Leg pain pain is a common complaint, especially for people who run a lot. Although running is a great exercise it asks a lot of the muscles in the thigh and hip, and when we have been sedentary for a lot of the day sitting at desks this can be a lot for the body to cope with. A common area for people to experience pain is at the top of the thigh near the pelvis. It often goes with rest only to return as soon as we start training again.
In order to understand what causes this problem we need to know little bit about the muscles around this area. The four main muscles in the thigh (Quadriceps) are mainly concerned with straightening the leg. One of the muscles also helps in assisting the hip flexors which bring the thigh to the front again so we can take the next step forward. However the main hip flexor is a little know muscle called psoas (it’s a silent ‘p’ if you want to impress your friends!). It attaches to the lower back and the inner thigh and can therefore cause problems in both these areas. If this muscle becomes chronically short, for example if we sit a lot, then it can’t operate at its full potential and struggles when we ask it to work hard when we’re running and sprinting.
The reason for the pain at the top of the thigh is often not the psoas muscle itself as this is often working at below full potential, but the small muscle of the quadriceps I mentioned in the previous paragraph. As this assists in flexing the thigh it gets recruited when the psoas isn’t working correctly, and so becomes prone to injury and therefore pain and tenderness. We therefore experience thigh pain from the smaller accessory muscle at the top of the thigh, but it's not because this muscle isn’t working well, it's because it’s working too hard!
To address the problem we need to treat the local inflammation but most importantly the shortened hip flexors. Just treating the injured muscle doesn’t address the root cause and so the injury keeps returning.
I am often asked what the difference is between osteopathy and physiotherapy, and which treatment would be most suitable. It can be hard to know who to see, and if one treatment is better for certain conditions. In today's private practice the two professions have many similarities and treat pretty much the same problems – equally successfully - albeit with a slightly different ideology and approach.
Osteopaths view the body as a unique, interconnected system which has the ability to heal itself given the right environment. Osteopathic treatment focuses on correcting any disruption in this system - such as restricted joints, poor spinal alignment, muscle tension and imbalances and incorrect posture/movement patterns. Each person is assessed individually and not treated according to any set protocol.
Osteopathic diagnosis and treatment is around 90% 'hands-on'. The techniques employed vary from soft tissue techniques such as massage and passive joint movements to joint manipulations (often referred to by patients as 'cracking'). They may also use ultrasound or acupuncture, and in many cases advise on lifestyle and posture. Exercises and/or stretches may also be given.
Physiotherapists concentrate on restoring optimum function and performance to the problem area. As physiotherapy has been an intrinsic part the NHS for many years, the availability of funding has driven research and enabled studies leading to the development of 'treatment protocols' for the treatment of specific problems.
Physiotherapy diagnosis and treatment is less 'hands-on' (around 60%) as more focus is given to observing movement and correcting technique. The techniques employed by physiotherapists vary from soft tissue techniques, such as massage and passive joint movements, to more extensive rehabilitation exercise programs. Ultrasound may also be employed.
If people who primarily focus on muscles sit at one end of a spectrum (i.e. massage therapists to relax or personal trainers to strengthen) and people who primarily focus on joints sit at the other (i.e. chiropractors), physiotherapists and osteopaths sit together in the middle.
So who should I see? It really comes down to personal preference. Both professions can successfully treat the same conditions, so if you still can’t decide my advice would be to ask around for a recommendation, as the individual is probably more important than the profession.
But if you have a problem... Do something about it! It is more important that you see someone (physiotherapist or osteopath) rather than see no one at all!!