Hip Pain from Old Ankle Injury

Question:

A client of mine suffered a severe right ankle sprain while playing basketball. He was on crutches for a long time and then used a cane for a few months. He now has hip pain on his right side. He has gone to many doctors, and tests have found nothing anatomically wrong with his hip. I ask him to point to where the pain is, and he points to his hip joint a little posterior to the joint itself.

We did a myofascial release on his piriformis with the foam roller, and it was excruciatingly, abnormally painful. When he performed an overhead squat, his lower back arched as he was going down. He can perform squats using the fitball as back support/free standing squats/split stance squats/ lunges/step-ups onto a platform just about everything except a squat using the Free-Motion machine. When using that machine, no matter how light the weight, it aggravates his hip in exactly his sore spot.

Can you help me in analyzing this problem?

Answer

As always, remember to consult a doctor before beginning a training program.

First let me advise you to include as much objective and subjective info as possible in your assessment of a client. An example in this case would be muscle tests for the hip flexor (Thomas test), IT band (ober test), ROM of the calf and hamstring, as well as noting whether the feet are flat or normal. This will help with more complete answers.

Does your client need to squat on the Free Motion machine to have a complete program? If nothing else aggravates it, then I don’t see a problem. Just don’t do it because it is not essential to his activities of daily living.

It sounds to me like he might have trochanteric bursitis or some other inflammatory condition (this is not a diagnosis, just an observation). This is something to have a good physiatrist look at. (As a side note, I encourage all trainers to make good relationships with specialists in sports medicine, physical therapy and chiropractic care. They can come in handy for referrals and brain picking.) The other thing to look at is his ankle ROM. If it is limited, the hip may have to take up the slack.