Presentation
The patient presented with chronic hip pain accompanied by pins and needles in the foot. Symptoms had been recurring and were interfering significantly with exercise.
The patient had previously been an avid runner but had not been able to return to running because of the hip pain.
The history included a stress fracture near the hip. The fracture had healed, but pain around the hip persisted afterward. Subsequent imaging and neurological evaluation had not identified another clear structural or neurological cause.
Previous treatment included physical therapy and a cortisone injection. Walking and exercise tended to aggravate the symptoms.
Examination
Examination found significant muscular tension throughout the hip, including the TFL, rectus femoris, hip flexors, gluteal musculature, and piriformis. Significant tension was also found through the low back.
Because hip mechanics can be influenced by tension from multiple directions, examination and treatment were not limited only to the area where the patient felt pain. Restrictions through the front, side, or back of the hip can potentially alter movement around the joint and contribute to excessive compression or irritation during activity.
Assessment
The previous stress fracture had healed, but persistent muscular guarding around the hip remained.
Following an injury, the muscles surrounding the area may work harder to protect and stabilize it. If that guarding becomes persistent, increased tension around the hip may contribute to greater compression at the joint and less efficient movement.
Our working assessment was that tension through the hip flexors, TFL, gluteal muscles, and deeper posterior hip musculature was contributing to continued restriction and irritation around the hip.
Although the hip was the primary complaint, nearby areas such as the low back can also become involved. If one joint is not functioning properly, the body may adapt how it moves and manages load.
The pins and needles, along with intermittent radiating symptoms into the leg, suggested a neurological component that required looking beyond the hip itself.
Treatment
Acupuncture, electroacupuncture, and manual therapy were used through the anterior, lateral, and posterior hip, including the quadriceps, hip flexors, TFL, gluteal musculature, and piriformis region. The goal was to reduce excessive muscular tension around the joint and improve comfortable movement.
The lumbar and sacral regions were treated in addition to the hip because of the pins and needles and radiating symptoms into the leg and foot.
Treatment also extended into the leg to address the radiating symptoms.
Self-care included stretching and foam rolling throughout the hip and leg.
Response
The patient initially reported feeling better following treatment, although the improvement was not immediately consistent.
Symptoms flared during the early course of care, including an increase in the nerve-related complaints.
By the next visit, symptoms had improved considerably and had begun to stabilize. Pain had decreased to about 3/10, and the previously reported nerve symptoms were no longer a complaint.
At the last recorded visit, the patient reported continued improvement. She was continuing with self-care, including stretching and foam rolling.
Some clinical details have been generalized to protect patient privacy. Individual results vary.