Torrance Orthopaedic & Sports Medicine Group
Physical, Hand & Aquatic Therapy
23456 Hawthorne Blvd.,
Torrance, CA 90505-4716
OPENING FALL 2017!
July 15, 2016
"My hip makes a snapping sound when I move it, and I can feel it pop. Is this a serious problem?"
The large muscles and tendons in the hip sometimes become so tight that they pop and make snapping sounds when they move over the bony surfaces of the hip joint. As long as it doesn't hurt, it's not considered a serious problem and probably doesn't need medical attention. It can, however cause painful swelling of the hip bursae, which are the little fluid-filled sacs that add cushion in the hip. Their job is to be the pain-free buffer zone between bones and the muscles and tendons that rub over them. When they're unable to do this, they become painful and swollen, causing a condition called bursitis.
Snapping hip can be felt in the back or front of the joint. There is a large tendon in the front of the hip that moves back and forth over the top of the thighbone from front to side. There is a smaller tendon in front of the hip that can catch on the bony structures as well. The hamstring muscle can catch on the "sit" bones in the back of the hip. Snapping in any of these three places would be felt and/or heard.
A more serious cause of snapping hip may be damaged cartilage. Torn cartilage catching on the inner structures of the hip joint can become extremely painful to the point of no longer being able to walk. Pain that interferes with daily living should be addressed by a doctor. Earlier treatment may put off surgery or help avoid it altogether, although every patient is different.
Athletes of any age who participate in repetitive hip-bending activities may be prone to snapping hip, but adolescent athletes are especially prone because muscles can be tight during growth years. Dancers are also particularly prone to the condition. An orthopedic doctor specializing in the hip area or sports medicine has a lot of experience helping patients with this condition. To properly diagnose it, he or she will want to know what activities bring the pain on, will take a health history, and will probably x-ray the area to rule out bone problems.
Physical therapy, special stretches, anti-inflammatory medication, injections, activity modification, rest, and ice are all common nonsurgical treatments to alleviate pain associated with snapping hip issues. Surgery may be necessary if these treatments fail or if cartilage needs to be repaired.
January 22, 2016
Who's at risk for a hip fracture?
A hip fracture is actually a break at the top of the thigh bone, just below the hip socket. These types of injuries are painful and very serious. Someone with a broken hip cannot walk. Most hip fractures happen when someone with low bone density falls or was injured in an auto accident.
Women with small builds over the age of 65 are by far the most at risk for hip fractures. Genetics, family history, and hormones also play a part. However, even if you or a loved one have some or all of these risk factors stacked against you, there are several effective ways to reduce the chances of getting a hip fracture. Here are some of the best ones:
• Diet: Eat a healthy diet with enough calcium and Vitamin D. If your diet alone doesn't provide enough, your doctor may recommend calcium supplements. Make sure to take the correct amounts—too little won't help your bones enough; too much can cause other health problems.
• Exercise: Even moderate exercise, such as stair climbing, jogging, hiking, swimming, and many others, slows bone loss and increases muscle strength around the hip area, which stabilizes and protects the bones. Weight bearing exercises are especially helpful because the bones respond by building themselves stronger, increasing bone density.
• Balance/Stability: Having good balance reduces the likelihood of falling. There are many balance training exercises that can improve the body's stability. Some medications can cause dizziness or fatigue, so be aware of any side effects that could increase the chance of falling.
• Other Hip Problems: Be aware of any other problems in the hip or back that could contribute to poor posture or add stress to the hip bones. A board certified orthopedic doctor can help diagnose and treat those conditions, and in turn reduce the risk of a future hip fracture.
August 5, 2015
Alcohol in Moderation for Healthy Hips
Excessive alcohol consumption over time, often defined as alcoholism, can be a risk factor in disrupting the blood supply to the "ball" part of hip bone. Once the blood supply has gone from the bone, it dies, and the ball, or femoral head, must receive medical attention to avoid total collapse. The condition is called osteonecrosis of the hip. It affects more men than women and is most common among 40-65 year olds.
Alcohol is not the only suspected cause of bone death in the femoral head. Previous injuries can cause damage to the blood vessels in the bone. People who use corticosteroid medications long-term are also believed to be at a higher risk. Certain diseases and conditions, such as Crohn's disease, sickle cell disease, and several others, also may predispose someone to hip osteonecrosis.
Gradual onset of pain, from mild to intense over a period of months to up to a year is common. Pain can be present both in and adjacent to the hip joint and in the buttocks. In advanced stages, weight bearing and everyday movement of the joint can become difficult.
Nonsurgical treatments often do not work for patients with osteonecrosis of the hip. That's because it's a progressive condition that worsens over time. There are many surgical techniques that usually give better results:
• For early diagnosis, before collapse:
• Pressure relief (called core decompression) on the bone is a drilling of holes through the femur up to the head. This encourages blood supply to reestablish from the living section of the femur up into the dying head area. A bone graft to strengthen the weakened section of bone can help the area rebuild itself quite successfully. Many patients report complete relief of symptoms after recovering from this procedure.
• A bone graft from the patient's own leg bone containing a viable blood supply is called a vascularized fibula graft. This can be implanted into a hole drilled into the femoral head, where it can add circulation and strength to the dying area. When the condition is diagnosed early, this procedure can also offer a very successful recovery.
• For late diagnosis, after collapse:
• A total hip replacement is recommended at this stage. This procedure has a very high success rate (90-95%) for returning patients to a healthy, active lifestyle that is free from hip pain.
June 8, 2015
"I have a sudden pain in my hip and groin!"
Sudden pain that doesn't go away is usually caused by a single event and is probably an injury. The twisting, cutting, and pivoting movements in some intense sports are often the culprits.
Pain in the groin area, right next to the hip joint, may be what is commonly called a sports hernia. A sports hernia is not actually a hernia at all, however. Its real name is "athletic pubalgia," which is a tear of the soft tissues in the lower abdomen and the upper leg where they attach to the pelvis near the groin. The condition is more common in men than women.
Athletic pubalgia can eventually lead to a regular hernia with underlying organs pushing out, but most people seek treatment before this happens. Failure to seek treatment can result in terrible pain and can prevent someone from returning to their sport.
Treatment for athletic pubalgia is usually nonsurgical. Rest from the extreme sport that caused it is the most important part of recovery. Ice, physical therapy, and anti-inflammatory medications are also essential. Returning to sports should be done cautiously at first. If the pain returns, surgery may be necessary to repair the torn tissues.
Surgical options include endoscopic or open tendon repair, cutting of a nerve that causes the pain, or even the cutting of a tight tendon so it can grow back longer, be under less pressure, and give the athlete greater range of motion.
April 20, 2015
"I have pain in the back of my hip. Is it time to consider hip replacement?"
Pain in the back of the hip can be deceiving. Many patients with that symptom come into our office thinking they have a hip problem, when many times the diagnosis is a back problem. Often the pain is radiating out of a pinched nerve in the spine, and if that's the case, it's actually time to see a spine specialist.
Other types of hip pain don't mean a hip replacement or other surgery is inevitable, either. Once a diagnosis of a hip problem is confirmed, there are many types of conservative, non-operative therapies to delay or avoid a hip replacement:
Anti-inflammatory medications, RICE (Rest, Ice, Compression, and Elevation), heat and stretching, weight loss, low-impact cardiovascular exercise, and judicious use of cortisone injections can be extremely effective. Newer research is scant and the reports only anecdotal, but Platelet Rich Plasma injections and stem cell therapy with the patient's own stem cells have shown a lot of promise and are the "hottest" areas of trial and research in this area.
January 29, 2015
Teens Can Get a Pelvis Fracture, Too
Athletic teenagers who have sudden pelvic pain during intense sports may describe symptoms similar to that of a pulled muscle. It may be a small pelvis fracture instead: the hamstring muscle attached to the pelvis has pulled away and taken a small piece of bone with it. Prompt medical attention is advised. An x-ray and examination by an orthopedic specialist is the best way to properly diagnose this injury. It will normally heal without surgery but still needs treatment. Patients will often need crutches for 10-12 weeks and may also need blood thinners to protect from blood clots. Physical therapy can be prescribed to help the teen athlete return to sports.
Elderly people with osteoporosis are also susceptible to pelvic fractures, especially after a fall during normal everyday activities. Because their bone density is lower, the bones are brittle and can break after even a moderate fall. Just like the teen athlete's fracture, this type of fracture will heal best if the patient is treated promptly. Surgery is also usually not necessary.
The most common type of pelvic fracture is from high-speed trauma, such as that from a car accident or fall from a height. Accidents that crush the pelvic area are particularly dangerous. Immediate medical attention is required in all of these trauma situations. Severe damage to the pelvis and internal organs often leads to excessive bleeding, which can put the patient at risk of going into shock. Surgery is usually necessary to restore the patient to function and health, and recovery may take a long time.
An orthopedic doctor is a fantastic resource to consult for any type of pelvic injury. He or she can properly diagnose the injury and will be especially helpful in constructing a strength and recovery plan that is tailored specifically to the patient's athletic goals and lifestyle needs.
November 13, 2014
Hip Pain: Causes Can Begin in Childhood
Not all hip pain is associated with arthritis. FAI, or femoroacetabular impingement, is a condition where the hip bones form in an abnormal shape during childhood. The hip is a ball and socket system with cartilage between the bones. With FAI, there is extra bone on the ball, socket, or both. It wears down the cartilage and eventually can become painful.
Who gets FAI symptoms?
1) Many people with FAI don't feel pain for decades after their hips have formed
2) Some people never have pain
3) People with FAI who are extremely athletic can develop symptoms from the teenage years on
How is FAI pain treated?
Conservative treatments include activity modification, physical therapy to strengthen the hip muscles, and anti-inflammatory medications. If those treatments do not work, hip arthroscopy surgery may be necessary. During the surgery, the orthopedic surgeon's goal is to trim and reshape any bone deformities and repair damaged cartilage.
September 4, 2014
"Creak! Pop! Ouch!"
Hip Joint Osteoarthritis
Osteoarthritis is a major problem for the general population. The CDC reports that:
• Of persons ages 45–64, 30.3% report doctor-diagnosed arthritis
• Of persons ages 65 or older, 49.7% report doctor-diagnosed arthritis*
There are different types of arthritis, but osteoarthritis is by far the most common form of the disease. Osteoarthritis affects most weight bearing joints, especially knees and hips. It is "degenerative," meaning it comes on gradually, wearing away the cartilage that covers the ends of the bones.
This results in a hip that is usually more stiff and painful in the morning than in the afternoon. Rotational movements like getting in and out of the car are often the most difficult. Other symptoms include crepitus (creaking and popping), warmth, and inflammation.
There is no cure for osteoarthritis, but non-surgical or surgical management commonly address the symptoms. Treatments include anti-inflammatory medication, physical therapy, and exercise modification. More advanced, very painful cases of osteoarthritis often require surgery, ranging from arthroscopic debridement to total joint replacements. A hip replacement can last 15-25 years.
*MMWR 2013; 62 (44) 869- 873. [Data Source: 2010- 2012 NHIS] http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6244a1.htm?s_cid=mm6244a1_w
July 3, 2014
Hip Replacement: Is it time?
Nearly 4 million* people each year go to the doctor for orthopedic hip problems. Fewer than 10%** of those visits results in hip replacement. So how do you know if you're going to end up among them?
Our doctors weigh in:
Todd A. Shrader, MD says, "If you're having hip problems, see an orthopedic doctor so you can have specialized care aimed at getting you back to as close to 100% of normal as possible. That's the real advantage to being treated by an orthopedic surgeon. It doesn't mean you need surgery. You're just in the hands of someone who is in tune with your problem and has a ton of experience helping people a lot like you."
What about pain?
"Sharp, debilitating pain, or pain that keeps a person from their normal sporting activity should be enough to bring someone in to see a doctor," says Glenn J. Huber, MD. "If the pain is keeping you from comfortably doing the activity that you're trying to do, whether it's an activity of daily living or a sporting activity, then it shouldn't be ignored."
Once you see a specialist, he or she can evaluate you by thoroughly investigating your medical condition and history. It's likely they'll take images of your hip before creating a treatment plan for you.
April 24, 2014
Athletes! Stiff and painful hips in the morning?
Your Hips Don't Lie…
A labral tear is a tear in the soft elastic tissue surrounding the outside rim of the hip socket. The labrum helps to hold the head of the femur (ball on the top of the upper leg bone) in place. Labral tears typically occur gradually, but sudden trauma can also cause damage.
Some symptoms of a labral tear are:
• Catching, clicking, and pulling in the hip
• Hip is stiff and painful in the morning
• Deep pain in the groin on the affected side
The injury is common among young and middle-aged athletes, especially those in sports such as football, hockey, soccer, and running. Several years ago, before better imaging techniques like MRI scans became widely available, labral tear injuries were often diagnosed as "groin pulls."
Treatment does not have to include surgery. Non-surgical options include physical therapy, changing exercise routines, and medications.
In more severe cases, surgical procedures such as arthroscopic debridement (shaving the torn portion of the labrum) or arthroscopic repair (securing the torn portion to its normal position) can be performed. In very severe cases, arthroscopic labral reconstruction (adding to the torn labrum with a graft) may be necessary.
February 21, 2014
Outer Hip Pain Can Be Caused by Trochanteric Bursitis
Trochanteric bursitis is the inflammation of the bursa (fluid-filled sac near a joint) on the greater trochanter, or bony part of the hip. Bursa sacs are located throughout the body and act as a cushion between bones and soft tissue. Healthy bursa reduce friction and irritation, but inflamed bursa cause discomfort and pain.
When the hip bursa becomes irritated or inflamed, it causes pain at the hip on the outside of the hip and thigh or in the buttock.
Causes for irritation can range from overuse, incorrect posture, injury, previous surgery, rheumatoid arthritis, spine problems, bone spurs, or calcium deposits. It's most common in women and middle-aged and older individuals.
Common Symptoms of Trochanteric Bursitis:
• Pain that increases with getting out of the car or from a low seat
• Pain walking up stairs
• Pain while lying on the affected side
Treatment for Trochanteric Bursitis does not usually require surgery. Doctors typically design a treatment plan that fits well with an individual's lifestyle. It can include activity modification, anti-inflammatory medications, corticosteroid injections, and physical therapy. The condition usually improves with measures like these.
Acute (sharp) pain, any pain that interferes with daily activities, or when the area is red, swollen or warm should be evaluated by an orthopedic physician.
October 22, 2013
Is Your Spine Making Your Leg Hurt?
WHAT IS SCIATICA?
Sciatica is characterized by low back and buttock pain that radiates along the back of the thigh and sometimes to the toes. Numbness and tingling along with limited trunk range of motion can also present. People will sometimes complain more of leg pain versus low back pain. The pain can be described as dull, aching, or sharp. As we get older, changes occur in our spinal discs. In a herniated disc, the material inside the disc bulges against the spinal ligament.
WHO GETS IT?
This condition is commonly seen with people between the ages of 40-60.
HOW DO YOU GET HELP?
Treatments include short-term bed rest, physical therapy, medications and in rare instances, surgery. Statistics show that the condition resolves within 2-4 months with non-invasive treatment. Only a small number, about 2%, of patients will undergo surgery.
September 23, 2013
Do orthopedic surgeons always want to operate?
An orthopedic surgeon is first and foremost a medical doctor who helps patients get better. Most of the time that doesn't mean actually having surgery. The doctors at TOSMG estimate that for every patient who comes to them with orthopedic problems, less than 1 in 10* will actually have surgery. So what happens to the rest?
Physical therapy, rest, ice, anti-inflammatory medications, changing habits, injection therapy, and stretching are among the most common prescriptions for our patients. It's only when a combination of these more conservative treatments fail that surgery may be suggested. But the simple fact is that most people get better without it.
*Estimate only. Does not include patients who are referred for a surgical consultation, meaning that another doctor has already determined, and that the TOSMG doctor agrees, that the patient needs a highly trained, expert orthopedic surgeon in order to get the best outcome.
September 16, 2013
Helping a Hurting Hip
Hip bursitis is diagnosed when the fluid-filled bursa sac around the hip joint becomes inflamed or irritated. The condition is most often caused by repetitive, minor impact on the area, or from a sudden, more serious injury. People over 50 and especially women are most commonly affected by hip bursitis, and they may have the following:
• Hip pain
• Hip tenderness
• Pain made worse by repetitive movement
• Stiffness around the hip joint and outer hip
• Pain at night while lying on the hip
See an orthopedic doctor if you have any of these symptoms. Hip bursitis shares some common symptoms with other orthopedic problems, and can go misdiagnosed for years as a result. It may also coexist with obesity, arthritis, and back pain. To get an accurate diagnosis, see an experienced orthopedic doctor who will conduct a thorough physical exam and take MRI and/or x-ray images.
There are many treatment options for hip bursitis, including rest, cold packs, anti-inflammatory and pain medications, cortisone injections, stretching, physical therapy, and more. Surgery is rarely recommended.
March 4, 2013
"Proper Use of a Cane"
Using a cane or other assistive devices can help in relieving/decreasing pain, adding stability and easing the pull of certain muscles.
Here are a few helpful tips on how to use a cane:
A) Walking: The assistive device should be used on the opposite side of the affected limb. If used for balance, pick a side that's most comfortable.
Move the cane and affected limb at the same time. Stand tall with good posture and look ahead, not down at your feet.
B) Proper fit: The length of the cane should be adjusted so that the top of the cane should line up with the wrist joint when standing straight with the arm completely relaxed at your side.
C) Going up Stairs: Up with the "GOOD". Step with the unaffected limb first.
Then move the cane and affected limb up to the step together.
D) Going down Stairs: Down with the "BAD". Step down with the affected limb and the cane together.
Bring unaffected limb down to the same step. When negotiating stairs, it's always safer to use a railing with the free hand whenever possible.
October 1, 2012
Piriformis syndrome is a disorder in which the piriformis muscle compresses the sciatic nerve. The piriformis is a flat band-like muscle located in the buttocks and assists in the stabilization in the hip joint. The sciatic nerve either passes through or runs alongside the piriformis muscle and branches out to innervate the muscles of the leg. Pain, numbness and tingling can originate in the buttock but can travel down the length of the leg, when the piriformis compresses the sciatic nerve. These symptoms can be triggered with firm pressure on the muscle, climbing stairs or sitting for extended periods of time. A physical exam using certain movements to elicit pain by a doctor or physical therapist here at TOSM can be used to help diagnose piriformis syndrome, although there is no definitive test. Avoidance of aggravating factors, rest, ice/heat and a stretching/exercise program are traditional treatments for piriformis syndrome.