Saturday, December 29, 2012

All signs point to pectineus

Update: I am doing dry needling for the trigger points in my pectineus, and it is working wonders. If you can find a physical therapist that does dry needling in your area, please do it because it is amazingly effective.

It’s been about two weeks without squatting (or working out at all, unfortunately), and the pain in my hip has alleviated quite a bit. As I think about it the symptoms seem to point to a strain than protecting a joint more and more.  As I
Pectineus trigger points. If it hurts
here, it's probably the pectineus.
continued squatting the pain got worse and worse.  At first, after the previous PRP treatment, I didn’t have any pain at all, it felt amazingly normal.  Then I tried squatting again.  I remember the first time I tried front squatting I felt something in my hip go off, kind of like a pop.  I just figure it was the damage in the labrum, but now it’s becoming apparent that it was the pectineus.  While this makes me feel foolish/wasteful for an unnecessary PRP treatment, the idea/hope that this is merely a muscle strain makes me feel… cautiously optimistic.  As usual.

I realize I must sound crazy, going from one idea of what’s wrong to the next, but my hip keeps presenting different problems. The pain has moved around, it seems like muscles (e.g. psoas) that were tight from protecting the hip joint are no longer tight. Meanwhile, other muscles like the pectineus, are tightening up. This hip issue has been like those Russian nesting dolls where each doll holds another one inside of it.  Every time you think you’ve reached the end, that there couldn’t be another doll, there is.  Every time I find and address one issue, another one shows up in its place. Every time I peel back one issue, it reveals another.  I understand this is the price I pay for being active, that most people, years ago, would have just given up and said “ok, well, I guess I just can’t squat anymore” or something like that. But I really, really believe that I should be able to do whatever I want without pain. Just because it’s really complicated doesn’t mean it’s impossible.

I’ve found this thread on Tnation that is helping me diagnose this as a pectineus problem and not as a psoas problem. To surmise the thread:

  1. If the pain stems from squatting, it probably isn't the psoas since the psoas is hardly at maximal stress during the squat. However, if you experience pain coming into and getting out of the hole, then it is probably the pectineus.  As you get into the hole (end of the range of motion) you stretch the pectineus and other adductor muscles as well. As you come up, those muscles have to fire to counter the effects of the glute med/min on the knee's position.
  2. To diagnosis: lie on the floor, bring both knees up to either side of you chest, like they would be in a deep squat. Is there muscular pain? If yes then unlikely to be psoas, more likely to be adductor related, specifically pectineus.
  3. Any pain/tenderness on the pubic tubercle? Again yes points to pectineus, since that is the origin of the muscle.
So the plan is to rest it for a while, perhaps until it stops randomly hurting throughout the day, and then the whole stretching and rehab thing can begin.

[Edited on 7/11/13, added points on dry needling and took the info from the Tnation link and put it on the post in an easier to understand format]


Jake said...

Hi Adam, do you experience pain as well when performing the lying hip internal rotation test on the affected side ?

Adam said...

I just tried self administering that test and I don't seem to feel anything on the affected (right) side. I do feel some pain when I do it with the left side. I already knew this and I'm currently getting some PRP treatments for the left side, and it seems to be related to the pain on the right side. ...It's very strange.

Why do you ask?

JAke said...

I am facing similar issues, pain when coming up from the bottom of a squat.

It has been a year plus or so and all the foam rolling and mobility drills don't seem to help much.

Already scheduled an appointment for scans with my doc to rule out any tears/tissue damage.

Thanks for your time. Can't wait to get back to squatting again. :)

Adam said...

Well if you live near Austin I highly recommend Dr. Fullerton. Of all the Drs I've seen he seems to be the most adept at identifying what is going on with my body. If you have any other questions feel free to email me at