damage, resulting in spine rigidity.
Symptoms of Non-Radiographic Axial Spondyloarthritis
There are differences between back pain associated with muscle strain and arthritis. Back pain symptoms include:
Starts to present before age 40.
It has a gradual onset and can go unnoticed for years.
Improves with movement or activity.
Eases up throughout the day.
Starts up in the evening when resting.
Other symptoms include:
Joint stiffness
Swollen fingers
Heel pain
Bilateral buttock discomfort and pain
Slowing Progression
Progression from non-radiographic axial spondyloarthritis to ankylosing spondylitis occurs in 10% – 20% of individuals over a two-year period. Progression factors include genetics, gender, degree of joint damage, and level of inflammatory markers at the time of diagnosis.
Early diagnosis and treatment can slow the progression before significant joint damage with anti-inflammatory therapy, rheumatological therapy, and targeted exercise.
Work with a specialist like an orthopedic spine specialist and rheumatologist that understands the disorder and is up to date on the most recent treatment modalities.
Individuals with non-radiographic axial spondyloarthritis should expect to have serial X-rays to gauge the progression of the disease.
Staying healthy and active is recommended to slow the progression of nr-AxSpA and AS.
Recent medical advances and lifestyle adjustments can slow the progression in most cases.
axSpA
References
Six tips for living well with ankylosing spondylitis. Available at https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/in-depth/6-tips-for-living-well-with-ankylosing-spondylitis/art-20478753. Accessed 11/07/2022.
Ankylosing spondylitis. Mayo Clinic. Available at https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808. Accessed 11/05/2022.
D. J. Pradeep, A. Keat, K. Gaffney, Predicting outcome in ankylosing spondylitis, Rheumatology, Volume 47, Issue 7, July 2008, Pages 942–945, https://doi.org/10.1093/rheumatology/ken195
Kucybała, Iwona, et al. “Radiologic approach to axial spondyloarthritis: where are we now and where are we heading?.” Rheumatology international vol. 38,10 (2018): 1753-1762. doi:10.1007/s00296-018-4130-1
Michelena, Xabier, López-Medina, Clementina, and Helena Marzo-Ortega. “Non-radiographic versus radiographic axSpA: what’s in a name?”.” National Center for Biotechnology Information. October 14, 2020. https://doi.org/10.1093/rheumatology/keaa422
Swift D. Ankylosing spondylitis: disease progression varies widely. Medpage Today. Accessed 11/05/2022.Available at https://www.medpagetoday.com/rheumatology/arthritis/49096
The thighs in the lower half of the body work together with the hips to stabilize the legs when the body is in motion. The thighs and the hips also support the weight of the upper half of the body and are surrounded by muscles, ligaments, and nerve roots to supply blood and sensory-motor function to the legs. One of the thigh muscles that work with the hips is the tensor fasciae latae (TFL) muscle. When the thigh muscles are being overused or suffer from injuries, tiny nodules known as trigger points (myofascial pain syndrome) can affect a person’s ability to function worldwide. Today’s article examines what the tensor fasciae latae muscles do, how myofascial pain syndrome affects the thighs, and various stretches/techniques for the thighs. We refer patients to certified providers who incorporate multiple methods in the lower body extremities, like thigh pain treatments correlating to trigger points, to aid individuals dealing with pain symptoms along the tensor fasciae latae muscle. We encourage and appreciate patients by referring them to associated medical providers based on their diagnosis, especially when it is appropriate. We understand that education is an excellent solution to asking our providers complex questions at the patient’s request. Dr. Jimenez, D.C., utilizes this information as an educational service only. Disclaimer
What Does The Tensor Fasciae Latae Muscle Do?
Do you have difficulty walking for a long period? So you feel that your hips feel unstable when you move? Or do you feel radiating pain down from your thighs to your knees? Thigh pain associated with these symptoms can affect a person’s ability to move around from one location to another due to trigger points affecting the tensor fasciae latae muscle. The tensor fasciae latae (TFL) muscles are located at the proximal anterolateral thigh and originate from the anterior superior iliac spine. The TFL muscle is between the superficial and deep muscle fibers of the iliotibial (IT) band, as its attachment assists with knee flexion and lateral rotation. The TFL muscles also work together with the gluteus muscles in various hip movements. Studies reveal that the primary function of the TFL muscles is providing balance to the body’s weight and the non-weight-bearing leg to walk. The TFL muscles allow the individual to walk, run, and assist with movement and stabilization to the hips and knees without pain inflicted on the joints and muscles.
Myofascial Pain Syndrome Affecting The Thighs
Since the TFL muscles allow the person to walk and run, this muscle can become overused and strained through repetitive motions causing many issues to the hips, knees, and thighs. When these issues affect the TFL muscles, they can develop nodules along the muscle fibers known as trigger points or myofascial pain syndrome. Myofascial pain syndrome is a musculoskeletal disorder that can invoke referred pain in one location of the body while affecting the surrounding muscles in a different body location. Myofascial pain syndrome associated with the TFL muscles can cause issues to the hips, thighs, and knees while affecting a person’s ability to walk. Studies reveal that the prevalence of myofascial pain syndrome on the TFL muscles correlates to pain and disability in the thighs. When myofascial pain syndrome affects the TFL muscles, it can mimic chronic knee osteoarthritis.
Even though myofascial pain syndrome is challenging to diagnose, it is treatable through various stretches and techniques. In Dr. Janet G. Travell, M.D.’s book, “Myofascial Pain and Dysfunction,” it mentioned that when patients have active trigger points in their TFL muscles, they become aware of the referred pain affecting their hip joints and are unable to lie comfortably on their sides due to the body-weight pressure pressing on the affected TFL muscle. The book also points out that when pain is referred to from trigger points associated with the TFL muscles, it can be mistaken for pain in the glutes.
Trigger Point Of The Week: Tensor Fasciae Latae- Video
Have you been experiencing difficulty walking from one location to another? Do you feel pain in your thighs or knees? Or do you have a problem lying down on your side that is causing you pain? If you have been dealing with walking issues, it could be due to myofascial trigger pain in your tensor fasciae latae (TFL) muscles affecting your ability to walk. The TFL muscles help provide stability to the hips and thighs and assist with knee flexion and lateral rotation. This muscle also allows people to walk and run without any pain inflicted on the joints and muscles. When repetitive motions start to cause the TFL muscles to become overused and strained, it can lead to myofascial pain syndrome or trigger points developing, causing referred pain to the thighs. The video above explains where the TFL muscles are located and where the trigger points on the TFL muscles are causing pain to the thighs. Myofascial pain syndrome can mimic other chronic conditions like knee osteoarthritis, which causes pain and disability to the lower half of the body.
Various Stretches & Techniques For The Thighs
Now myofascial pain syndrome is challenging to diagnose in an examination due to the referred pain affecting one location of the body than the actual source of where the pain is coming. However, it is treatable through various techniques and stretches for the thighs to restore leg mobility. Studies reveal that direct stretching of the TFL (tensor fasciae latae) muscles can reduce long-term pain effects on the hips, thighs, and lower back and improve hip and thigh mobility. Various stretches like hip extensions and laterally rotating the hips can break the myofascial trigger points in the TFL muscle. Using a foam roller on the hips can gently stretch and loosen the muscle fibers on the TFL and help warm up the muscle before working out. Sitting down correctly in a chair can help the hips from causing more muscle strain to the thighs and prevent the TFL muscles from being shortened. Incorporating these stretches and techniques can improve hip and thigh mobility in the legs, allowing the individual to walk or run without pain.
Conclusion
The TFL (tensor fasciae latae) muscles are located on the proximal anterolateral thigh between the IT (iliotibial) band, which assists with knee flexion and lateral rotation. The TFL muscle also works with the gluteal muscles and allows the person to walk, run, and help with stability movement to the hips and knees with inflicted pain on the joints and surrounding muscles. When the TFL muscles become overused, they can develop myofascial trigger pain on the TFL, causing referred hip, knee, and thigh pain. This can cause the individual not to be able to walk for long periods and think they might have osteoarthritis in the knees. Fortunately, people can incorporate various stretches and techniques to reduce the pain in the thighs and hips while managing myofascial trigger pain along the TFL muscles. These various stretches and techniques allow mobility back to the hips and thighs so the individual can walk without pain.
References
Gottschalk, F, et al. “The Functional Anatomy of Tensor Fasciae Latae and Gluteus Medius and Minimus.” Journal of Anatomy, U.S. National Library of Medicine, Oct. 1989, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1256751/.
Ohtsuki, Keisuke. “A 3-Month Follow-up Study of the Long-Term Effects of Direct Stretching of the Tensor Fasciae Latae Muscle in Patients with Acute Lumbago Using a Single-Case Design.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, May 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047246/.
Simons, D. G., and L. S. Simons. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
Sánchez Romero, Eleuterio A, et al. “Prevalence of Myofascial Trigger Points in Patients with Mild to Moderate Painful Knee Osteoarthritis: A Secondary Analysis.” Journal of Clinical Medicine, MDPI, 7 Aug. 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464556/.
Trammell, Amy P, et al. “Anatomy, Bony Pelvis and Lower Limb, Tensor Fasciae Muscle – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 8 Aug. 2022, https://www.ncbi.nlm.nih.gov/books/NBK499870/.
The body experiences physical changes during pregnancy. As the baby grows, the body has to adjust, which can cause unfamiliar aches and pains. A common issue for pregnant women is sciatica symptoms or lumbar radiculopathy, which radiates discomfort sensations that travel down the lower spine, down the back of the thigh, and into the foot. Chiropractic care and massage therapy can realign the spine and hips, therapeutically massage circulation through the body, relieve symptoms, and restore function.
Pregnancy Sciatica
The sciatic nerve is the largest in the body and the main nerve in the legs. In most cases, sciatica happens when this nerve gets compressed by bulging, slipped, or ruptured spinal discs, arthritis, or spinal stenosis.
Symptoms
Aches and pains that result from sciatica range from mild to severe sensations. Symptoms include:
Pain that travels from the pelvis down the back of the leg.
A burning sensation in the low back and buttocks.
Jolting pain that feels like an electric shock.
Numbness, muscle weakness, or tingling in one leg or foot.
Tingling sensation in one part of the body and pain in another.
Pain that worsens when coughing, sneezing or sitting for long periods.
Causes
Sciatica during pregnancy can be caused by:
Weight gain is going to pull the spine and muscles down.
Increased fluid retention can place added pressure on the nerve as it passes through the pelvis.
The expanding uterus can press down on the nerve in the lower part of the spine.
The growing belly and breasts shift the center of gravity forward and stretch the lordotic curve causing the muscles in the:
Buttocks and pelvis to tighten up and compress the sciatic nerve.
The baby’s head can rest directly on the nerve when settling into the proper birth position in the third trimester.
A herniated or slipped disc caused by the extra pressure of the growing uterus can be the cause, although this is less common.
Pregnancy also causes the body to release a hormone called relaxin, designed to relax the ligaments and prepare the pelvis for childbirth.
Loose ligaments can cause spinal compression and affect the sciatic nerve.
Sciatica will most likely occur during the third trimester when mother and baby are bulking up, but it can develop earlier, although this is less common. Most women experience symptoms on one side, though it can affect both legs. The condition can be constant or intermittent, depending on the amount of pressure placed on the nerve, and can remain for a few months after giving birth when the excess weight and fluid are gone.
Treatment Techniques
Simple home remedies and treatment to help ease the symptoms. These include:
Sleep on Your Side
Rest on the side of the body that does not present symptoms when lying down.
Prenatal massage can reduce stress, improve blood circulation, and regulate hormones.
Chiropractic and Physical Therapy
Chiropractic is non-invasive and drug-free, making it a safe and gentle option for mom and baby.
A professional chiropractor can evaluate the condition.
Identify and remove interferences in the nervous system from the source.
Realign the bones.
Provide a personalized treatment plan to alleviate symptoms and stretches and strength-building exercises.
Sciatica In Pregnancy
References
American Pregnancy Association: “Prenatal Massage Therapy.
American Pregnancy Association: “Sciatic Nerve Pain During Pregnancy: Causes and Treatment.”
FRIEDMANN, E. “Narrowing of the spinal canal due to thickened lamina a cause of low-back pain and sciatica.” Clinical orthopedics vol. 21 (1961): 190-7.
Goldsmith, Laura T, and Gerson Weiss. “Relaxin in human pregnancy.” Annals of the New York Academy of Sciences vol. 1160 (2009): 130-5. doi:10.1111/j.1749-6632.2008.03800.x
KULOWSKI, J. “Unusual causes of low back pain and sciatica during pregnancy.” American journal of obstetrics and gynecology vol. 84 (1962): 627-30. doi:10.1016/0002-9378(62)90156-4
Trager, Robert J et al. “Ischial osteochondroma as an unusual source of pregnancy-related sciatic pain: a case report.” Chiropractic & manual therapies vol. 30,1 45. 17 Oct. 2022, doi:10.1186/s12998-022-00451-3
The skeletal joints can keep the body upright and stabilized while protecting the internal organs. The skeletal joints also are at risk of factors (normal and traumatic) that can impact the body, thus potentially causing painful symptoms to affect different body areas. Hip pain is among the most common complaints for many individuals, especially the elderly. To that point, when the body suffers from hip pain, it may involve pelvic pain and associated symptoms that mimic other issues within the body. Today’s article examines the causes of hip and pelvic pain, the symptoms related to hip and pelvic pain, and how chiropractic care may relieve hip and pelvic pain. We refer patients to certified providers specializing in osteopathic treatments to help many individuals with hip and pelvic pain. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer
The Causes Of Hip & Pelvic Pain
Do you experience stiffness located on your low back or hips? What about sciatic nerve pain that travels down your legs? Or have you been experiencing cramping around the pelvic regions of your body? Experiencing these symptoms may be the potential cause that you might be dealing with hip and pelvic pain. Even though hip pain is often associated with older individuals, it can affect many individuals of different ages. Studies reveal that the pathologies outside the hips may be the cause and referred pain, making diagnosing hip pain difficult. Hip pain causes could be overused joints and soft tissues that support the hips due to repetitive motions, strain from the multiple muscles that support the hips, or arthritic symptoms. Studies reveal that individuals who work in a desk job will potentially develop low back pain due to prolonged sitting, thus becoming associated with excessive mobility of the lumbar spine and decreased hip joint mobility.
Individuals with hip pain could risk developing pelvic pain associated with the overuse of joints and soft tissues. Now how pelvic pain correlates with hip pain, and what’s the causation? Studies reveal that the stabilizing muscles (iliopsoas, pectineus, obturator externus, gluteus minimus, and piriformis muscles) are overworked and become consequent hip and joint destabilization. This causes the affected muscles to become tired and weak and triggers sciatic nerve compression along the piriformis muscle. Pelvic pain associated with hip pain may cause dysfunctional musculoskeletal symptoms along the lower abdominals, hips, and lumbosacral back.
The Associated Symptoms Of Hip & Pelvic Pain
The factors involved with hip and pelvic pain could potentially have associated symptoms that might affect the body’s lower extremities. One of the most prominent symptoms of hip pain is groin pain, which could possibly be involved with pelvic pain since the ligaments and muscles that encompass the hips and groin may be weak and overused. Sometimes various underlying causes do contribute to hip and pelvic pain, causing associated symptoms that may confuse the individual in pain. Hip and pelvic pain may refer to low back and sciatic nerve pain since the lower spine and hips are close together; thus, pinpointing where the true source of pain is in the body’s lower half makes it confusing. Some of the symptoms associated with hip and pelvic pain include:
Low back pain
Muscle weakness
Sacroiliac joint dysfunction
Bladder issues
Sciatic nerve pain
Piriformis syndrome
The 3 Common Causes Of Hip Pain-Video
Have you been dealing with muscle stiffness around or along your hips and lower back? Do you have bladder issues? Or have you experienced muscle weakness in the lower extremities of your body? Some of these symptoms could be associated with hip and pelvic pain. The video above explains the three common causes of hip pain, and interestingly, one of the causes of hip pain could potentially involve the lower back. Studies reveal that since the low back and hips are close to each other, alterations in the lumbopelvic region could potentially be involved with low back pain. Some of the issues associated with the alterations in the lumbopelvic area include:
Limited range of motion on hip rotation
Tissue injury
Stiff joint capsules
Micro/macro trauma
Fortunately, hip and pelvic pain management may help alleviate referred pain issues through chiropractic care.
Chiropractic Relief For Hip & Pelvic Pain
Individuals dealing with hip and pelvic pain may find relief through chiropractic care. The pelvis is a direct continuation of the spine as the sacrum (the five lowest fused vertebrae) and the pelvic girdle complex interact with the joints from the lower skeletal system. If there is pain in the lower body and the individual is unsure whether it is their back or hips, their first course of action is to visit their primary doctor or a chiropractor. Afterward, they will review the individual’s medical history while performing a series of physical exams like various movements to make an accurate diagnosis. Once the pain diagnosis is identified, chiropractors utilize total body alignment by restoring balance in the pelvis and the spine through manipulation. When the spine and hips suffer from a subluxation, it can cause unnecessary strain on the surrounding muscles around the spine and hips. To that point, realigning the spine from a chiropractic adjustment could reduce or eliminate the excessive stress affecting the surrounding muscles. Chiropractic care can also promote various therapies that increase balance along the hips and pelvic region, which include:
Stretching
Therapeutic massage
Physical activities/Exercise therapy
Nutrition
Whether the pain is located in the hips, low back, or pelvic regions, chiropractic care can help restore, address, and alleviate the pain while maintaining optimal long-lasting results.
Conclusion
The skeletal joints can help keep the body upright and stabilized while protecting the internal organs from normal and traumatic factors. When these factors begin to cause an impact on the body, the skeletal joints are at risk of developing pain along the musculoskeletal structure. Hip and pelvic pain have an overlapping relationship as they are amongst the most common complaints for many individuals. To that point, pain from the hips or the pelvic may mimic other issues associated with chronic disorders. Incorporating treatments like chiropractic care can help alleviate, address, and restore the body through spinal manipulation. This allows individuals to be pain-free and help restore balance in their joints.
References
Harris-Hayes, Marcie, et al. “Relationship between the Hip and Low Back Pain in Athletes Who Participate in Rotation-Related Sports.” Journal of Sport Rehabilitation, U.S. National Library of Medicine, Feb. 2009, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699456/.
Lee, Dae Wook, et al. “Chronic Pelvic Pain Arising from Dysfunctional Stabilizing Muscles of the Hip Joint and Pelvis.” The Korean Journal of Pain, The Korean Pain Society, Oct. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061646/.
Luthra, Jatinder Singh, et al. “Understanding Painful Hip in Young Adults: A Review Article.” Hip & Pelvis, Korean Hip Society, Sept. 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6726866/.
Nishimura, Takaaki, and Ryo Miyachi. “Relationship between Low Back Pain and Lumbar and Hip Joint Movement in Desk Workers.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, Oct. 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590845/.
A pinched nerve in the hip can cause numbness, tingliness, weakness, and pain. A pinched/compressed nerve creates pressure that can result from a bone structural issue like hip misalignment or the nerve getting overly stretched, stuck, twisted, or kinked. The pressure obstructs the neural pathways and decreases neural activity. This causes pain. If discomfort or pain is present, chiropractic, physical rehabilitation, rest, exercise, and ice and heat can release and reset the nerve and help prevent re-injury.
Pinched Nerve In The Hip
A pinched or compressed nerve results from pressure being applied to the nerve. A pinched nerve in the hip often causes pain in the groin region, radiating down the inner thigh to the knee. The pain can feel like a dull ache or a sharp, burning pain. Individuals also report tightness, numbness, or a tingling sensation in the buttocks. The most common causes include:
Unhealthy posture.
Sitting for too long without moving around.
Misaligned bone or cartilage.
Muscle strain.
Pregnancy.
Obesity.
Inflamed tissue.
Herniated disc.
Arthritis.
Bone spurs.
Chiropractic
Different causes require different treatment approaches. For example, an obese individual could require chiropractic adjustments, specific exercises/stretches, and diet adjustments to address the whole body. The recommended treatment plans can vary but usually include:
Physical therapeutic massage.
Manipulative therapies of the joints and muscles.
Mobilization of the joints.
Soft tissue treatments.
Spinal decompression.
Exercise.
Walking and activity can worsen the pain when the hip presents with pain. This can cause the rest of the body to compensate by shifting the weight to the healthy side, which can cause even more pain in the back or legs or cause another injury. Regular chiropractic hip adjustments will improve posture, maintaining muscle and skeleton alignment that will prevent pinching nerves in the hip.
Chiropractic Hip Treatment
References
Ahuja, Vanita, et al. “Chronic hip pain in adults: Current knowledge and future prospective.” Journal of anaesthesiology, clinical pharmacology vol. 36,4 (2020): 450-457. doi:10.4103/joacp.JOACP_170_19
Christmas, Colleen, et al. “How common is hip pain among older adults? Results from the Third National Health and Nutrition Examination Survey.” The Journal of family practice vol. 51,4 (2002): 345-8.
“Free Communications: Case Reports: Hip.” Journal of Athletic Training vol. 38,2 Suppl (2003): S.73–S.74.
The hips in the lower extremities of the body help stabilize the weight of the upper half while providing movement to the lower half. The hips also allow the body to twist, turn, and bend back and forth. The hip joints connect to the inside of the pelvic bone, while the pelvic bone is connected to the sacroiliac joint, which connects to the spine. When natural wear and tear affects the joints as the body ages, issues like hip pain and osteoarthritis associated with low back pain occur, causing various symptoms to arise in the body. Today’s article looks at osteoarthritis, how it impacts the hips, and how to manage hip osteoarthritis. We refer patients to certified providers specializing in musculoskeletal therapies to help those with hip pain and osteoarthritis. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer
What Is Osteoarthritis?
Have you been experiencing pain in your hips or lower back? How about muscle stiffness near the groin? Do symptoms associated with sciatica seem to flare up near your hips and the back of your leg? Many of these symptoms are signs that you could be at risk of developing osteoarthritis near your hips. While arthritis refers to inflammation of the body’s joints, osteoarthritis is a type of arthritis that causes degeneration of the joint cartilage, triggering joint pain and functionality loss. Even though there are several hundred types of arthritis, osteoarthritis is one of the most common types that many people, especially older adults, are affected by. As the body becomes older naturally through age, the repairs from an injury begin to slow down, and the cartilage (the connective tissue that protects the bones from each other) will start to thin out, triggering bone rubbing together, causing inflammation to occur, bone spurs, and inevitable pain. Osteoarthritis is often associated with old age and is multifactorial as factors that can increase the risk of developing osteoarthritis include:
Sex
Age
Obesity
Joint injuries
Genetics
Bone deformities
How Does It Impact The Hips?
Since osteoarthritis affects the joints, how does it cause an impact on the hips? When health issues affect the body, it can cause painful symptoms to gradually worsen and become a risk of developing hip pain. Studies reveal that hip pain is common in all adults and activity levels in the anterior, lateral, or posterior regions near the hips.
Anterior hip pain: Causes referred pain (pain felt in one part of the body but is actually in a different location) associated with internal organ systems.
Lateral hip pain: Causes wear-and-tear pain on the soft muscle tissues on the sides of the hips.
Posterior hip pain: Causes referred pain associated with the lumbar spinal pathology like sciatic nerve entrapment correlating with a deep gluteal syndrome.
All these issues affecting the hips overlap with various issues associated with osteoarthritis. When hip pain originates from osteoarthritis, factors like minimal physical activity or slight movements while resting in bed can worsen due to the hip joints having limited or restricted movement. Studies reveal that hip pain is associated with simple movement impairments that make it difficult to diagnose due to referred pain from the spine, knees, or even the groin area.
How does hip osteoarthritis correlate with groin pain? Studies reveal that when a person is dealing with hip osteoarthritis, groin and buttock pain are slightly more common. The hip joint is behind the groin muscle, which is why groin pain overlaps with hip pain as the root. Hip and groin pain could also be involved with radiating pain down toward the knees in the body.
Exercises For Hip Osteoarthritis- Video
Are you experiencing bladder issues? How about stiffness near or around your hips and groin area? Do issues like low back and sciatica pain? Experiencing these issues could be signs of hip osteoarthritis affecting your lower body. Studies reveal that hip osteoarthritis is a significant source of morbidity, pain, gait abnormalities, and functional impairments potentially involved with other issues. Fortunately, there are ways to manage hip osteoarthritis, as the video above shows eight great exercises for hip osteoarthritis. Certain exercise moves for individuals with hip osteoarthritis can help strengthen the surrounding muscles around the joints while increasing joint mobility to reduce pain and stiffness. Exercising can also be beneficial to the individual as it can provide:
Increase blood circulation
Maintain weight
Provides energy boost
Improves sleep
Promotes muscle endurance
Other available therapies help manage hip osteoarthritis while alleviating associated symptoms affecting the body.
Managing Hip Osteoarthritis Pain
Many individuals suffering from hip osteoarthritis try to find ways to relieve the pain. While they can’t do anything to prevent wear and tear on the joints completely, there are ways to slow down the process and manage hip osteoarthritis in the body. Small changes like incorporating food can dampen inflammatory effects on the joints while providing nutrients to the body. An exercise regime can help strengthen the weak muscles supporting the joints while increasing mobility and range of motion. Treatments like spinal traction and chiropractic care relieve pain and stiffness from joint disorders like osteoarthritis. Chiropractic care provides spinal manipulation on the back and joints to be adjusted. While spinal traction helps the compressed discs lay off the pressure on the surrounding nerves associated with hip pain. Incorporating any of these can help slow the progression of hip osteoarthritis and bring back mobility to the hips.
Conclusion
The hips provide stability to the upper and lower parts of the body. While supporting the weight of the upper half and movement to the lower half, the hips can succumb to wear and tear in the body. When the hip joints begin to wear and tear slowly, it can lead to the progression of hip osteoarthritis, where the cartilage of the joints begins to cause the bones to rub against each other, triggering inflammation. Hip osteoarthritis makes diagnosing difficult because the referred pain from the spine, knees, or groin area overlaps the symptoms. All is not lost, as there are available treatments to manage hip osteoarthritis that can help slow the progress of this disorder and bring back the mobility of the lower half of the body.
References
Ahuja, Vanita, et al. “Chronic Hip Pain in Adults: Current Knowledge and Future Prospective.” Journal of Anaesthesiology, Clinical Pharmacology, Wolters Kluwer – Medknow, 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022067/.
Chamberlain, Rachel. “Hip Pain in Adults: Evaluation and Differential Diagnosis.” American Family Physician, 15 Jan. 2021, https://www.aafp.org/pubs/afp/issues/2021/0115/p81.html.
Khan, A M, et al. “Hip Osteoarthritis: Where Is the Pain?” Annals of the Royal College of Surgeons of England, U.S. National Library of Medicine, Mar. 2004, https://pubmed.ncbi.nlm.nih.gov/15005931/.
Kim, Chan, et al. “Association of Hip Pain with Radiographic Evidence of Hip Osteoarthritis: Diagnostic Test Study.” BMJ (Clinical Research Ed.), BMJ Publishing Group Ltd., 2 Dec. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4667842/.
Sen, Rouhin, and John A Hurley. “Osteoarthritis – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 1 May 2022, https://www.ncbi.nlm.nih.gov/books/NBK482326/.
The muscles in our body help us be active when we want to be, rest and repair after activities, and continue to provide everyday movements that help keep the body functioning correctly. For athletes and the general population, physical training and eating healthy foods help deliver fuel to not only the internal organs but also help support the muscles, ligaments, and skeletal joints from injuries. As many individuals start to think about their health and wellness, many factors tend to pop up that can cause them to halt their health and wellness journey. Issues like stress, accidents, traumatic events, and lifestyle habits can affect the body and, over time, can become the risk of developing into chronic problems. An example would be where a person is experiencing hip pain associated with piriformis syndrome. Today’s article looks at piriformis syndrome, how it can cause more than hip pain, and how there are available treatments for piriformis syndrome. We refer patients to certified providers specializing in musculoskeletal therapies to help those with piriformis syndrome. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer
What Is Piriformis Syndrome?
Have you been experiencing pain radiating from the buttock down to your legs? Does it hurt when you are sitting down? Or are you feeling tingling sensations and numbness on your butt and thighs? Some of these symptoms might be signs that you might be experiencing piriformis syndrome. Research studies have defined piriformis syndrome as a clinical condition where everyday stress affecting the body causes the piriformis muscle (the small muscle deep in the buttock region) to become tight and irritates the sciatic nerve. When that sciatic nerve becomes aggravated, it can become the risk of developing into sciatica. Many individuals don’t realize that the sciatic nerve also gets affected when their piriformis muscles in the buttock region become overused and tight through strenuous activities. This is due to the belief that any unusual traumatic abnormality in the piriformis muscle will be associated with sciatica symptoms. However, when a person is experiencing buttock pain that travels down the leg caused by the affected piriformis muscle, many will rule out some of the more common causes of sciatica like nerve root impingement triggered by disc herniation.
Surprisingly, three primary causing factors can be associated with piriformis syndrome. The first causing factor is myofascial trigger points may be the results of referred pain (pain or discomfort from another body location). The second causing factor is nerve entrapment against the greater sciatic foramen passing through the various piriformis muscles. And finally, the third causing factor is sacroiliac joint dysfunction due to piriformis muscle spasm. Studies reveal that the piriformis muscle helps stabilize the sacroiliac joint; when the small muscle starts to become irritated, it causes pain in the buttock region. But how does sacroiliac dysfunction relates to piriformis syndrome? Well, since low back pain is associated with sacroiliac dysfunction, the pain will often radiate down to the knee and the groin muscles while becoming a risk of developing piriformis syndrome.
Piriformis Syndrome Causes More Than Hip Pain?
Due to its broad size in the greater sciatic foramen, the piriformis muscle can become overused and tight, thus becoming piriformis syndrome. Piriformis syndrome can also become a risk to the numerous vessels and nerves that exit out in the pelvis region and may become compressed, causing more than just hip pain. Studies reveal that piriformis syndrome may be masquerading as ischiofemoral impingement triggering extra-articular hip pain by entrapping the quadratus femoris muscle causing groin pain. Another cause that piriformis syndrome is associated with is chronic pelvic pain. How does chronic pelvic pain correlate with piriformis syndrome? Chronic pelvic pain is a non-cyclic pain localized in the pelvis, potentially involving the surrounding muscles like the piriformis muscle supporting the irritated hip joint and pelvis region. Piriformis syndrome could also be an overlapping condition risk of developing other health issues like fibromyalgia in many people. Some conditions have common symptoms associated with piriformis syndrome, including:
Tingling sensations
Numbness
Muscle tenderness
Pain while sitting
Discomfort while exercising
The Difference Between Sciatica & Piriformis Syndrome-Video
Have you found it challenging to be comfortable while sitting down doing leisure activities? How about radiating pain that travels down your leg? Or do your hips feel tight and stiff? Experiencing these symptoms means that you might suffer from piriformis syndrome. The video above explains the difference between piriformis syndrome and sciatica. Studies reveal that piriformis syndrome is classically defined as sciatic pain; however, it is not sciatica. Sciatica is caused by compressed sciatic nerve due to herniated disc in the lumbar spine. In contrast, piriformis syndrome is caused when a traumatic injury or an underlying condition causes the piriformis muscle to spasm and aggravate the sciatic nerve. Various factors like prolonged sitting, repetitive movements that involve the legs, and even extensive stair climbing can cause the piriformis muscle to be easily damaged or injured, causing piriformis syndrome. Fortunately, there are ways to alleviate sciatic nerve pain and improve piriformis syndrome.
Treatments Available For Piriformis Syndrome
Many treatments are accessible to manage the pain and discomfort caused by piriformis syndrome for suffering individuals. Some people take over-the-counter medicine to decrease the pain, while others utilize a hot/cold pack on the affected area to relieve discomfort. The symptoms associated with piriformis syndrome usually go away without any additional treatment; however, if the pain or discomfort is still there, many people might benefit from alternative options for treatment, like chiropractic care, physical therapy, or even spinal decompression. Whether it is through gentle stretching, spinal manipulation, or decompression, these treatments are for anyone dealing with piriformis syndrome and its associated symptoms. Physical therapy can help decrease the painful symptoms associated with piriformis syndrome through gentle stretches that help return a person’s range of motion. Chiropractic care incorporates spinal adjustments and manual manipulations to treat various injuries or conditions. Spinal decompression uses traction to gently pull on the spine to release the aggravated nerve from causing pain. The relief can gradually restore a person’s natural health while managing its associated symptoms with various treatments available for individuals with piriformis syndrome.
Conclusion
Piriformis syndrome is a condition where everyday stress affects the piriformis muscle in the buttock region to become irritated and tight while aggravating the sciatic nerve. Many think traumatic abnormalities affecting their piriformis muscle will be associated with sciatica symptoms. However, sciatica is due to nerve root compression triggered by disc herniation. Piriformis syndrome is where that small muscle is overused from various factors that cause more than hip and butt pain. Some overlapping conditions associated with piriformis syndrome can become mediators for groin and pelvic pain. Fortunately, chiropractic care, physical therapy, and decompression can help restore the body gradually by managing piriformis syndrome and its associated symptoms.
References
Hicks, Brandon L., et al. “Piriformis Syndrome.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 21 Apr. 2022, https://www.ncbi.nlm.nih.gov/books/NBK448172/.
Newman, David P, and Liang Zhou. “Piriformis Syndrome Masquerading as an Ischiofemoral Impingement.” Cureus, Cureus, 16 Sept. 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8520408/.
Professionals, Northwest Medical. “Piriformis Syndrome/Sacroiliac Dysfunction.” Northwest Medical Center, 2021, https://nw-mc.com/piriformis-syndromesacroiliac-dysfunction/.
Ro, Tae Hoon, and Lance Edmonds. “Diagnosis and Management of Piriformis Syndrome: A Rare Anatomic Variant Analyzed by Magnetic Resonance Imaging.” Journal of Clinical Imaging Science, Medknow Publications & Media Pvt Ltd, 21 Feb. 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843966/.
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