I once had a patient, a very active 85 year old lady, Mrs. V – who was experiencing severe hip pain. She noticed it about 2 weeks previously after lifting a water bottle – there was no pain initially but it came on over the following few days. Mrs. V had a past history of some hip and back arthritis but was otherwise healthy. X-rays of hip and back were negative for fracture. Family was concerned and was being encouraged by other caregivers to place Mrs. V in a nursing home. They thought her recent decline was simply old age and since she was having difficulty managing at home, she needed to accept that she needed to move to a nursing home.
On examination, Mrs. V was walking with an antalgic gait, using a walker (two weeks previously, she did not need the walker). Upon further examination, she had full pain free range of motion of the lumbar spine. Hip range was 110 degrees of flexion, ½ range internal rotation and external rotation slightly limited. Muscle strength was within normal limits except flexion, which was weak and painful. There were active trigger points in adductors, psoas and gluteus medius. Reflexes and SLR were within normal limits. My diagnosis at that time was muscle strain. Goals for the first treatment were to reduce hip pain, restore function and clarify diagnosis re: hip flexion weakness. Treatment was acupuncture for general pain relief as well as dry needling to release the trigger points in the affected muscles. Following treatment, there was improved range of motion and decreased pain. Gentle ROM exercises were taught to the patient. On follow up visit, Mrs. V reported 1 – 2 days relief following the treatment then her pain returned – to the same severity as prior to the treatment. This was a red flag – when pain returns so quickly – further investigation is required. I contacted the doctor and requested further x-rays. A fracture was found and Mrs. V was admitted to the hospital for surgery. Following surgery, Mrs. V went home and went through standard post op therapy. She made an excellent recovery and continued to life happily and independently in her own apartment for many more years.
Janet Delorme
*For more information on dry needling, visit www.neseminars.com
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