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The patient's medical history gives some clues as to the pain-producing
structure. For instance, in what position does the athlete sleep?
The athlete who does not sleep
on his/her side most likely has a problem around the greater trochanter, where
the tendons
and the muscles of the hip
joint attach, because sleeping on the side would compress these structures and
cause pain.
Patients with sacroiliac
relaxation or ligament injury typically sleep on their sides or abdomens, but
very seldom sleep on their backs. Rolling onto the back during
sleep, in these cases, will frequently wake the person from a sound sleep.
Often the difficulty of finding a comfortable position makes sleep nonrestful
and the person arises tired.
When a person has sacroiliac
ligament
injury, it is presumably the straightening of the lumbar spine
and flattening of the back with posterior rotation of the sacrum that is so
painful that sleep is difficult in a recumbent position. In this condition,
difficulty is also experienced while sitting and rising from a chair.
Sitting puts a lot of pressure on the structures that attach to the ischial
tuberosity. The hamstring muscle and sacrotuberous
ligaments
attach there. The person who complains of pain while sitting and does not have
excruciating pain while running, but more of a dull ache that comes and goes,
most likely is suffering from sacrotuberus ligament sprain. Hamstring
muscle syndrome has a characteristic complaint of pain while in the sitting
position. The pain is often relentless, causing the person to change position
or stand up for relief. The athletes complain of pain at the buttock,
caused by stretching while running or performing gymnastics. The pain is
typically induced by forcibly driving the leg
forward, as in sprinting or hurdling. The pain is seldom felt while running
slowly or lying down. Endurance athletes feel the pain of hamstring
muscle syndrome during sudden spurts and while trying to increase speed.
Kicking the ball with maximal force causes pain for soccer players with this
condition. The physical examination reveals significant tenderness around
the ischial
tuberosity in both sacrotuberus and hamstring muscle strain.
Hip
ischiofemoral ligament sprain typically causes a reflex inhibition of the
gluteus medius and gluteus minimus muscles. This is one of the main reasons
that ligament
injuries cause a decline in an athlete's performance. Often ligament
injuries cause a reflex inhibition of the muscles that surround the joint that
the ligament is designed to protect. The body protects the joint by allowing
the muscles to become weaker (reflex inhibition) when the joint ligaments are
injured. This weakness is evident to the person, especially the athletes. The
person usually sees that there is a problem and seeks medical attention so that
further injury is prevented.
Any change in performance, such as a subtle weakness or a new pain, needs to be
checked out as soon as possible. Often a simple ligament sprain can be detected
and adequately treated with no loss of training time.
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