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Pain where leg meets pelvis: The request could not be satisfied


Groin Pain When Walking or Running

Rest, reducing the inflammation
and increasing the blood circulation for healing

What Can you do about Groin Pain When You Walk or Run?

A groin strain is an overstretch or tearing injury to the inner thigh or front of the hip. Groin strains make walking, lifting the knee, or moving the leg away from or toward the body difficult and painful. Groin strains can occur from overuse of the muscles, or from a sudden contraction of the muscles. Pain can range from a dull ache to sharp pain. The pain will often be worse when walking or moving the leg. A person may also experience spasms in the inner thigh muscles. Weak adductors, poor off-season conditioning and inadequate warm up or stretching increase the risk of an adductor strain.


  • Sudden pain in the groin or medial leg sometimes associated with a pop.
  • Pain on palpation of the muscle with possible swelling and bruising.
  • Loss of motion at the hip joint
  • Upper inner thigh pain
  • Weakness of the adductor muscles
  • Difficulty putting weight on the affected leg. Crutches may be necessary to move around.
  • If not cared for properly this may become a more chronic situation.

Groin strains are graded with numbers 1 to 3, depending on how serious the injury is:

  • Grade 1 causes some pain and tenderness, but the stretch or muscle tear is minor.
  • Grade 2 causes pain, tenderness, weakness, and sometimes bruising.
  • Grade 3 is a severe tear of the muscle, causing bruising and a lot of pain.

Groin Pain Treatment

Treatment of groin pain will depend on the severity of the condition. When treating the principles of RICE (rest, ice, compression and elevation) should be initiated.

  • Rest: avoid the activities that produce the pain (jumping, running, going up or down stairs, kneeling and squatting. )
  • Ice: apply ice to the tendon or area of inflammation. It is one of the fastest ways to reduce swelling, pain and inflammation. Apply it right away and then at intervals for about 20 minutes at a time. Do not apply ice directly to the skin.
  • Compression: such as an ace bandage to help take stress off the injured muscle may be useful. When using ice, apply light compression. This is especially helpful if swelling is present.
  • Elevation: elevate the area to help reduce swelling.

Physical Therapy for Groin Pain

Your physical therapist will perform a thorough evaluation to assess and determine the following:

  • Tendon: a series of tests will be performed to determine which tendon is involved.
  • Strength: resisted testing is performed to determine if there is associated weakness or strength imbalances
  • Flexibility: tight muscles can contribute to poor mechanics and weakness creating imbalances and making the hip more susceptible to tendinitis.
  • Technique: Often it is the way we perform motions (run, jump, cycle or row) that may cause a problem. Discuss and observe the activities you participate in, that may have started the problem to improve technique.
  • Training: review your training program and any sudden changes that may have precipitated or caused the present condition.
  • Alignment or footwear: a physical therapist will assess your leg lengths, foot mechanics and alignment to see if there are any imbalances. Checking for appropriate footwear is a crucial part of balancing the stresses applied to your legs and body.

Physical therapy for groin pain must remain conservative at the onset to avoid aggravating the condition. Emphasis will be on rest, reducing the inflammation and increasing the blood circulation for healing. Once the initial inflammation has been reduced, a program of stretching and strengthening will be initiated to restore flexibility to the muscles involved and improve strength to reduce stress on the tendons and the hip. Taping or strapping to rest and reduce the stress placed on the tendon and promote healing may be necessary. Your therapist is trained in these specific taping techniques.

Common Physical Therapy interventions include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility and range of motion of the knee and hip. Use of mobilization techniques also help to modulate pain.
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the knee and lower extremity to support, stabilize and decrease the stresses place on the burse and tendons of the hip joint.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, running, kneeling, squatting and jumping) of the involved lower extremity to reduce stress on the burse and tendons in daily activities. Taping, strapping or bracing may be useful to rest the tendon and promote healing.
  • Modalities including the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation of the involved tendon and bursa.
  • A home exercise program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

In general, patients respond well to conservative treatment of a groin pain. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of tendinitis. In most cases, full return to activity will take from 2-6 weeks depending on the severity


https://www.medicalnewstoday.com/articles/321007. php


Adductor Or Groin Strain

Groin Pain Articles

Symptoms, Treatments, Causes, and More

Your hip is the joint where your thigh bone meets your pelvis. It is called a ball-and-socket joint, because the ball-like top of your thigh bone fits into a cup-like area within your pelvis, much like a baseball fits into a glove.

Normally, the ball glides smoothly within the socket, but a problem with the ball or socket rim can interfere with smooth motion. Trauma from repetitive hip flexion damages the cartilage of the socket, leading to hip impingement or femoro acetabular impingement (FAI). It is believed to be a major cause of early osteoarthritis of the hip, particularly in those under age 40.

Hip Impingement Symptoms

You can have hip impingement for years and not know it, because it is often not painful in its early stages.

When hip impingement causes symptoms, it may be referred to as hip impingement syndrome. The main symptoms are  “pain” in the groin, especially when walking or flexing the hip, and decreased range of motion in the hip. 

At first, you may only feel pain when you move the hip near its limits. As the condition progresses, however, you may feel pain with more subtle activities, such as sitting for a long time or walking up a hill. Pain that occurs at night or when walking on flat ground suggests that the cartilage cushioning the ball and socket has begun to break down and wear away, a condition known as osteoarthritis.

Hip Impingement Causes

There are two main causes of hip impingement:

A deformity of the ball at the top of the femur (called cam impingement). If the head is not shaped normally, the abnormal part of the head can jam in the socket when the hip is bent. This may occur during activities such as riding a bicycle or tying your shoes.

A deformity of the socket (pincer impingement). If the front rim of the socket (called the acetabulum) sticks out too far, the area of the thigh bone (femur) just below the ball, called the neck of the femur, may bump into the rim of the socket during normal hip flexion movement.

In some cases, there is a problem with both the ball and the socket. Other problems that can cause hip impingement include conditions such as:

  • Legg-Calve-Perthes disease, a disease in which the ball part of the hip joint doesn’t get enough blood, which causes the bone to die.
  • Slipped capital femoral epiphysis, a separation of the ball from the thigh bone at the upper growing end (growth plate) of the bone in adolescents. It is more common in children who are obese.
  • Coxa vara, an unusual condition in which the thigh bone and ball do not grow at the same pace in children. This discrepancy leads to deformity of the hip joint.

Hip Impingement Tests and Diagnosis

If you have symptoms of hip impingement, your doctor can diagnose the problem based on your description of your symptoms, a physical exam, and the findings of imaging tests. These tests may include one or more of the following:

  • X-ray, a test that produces images of internal structures on film. X-rays can show irregularities in the shape of the ball or top of the thigh bone or excess bone around the rim of the socket.
  • Magnetic resonance imaging (MRI), a procedure that uses large magnets, radio waves, and a computer to produce detailed pictures of tissues inside the body. An MRI can show fraying or tears of the cartilage, including that which runs along rim of the socket (labrum).
  • CT scan, a technique that combines special X-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. These images can be examined on a computer, printed, or transferred to a CD. A CT or MRI scan can help a doctor decide whether you need surgery.

Hip Impingement Treatments

Treatment for hip impingement should begin with:

  • Resting the affected hip
  • Modifying your activities to avoid moving the joint in a way that causes pain
  • Exercising as recommended by your doctor or physical therapist to strengthen the muscles that support the hip
  • Physical therapists who specialize in the hip or recovery of hip injuries can do a lot to help strenghten muscles around the hip and relieve inflammation.
  • Taking anti-inflammatory and pain medications

If these treatments do not relieve pain, your doctor may recommend hip impingement surgery.

The type of surgery needed will depend on the problem causing hip impingement and how much cartilage damage has occurred.

Often, surgery for hip impingement can be performed arthroscopically. This technique involves inserting a lighted scope and thin tools through small incisions over your hip instead of making a large incision. Arthroscopy is usually an outpatient surgery. This means you can go home the same day.

The earlier you have surgery, the greater your chances of a complete recovery. But even if cartilage has been damaged, surgery may still reduce pain and improve range of motion.

If cartilage damage is severe, however, hip replacement may be the only treatment that will relieve pain and improve function.

However, there are promising experimental treatments, including one in which parts of your own blood are injected into joints to stimulate cartilage growth.

What is Symphysis Pubis Dysfunction

If you are pregnant and experience pain in the groin and inner thighs around the start of your second trimester, there is a chance that you are suffering from Symphysis Pubis Dysfunction (SPD), a common pregnancy pains. In one study1of the British population, the incidence of SPD varies from 1:360.3% to 2.77%. Thankfully, the pain goes away after delivery. In Singapore, we see this condition at Core Concepts fairly often.

The symphysis pubis is a fibrocartilaginous (a mixture of fibrous tissue and cartilaginous tissues) joint that connects the two halves of the pelvis together and keeps them steady during activity (see image). This joint is supported by a network of muscles and ligaments that allow very little movement to occur under normal circumstances. During pregnancy, the symphysis pubis widens an average of 2-3 mm from the usual 4-5mm gap. The average gap is about 7.7mm. This widening of the pelvic ring helps facilitate the delivery of the baby.

Symphysis Pubis Dysfunction is when this joint becomes overly relaxed, allowing the pelvic girdle to become unstable. This leads to pain and inflammation.

In severe cases, the symphysis pubis partially or fully ruptures, increasing the gap to more than 10mm. Also known as the diastasis of the symphysis pubis (DSP).

SPD typically starts in the second trimester. The start of pain is usually gradual and can be very intense. It is usually relieved by rest. The good news is that symptoms commonly disappear shortly after delivery. A small percentage of women, however, continue to experience pain for several months after delivery.

Why does it happen?

Symphysis Pubis Dysfunction is a result of a combination of factors; an altered pelvic load, hormonal and biochemical alterations causing ligament laxity and a weakening of pelvic and core musculature during pregnancy, leading to instability.

Symphysis Pubis Dysfunction Symptoms

You may have SPD if you have one or more of the following:

  • Pain localised to your symphysis pubis, including shooting, stabbing and burning pains, grinding and audible clicking sensations and/or persistent discomfort.
  • Pain radiating to lower abdomen, groin, perineum, thigh, leg and back
  • Difficulty in walking, climbing up or downstairs, rising up from a chair, impaired weight-bearing activities, e.g. standing on one leg or lifting/parting the legs, turning in bed.

Diagnosing SPD

Symphysis Pubis Dysfunction today is becoming more widely understood by GPs, obstetricians and midwives in Singapore. It is diagnosed by a combination of your own description of symptoms and a battery of tests designed to look at the stability, movement and pain in the pelvic joints and structures surrounding it. Imaging, such as X-rays, is the only way to confirm the misalignment of the pelvic bones. However, due to the concerns of fetal exposure to radiation, ultrasound is the preferred modality for assessing symphyseal widening in pregnancy.

Your doctor or midwife may refer you to a physiotherapist who has experience in treating this condition.


A specialist physiotherapy assessment and review should be arranged. The physiotherapist can advise on back care and strategies to avoid activities that put unnecessary strain on the pelvis and on safe exercise during pregnancy.

Exercises for the pelvic girdle and core stabilizers of the trunk will form a large part of both the treatment and are aimed at improving the stability of the pelvis and back.  

In some cases, while mobilisation (a gentler form of manipulation) of your hip, back or pelvis may be used to correct any underlying movement dysfunction.

Other manual techniques include both muscle energy technique (MET) and myofascial release. The physiotherapist may also prescribe a pelvic support belt to give quick relief.

Other alternative treatments include the following: hydrotherapy (an exercise in water) and acupuncture which, sometimes can be useful.

Symphysis Pubis Dysfunction (SPD) Home Advice

Here are some things pregnant women with SPD can do to significantly minimize their discomfort.

  • Avoid activities that cause discomfort, e. g. lifting, carrying, prolonged standing, walking and strenuous exercise
  • Rest more frequently in a position that is comfortable, such as:
    • lying with your knees bent and supported
    • lying on your side with a pillow between your knees
    • sitting with your knees slightly apart
    • avoid sitting with legs crossed.
  • Mild to moderate exercise, including abdominal wall and pelvic floor exercises, is acceptable.
  • Avoid straddling and squatting movements, which means moving with knees apart (hip abduction), when:
    • getting in and out of a car. Try to keep your knees together.
    • getting in and out of bed. When moving in bed, try to keep legs together particularly when moving from side to side. Do not push with one foot as this will worsen the pain. Push equally with both feet to move about the bed.
  • Adopt good posture, avoid bending and twisting.
  • If swimming, avoid the breast-stroke with the legs kicking outwards.
  • Ice packs can be used for five minutes at a time or an ice cube can be rubbed on the symphysis pubis for 20–30 seconds


  1. Owens K, Pearson A, Mason G. Symphysis pubis dysfunction – a cause of significant obstetric morbidity.Eur J Obstet Gynecol Reprod Biol 2002;105:143–46.
  2. MacLennan AH, MacLennan SC. Symptom-giving pelvic girdle relaxation of pregnancy, postnatal pelvic joint syndrome and development dysplasia of the hip.Acta Obstet Gynecol Scand1997;76:760–64.
  3. Jain S, Eedarapalli P, Jamjute P, Sawdy R. Symphysis pubis dysfunction: a practical approach to management.The Obstetrician & Gynaecologist 2006;8:153–158.

Lumps in the Groin | When to see a Doctor | Causes & Treatment

What do you mean by the groin?

Your groin is the part just above the top of your legs, between the lowest part of your tummy and the top of your thigh. You have a groin on either side, around the crease where your leg joins the rest of your body. The groin is over the hip joint and contains several of the muscles of the leg. There is a group of glands (lymph nodes) in the groin area, which normally cannot be felt. It also contains the inguinal canal on each side. The inguinal canal is a passageway for structures such as ligaments to pass between the tummy and the genital area.

See also the separate leaflet called Scrotal Lumps/Pain and Swelling.

What are the most common causes of lumps in the groin?

Lumps can come from any structure in the groin at any level from the skin on the outside to the bone on the inside.

The most common causes of lumps in the groin are as follows.

Skin infections

This includes infections such as boils or abscesses. Sometimes infections can develop around the hair follicles of pubic hair in this area, particularly if there is trauma from shaving or waxing or from rubbing on underwear. These lumps would be red or pink and sore. It would hurt to touch them. They can vary from slightly sore pimples to very large abscesses.

Hidradenitis suppurativa is a long-term (chronic) skin condition, leading to painful and repeated lumps of pus (boils or abscesses).

Swollen lymph glands

Lymph glands are small lumps all around your body that are part of your immune system which helps you fight infection. Normally you can’t feel your lymph glands but if they become swollen you may feel them as a lump or lumps. The groin is one part of your body where this can occur. The most common cause of swollen lymph glands is infection. This is your lymph glands just doing their job and fighting off the infection. Infections of the areas around the groin may cause the lymph nodes here to swell – for example sexually transmitted infections (STIs), nappy rashes, or skin infections. Lymph glands can also swell up in response to infections which affect your whole system, such as glandular fever, chickenpox or flu. When lymph glands swell due to infection, they usually settle back to their normal size once the infection has gone.

Less commonly, lymph glands can swell due to a type of cancer. Cancers of the blood system, such as lymphoma or leukaemia, can cause swollen lymph glands. Cancers from other parts of the body can also spread to the lymph nodes, causing them to become bigger. Lymph glands which are swollen due to a type of cancer tend to be hard or solid, and do not go away as they do when swollen due to infection. They usually grow slowly, whereas glands swollen due to infection suddenly appear.

There are some other uncommon causes of swollen lymph nodes, such as sarcoidosis, systemic lupus erythematosus (SLE), HIV and AIDS.


A hernia occurs when an internal part of the body pushes through a weakness in the surrounding muscle or tissue wall. The groin is a common site for a hernia, and there are three types of hernia which can occur here:

  • An inguinal hernia – more common in males.
  • A femoral hernia – more common in females.
  • An incisional hernia – in the area of a previous operation scar or injury.

A hernia usually feels very soft and tends to go away when you lie down. If the tissue inside the hernia gets stuck, it can be hard and painful. If this occurs, you should see a doctor urgently.

The groin is a common site for hernias

What are the other possible causes of lumps in the groin?

Other skin lumps

Other than infection, there can be other skin conditions which can cause a lump in the groin. For example:

  • Fluid-filled lumps (cysts).
  • Warts. These are little skin lumps caused by a virus. Those around the genital area are called genital warts and may be sexually transmitted.
  • Tumours of the skin. These can be non-cancerous (such as papillomas) or cancerous. The groin is an uncommon place to get a skin cancer as it is not exposed to the sun as much as other parts of the body usually.

Fatty lumps

Lumps which come from the layer of fat beneath the skin are called lipomas. They are quite common and can occur anywhere in the body where there is a layer of fatty tissue. They feel quite soft and usually are harmless.

Enlarged blood vessels

Sometimes a vein or artery can become swollen, causing a lump. A swollen artery in the groin is called a femoral aneurysm. Swollen veins are called varicose veins, and in the groin this is called a saphena varix.

Undescended testicle

While a baby boy is growing inside his mother’s womb, his testicles (testes) gradually move from inside his tummy down to the bag or sac (the scrotum) under his penis. Sometimes one gets stuck along the way, and sometimes can be felt as a small lump in the groin. Baby boys are checked at birth and at six weeks to be sure their testicles are in the scrotum. If the testicles have not moved down to the scrotum by the age of 6 months they may need an operation to move the testicles to where they should be. See the separate leaflet called Undescended Testicles (Cryptorchidism) for more information.

What are the causes of pain in the groin?

There are also several causes of pain in this area with no lump to feel. The most common cause of this is a problem with your hip, in particular wear and tear (osteoarthritis of the hip). Another common cause is a pulled or torn muscle (a groin strain), usually from a sporting injury.

A sporting injury could cause pain around the groin

Should I see a doctor?

Always see a doctor if you have an unexplained lump which does not settle on its own. See a doctor as soon as possible if your lump seems to be getting bigger. See a doctor urgently if:

  • The lump is very painful.
  • You have pain in your tummy area along with being sick (vomiting) and/or not being able to poo.
  • You have a high temperature (fever) and feel unwell in yourself.

Will I need any tests?

Your doctor will ask you some questions, and then examine the lump or lumps in your groin. In some circumstances, the diagnosis will be clear at this stage and no further tests will be needed. For example, if you have a one-off boil or abscess you would not need any more tests. In many cases, an ultrasound scan will be helpful. This can confirm the type of lump you have, and give more information about it. For example, if your doctor thinks your lump is a hernia, a scan can confirm this and determine which type of hernia it is and whether it needs treatment. The scan shows what the lump is made out of. For example, if it shows fatty tissue, it suggests a non-cancerous fatty lump (lipoma). If you have an aneurysm, the scan will show a swollen artery. Undescended testicles can be seen on an ultrasound scan. A lump filled with fluid suggests a cyst, and so on.

Blood tests may also be helpful. These can help determine if swollen lymph glands are due to infection, and in some cases blood tests can help find the cause of the infection. In people who get repeated boils or abscesses a blood test to check for an underlying reason such as diabetes may be useful.

Occasionally it may be necessary to take a sample of the lump for further analysis. This is called a biopsy. A sample of the tissue inside the lump can be taken with a thin needle, or the whole lump removed. The sample is then examined under the microscope to find out the cause. This is helpful if some kind of cancerous lump or lymph gland is suspected.

What is the treatment for lumps in the groin?

This is different depending on the cause. There is no one single treatment for all lumps in the groin. Once your doctor finds the cause, he or she will advise on treatment options.

University OB/GYN Associates Blog | Pregnancy: Pain in Groin and

Looking down at the pregnancy test and seeing a positive symbol on the stick is a moment of revelation, the realization that you are about to embark on the journey of a lifetime, with parenthood the final destination. When you first become pregnant, a million things can go through your mind, and suddenly you have a lot of questions. How do I manage my health while I am pregnant? What is my due-date? When can I find out the sex of my baby? What happens to my body during pregnancy?

Normal pregnancy lasts nine months, which equals out to 40 weeks. It begins from the first day of your last period cycle, to the date of the baby’s delivery into the world. Many delivery dates are not exact. In some case the baby may come a bit early and in others a bit late. The only way to ensure your due-date is to schedule an induced labor or a C-section. This is usually only done if there are specific health reasons to do so. 

Pregnancy is divided into three trimesters (I, II, II). During each trimester or period of pregnancy, your body grows and changes, and your to-do list and priorities will do the same. While nine months gives you plenty of time to get ready for your baby’s arrival, it’s always helpful to know how to prepare.

If you plan to get pregnant or are already pregnant, these are some things you should know as you prepare for the day baby arrives. 

First Trimester (1-12 weeks)

A woman’s first trimester of pregnancy is the first 1-12 weeks. During the first trimester, the baby begins as an embryo, and is just the size of kidney bean. With increased levels of hormones like estrogen and progesterone, your body begins to change almost immediately after you become pregnant, and your menstrual cycle will stop within two weeks of conception.  The baby also starts the early stages of development as your body is changing. The baby’s heart is beating quickly, and the intestines begin to form, as well as the earlobes, eyelids, mouth, and nose.

 During the first trimester expect the following from your body:

·       Sore, fuller, and heavier breasts: Hormone increases make your breasts feel sore and sensitive. This should subside after a few weeks.

·       Fatigue: Soaring levels of progesterone make you extremely tired, not to mention the fact that your body is adjusting and trying to compensate for two.

·       Nausea and/or vomiting: You may experience morning sickness during the first month of pregnancy. To help with this, avoid going long periods without eating. Eat small amounts every couple of hours and try to avoid high fat foods.

·       Frequent Urination: Your kidneys process extra fluid during pregnancy so you may find yourself urinating more.

·       Food Aversions: You may develop aversions to foods you normally like and become sensitive to foods you used to be able to eat with no issues. Your tastes may also change during pregnancy.

·       Emotional Changes: Being pregnant, especially for the first time, can bring on a host of emotions all at once. You may feel happy, excited, apprehensive and tired all at the same time. This is completely normal. It is normal to worry and wonder about the health of your baby, the adjustment to parenthood, as well as the financial commitment of having a child. You might even experience mood swings. Remember this is temporary. If your moods swings become severe, you should let you doctor know.

·       Pre-natal Care: It is very important to choose your healthcare provider (obstetrician or nurse mid-wife) during the early stages of your pregnancy. Your healthcare provider will perform an overall health assessment, go over any risk factors you may have, determine the gestational age of your baby and create a plan for the next nine months. After your first visit, you will likely see your doctor every 4 weeks.

Second Trimester (13-27 weeks)

A woman’s second trimester of pregnancy begins at 13 weeks and lasts through week 27. At the beginning of the second trimester, babies are about 3 1/2 inches long and weigh about 1 1/2 ounces. As the weeks go by, your baby’s skeleton starts to really develop and get stronger. He or she develops the ability to hear, and you are likely to feel it moving and kicking during this time period.

Your second trimester of pregnancy is known as the “honeymoon period”. Typically during this period, you have renewed energy and are feeling pretty good.  Nausea stops, emotions level off and you might even feel like having sex. You’ll be showing by this time, but you won’t be big enough to feel uncomfortable. It is during the second trimester you can find out the sex of your baby as well, usually between 16-20 weeks.

During the second trimester expect the following from your body:

·       Growing breasts and Belly: Your breasts will continue to enlarge so you may need new bras, and your belly will become larger as your uterus expands for the baby.

·       Skin Changes: You may notice the formation of brown patches on your face and skin. You may also develop a dark line down your belly. As your belly and breasts grow, you might also develop stretch marks. All of this should fade after your delivery.

·       Braxton-Hicks contractions: As your body starts to prepare for going into labor, you may notice your belly tightening. This tightening are Braxton-Hicks contractions. If those contractions become regularly timed or painful, you should call your doctor immediately.

·       Baby Movement: You will start to feel your baby kicking and moving around.

·       Leg Cramps: Getting leg cramps, especially at night, is normal during pregnancy. It’s a good idea to stretch your legs, wear comfortable, supportive shoes during your pregnancy, keep as active as possible, and avoid dehydration to help keep leg cramps at bay. 

Third Trimester (28-40 weeks) 

A woman’s third trimester of pregnancy is 28-40 weeks. The baby should weigh about 2 1/4 pounds by the start of the third trimester. They can now blink their eyes, are developing fingernails, toenails, and some hair. Their brains are developing along with their bodies. In other words, during this last stage, your blossoming baby will spend his or her final weeks in utero putting on weight. At full term, the average baby is more than 19 inches long and weighs nearly 7 pounds.

This stage of the pregnancy can be a little tough, both emotionally and physically. At this point, many women want to stop being pregnant. The baby’s growth and movement may be making you feel uncomfortable, your body may ache and you may be swollen, especially your feet. Try to remain positive and remember you are nearing the end and will be welcoming your new baby soon!

During the third trimester expect the following from your body: 

·       Breast Leakage: Your breasts may be heavy and begin to leak due to milk production. Lactating and leakage is totally normal, so don’t worry.

·       Digestive Disturbances: During this last stage of pregnancy (or during pregnancy in general) heartburn and acid reflux are common. You might feel some digestive discomfort, especially as your baby grows.

·       Braxton-Hicks contractions: The tightening your abdomen will continue and may become more frequent and pronounced as you near your due date. If they becomes painful or regular, call your doctor immediately.

·       Lots of baby movement: The baby is growing so expect to feel lots of movement.

·       Back Aches: Back aches are very common during the third trimester. Pregnancy hormones affect your bones and connective tissues and a large belly puts added strain on the back. Be sure to sit in chairs with good support, wear good, supportive shoes and use ice and heat on the sore spots on your back to help get relief.

·       Swelling: Swelling is a normal part of pregnancy and can become more pronounced as your due date draws closer. This swelling is caused by an increase in blood and fluid produced by the body during pregnancy. It affects the face, hands, feet and ankles.  Gradual swelling is normal, however if your face and hands swell suddenly, it could be a sign of preeclampsia, so call your doctor immediately.

·       Frequent Urination: More pressure on your bladder from the baby moving deeper in the pelvis can cause you to urinate a lot more often.

·       Shortness of Breath: As the baby takes up more space, you may feel winded, especially with activity.  Try to maintain good posture to help your lungs expand normally.

During all three trimesters it is important to get as much sleep as possible, eat healthy, exercise, and just take care of yourself in general. Make sure you see your doctor at the regularly scheduled intervals as well. Talk to them about your labor and pain management and any special requirements you may have for the birth, such as natural child-birth free of medications, or birth-in-water.  If you can, take child-birth classes as these can really help you prepare for what is to come in the delivery room.

If you are pregnant let the experts at University OB/GYN Associates help you prepare> Call us at (315) 464-5162 to request an appointment or request an appointment online.








What is pelvic girdle pain?

Pelvic girdle pain (PGP) is pain which is felt around the pelvic joints, lower back, hips and thighs. Around 1 in 4 pregnant women experience PGP.

It can vary from mild to severe. The symptoms can be different for each woman. Although this pain is common, it is not a normal part of pregnancy.

Symptoms of pelvic girdle pain

Symptoms can vary and may be more severe for some women. You may have pain or discomfort in any or all of the following places:

  • over your pelvis, especially at the pubic bone at the front
  • along your groin area
  • below your tummy
  • in your hips
  • across one or both sides of your lower back or buttocks (bottom)

Difficulty with movements

You may have difficulty with certain movements including:

  • walking
  • putting your weight on one leg at a time, such as climbing stairs, dressing, getting out of the bath
  • parting your legs – for example, getting in and out of a car
  • hip movements, such as turning in bed
  • lying on your back or side

When to get help

They may refer you to:

  • a chartered physiotherapist who specialises in women’s health
  • another healthcare professional, like an occupational therapist

They can sometimes give you equipment to help you to manage better at home.

Causes of pelvic girdle pain

Pelvic girdle pain can be caused by a combination of factors.

  • Pregnancy hormones make your ligaments looser. This can lead to increased or uneven movements in the pelvis and the extra movement can cause pain.
  • As your baby grows, this can change your posture and put strain on the pelvis and lower back.
  • Your pelvic girdle joints can become misaligned. This happens because of changing muscle activity and increased movement. It can cause pain and discomfort.
  • Having a history of back pain.
  • The position of the baby.

Osteitis Pubis and Groin Pain

At CSPC we are experienced in treating Osteitis pubis, which can be used to describe pain emanating from the pubic symphysis, the joint where the two halves of the pelvis come together at the front of the pelvis. The pelvic bones form a ring with the pubic symphysis at the front and are joined at the back of the pelvis at joints on each side of the sacrum (the sacro-iliac joints). The pubic symphysis is a thin joint which under normal circumstances has very minimal motion. In osteitis pubis, or with other types of groin pain, the pubic symphysis can be out of line, with one side higher or lower, or further forward or back than the other. It can also move more than it should during movement and walking, and it is this malalignment and excess movement that can result in inflammation and pain.

Osteitis pubis is thought to result from inflammation of the pubis symphysis, and the ligaments that attach to it and is characterised by pain, and sclerosis and bony changes of the pubis symphysis, which can be seen on X-ray and MRI scan. It can be very debilitating for sportsmen and women and for women post childbirth. In addition to being very painful, it can cause muscle inhibition, and feelings of weakness and loss of power. It can also result in a loss of technique and performance.

Causes of Osteitis Pubis

Osteitis Pubis can have a number of different causes and it is this that can make it a difficult problem to get rid of. We have found that the more complex and resistant cases of osteitis pubis have many of the causative factors, and that unless the physiotherapist is able to address most or all of them, the result is likely to be less good, especially in the sporting population.

The pubic symphysis can be an area that becomes notoriously difficult to heal once it has become chronic. Causes of osteitis pubis can include the following, which are also factors that can prevent or slow down the healing process, causing ongoing pain:

  • Sports activities (football and rugby are most common)
  • Surgical procedures (gynaecological or abdominal, hernia repairs)
  • Pregnancy and childbirth
  • Trauma/injury
  • Spinal malalignment
  • Pelvic malalignment (the pubic symphysis itself may be out of line)
  • Poor posture
  • Leg length difference
  • Foot biomechanics
  • Technique- walking and /or running
  • Poor flexibility
  • Poor muscle strength and recruitment – although muscles can also become overactive and therefore short and tight
  • Breathing issues
  • Reduced core strength and control of the spine and pelvis during activity
  • Poor glut strength and overuse of adductors
  • Visceral organs (organs in the abdominal or pelvic cavity)  may become affected, which can refer pain, or cause pelvis malalignment
  • Hip problems
  • Poor balance

 Symptoms of Osteitis Pubis

The most common symptom of osteitis pubis is pain over the front of the pelvis. The pain is often central, although can be worse on one side than the other. It can also radiate down into one thigh or into the groin. It is possible to have similar pain in the groin without having full osteitis pubis and it would still be treated in a similar way

Other symptoms can include:

  • Weakness
  • Limping gait
  • Pain during sport
  • Change of technique through inhibition of muscles
  • A feeling of generally being “crooked”
  • Pain in the groin
  • Pain in the lower abdomen

X-rays of patients with osteitis pubis typically show an irregular pubic symphysis with sclerotic (thick) bone edges and evidence of chronic inflammation. An MRI test is usually not needed, but will show inflammation of the joint and the surrounding bone.

Getting Rid of Osteitis Pubis

Generally when a client presents with osteitis pubis or chronic groin strain, there is usually a mitigating factor that is preventing it from healing. This may be that the joint itself is out of line for some reason, or that the muscles that function around the pelvis are too tight, too weak or overactive. This can cause changes in the way you move or stand. Invariably it is this that is not allowing the area to heal and the resultant pain in the pubic symphysis then causes further dysfunction in the body, as it tries to compensate. It is only by re-aligning the spine and pelvis and stretching and/or strengthening the muscles around the trunk, pelvis and lower limb, and re-training how we use those muscles, and the way we walk or run, that we can start to allow the painful area to heal. This is sometimes why cortisone injections may not work in the area (although they can be effective if the area is aligned and the issues above have been addressed). In our experience, it is better to have a cortisone injection once all causative factors have been addressed, as the result will be more likely to be successful.

It is always important to find out why the osteitis pubis came on initially. We have seen some cases where the groin pain has arisen because of issues with the shoulder or neck for example.

Treatment of Osteitis Pubis

The physiotherapist will take a thorough case history and will assess all of the areas  described above.

Treatment will then begin to address these issues, aiming to help re-align the spine and pelvis, to reduce pain and normalise the way you move.

Treatment can include:

  • Spinal and pelvic alignment work
  • Muscle energy techniques
  • Soft tissue work and stretching
  • Myofascial release
  • Lower limb and core muscle strengthening
  • Referral to podiatry if necessary for leg length assessment and biomechanical analysis
  • Visceral work if required- this can often hold the body out of alignment
  • Postural analysis
  • Retraining of walking and running technique
  • Retraining of technical skills
  • Balance retraining
  • Home exercise program
  • Breathing retraining

Treatment of osteitis pubis is most successful, particularly in the more chronic cases, if all of the above are addressed if required. We have had a large amount of success in treating osteitis pubis at CSPC by treating it in this way, and with the greatest chance of non-recurrence. With the high level sportsperson, we may also have to retrain running technique, and the way they move during their sport, for example around a football pitch.

We frequently see patients with osteitis pubis who have also developed issues with breathing, which further exacerbates symptoms and movement dysfunctions, which must also be retrained. This may happen due to the patients resorting to breath-holding and overusing the abdominal muscles to try to stabilise the pubic symphysis, and this must also then be retrained.

Preventing Recurrence

If osteitis pubis and groin pain are treated by addressing all of the causes and not just the symptoms, there is a greater chance that the injury will not return, or if it does, it will not be as bad as it was initially. Most of the resistant cases are caused by problems with technique, biomechanics, visceral issues, surgeries, accidents and breathing issues, and by being thorough and addressing as many of the issues as possible, the sportsperson should be able to return to high level sport, often performing at a higher level, as many of these issues have been present for years, causing other minor injuries, until they result in this major injury, which then needs to be fully addressed and rehabilitated.

Pregnancy and Osteitis Pubis

Osteitis Pubis is very common in pregnant women and women post pregnancy. During pregnancy, a hormone called relaxin is released immediately, which helps to prepare the ligaments in the pelvis for birth. Relaxin not only affects the ligaments around the pelvis, but also affects all other ligaments in the body, for example, those around the hips, shoulders and in the feet. Relaxin starts to affect ligaments at 6 weeks, and relaxin levels peak at 12 weeks, but continue throughout pregnancy. The pubic symphysis and SI joints particularly affected by relaxin. The other additional effect for pregnant women, is that by the ligaments around the pelvis, hips and feet becoming more lax, there will be more joint play in all the joints, further affecting the stability of the pubic symphysis, and causing pain. Lax ligaments in the hips and feet will also cause changes in biomechanics, which can affect the pelvis.

More specific advice for pelvic pain in pregnancy will be given on the pages on pregnancy on this website.

Advice for sufferers of Osteitis Pubis

Below are some stretches and exercises that we recommend to those suffering from osteitis pubis. Please note that these are no substitute for a full assessment, but may help to start addressing some of the symptoms.

Quadriceps stretches

Tight quads (the muscles down the front of the thigh) will have the effect of tipping  the pelvis forwards (anteriorly tilting the pelvis). If one quads is tighter than the other, the pelvis will also have a torsion (twist) in it, which will stress the pubic symphysis. To run, walk and kick a football without stressing the pubic symphysis, it is necessary to have full range in the quads. We recommend the following stretches and foam rolling exercises.


Quadriceps stretch (front of thigh):

  • Lying on side, bottom knee bent up level with hips
  • Tighten abdominals, and flatten back
  • Hold top ankle so that heel is  touching buttock
  • Pull top leg back behind you until good stretch is felt in front of thigh
  • Keep knee lower than hip and back flat
  • Hold 30 seconds x 3

Foam rolling the quadriceps:

Face-down with both thighs resting on top of the foam roller. Support yourself on your elbows and forearms, and keep your abdominal and back muscles tight to stabilize your spine. Roll slowly back and forth on the roller, from just above your knees to just below your hips, and pause at any spot that feels especially tender.

Hamstring stretches

Short hamstrings will cause a posterior tilt of the pelvis due to their attachment onto the sitting bones. This will cause a flattening of the lumbar spine (lower back) and a loss of lordosis. If one hamstring is shorter than the other, it can also cause a torsion (twist) in the pelvis, putting stress on the pubic symphysis. A flattened lumbar spine will also inhibit the core muscles, leading to poor pelvic control. We recommend the following hamstring stretch.

 Hamstring stretch:

  • Sitting on chair
  • Perfect posture, with good lumbar arch (lordosis)
  • Slowly straighten one leg, maintaining perfect posture
  • Full stretch is the point just before the back starts to lose its lordosis
  • Hold 30 seconds x 5





Calf strength

Often overlooked as a contributing factor in Osteitis Pubis, calf strength is important, especially in the sports person. Adequate calf strength is required to push the foot off the ground, and helps to drive the legs through under the pelvis, especially when running.  This helps to activate the muscles down the back of the body (i.e. hamstrings and gluts).  When the calves are weak, the quads and hips flexors can over-activate to help lift the thigh through, in the absence of the drive from behind, which exacerbates the issues described above with tight quads. We recommend that all athletes should be able to do a minimum of 3 x 25 of each of the following exercises:

 Soleus Raises (deep calf):

  •  Stand facing the wall, on one leg with the knee bent.
  • Keep knee over second toe at all times.
  • Without moving hips, lift heel off floor and go onto toes, then lower.
  • Do not let knee fall in.
  • Go through full range, aiming for smooth movement.
  • Build up to 3 x 25
  • Do daily after running





Gastrocnemius Raises (straight knee):

  • Stand on edge of step on one leg with knee straight
  • Fingers on wall for balance
  • Go up and down with heel, keeping knee straight
  • Go through full range with a smooth movement
  • Build up to 3 X 25
  • Do daily after running

(Once this becomes easy, you can make it more plyometric on alternate days by going for speed upwards)

Ability to flex the knee to hip height without hitching the hips

It is important to be able to bring the knee to hip height ( as you would when running or going up the stairs) without hitching the hip or deviating through the pelvis. Similarly it is important to be able to move the leg separately from the pelvis in a variety of other actions ( lunging, changing direction, kicking a ball etc). Inability to do this will stress the pubic symphysis and will inhibit stabilising muscles around the pelvis from working. This is a simple exercise that will start working on dissociating the hip from the pelvis.

Balance and dynamic balance

Poor balance and inability to stabilise the body when moving will result in stress on various joints and will mean that a variety of compensations will occur to try to keep the body from falling over. This can mean anything from breath-holding (see section on breathing pattern disorders), over activity in the abdominals, toe scrunching and a host of other issues.

The following exercises are useful in helping to retrain balance, although the exercise on the step should only be done if pain free, and if you have adequate balance to remain safe.

Dynamic Balance (ref Joanne Elphinston):

Good functional balance is important in all sports. A good test for assessing functional balance is to stand on one leg and turn the head from side to side, saying the days of the week out loud, making sure you aren’t screwing up your toes. By turning the head, speaking and breathing, you are training your balance reactions without using non-functional bracing strategies.

The exercises above are just a few that can be useful in starting to address issues with pubic symphysis pain. If the condition is long standing, or is very painful, it would be more useful to be fully assessed by one of our physiotherapists, to get personalised programme to get to the root causes of your pain and to help to address it as quickly as possible.

Do not do any of the exercises above if they cause pain at the time or increase pain after doing them. If this occurs, it is likely that you need some hands on and realignment work before starting on a rehabilitation programme.

Testimonial: David Falconer -Semi professional football player
I traveled to see Alison from Glasgow having suffered from osteitis pubis for around a year and after hearing good reports regarding her treatment of this condition.
After trying numerous physiotherapists, ART therapists, acupuncturists, chiropractors/ osteopaths, & surgeons in Scotland with no great results, I did have my doubts as to whether I would ever be able to play football pain free again and was contemplating hanging up my boots- luckily I heard about Alison, and I haven’t looked back.
The attention to detail and anatomy knowledge I experienced was unbelievable and the best I have ever received- every aspect of my body, posture, and breathing was analysed over a two day period that addressed every fundamental weakness/ issue I had.
Even though the aches, and pains that had plagued me for over a year felt better after these initial two days it was after a week+ of doing the exercises given to me that I seen a huge difference. I am now at the stage where I can play pain free and I can’t thank/ recommend Alison and the clinic highly enough.

Bursitis of the hip joint | ortoped-klinik.com

Hip bursitis

Pain in the groin or thigh area is the most common symptom of inflammation of the bursa of the hip joint. Pain in the hip or groin can be widespread or localized.
As a rule, pain increases with movement and with load on the leg. Often there is pain in the area of ​​the adjacent thigh muscles.
Pain in lying on the side is typical for irritation of the joint capsule located on the so-called large hill (lat.Trochantor major).

What is the role of the joint capsule?

The bursa is usually found in those parts of the body where the layers of tissue move. The bursa is a sliding layer of free-lying connective tissue and mucous membrane. Their task is to protect the places of increased friction from damage.
Most often, inflammation of the articular capsule of the hip joint occurs on the surface of a large mound on the lateral side of the thigh.

Here, a thick tendon is located on the thigh bone.Subsequent articular bags are located deep in the thigh in front of the capsule of the hip joint, between the highly developed muscles of the thigh.

Why is it so difficult to make a diagnosis?

The exact location of the bursa and the symptoms of the disease are not well known. It is also difficult to separate them from a symptom of other diseases. But in recent years, the diagnostic capabilities have improved significantly.

Causes of inflammation of the joint capsule of the thigh:

  • mechanical irritation
  • pressure on bone protrusions or overstrain
  • bacterial infections
  • inflammatory rheumatic diseases (arthritis)
  • crystalline arthropatitis (gout, salt deposition)

Before starting treatment, the cause of the pain should be determined with certainty.Also, the lumbar spine and knee joint should be included in the clinical examination and diagnosis in order to exclude radiating pain.


The recommended treatment is primarily physical therapy – cooling and injection procedures.

Depending on the cause of the inflammation and the location, more intense physical treatments are possible. The use of high-frequency wave therapy has a soothing effect on irritated structures.


This article describes the causes and treatment of bursa inflammation in the hip joint. The hip joint has several joint capsules. Here was given a description of the functions of the joint capsule and the causes of inflammation. Description does not apply to other joints. Latin name Bursitis. Damage to the bursa causes pain in the hip or groin. It is possible that the symptoms coincide with those of hip arthrosis (Coxarthrose).It is especially common in athletes and people with various disorders of the musculoskeletal system.

organization of arrival

90,000 “Ankylosing spondylitis”: possible complications | Clinical Diagnostic Center

“Ankylosing spondylitis”: possible complications / Interview with Anna Okhotnikova, a rheumatologist at the 24-hour hospital BUZOO “CDC”

Ankylosing spondylitis (ankylosing spondylitis) is a chronic, gradually progressive inflammatory disease of the spine and sacroiliac joints, which can occur simultaneously with damage to peripheral joints, entheses and internal organs. Anna Okhotnikova, a rheumatologist at the 24-hour hospital at the CDC, tells about the symptoms of the disease and its various consequences for the body:

The clinical manifestations of spondyloarthritis are varied, they appear gradually, sometimes unnoticed by the patient; at the onset of the disease, long-term spontaneous remissions are often observed. Ankylosing spondylitis most often begins with inflammatory back pain (in 75-85% of cases) and peripheral arthritis (in 15-25% of cases)

The following symptoms are characteristic of the onset of ankylosing spondylitis:

deep pain in the spine associated with limitation of movement in the lumbar spine

Morning stiffness of the spine, which disappears during the day.

The central place in the clinical picture is occupied by the defeat of the axial skeleton (spine, pelvis, hip, shoulder and mandibular joints).

The criteria for inflammatory back pain are:

slow (creeping) start that stretches over weeks,

night pain, better on waking,

ameliorated by exercise,

Worse, sleep and rest.

Inflammatory pain reflexively causes muscle spasm, which contributes to the development of spinal stiffness.In the early stages of the disease, the limitation of movements in the spine is caused by inflammation and painful spasm of the muscles of the back, in the later stages – mainly by ossification of the spine.

In case of damage to the thoracic spine, costal-vertebral joints, pain appears in the chest, sometimes encircling, aggravated by coughing, deep inhalation, and twisting of the torso. As a result of the defeat of the costal-vertebral joints, the respiratory excursion of the chest decreases, while the respiratory function is compensated by the diaphragm.

The defeat of the joints of the anterior chest wall (sternoclavicular, sternocostal, arm and body of the sternum) can be observed at any stage of the disease. Arthritis of the joints of the anterior chest wall occurs with ankylosing spondylitis in 17% of cases. Symptoms can range from mild soreness to severe, firm swelling.

Damage to the cervical spine occurs at a later stage of the disease. Initially, pain appears, the range of motion of the neck gradually decreases: rotation and bending are limited.In some cases, complete ankylosis of the cervical spine occurs with absolute immobility of the head and neck. The consequence of cervical spondylitis can be the phenomenon of discirculatory encephalopathy, accompanied by dizziness, nausea, headache.

Damage to peripheral joints can occur at any stage of the disease and is sometimes one of the first symptoms. In more than 50% of patients, peripheral joints, including the hip and shoulder joints, are involved in the process.Peripheral arthritis can be both a temporary manifestation of the disease and pass without a trace, or it can often be a recurrent manifestation, leading to persistent dysfunction of the joint. Large and medium joints of the lower extremities (hip, knee, ankle) are mainly involved, arthritis of individual joints of the toes is possible, temporomandibular joints may be affected.

A special variant of arthritis in this disease is a lesion of the hip joint (coxitis).It develops in about 1/3 of patients with ankylosing spondylitis; in adults, coxitis develops in the first 10 years of the disease. It is manifested by pain in the groin area, which can radiate along the front and side of the thigh, into the buttocks, and the front surface of the lower leg. It is possible to identify asymptomatic X-ray changes in the hip joints.

In addition to pain in the joints, there are also pain in the bones. It’s about inflammation of the places where tendons attach to bones. The very first symptoms of ankylosing spondylitis are sometimes pain in the heels, which make standing on a hard floor very unpleasant.Inflammation of the tendon attachment at the ischial bone makes sitting on hard chairs unpleasant. Other tendon attachments may also be affected. Inflammation of the tendon attachments is so characteristic of ankylosing spondylitis that they, along with other characteristic signs, can even be considered a diagnostic criterion.

Ankylosing spondylitis is a “systemic disease”. The malfunctioning of the immune system can also manifest itself in other organs, not only in the spine. General clinical manifestations of the disease:

temperature rise in the evening not higher than 37.5C, lethargy, weight loss with preserved appetite, fatigue.

EYES. About 40% of patients experience eye inflammation one or more times in their lives. It is about iritis (inflammation of the iris). If, in addition to the iris, the adjacent areas of the eye are inflamed, the doctor speaks of iridocyclitis or uveitis. The eye hurts (especially with large changes in brightness, in which the pupil should constrict), becomes sensitive to pressure and turns red.

HEART. Pathology on the part of the heart occurs the more often, the longer the disease lasts and the more severe it is.After a 15-year duration of the disease 3.5%, and after a 30-year duration 8-10%. Inflammatory changes in the heart caused by ankylosing spondylitis develop where the aorta leaves the heart. They can lead to heart failure (the valve no longer closes properly and with every heart beat, blood flows back to the heart). But inflammation can also block neural regulation between the atrium and the main chamber and lead to irregular heart rhythms. To avoid these unpleasant complications, it is important for patients to eliminate or mitigate risk factors such as smoking, high blood pressure, being overweight, and lack of movement.

LIGHT. Lung function is maintained due to abdominal breathing, even with complete ossification of the costal joints. But breathing volume can be severely limited. In about 15% of patients, this leads to fibrosis of the upper lobe of the lung (overgrowth of connective tissue in the lung), which facilitates infection of the lungs by bacteria and fungi. A countermeasure against this side effect (along with smoking cessation as a risk factor) is to maintain as much breathing as possible, which can be achieved through breathing exercises and physical training.

KIDNEYS and LIVER. Due to inflammatory processes, protein molecules are deposited in almost all organs, which is called amyloid. In the late stage, a lack of volume in the kidneys and liver can limit the function of these organs. Then they talk about amyloidosis. He is treated with diet and cortisone drugs. Amyloidosis is a compelling rationale for the use of these drugs, despite their side effects.

NERVOUS SYSTEM. Rarely, but still occur in the late stage of ankylosing spondylitis, complications in the nervous system.Due to the complete ossification of the edges of the intervertebral discs, myelopathy (a disease of the spinal cord) can be caused. A similar picture can be caused by displacements between the first and second cervical vertebra.

With the patient’s correct and reasonable understanding of his illness, the attention and support of a competent specialist, mutual cooperation, with an optimistic attitude and active participation of the patient in the treatment and rehabilitation process, ankylosing spondylitis can be controlled.

90,000 Dislocations of the femur in the hip joint (incl.dislocations of the head of the endoprosthesis, hip arthroplasty, periprosthetic fractures)

The hip joint is the largest and most powerful joint in the human body, responsible for functions such as hip movement, lifting and lowering, flexion and extension of the legs, and also takes part in torso bending. Dislocation of the femur in the hip joint is an injury in which the head of the femur is displaced outside the acetabulum.These dislocations make up no more than 5% of all dislocations. Dislocations can be divided into 2 types: anterior and posterior dislocations. Anterior dislocations are extremely rare and represent downward displacement of the femoral head with rupture of the joint capsule. Posterior dislocation occurs more often, as a result of which the head of the hip joint pops back.

In cases when the hip joint loses its functions (smooth cartilage is erased, which provides easy gliding of the femoral head in the acetabulum) and any movements cause unbearable pain, patients undergo arthroplasty. An endoprosthesis is an artificial substitute for any human organ (performing its function), which is located inside the human body. Hip arthroplasty is an operation to replace the affected joint components with an endoprosthesis, which has the anatomical shape of a healthy joint and allows full range of motion. Dislocations of the field of such an operation are very rare, but they do happen, and mainly these are dislocations of the head of the endoprosthesis.

The main causes of trauma.

Most often, such injuries occur during road traffic accidents, also during falls from a height, during explosions and collapses.

  • The causes of dislocation of the head of the endoprosthesis are:
  • Joint surfaces poorly touching
  • Overweight
  • Excessive stress on the artificial joint after surgery
  • Possible penetration into the joint cavity of infection
  • Poor endoprosthesis installation
  • Abrasion of joints, etc.

Signs of dislocation.

Symptoms of dislocation of a healthy joint and an endoprosthesis are the same.

  • Acute pain in the thigh region
  • Standing on an injured leg is unbearable
  • Inability to perform movements in the hip joint.
  • Obvious deformity of the hip joint (depending on the type of dislocation)
  • Forced position of the leg (depending on the type of dislocation)
  • Increased pain when attempting any movement with the injured leg
  • Swelling and hemorrhage in the buttocks, groin and femur





Treatment should be carried out in the trauma department by qualified specialists.

  • Dislocation of the femur without any complications is adjusted under general anesthesia in a closed manner (using various reduction techniques).
  • Surgical treatment is indicated in cases where fractures of the neck or hip bone are added to the dislocation. (If the cartilage is damaged during dislocation of the hip (which can lead to coxarthrosis in the long term), there is a need for arthroplasty of the hip joint).
  • Applying a plaster cast or skeletal traction for 3-4 weeks.
  • After that, the patient is recommended to walk on crutches for 10 weeks and rehabilitation procedures are prescribed.


Recovery process after hip dislocation:

  • Physiotherapy
  • Therapeutic gymnastics
  • Massage
  • Vitamin therapy

If all the recommendations of the doctors are followed, the prognosis of recovery is favorable.

Periprosthetic fractures.

Periprosthetic fractures can occur after arthroplasty. They represent a fracture in the area of ​​the endoprosthesis components. This is a serious complication that requires surgery. Because of the development of osteoporosis, the treatment of these fractures is difficult.

Aneurysmal bone cyst – destructive damage to the bone (possibly formed on the basis of local hemodynamic disorders), characterized by reactive proliferation of connective tissue containing cavities filled with liquid blood.It develops at any age, but mainly in children and adolescents – up to 80% of patients under 30 years of age and more than 50% of patients at the age of 10–20 years. Any bone can be affected, the most common localization: the bones of the spine, then the distal femur and proximal parts of the tibia and humerus, pelvic bones. The disease is somewhat more common in men. Secondary aneurysmal cyst (up to 30% of cases) is formed against the background of a pre-existing bone lesion, most often develops with chondroblastoma, giant cell tumor, fibrous dysplasia, chondromyxoid fibroma; with malignant neoplasms – osteosarcoma, metastasis of carcinoma.A distinctive feature of the aneurysmal bone cyst is the spread of the pathological process into neighboring bones (more often the bones of the spine – up to 12% of cases) and through the epiphyseal growth plate.

Clinical picture. Pain that intensifies with time and with physical exertion; pathological fractures are possible.

Radiographically reveal an eccentrically located lytic focus of the bone marrow cavity of the metaphysis; sclerosed edges, periosteal reaction.


Macroscopically, the tissue is hemorrhagic, brown in color, contains cysts with non-coagulated blood.

Microscopy. Cavernous spaces limit the septa of fibrohistiocytic tissue containing osteoclast-like cells, bone trabeculae of varying degrees of maturity, numerous mitotically dividing fibroblasts and osteoblasts, hemorrhages, hemosiderin grains.

Differential diagnostics. Giant cell tumor, giant cell reparative granuloma of bone, solitary bone cyst, telangiectatic osteosarcoma.

Treatment. Marginal bone resection with a pathological focus and plastic defect.

Exodus favorable; often recurs – up to 50% of cases with curettage.

Sacroiliitis – inflammation of the sacroiliac joint

Sacroiliitis is an inflammation of the junction of the sacrum with the ilium, that is, the sacroiliac joint (joint). This may be the cause of your lower back pain.By itself, sacroiliitis is rare. Usually it develops when there are already systemic, rheumatological diseases of the connective tissue – the integrity of the joint surfaces is destroyed and a pronounced pain syndrome appears due to a gradual dysfunction.

That is why sacroiliitis itself is not so dangerous as the diseases it accompanies. If you do not consult a doctor in a timely manner, they can give complications to other organs.

The reasons for the development of sacroiliitis can be:

  • primary sacroiliitis – initially develops in the joint;
  • trauma, infection, bone tumor that has developed from the tissues of the spine;
  • secondary sacroiliitis against the background of another systemic disease: when a rheumatological disease occurs, immunity fails, it triggers a defense reaction (the so-called immune response) against its own connective fibers.

Such rheumatological diseases can be spondyloarthritis, rheumatoid and psoriatic arthritis, infection or swelling in the joint, as well as trauma to the bones and ligaments.

Also, look for symptoms such as fatigue, fever and lower back pain, and stiffness in the hip and pelvis.

Sacroiliitis suffers from every second in a thousand, and more often men than women. About 15% of the sick lose their ability to work after 10-15 years, and, consequently, the quality of life decreases.

Methods for determining sacroiliitis include laboratory tests, radiography, CT and MRI. Each of these methods contributes to the overall picture of the disease:

Laboratory diagnostics will tell you about the general condition of the body, how active the inflammatory process is and to what extent the internal organs are involved in it.

X-ray informs about abnormalities in the bone tissue, that is, in the bones. However, at the initial stages, sacroiliitis does not affect them, and it is unreasonable and dangerous to wait for bone changes (and these are years!) At an advanced stage. Thus, this method will not be an adequate solution for making a diagnosis in the primary stage of sacroiliitis.

CT and MRI – more accurate methods. However, they “see” the problem differently and interact differently with the surveyed area, so the diagnostic results will also differ.

In acute inflammation, the MRI method is the most informative – it shows fatty changes in the bone marrow in the area of ​​inflammation, fluid in the joint and articular cartilage, the focus of inflammation in the tendons and muscles.

For the diagnosis of later stages of sacroiliitis, the CT method has proven itself well. It better shows bones and cartilage in the area of ​​inflammation, erosive changes and subarachnoid sclerosis. In addition, it is important that CT diagnostics makes it possible to exclude a cancerous tumor of the sacrum or vertebrae in a patient with sacroiliitis.

Our radiologists consider the main task of identifying the root cause of the development of sacroielitis.