This month I want to describe an interesting case of hip and leg pain with a surprising component that was treated successfully by neural therapy. The patient was an otherwise healthy woman of 62 years whose pain had developed while exercising four years previously. The pain came on suddenly without any preceding trauma or strain, and she had never experienced a similar pain before.
The pain centered in the right anterior thigh, was relieved somewhat by movement and flexing her hip. She slept more comfortably on the opposite side. The thigh muscles felt stiff and with time slight swelling developed in her thigh.
The pain worsened so the family doctor proceeded with nerve conduction studies and an MRI, which contributed nothing. A neurosurgical consultation also came up empty. Physiotherapy and chiropractic manipulation provided some help in the beginning, but none as time went by.
Her only previous injury was a fall off a ladder onto her right side eight years before with pain in the hip area lasting several weeks. Her surgical history included a remote appendectomy, tonsillectomy and adenoidectomy, cholecystectomy and hysterectomy.
Physical examination showed a symmetric pelvis anteriorly and posteriorly with no sign of sacroiliac instability. Mild restriction of straight-leg raising was found on the right and considerable spasm of the right psoas, piriformis and hip adductor muscles.
This seemed like a straightforward mechanical problem that should respond to osteopathic manipulation. Her otherwise good health and relative lack of serious trauma were in her favour. However, the gradual worsening of her symptoms with time and the mild swelling of her thigh was puzzling. In fact the swelling, (absent trauma or any sign of inflammation) suggested an autonomic nervous system component.
Osteopathic manipulation: "muscle‐energy technique" of the hamstrings, piriformis and psoas muscles was conducted, and as I feared, the response was disappointing. In an uncomplicated situation, muscles should "release" easily. There should be a "sweet" feel as this happens, as if the muscles are relieved at being freed from their constraints.
In my patient's case, the muscles were stingy and only reluctantly and partially gave way. This is a sign of either a more important mechanical problem (somatic dysfunction) elsewhere, or an interference field somewhere in the body.
I had already examined her from head to toe for somatic dysfunction, so this left an undiscovered interference field as the likely cause. One clue was a depressed affect. The patient admitted to feeling depressed but blamed it on pain and loss of her usual excellent health. Using autonomic response testing, I checked her liver, and sure enough, an interference field was found. When challenged with various substances that can "disturb" the liver, there was a response to DMSO, the "universal solvent". This was a sign that the liver was being stressed by an organic solvent. (See chapter 10 of my book.) The patient admitted to a hobby of stripping paint from furniture ‐ a high‐risk activity for the liver. The patient's liver interference field was treated with a Tenscam device; (an alternative would have been quaddles of dilute procaine over the liver and right upper shoulder, according to the Head zones. The patient was instructed to avoid all contact with organic solvents and to eat a diet rich in eggs, garlic, brassicas, and other sulphur-rich foods.
Three weeks later the patient returned feeling "much better". The pain had worsened for one day, and then subsided suddenly and dramatically. Her mood was also much improved. A slight relapse had occurred just before her return visit and on examination she again had tight right psoas, piriformis, hamstrings and hip adductor muscles. Swelling of her thigh also persisted.
This indicated that another interference field was still present. A repeat examination using autonomic response testing showed the liver to be clear, but the hip joint itself to be an interference field. Perhaps the hip joint interference field had been silent since the patient's fall on her right side eight years before. And perhaps the toxic effect of the organic solvents on the liver had brought the hip interference field to the surface.
The restriction of motion of the hip joint in multiple directions was consistent with the "capsular pattern" described by Cyriax. I was surprised to find that the capsular pattern concept has been challenged by some studies, but inter‐examiner reliability experiments in turn question the validity of all research relying on physical examination for range of motion. In any case there is almost certainly a sympathetic nervous system effect in these joint capsule disturbances. (See related comments on the "frozen shoulder" in Vol. 2 No. 6 of the archives.)
The hip joint interference field was treated with a Tenscam device. Alternative treatments would be quaddles of dilute procaine over the hip area, or an intra‐articular injection of 5 cc of procaine ½%.
The result of this last treatment remains to be seen, so I cannot yet give you the end of this story. Perhaps the subject of another newsletter!
Robert F. Kidd, MD, CM