She limped in the room with a cane, beautiful deep dark skin, high cheek bones with large eyes, coved with a tint of redness, possibility from crying. She sat confidently. She could have been an African royalty by her mannerism.
Good afternoon, welcome to the clinic, how can I help you? I am here because for my hip pain, back and neck pain. I use this cane, without it I am afraid to fall. What happened that you ended up with this hip pain and a cane?
I slipped and fell off a flight of stairs. I work in East LA school district as a Special Education Teachers Assistant. We see kids that are in gangs or are academically behind. There are these Hispanic kids in my school who were harassing me and calling me Monkey, and make monkey sounds when I pass by,… her tears rolled down her check landing on her shirt, she gracefully and bashfully took her fingers and gently wiped her tears away to avoid her mascara covered her skin.
My jaw dropped! That was not what I expected to hear in 2018, in America! WTF! We had a black president, we are in a democratic state, we host immigrants from all over the world. She is an educated, respected 50-some year old woman. How could this happen? We have systems, laws, regulations. (What in the world!!!!! Is this behavior all about, from another minority)?
You see, I am from Panama, the English speaking side, the Spanish gang in my East LA school , 4 boys, from 14-16, think I am black, they harassed me calling me names and bullied me in hallway as I was passing, I got nervous and scared wanted to get away I rushed towards the stairs leading to faculty room, I missed the first step, fell off 8 steps landing on my hands and side. One of the teachers who was going to her class saw me and came to rescue. Embarrassed scared, and in pain, I put myself together and walked away hoping walking will take away the pain.
Took few days off, I contemplated to file for work injury but am so scared of losing my income. So I decided to be quiet, just stay in during breaks and lunch to avoid running into to them in the schoolyard.
I listened in disbelief and was heartbroken for her. All I can do is just do my best for her. “Sometimes its not doing the right thing that matters its doing what is the best to be done given the circumstances you are faced with.” She said while holding back the tears.
Sharleen, I reached out to her and held her hand. I will do my best to take care of your pain, that way, you can make the best decision for you and your family when you feel healthy Ok? She managed a smile and in her Caribbean accent said “that would be a good”.
So what area of your body bothers you most that you want us to address first together?
I have terrible hip pain [Fig-1] without this cane I cannot move around, the pain is too terrible. It sometimes radiates to my back or front of my leg. Its worst when I sleep on it or sit for too long, stand in line at supermarket. I warm it up at home by the pain is unbearable. I have to hold on to the stairs to walk up/down. Its there all the time and gets worse or better thru out the day.
My examination was to find the underlying cause and prioritizing her condition based on her examination and response to tests.
[Fig-2] Trendelenberg test: is (+) for weak gluteus muscle, lack of stability in walking is consistent with her pain pattern. She feels sever pain with palpating the area around her hip and worse with any resistive static hip muscle tests. Active and passive ranges of motion (ROM) were limited overall by 50-80%, but it was the resistive ROM was extremely painful.
Xrays: 2 view Hip, 2view Lumbo-Pelvic, (Seated and Standing AP-Pelvis). & 4 view L/S. These are dynamic x-rays to show how your body is compensating or has learned to adapt to damages and your limp.
Along with your exam findings and x-rays, its easier to find the underlying cause of your problem to help determine if your problem is soft-tissue or hard tissue (muscular vs. skeletal). From there we can ascertain the best course of care for you.
Soft tissue treatments
Phase I: mild myofacial release and P-ROM, PhaseII: deep tissue and – ART, if at any time you feel worse we need to bring in medical support for Trigger point Therapy (TPT) with injection if necessary.
So this is a 2 part problem:
- Pelvis tilts with every step upward and forward. The forward tilt can cause “Femoral Acetabular Impingement” and groin pain.
- Pelvis unstable due to muscle weakness. Muscles/Tendons/Bursa inflamed due to above. Note that until the muscles are strong this will continue to be a problem. The exercises may be painful or cause pain but they will continue to contribute to the problem until they are strong so its important to use OTC [over the counter] pain relief to get you thru the acute while we work towards goal of Phase I care program: (To reduce pain and inflammation as a tool to get the muscles strong).
Hip traction, Ultrasound and heat along with spinal alignment and trigger point care will help you perform your exercises as below while in office: GLUTEUS MEDIUS STRENGTHENING – 45 degree HIP ABDUCTION STRENGTHENING STANDING or SIDE LYING recommended 4x per day sets of 10-15 reps.
- By 4th week she was 50% better, and was diligent with her home care.
- By 12 week she was pain free, Cain free and back on her feet walking without a limp. She would need to be proactive with her health and join swimming classes or aqua aerobics. She mentioned she has been stronger than before physically and emotionally.
Should you need any help or know of someone who needs help do not hesitate to contact us. Do not sit back and watch a curle discrimination or unjust actions injure, hurt or insult fellow human beings.
We are all children of this world.
Dr. Romina Ghassemi