I thought I would provide the readers of this column a first hand account of how medical standards can fall short when it comes to pain at the hip region. My office is located in New York. I was asked to examine a woman who lived in Texas who was told that she required a total hip replacement. She was told that the severe pain that she was having in her left hip region and inner thigh was the result of having no cartilage at the hip joint: the proverbial "bone-on-bone" scenario.

This woman had to walk with a cane to take all weight off her left leg due to the severe nature of her pain. She had seen several orthopedists who were all in agreement that the x-rays showed that her hip was was "bone-on-bone" and that the hip replacement was necessary to resolve her pain to function normally. This woman was very concerned about the idea of having her hip replaced. She saw it as a major undertaking that should only be performed if absolutely necessary.

This woman's daughter happens to live in New York and saw an interview with me during which I described the fact that innumerable surgeries are being performed unnecessarily due to false diagnoses based on inconclusive diagnostic tests such as x-rays and MRIs. The woman felt compelled to come to New York so I could evaluate her hip and determine whether the joint needed replacement.

I was obviously honored that a person would be willing to travel across the country for a one shot evaluation to determine whether joint replacement surgery was valid or not. The day arrived and I met this woman. It was horrible to observe just how much pain she was in. She was unable to bear any weight at all on her left leg. I had her lay down on a plinthe and I began my examination.

I explained that clinical findings determine the health of a joint, not an x-ray. In evaluating her hip range of motion, I found it to be very mildly decreased from the right hip. This is a very good sign. If the left hip was "bone-on-bone", there would be no joint space in her hip. Joint space is the space between the two bones that make up a joint. This space is required for the bones to move--to create motion of the joint. If there is joint motion, and in this case there was, then by definition the joint can not be "bone-on-bone". The x-ray is simply showing a decreased joint space. A decreased joint space is not enough to cause pain or require joint replacement surgery.

Next I had her lay on her side and I compressed the femoral head (thigh bone) into the hip joint. If the joint was the cause of the pain, then compressing the head of the femur into the joint would create severe pain. In this case, no pain was experienced at all. This was another good sign. These key findings confirmed to me that the joint was not the cause of her pain. In continuing the examination, I ask the woman to point to exactly where she experienced her pain. She pointed to just above her hip joint, right at a muscle. The muscle is called the gluteus medius muscle. It is responsible for supporting the leg when  when walking. The other location she identified was the inner thigh. I established that the tissue she was pressing on was a muscle called the gracilus. It opposes the gluteus medius. Since the gluteus medius had strained severely, it allowed the gracilus to shorten severely. This caused it to strain and also become severely painful.

So there you had it, a thorough evaluation confirming that the cause of this woman's pain was not the hip joint even with an x-ray saying it was the cause. So what did I do to resolve the pain? That was easy. I heated, massaged and stretched the key muscles that were strained and painful. I had her stand up and asked what her pain level was. It went from 9 out of 10 to 0 out of 10. She then proceeded to walk without the use of her cane. She had no trouble bearing weight on the left leg. She began to cry in complete disbelief of what had just happened. I explained that was just a short term reduction in pain. The true resolution would come from strengthening the appropriate muscles that help support her on the left leg. We performed an exercise routine to accomplish just that. I wrote down the protocol to follow. She would take this to a therapist in Texas so they would know what to do.

Flash forward several weeks. I received a call from the same patient who was seemingly at her wit's end. She told me that she tried three different physical therapists in Texas. She gave them my book which described how to perform the exercises she needed to strengthen the appropriate muscles. She explained to them what my findings were and how it was not the hip causing the pain but surrounding muscles. She said they all tried "bizarre" techniques that were in no way similar to what I had done. Not only is her left leg causing her pain but her right as well.

In the coming weeks this patient is coming to see me to resolve her pain. The story will be continued upon completion of her therapy sessions.