Common Conditions Treated by Dr. Mahooti

Hip / Buttock / Thigh 

“Hip pain” means different things to different people.  Some people describe pain in the front part of the hip (the groin), while others point to the outer side of the hip, the buttock, and the low back.  Other people call it “sciatica” (which is a symptom, not a diagnosis), which has multiple causes.  Oftentimes one problem in the hip area creates a snowball effect that results in pain and dysfunction throughout the entire hip region. Imaging studies (X-Rays, MRIs) can help determine the likely cause(s), as can diagnostic/therapeutic injections. 

Myofascial Trigger Points –  are tight, tender muscle “knots” that are almost always present in people with pain in the hip, buttock, and thigh pain.  Sometimes the Trigger Points are the cause of the problem, other times they are the result of an underlying problem, as described below.  Dr. Mahooti is a national expert on Myofascial Trigger Point pain and treatment with Therapeutic Needling.  

Groin (Front of the Hip)

If your pain is deep in the front of your hip or groin, it’s often (but not always) related to problems inside the hip joint itself.  Common causes include:

• Myofascial Trigger Points in your thigh (quadriceps, adductors, pelvis muscles) can cause groin pain.
• Hip Osteoarthritis – wear and tear of the joint cartilage causing stiffness and aching in the groin, especially when walking or getting up from a chair.
• Hip Labral Tear – injury or fraying of the cartilage rim around the hip socket, leading to catching, clicking, or sharp groin pain.   Note:  Labral tears do not necessarily cause hip pain. Nearly 70% of people over the age of 40 who do not have hip pain will have a labral tear on MRI.  Labral tears are often incidentally found on MRI in people who do not have hip pain.  have no hip pain, and most people with hip osteoarthritis
• Hip Impingement (Femoroacetabular Impingement, “FAI”) – occurs when the ball and/or socket of the hip (femoroacetabular) joint is misshapen and over time often results in hip pain, labral tears, and osteoarthritis.
• Acute Muscle Strain / Injury – acute strain or injury of the muscles in around your hip and thigh (Hip Flexors, Adductors) 
• Referred Pain from the Lumbar Spine – sometimes, a pinched nerve, arthritis, and/or bulging discs can cause pain that feels like it’s coming from the hip joint.

Outer Hip (Side of the Hip)

Pain on the outer side of the hip and thigh is usually (but not always) from structures around the hip joint.  

Common causes:

• Myofascial Trigger Points along the buttock and outer thigh (vastus lateralis and IT band) can often cause outer hip pain.
• Trochanteric Bursitis (“Hip Bursitis”) – is often described as inflammation of a fluid-filled sac over the bony point of the outer hip. However, hip bursitis is a misnomer; bursal fluid is rarely evident on diagnostic ultrasound.  Most cases are due to hip tendinopathy, or referred from Myofascial Trigger Points along the thigh or buttock muscles that refer pain to the outer hip.
• Gluteus Medius / Minimus Tendinopathy (“Hip Tendonitis”) – strain or degeneration of the hip stabilizer tendons; may hurt when walking, climbing stairs, or standing on one leg.
• Nerve Entrapments in the hip region are probably more common cause of hip pain than is currently recognized.
• Referred Pain from the Lower Back – sometimes, a pinched nerve, arthritis, and/or bulging discs can cause pain that feels like it’s coming from the hip joint.

Buttock (Back of the Hip)

Pain felt deep in the buttock may come from the spine, sacroiliac joint, nerves (in the buttock itself), or muscles and fascia (“myofascial pain”).

Common causes:

• Myofascial Trigger Points in the buttock, thigh, or lower back can all cause buttock pain.
• Piriformis Syndrome – spasm, weakness, and/or tightness of the piriformis muscle can result in irritation of the sciatic nerve as it courses through the deep buttock muscles, resulting in buttock and posterior thigh pain, tingling, burning, or numbness.  If the neurologic symptoms go below the knee to the foot or toes, it suggests a pinched nerve in the lower back at the nerve root, called “lumbar radiculopathy,” which is derived from the term radicle, which means the root. (i.e. in math, the “square root” of a number is also called the “radicle”.)  
• Sacroiliac (SI) Joint Dysfunction / Arthritis– irritation or stiffness where the spine meets the pelvis, often producing one-sided lower back, buttock pain or posterior thigh pain.
• Hamstring Tendinopathy – pain where the hamstring attaches to the sitting bone, often worse when sitting for long periods.
• Deep Gluteal Pain Syndrome – a term used to described chronic, persistent buttock pain that does not respond to standard treatments.  Entrapped nerves, irritated tendons, and other potential causes are possible. 
• Referred Pain from the Lumbar Spine (Sciatica) – nerve irritation in the lower back can cause aching, burning, or shooting pain through the buttock and down the leg.

 Thigh (Quadriceps, Hamstrings, Adductors)

Your thigh is between your hip and your knee. Essentially all the conditions that affect your hip, low back, and knee can also cause thigh pain.

Other common causes include: 

• Acute injuries / strains of the thigh muscles 
• “Pulled muscle” (strain, tear):  hamstring, quadriceps, adductor
• Contusion (bruise)
• Adductor strain (“pulled groin”)
• Nerve entrapments (e.g. Meralgia Paresthetica)

 Myofascial trigger points are a common, overlooked cause of thigh pain. They can develop “out of nowhere” in three basic ways:

1. Sudden onset, no injury (“acute”): During a routine activity such as walking, gardening, housekeeping you develop sudden pain (tightness, stiffness)in a body part (hip, thigh, shoulder…)
2. Delayed onset (“subacute”):  After a routine activity (you may have overdone it a bit) or a new activity (yardwork, hiking, exercising, playing a sport).
3. Post-injury:  in the weeks or months after an injury, you develop persistent pain, stiffness, instability, weakness and/or a number of other symptoms that may be “hard to describe”.  You may have been told you have “scar tissue” or made to feel it is all “in your head” because all your diagnostic tests and “unremarkable” or normal.