Recurrent LBP and clicky hip / pubic symphysis

[joddles99]

Hi There,

Any suggestions greatly appreciated.....

31 yr old female, initially injured lumbar spine 2005 when went to sit in a chair misjudged it and landed on the floor. Since then every six months has had trouble with her back, eac injury tends to settle but currently trying to get to the bottom of the problem to stop it from recurring yet again. Following the initial injury was off work for about 3months, xrays showed sacralisation of L5, MRI scan fine.

Currently all LBP has settled but patient describes hip pain and reports that it has been a problem off and on ever since original injury but til now had always put it down to standiung all day. Patient works as a cafe manager and is slightly overweight but relatively active in walking 40mins to and from work most days.

On assessment today active lumbar movement is full and no real tenderness on palpation. Piriformis, Gluts and TFL all tight and very tender to touch. Passive hip flexion creates pain in the anterior hip at end of range and the flexion at 90 degrees is coupled with external rotation. Flexion with adduction is quite sore. If she lies on her back and bends her leg up actively on straightening it there is a click somewhere in the front of the hip, if i press against both ASIS's the click is removed so I'm thinking maybe pubic symphysis.

i treated today with hip distraction glides with seatbelt which removed the catch with hip fl and adduction combined. and TP's / STM to gluts etc. She is doing pilates and back stretches and i've given her stretches for her gluts, piriformis and TFL.

Any suggestions regarding the "click"/ instability?

Cheers

[linbin]

as from the information my differential diagnosis will be
SIJ DYSFUNCTION
SPRAIN TO SIJ POSTERIOR LIG
HIP JOINT PATHOLOGY
PUBIC SYMPHYSIS DIASTASIS

so do all the relevant tests related
approach the case from movement impairment syndrome perspective
try wearing a belt around pelvis for a couple of days and implement pilates core ex