Levi Perry

So I haven’t been in clinic since my surgery, but I did perform a hip exam on my Mom (Lol), so let me share:
She has been having bilateral hip pain (R>L) for upwards of a year to varying intensities. Subjectively, pain is on lateral aspect and some “deep down” in joint, as well as low back (she pointed to SI area). Pain is activity dependent and worsened by walking longer distances, standing, stairs, and some pivoting. No history of trauma or anything. When she told me this over the summer, I was thinking OA or lumbar, but after our hip unit, my primary hypothesis was glute med tendinopathy. Functional testing – DL squat had decreased depth, but was symmetrical and displayed no valgus or trunk lean and was only painful for both knees (she avoids squatting because of her knee pain…I left her knees for another exam due to time). Single leg stance displayed very poor balance, but no valgus, trendelenburg, or pain provocation. Active and passive ROM was normal. The only thing that reproduced her pain was inner flexion quadrant and FADIR (deep pain) and resisted IR (lateral pain)… she was not very irritable that day. At this point, I was confused by the presentation, but I was retaining my primary hypothesis of tendinopathy for a lack of a better replacement. The lack of ROM restriction largely ruled out OA, but I wasn’t really able to explain the deep pain from FADIR. I was also thinking that there was very likely not just one thing going on… maybe FAI or minor OA provoked by FADIR, tendinopathy provoke by resisted IR, and SI playing some role here? I skipped PAM because there was no ROM loss. Glute med MMT was about 4/5, but caused no pain (which really surprised me). FABER (-), Straight leg test (-), Scour (+ only in inner flexion quadrant), de-rotation (+). Palpation to glute med tendon painful, as well as glute med and TFL muscle bellies (glute > TFL), greater trochanter painful. Palpation to Right SI joint produced localized pain. I told her she would have to wait until I learned about the SI joint, but that there was likely something going on with it, and potentially strengthening glutes could help stabilize it. Easily the most provocative aspect of the exam was the palpation. I educated her on potential aggravations to a glute med tendinopathy (she sleeps on R side and doesn’t use a pillow between legs). I previously had given her the Myrtl hip routine and some stretches, but i told her to focus less on the stretches, which could potentially even aggravate things, and focus more on clamshells, SL abduction, and maybe a glute max exercise. I told her to do the exercises until fatigue or loss of form, and let me know if they aggravate her too much. I would really like to have her doing DL or SL squat stuff, but it bothers her knees too much. My plan is to progress the clamshell and abduction to something more functional, like step ups/downs (if knee can tolerate), and something in single leg to work the glutes and also her balance deficits.