Backpacker's/ Purse Hip

Lately, I've been seeing a considerable amount of lateral hip pain.  Specifically off the iliac crest, the edge of the hip on your side.  As seen on the video, there are a number of attachments of muscles onto the iliac crest which span from the large muscles like the latissimus dorsi and erector spinae to trunk muscles like the external oblique, tranverse abdominus and quadratus lumborum.  You can imagine that any muscle imbalance created, such that, there is either a strength deficit or asynchronous firing amongst muscle groups, this could create abnormal firing patterns and such alterations in your trunk, posture and overall lead to pain and injury.  

With most injuries of this type, causes include two main categories, biomechanical error or overload principle.  The error in this case is the back pack/purse which is worn on one side and thus activating one side to pull on the other.  This leads to re-educating muscle groups and poor firing pattern.  The other is overload principle which is loading that side of the body for prolonged periods of time and then some.  

Addressing the situation with corrective rehabiliation aimed at muscle re-education of the whole kinetic chain, from foot to head is key.  Creating a balanced ergonomically sound structure.  Eliminate the backpack/purse on one side and go with over both shoulders.  In fact, I prefer to have my athletes wear them like this because it helps protract/pull back the scapula and lift the chest, off-setting those tight pectoralis/chest muscles we all get as well as relax the cervical/neck curve by shutting down the muscles that attach to the neck and upper back (occiput and trapezius).  I often will prescribe a figure of 8 brace (which i have done for years in clavicle fractures-it approximates the fracture and many times my athletes will say their upper and lower backs feel better too).  I'll use a kinesio-tape imbedded shirt like intelliskin too.  

Hope that helps!

Dave Carfagno, DO, CAQSM


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