sore hip advice?

I have had major back problems for 25 years. (I'm 49) My experience is the same as Phil's. Stretching for 20 minutes when I first get out of a hot shower in the am and swimming fours times a week is the only thing that has let me lead a sort of normal life. Without swimming, I'd be a basket case. ( Mentally, as well as physically.) This leads back to Jim Thorton's thread--- Stretching deeply every day and especially before major stress is essential!!!

My personal thanks to Karlene for assisting just when I was becoming too tired of the misinformed criticism to even respond anymore. Reinforcements, just when I needed them. The requirements she wrote about are the same where I went to school, too, as is the case for every accredited college of chiropractic.

Anna, I can appreciate that you did not receive a favorable outcome from chiropractic for your particular injury. However in your postscript to Greg, you continue to bash the entire profession based on your personal experience and the experiences of a limited number of friends. As an associate professor at Texas Chiropractic College, perhaps I can shed some light on the amount of regulation and education that is involved in the chiropractic profession. All accredited chiropractic colleges are accredited through two entities that are recognized by the US Dept. of Education. The first is the regional college accrediting body. For our college, that is the Southern Assn. of Colleges and Schools. The second accrediting agency is the Council on Chiropractic Education, the profession-wide accrediting body. Having been involved in two reaffirmations of accreditation, I can assure you that the scrutiny we undergo from both governing bodies is extremely comprehensive and exhaustive. The full process takes one to two years. Additionally all chiropractic students take National Board examinations covering basic sciences (Anatomy, Physiology, Pathology, Microbiology, Chemistry, Neuroanatomy) and clinical sciences (Diagnostic Imaging, General Diagnosis, Neuromuscular Diagnosis, Chiropractic Practice, Associated Clinical Sciences). There is also a National Board examination in Physical Medicine and Rehabilitation and part IV of the National Board exam is an objective structured clinical evaluation (OSCE) exam. This involves hands-on practical examination on simulated patients. Forty four of the fifty states require that students pass parts I, II, III & IV of the National Board examinations to be eligible for licensure. Additionally, states require that practitioners take continuing education hours in order to maintain licensure. I cannot speak for other chiropractic colleges but at Texas Chiropractic College our students have over 4,600 hours of education including the following: 625 hours of Anatomy 280 hours of Physiology 283 hours of Biochemistry and Nutrition 445 hours of Pathology 800 hours of Diagnosis including EENT, Serology, Dermatology, Geriatrics, X-Ray Interpretation and Neurology 136 hours of Obstetrics, Gynecology and Pediatrics 800+ hours of Orthopedics and Chiropractic Technique 900+ hours of Clinical Experience Additionally, we have a clinic extrance examination prior to our students entering our outpatient clinic and a clinic exit examination prior to graduation. These are barrier examinations that the student must pass to proceed in the curriculum or to graudate. Our College also has an active hospital rotation program in which our students are actively involved in rheumatology, neurology, orthopedic surgery, general practice and pain management rotations at regional hospitals including the Texas Medical Center and Univ. of Texas Medical Branch in Galveston. The profession has post-graduate specialties that practitioners can pursue. I would encourage you to try a practitioner with continuing education in sports. That would be either a CCSP (Certified Chiropractic Sports Practitioner) or DCSP (Diplomate, Chiropractic Sports Practitioner). I have noted that South Dakota has only 264 active practitioners in the entire state as of January 2002. This is comparison to Texas with over 4,500 active practitioners. Perhaps the small number of chiropractors in your state has limited the possibility that you can find a chiropractor that specializes in sports injuries. I regret that you did not have a positive experience with your chiropractor. But to paint the entire profession with a very broad brush based on your limited experience and lack of knowledge of our education, does chiropractic a grave disservice. Karlene Trebesiner, DC, CCSP

I just talked my editor at GQ magazine into letting me write about the active rehab of sports injuries. I'm trying to line up a consultation with top hip specialists (Greg Norman's doctor plus the physical therapist who works in conjunction with him), both of whom recently moved to the University of Pittsburgh Medical Center's new facility for sports medicine. I'll keep you guys posted on what these guys say. In the meantime, thanks very very much for all the advice. Lexa, your suggestions are excellent. I've found that I can swim about 30-40 minutes before my hip starts tightening up/acting cranky--so maybe I will prepare myself to accept truncated workouts for a while, followed by deck monitoring (and stroke advice) to my healthy comrades.

Karlene and Greg, I am fully aware of the training and schooling chiropractors are required to go through. When I had my injury, I read up on it. But in deciding whether or not to go to a chiropractor in this area, I had to rely on the experience of others (and not just friends of mine), and though some of them viewed chiropractic care favorably, they had never gotten any type of rehabilitation advice/care or seen positive long term results. My point is that it's a shame that some of the chiropractors out there do not make the best use of their extensive training. Once again, I did not "bash" the entire profession. As one other person noticed from my post, my biggest concern is with some of the chiropractic care available in my area. If you read the entire post, I applauded Greg and anyone who, like him, takes a whollistic approach to the practice and focuses on rehabilitation, not just bandages and quick, short term, fixes. If you are only going to read the negative in my posts and are not going to hear my out, then don't bother to read them. Anna

First of all, I would like to re-thank everyone who offered me advice on my hip pain. Here's a quick update for those of you who are interested and/or may have suffered a similarly injury of your own. Yesterday I went in to interview some doctors and physical trainers at the UPMC Sports Medicine Center (magnificent facility, by the way.) This is for my next GQ column, which is supposed to be on the active rehab of sports injuries. As with many of my columns, my editor was interested in having me serve as a guinea pig of sorts, and my recent hip pain seemed a perfect opportunity for the story's lead. I thought I was going to be given some stretching and strengthening exercises and be told to keep on swimming, etc., maybe at a somewhat reduced intensity. Instead, the PT (Pete Draovitch) and doctor (Marc Phillipon--both famous guys who have arthoscoped the hip joints and rehabed a ton of athletes like Greg Norman and Lynn Swan) did a bunch of hip manipulation (i.e., bend the joint in direction X, followed by "Does that hurt? How about this? And here?"), ordered an X-ray (which showed very minor "normal" arthritic changes), talked about having me undergo an MRI with some kind of dye injected into the joint, then finally concluded I have a combo of "capsular strain" and iliopsoas tendinitis. The likeliest cause is not the abductor Nautilus exercise I thought set things off, but rather the fly and breaststroke drills we've been doing tons of in practice lately. My joke in practice several weeks ago comes back to haunt me today--"Ah! My balls ache! My sockets are okay, but the balls ache!" If only I'd listened back then to the message the ball-and-socket joint had tried to tell me... From what I can gather, iliopsoas tendinitis is an inflamation of tendons that hook the hip flexors and other muscles to bones in the complicated hip joint. Anyone with an anatomy hobbyist mentality can read more about the latter condition at: www.emedicine.com/.../topic52.htm The bottom line recommendation I got from the doctor: two weeks off from any sports activity. No swimming, no weight lifting, no hiking around for hours at Kennywood Amusement Park with my sons, not even very much regular walking. Lots of sitting with ice, yes; but that's about it. At the end of this period, Dr. Phillipon seemed confident that the acute inflammation would have had a chance to die down, then I will be able to return for some rehab exercises to strengthen the compensating muscles, keep the joint more stable, stretches, etc. I can then return to swimming in a gradual way. I mentioned the USMS long course meet in August, and Dr. Phillipon said that if I take some time off now and prevent further aggravation, that shouldn't be a problem. If after two weeks I still have some pain, then they might have to do the MRI with dye to see if I maybe tore the labrum or other soft tissues inside the hip. This experience has made me want to reiterate a word of caution to my fellow borderline geriatrics. On the USMS forum, people have spoken about the Masters prerogative--i.e., depending on how your body feels, you can choose to opt out of a set, or avoid fly, or do anything else you think you need to do to prevent injury. As a diehard disciple of my excellent coach's, I admit that I have not always taken the various aches and pains of my fellow swimmers all that seriously. With the coach's help, and an unwavering belief that he is infallible in terms of swimming advice, I was able to have the best year of my whole swimming life last season. However, as great a coach as he is and will always be, I do think that his own youthful resillience and musculoskeletal magnificence (he's 31!) can sometimes perhaps blind him (well, not blind, but astigmatize him, maybe) to the vulnerabilities of the somewhat more mature (well, not mature, it's more like rotting) bodies of guys like me. I would like to reiterate a maxim of caution regarding physical exertion and the aging body: Anything that you have not done a lot of lately, don't do a lot of now. The kicking drills, for instance, though not nearly as strenuous as a set of 10 x 200s on 2:30 proved, for my body at least, way too much for my pathetic iliopsoas tendon to handle. I'm reminded of earlier in the season when the coach generously agreed to try to teach me the wave breaststroke on a thursday before a sunday meet. I'd entered the 200 *** for the first time in my life, and my goal was to try to make it into the local Y top 10. Well after an hour of whip kicking muscles I'd rarely remembered ever using, I was a little sore. But I thought nothing of it. That Sunday, I was warming up with some hyper leisurely breaststroke, my groin muscle pulled, and I had to withdraw from the 200 *** and the 400 im (because I could not kick any breaststroke at all.) There is nothing inherently wrong with any drills, wave *** stroke, etc. What I am going to try to do my best to remember, however, now and in the future, is that it's critical to work up to any new activity slowly and over a long period of time. Being in "great shape" is very specific to what you've trained for--any slight variations from what you are used to will recruit different muscles, tendons, cartilage, etc. And it's easy to dupe yourself into believing that because you're in "great swimming shape" these different-than-usually-recruited soft tissues will be similarly invulnerable to problems. As my own iliopsoas seems to point out, this is not necessarily true. Fortunately, the doctor said nothing about beer imbibing--so I will see my teammates this friday for pizza and beer. Thanks again for the advice. I should note that one fellow--name escapes me right now--prescribed exactly what the hip specialist said: 2 weeks out of the water, then very gradual return to activity. Thanks.

Thanks Jim, this is definitely a top-ten post.

I found the note from Tzivia Segal regarding hip injuries. He had e-mailed this directly to me rather than posting it out of fear perhaps someone would misdiagnose their own problem. Anyhow, I asked Tzivia if it would be okay to post this e-mail, which I think is informative and wise. He or she? (I confess I don't know the gender of the name Tzivia!) said that would be fine. Here goes: I saw your post on the Masters B-Board .... Not too long ago I did something to my hip ... not sure the original cause to this day. But as a couple weeks w/ regular ***-stroke and butterly (w/others) progressed it got worse and worse. It seemed as long as the injury was causing my muscles to flinch and grab (that jolting pain) any exercise worsened the situation. I hope by now you are past that. With the help of my trusty chiropractor, I did have the hip adjusted ONCE (and only once) which stayed. My chiropractor also did alot of deep muscle massage ... we found the abductor to be extremely tender ... probably the original injury ... and from that some core muscles in my stomach were very, very tight ... probably from compensating. It took about two weeks of essentially no swimming, then a slow build-up, to get back w/ it. Over it all there were the first two weeks of decline, two weeks of very painful grabbing, jolting, misbehaving muscles, two weeks of sore but more like an ache in the muscles during which time I did some very easy swimming ('s to EASY DOES IT!!!!! Tzivia

female -- fyi, not that it's much of factor in this discussion. The magnesium is to help muscles relax. I don't know if the magnesium matters much if it's not muscles ... although if the attached muscles are getting crampy or stiff from compensating for the injured tendon, then magnesium will help to keep the muscles able to relax easily. Wishing everyone good health!!! Tzivia

This topic is interesting to me because my back flares up every so often due to age-related "normal" (!!!) bone spurring. I am 76 and have returned to swimming this past year. Pretty quickly, I've had to quit the *** stroke because the kick definitely impacted the lower (lumbar) back. In his book, "No More Aching Back", Dr. Leon Root advises that after a period of back pain, one should avoid swimming prone. He advises that one should do the back stroke--and even then with a modified stroke that does not reach back over the head. PRETTY DISCOURAGING. At this point, I'm gingerly resuming the crawl, trying to let my body "talk" to me. I'm doing the steam room, the 20 minute stretching and the whirlpool, hoping to prove Dr Root wrong, at least about the freestyle. This discussion group represents a pretty expert group...and so I do await your comments and advice and shared experiences