Hip Problems

[NickiT]

I've been suffering with pain in my right hip for a few years now. I can't rememeber exactly when it started since it sort of crept up on me, but I do wonder if it's connected to the nasty ankle injury I suffered on the ice 3.5 years ago.

Anyway I eventually visited my GP just over a year ago but she was pretty useless so I went along to the physiotherapist I had seen when I was recovering from my broken ankle. He too never really got to the bottom of the problem.

In the meantime the pain got worse and I started to find that skating made it worse. I kept on telling myself I would get it sorted like you do.

Anyway in Febraury our local Chiropractic/Physiotherapy clinic were advertising on a stall in town so I booked myself in. I had an x-ray and the results were quite frightening. My pelvis is very twisted. To cut a long story short it appears that I have a significant leg length difference, my right leg being shorter than my left and this has caused my right hip to drop 2 inches lower than my left. I also have arthritis in the right hip joint because I've been skating so much on it while it was so out of line. I've been having regulary chiropractic and physiotherapy treatment but the pain remains and a new x-ray taken two weeks ago shows no change. I'm now starting to use orthotics - an insole to wear in my right shoe.

Naturally I'm somewhat worried about this and how it will affect my skating in the long term. After competing last week I'm taking a week out and going to ease off the skating over the summer to see if it helps with the pain. I'm so glad I sought treatment when I did because they reckon had I just continued to ignore it I'd be struggling to walk, let alone skate, 6 years down the line.

I would love to hear your feedback, especially if you know of anyone with a similar problem. At the moment it's unsure whether it's something that I was born like or something that occurred as a result of my horrendous ankle injury.

Nicki

[Elsy2]

So sorry to hear about you hip, it does sound frightening. I'm wondering if they also did a series of measurements to determine your leg length discrepancy. While my daughter was still growing (actually she still is growing..) I was told she also had a leg length difference, and her podiatrist had her wear a heel lift in one shoe. We later had a physical therapist do more precise measuring, and it was determined that the difference wasn't as extreme as we had thought and was within a normal range. In her case though, she was growing, and often one side will grow first and the other catch up. She also has periodic x-rays of her back, and sometimes due to her back pain the x-ray will make her spine look more crooked than it is simply because she is favoring one side due to back pain. I'm only saying this as the way you stand during x-rays can make them look worse than they actually are, and if you are in pain you may be standing in a way that makes things look worse...

It just sounds like 2" is a big difference that should have been noticed. Many people will have up to 1/4" difference and be fine. Those with a larger difference often do fine with a heel life or orthotic, so I hope that works for you!

I find that skating puts alot of stress on the hip flexor muscles, and stretching those is probably something we should all do. As to your ankle, I suppose it's possible that the healing of those bones could cause a leg length discrepancy that was not apparent before, but I'm not a medical person.

[NickiT]

Thanks for your input Elsy. I think it's unlikely that my leg length difference is as much as two inches, just that that is the difference in the height of the hips. They haven't actually measured my legs accurately but are surprised that I've never noticed it myself. To be honest since breaking my ankle people have often remarked that I appeared to be limping when in fact I wasn't and looking back this was probably as a result of this difference. I'm only on a very small heel lift at the moment as I need to build up gradually but I hope that this is going to do the trick. In the meantime I will continue with the stretches that I have been given to do.

Nicki

[jp1andOnly]

I had similar problems with my pelivs twisted, pain in the hips and an apparent leg length difference. I went to physio and we did ultrasound. We also found my IT band was so tight is was causing my muscles to tighten which led to pain, which led to my pelvis and hips being twisted and not aligned which then led to my leg length difference. Try doing some stretches for the IT band

One stretch is if you lay on your back and take your right leg and twist it so your knee rests over the left side of your body. Its hard to explain but my leg length difference of an inch is basically gone

[skaternum]

Okay, this is creepy. This is like reading a whole bunch of posts about me! I too had a twisted pelvis, leg length difference, sacroiliac pain, leg pain, incredibly tight IT band, hip joint pain, and all the other junk that usually goes together. I've been in physical therapy for 19 months now and have new orthotics too. It took almost a year to get the pelvis torque to go away. Just keep at the physical therapy. It probably took you years to get your poor body in such a state, so it won't get "fixed" overnight. If the problem is merely biomechanical, it can get fixed, but you'll have to patient and diligent. Good luck, Nicki.

[NickiT]

Wow!!! Someone who understands me!!! I did have incredibly tight butt muscles on that right hand side but with all the stretching that I've been doing and the physio too, these are now loosening up and in fact now my therapist isn't working on these - it's up to me to keep up with the stretching which I do. We are now working on the front groin muscle which is tight.

I was assured that this isn't a skating problem and I hope it isn't but obviously I am a free skater and I jump a lot and therefore I land on that side. I do wonder if the skating has made me a little lopsided, but I've never heard it on anyone else who is a skater. While it's not great that you have had to suffer, it's good and reassuring to hear of another skater with a similar problem. I've not been on the ice since Thursday and my hip (I daresay) is feeling better. Looks like it's a case of if I want to skate I've got to put up with the pain - for now anyway!!

Nicki

[rinsk]

Heh, sounds like my hips too...

I've got a twisted pelvis and knees and ankles that are also twisted funny and likely prone to injury as a consequence.

For the past couple of years, I've been getting recurrent tendonitis and bursitis in my hips. I can generally skate through it but I have to listen to my body and make deals with it (When it says, "no, that's the landing hip that's inflammed, you idiot", I hold off of jumps for awhile and work on other things. When it decides that I'm taking a break from rhumba and Westminster Waltz because it can't do the mhawk and choctaws, I have to drop them and work on dances that demand a little less in the way of contortionism).

[Patsy]

jp1andOnly--would you give further directions for that IT band stretch? I'm lying flat on my back, my right leg is straight up in the air, knee straight--now what?

Thanks for the help.

[NickiT]

Following another chiropractic session and another physiotherapy session this week, I now have confirmation from both practitioners that my leg length difference is actual and not apparent as we had originally thought and hoped. What it means is that the only real way of levelling out my pelvis and "losing" the 1.5-2cm difference that I have is to continue with heel lift in my right shoe. My physiotherapist is continuing to work at loosening the front muscle that runs from my spine to my pelvis as it is extremely tight at the moment. Both confirmed that it has nothing to do with skating but is just the way I am.

Nicki

[jp1andOnly]

I'll do my best to explain...

1. lay on your back with both legs straight
2. lift your right leg towards your chest but it should be bent. So actually you are lifting your knee towards your chest
3. Slowly pull you right leg (the knee will lead) over your left side of the body keeping it bent.
4. Your foot of the right leg will rest on the outside of your left knee (or will try depending on how tight you are)
5. The goal is to try and keep your pelvis straight and your hips. Do not let your body roll to the side. Try to bring your right knee to the ground which is hard and keep that pelvis and hips straight. The stretch can be felt at the back of your leg and in your hip. Switch legs


(i've heard this called the sprinters stretch but then again I could be wrong as I wasn't paying attention to the person)

Another stretch...

1.Lay on your back and bent your left leg so your knee is pointing up to the ceiling (90degrees). Your right leg should be down on the ground but bend it at a 90 degree angle so that you knee is pointing out
2. When you have done that, place your right foot on your knee. Your nee should be turned out. Its almost like you are crossing your legs. There should be a triangle that is made, between your legs
3.put your right hand thru that triange space, and your left arm around the outside of your left leg and grab your right hand. You should basically be hugging your left leg
4. Start using your arms to pull your leeft leg towards your body. You will feel the stretch. Repeat with other leg

(I believe my physio call this the pretzel stretch)

[skateflo]

Just to add some thoughts. I was having a horrible time getting on my ROE and finally ended up seeing a chiropractor as I wanted someone to really look at my whole body. An xray showed my right hip high, spine looked like scoliosis. His explanation included that sometimes stress, especially emotional, causes one to raise one side as if you are protecting yourself from harm (as if raising your leg and torso across in front of your body.) Over the course of treatments we got the hip down, spine much straighter, but it does require maintenance. My blade used to have to be mounted way to the inside but now is almost at the midline. I do require an orthotic in my right boot. I am very prone to tight hamstrings, IT band, and piriformis muscle, all of which effect my pain and skating. The other thing I have found is that if I work too much on the left side (spins, jumps, 3-turns, etc.) and ignore the right side, the twisting starts again. Most recently, I have found that I don't always place my knee over the 2nd toe but rather allow my knee to pitch so far inward that the torque really stresses my hip, knee, etc. I was having trouble with maintaining my balance over my spinning foot when I tried to swing my freeleg around - I kept falling to the inside - what was happening was that as I brought my freeleg around, my skating knee didn't stay straight but began to pitch inward moving my weight off the axis. It doesn't have to be misaligned much to cause injury. So I got out my back issues of Skating magazine when they had a series about off-ice exercises. Sure enough, balance and misalignment is the one of the most frequent causes of injuries. Now I really take some ice time to focus on watching where I am placing my knee and ankle. It is so easy to develope bad habits over time without realizing it.

I realize you are a much more advanced skater than myself, but sometimes we all need to go back to the basics. You might ask your coach or a friend to look at your alignment as you stroke, etc. or have someone do a video from the front, side, and back so you can look at it slowly.

You may be twisting more than you realize and trying to compensate in other subtle ways. I admit that off-ice exercises and maintenance can be a real drag especially if you work a full-time job etc.

Glad you finally found someone willing to work with you through all this.

[NickiT]

Originally posted by skateflo
You might ask your coach or a friend to look at your alignment as you stroke, etc. or have someone do a video from the front, side, and back so you can look at it slowly.


Thanks very much for your input Skateflo. The above is very true. My coach has often commented on the fact that I tend to skate with my left shoulder raised (it is my left hip that is higher than my right) and on my anti-clockwise crossovers my right hip appears to drop. Of course this is most probably connected to the twist in my pelvis and I have to admit I am finding it incredibly difficult to match the poorer side to the better side. I know everyone has a preferred side but for me I just have to work that bit harder on my weaker side to strengthen it.

Nicki

[skateflo]

Nicki,

A lot of us have weaker sides - just that we hate working it! As soon as I back off (laziness) from stretching, etc., back come the pains, tilt, and poor balance. Grrrrr!

You also might benefit from a good basic stretching book - like Anderson and his "everyday stretches" poster that takes 20 minutes. It really helps and includes all our skating muscle groups. I keep it taped up on my wall in my 'exercise' room.

I know how discouraged you must feel at times. My IT bands, hamstrings, and piriformis muscle (gives sciatic type pain) have been my nemesis.

On another note, hip pain can be caused by subtle things that only a really good orthopod and an MRI might be able to pinpoint - remember Tara Lipinski and Alexi Yagudin??? Small tears of the muscle and ligaments that attach to the hip can lead to chronic inflammation, etc. Trying to balance your love of skating and need to rest the hip can be very difficult. Remember you have a lot of years ahead of you (I assume) and you don't want to have a total hip replacement!

[sk8ndancr]

Nicki, I also have scoliosis due to a right leg which is one half inch shorter than the left. I never realized I had a shorter leg until I went to the chiropractor for back and neck problems. He ended up doing an X-ray, and showed me that the r shlr was 1/2 inch lower, and so was the r hip. Once he measured the difference on the x-ray, he gave me a lift for my shoe, which really helped the back problems. I had orthotics made for my skates, with the lift built into the right one, and skated like that for a couple of years. Eventually, I consulted with Harlick, and they recommended that I put a piece of leather between the blade and the boot, on both the ball of the foot and the heel, exactly the difference in leg length; instead of having the lift built into the orthotic. So I had another set of orthotics made, without the lift, and my skate fitter made me a spacer of leather, cut and shaped to match the blade plate. The difference was like night and day!! When the lift was built into the orthotic, it was like being in one high heel, and one flat. With the spacer, both feet are level. I can't tell you how much my skating improved!!! I am now working on Novice Moves and Pre-Gold dance. I think this is the best way to correct the problem. Good luck with whatever you decide to do! Don't give up; you will find something that works for you!!

[NickiT]

Originally posted by sk8ndancr
Nicki, I also have scoliosis due to a right leg which is one half inch shorter than the left. I never realized I had a shorter leg until I went to the chiropractor for back and neck problems. He ended up doing an X-ray, and showed me that the r shlr was 1/2 inch lower, and so was the r hip. Once he measured the difference on the x-ray, he gave me a lift for my shoe, which really helped the back problems. I had orthotics made for my skates, with the lift built into the right one, and skated like that for a couple of years. Eventually, I consulted with Harlick, and they recommended that I put a piece of leather between the blade and the boot, on both the ball of the foot and the heel, exactly the difference in leg length; instead of having the lift built into the orthotic. So I had another set of orthotics made, without the lift, and my skate fitter made me a spacer of leather, cut and shaped to match the blade plate. The difference was like night and day!! When the lift was built into the orthotic, it was like being in one high heel, and one flat. With the spacer, both feet are level. I can't tell you how much my skating improved!!! I am now working on Novice Moves and Pre-Gold dance. I think this is the best way to correct the problem. Good luck with whatever you decide to do! Don't give up; you will find something that works for you!!

Wow, that's very interesting. I never realised there were so many truly lopsided skaters about. As for me I consulted a chiropractor due to the increasing pain I felt in my right hip. Like you X-rays revealed that my right hip was a lot lower than my left, but unlike you I have no abnormal curvature in my spine. I've just skated for the second time with the heel lift in my boot and at the moment I'm only on a temporary one that is very thin, but once I get to the perminant one I will certainly consider getting the same done to my skate as you. What worries me with skating with the heel lift in place is that as it gets bigger, which no doubt it will, I will lose stability. Your idea sounds wonderful and would definitely overcome this problem. Thanks so much for your feedback.

Nicki

[skateflo]

Nicki,

The heel lift between the sole and the blade is excellant advice.

But I am also concerned about your ongoing hip pain. Is it improved at all? Do you think the skating is causing it entirely? If you are off the ice for 3-6 days, how is it then? If you need the lift for your boot, what about your everyday shoes? I'm just thinking that you correct the skate, then wear regular shoes so it puts stress on your hip (being lopsided) and the hip never has a chance to heal properly....just some more thoughts.

[NickiT]

Originally posted by skateflo
Nicki,

The heel lift between the sole and the blade is excellant advice.

But I am also concerned about your ongoing hip pain. Is it improved at all? Do you think the skating is causing it entirely? If you are off the ice for 3-6 days, how is it then? If you need the lift for your boot, what about your everyday shoes? I'm just thinking that you correct the skate, then wear regular shoes so it puts stress on your hip (being lopsided) and the hip never has a chance to heal properly....just some more thoughts.

The heel lift I use at the moment is for all my shoes. Originally I was to use it just two hours per day but I'm now increasing the amount of time I use it. I wasn't using it in my skate at all for the first two weeks, just my street shoes,purely because with the competition coming up I didn't want to risk throwing anything out skating wise, but now that the comp is over I've started to use it in my skate too.

I had 8 days off the ice after competing but unfortunately I still felt twinges when I first got back on. Even when I was off for a longer period with a sprained ankle I never lost the hip pain completely. I am aware that skating probably puts a lot of pressure on my hip and a bit of pain or discomfort when I skate is to be expected, but I do feel it when I do any other strenuous activity such as aerobics or taking long strides.

My physiotherapist has not advised me to give up skating and feels that the skating is not going to do me any harm, but obviously I am learning to listen to my body. It has improved a bit as I am now able to skate without painkillers which is pleasing!

Nicki

[sk8ndancr]

Nicki, I would think that the pain from skating is caused by skating with the uncorrected leg length. My scoliosis (and the pain) was caused by walking around without the leg length correction for 30+ years. When the chiropracter corrected it with the lift, he did it all at once, as soon as he measured the difference. As soon as it was corrected, the pain lessened and disappeared. The llift felt funny for the first couple hours; then I got used to it. I seem to remember working up to wearing it full time over 3-4 days. This was before I even started skating. If just walking around like that can cause pain and scoliosis, I would think skating on it like that would cause much more stress to your body. Why doesn't he want to correct it all at once? Or can he not measure the difference until the body relaxes more?

[NickiT]

Originally posted by sk8ndancr
Nicki, I would think that the pain from skating is caused by skating with the uncorrected leg length. My scoliosis (and the pain) was caused by walking around without the leg length correction for 30+ years. When the chiropracter corrected it with the lift, he did it all at once, as soon as he measured the difference. As soon as it was corrected, the pain lessened and disappeared. The llift felt funny for the first couple hours; then I got used to it. I seem to remember working up to wearing it full time over 3-4 days. This was before I even started skating. If just walking around like that can cause pain and scoliosis, I would think skating on it like that would cause much more stress to your body. Why doesn't he want to correct it all at once? Or can he not measure the difference until the body relaxes more?

It's interesting to see that you were corrected all at once. My physio and chiro both say that I have to increase the correction gradually because they think that it could "cause all sorts of problems" if we go for the whole difference in one hit. In fact last week I was told that they never build up to the full difference in leg length which surprised me. They estimate my difference to be 1.5-2 cm and I'm currently on a 2mm heel lift. I go back next week and will see what they say then.

I am interested and happy to read that the heel lift has sorted out your problems and caused your pain to go away. I really hope this will happen to me. Even today, just walking downhill with the lift in, caused me discomfort in my hip.

Nicki

[sk8ndancr]

Nicki, I am not too good with the metric system. How much is 1.5-2.0 cm? My difference was exactly 10mm, and they corrected it all the way. The way they measured it was right from the x-ray of my back; by making a horizontal line marking the height of each shoulder and each hip, and then measuring those differences, not the actual leg. Having spacers on the skate is definitely the way to go, though. If I could correct my shoes that way, I would! I suppose it would be a lot more noticeable than on skates though! Right now, no one ever notices it while I am skating. The only time anyone notices is in the locker room when I am taking them off! Keep me posted on your progress. Good luck!

[NickiT]

Originally posted by sk8ndancr
Nicki, I am not too good with the metric system. How much is 1.5-2.0 cm? My difference was exactly 10mm, and they corrected it all the way. The way they measured it was right from the x-ray of my back; by making a horizontal line marking the height of each shoulder and each hip, and then measuring those differences, not the actual leg. Having spacers on the skate is definitely the way to go, though. If I could correct my shoes that way, I would! I suppose it would be a lot more noticeable than on skates though! Right now, no one ever notices it while I am skating. The only time anyone notices is in the locker room when I am taking them off! Keep me posted on your progress. Good luck!

My difference is between 15 and 20 mm. They haven't gone by the difference in hip height on the x-ray though as due to the twist in my pelvis it is nearer 40-50 mm. When I first started having treatment my apparent leg length difference was 40 mm so that's a good sign that we've got it down, but now this is actual - the real diifference.

I'm glad things are working out for you with yours and I hope that in a few months I'll be able to say the same!!! Thnaks for your positive feedback!

Nicki

[NickiT]

I moved up to a thicker heel lift today. I have been suffering a bit with pain in my hip so I didn't skate yesterday but am hoping to get back tomorrow. Unfortunately my physiotherapist told me earlier that I will continue to have the pain for as long as I skate. Not good but I guess that's life:(

Nicki