Someone walks in convinced the problem is their back. The ache sits low, it has been there for months, and every conversation so far has been about the spine. Then you ask where exactly it hurts, and the answer is the groin.
That moment is the whole subject of this week's Pain 2 Power. Dr. Dave Kashuba and Mike McGann sat down with orthopedic surgeon Dr. Zach McVicker of the Paley Orthopedic and Spine Institute in Jupiter, who spends his days on the joint that keeps getting blamed on its neighbor.
By The First Rehabilitation Team · Reviewed by Dr. Dave Kashuba, Ph.D.
The hip that hides behind the back
Dave opened with the pattern he watches for. A patient reports back pain, but the pain travels toward the groin rather than down the leg. That points at femoroacetabular impingement, where the socket and the ball of the hip do not clear each other properly through range.
Dr. McVicker sees the same referral pattern from the other side of the table. “A lot of times it's causing the back pain, it's causing the groin pain and other symptoms that you're having,” he said. He listed what else should raise the question: pain toward the buttock, SI joint pain, soreness on the outside of the hip, and in some patients pelvic floor dysfunction. His summary of when to get it looked at was short. If you cannot find a reason for these things, the hips are worth checking, and often they are the answer.
An oval peg in a round hole
Impingement arrives in two shapes, and Dr. McVicker has a plain way of describing each. In a cam lesion the ball itself is misshapen: “instead of being round, it's more like an oval peg in a round hole.” In a pincer lesion the socket covers too much of the ball. Cam lesions skew male, pincer lesions skew female, and the pincer side is the harder repair. The labrum is often calcified by then and has to be reconstructed rather than simply repaired.
His description of the labrum is the one worth keeping. Think of a gasket between two pipes. It creates negative pressure, and that suction seal spreads your body weight across the whole dome of the joint every time you take a step. Lose the seal and the pressure concentrates on cartilage that was never built to carry it that way.
Dysplasia, and why it does not wait
The second most common problem he treats is hip dysplasia, which is the mirror image of a pincer. The socket is underdeveloped, so instead of load spreading across the dome there is not enough dome to spread it across. The result is edge loading, and he was blunt about where that goes: it “ends up in arthritis 100% of the time.” Labral tears show up early, and the soft tissue around the joint takes the stress.
The patient he described is a gymnast or a dancer who put in five hours a day for years while the hip was still developing. Around here the list also runs to basketball players, marathon runners, and, as Dave pointed out, seventy-year-olds playing tennis who are meeting this diagnosis for the first time.
Why early matters more than dramatic
Arthroscopic hip surgery is small: little cameras, poke holes, and a recovery Dr. McVicker described as much less painful than a total hip, though return to sport takes somewhat longer. The trade he cares about is a different one. A replacement gets you feeling normal quickly, “but it's not your own hip. You don't have the proprioception” that a native joint gives you.
Dave picked that word up and turned it into something you can test at the kitchen table. Close your eyes, let someone lift one of your fingers, and see whether you know it moved. People lose that sense, and in the lower body losing it means missteps. Missteps become falls, and a broken hip in an older adult starts a decline that is hard to reverse. Prevention work like this sits at the heart of our physical therapy program.
What Dave sends people home with
Behind most painful hips he finds a weak gluteus medius, and one exercise does the heavy lifting. Sit to stands, with a resistance band looped just above the knees. A sore hip makes you shift your weight onto the other leg without noticing; the band forces both sides to share the work. He adds standing leg abductions at the back of a chair, clams for the external rotators, and a prone cobra with the pelvis staying on the floor. His practical note was to make sure you can get back up before you get down there.
He also had advice about choosing who treats you, delivered in his usual style: do your research, and do not take a recommendation from the lady at the water cooler or in the Publix line.
Listen to the full conversation on the Pain 2 Power podcast page, watch episodes on our video library, and read more about how we treat hip pain and back pain. If your back pain has never quite added up, call us at 561-624-4263 or request an evaluation.
This article is general information, not medical advice. Every situation is different, so please consult a qualified professional about yours.