Turning Pain into Gain through Learning
Learning through research is one thing, but learning through personal experience is completely different. However the two complement each other beautifully. Physical pain as an example.
Article is quite long, maybe truncated in the email and if so can be viewed online here at InnerFood
IRONY: definition - “the full significance of a character's words or actions is clear to the audience or reader although unknown to the character”.
Well I am the character in this play of my life. And irony abounds in the events that have unfolded over the last few months. In August last year we published the article below on Osteoarthritis (OA). The impetus for writing this very thorough article on OA was accentuated because I was working as a contractor to deliver consultancy and couching for people diagnosed with OA here in Tasmania, Australia at that time. The best way to learn something more deeply is to write about it. So, I did.
I really love walking and partake often twice a day. A month after writing the above article I started to develop an annoying pain around the left hip area, mostly after the walk (or little bouts of HITT jogging) went beyond about 20 minutes.
Consciously trying to locate the source of the pain plus doing targeting stretching to alleviate tightness of the muscles leading to that area of the body, began to have less and less of a pain reducing effect.
Most of my long life (72 this year) has been blessed with very little pain. Of course there is empathy I can muster when friends and clients are in pain. Yet I was about to embark on a journey where palpable pain, unknown in origin or cause and unrelenting, would present itself in MY body.
This was all very annoying. (So entitled, I’m sure, after all those pain free years). Even though I had lots of professional health training and knowledge about potential causes and human anatomy, I couldn’t resolve the pain escalation myself. I approached my doctor armed with some initial research using Advanced Ai and a sincere desire to get to the bottom of the issue. The recent article below shows my early adoption of Advanced/Medical based Ai and its potential usefulness, particularly as doctors, surgeons, pathologists and radiologists are more and more leveraging its strengths themselves in 2025.
Collaborating with my doctor revealed that an X-ray of the hip area should be the first line of investigation. Great. Let’s go, this unexplained pain is annoying. And because pain can be very motivating, I began using Ai to investigate possible causes while waiting for the X-ray results.
This involves the simple process of articulating a prompt for the current chosen advanced Ai platform (Usually a paid version). A prompt is basically providing detailed questioning and supplying background information. This included a list of current symptoms, associated activities that related temporally to some symptoms and a request from the Ai platform for a differential diagnosis (DD).
A differential diagnosis is basically creating a list of the usual suspects from a medical/health perspective and systematically working through eliminating the more obvious ones first, often using judicious testing, imaging and a physical examination.
Note that a physical examination, unfortunately may be used less and less these days due to the way the medical system is evolving with doctors having barely more the 10 minutes per consult and a huge weight of admin tasks to perform during that 10 minutes in addition to speaking with you. Hence my banging on about health literacy and being as informed as you can before you walk in to an appointment to collaborate with your GP or other health professional.
Now why would I engage in my own learning rather than wait for what my GP says and leave it at that? Simple. There is something causing me pain. The source of that pain has not yet been confirmed. The cause of the source of the pain has not been identified. I’m waiting for a report from the radiologist who may or may not give a definitive diagnosis. I am able right now to produce a simple list of current symptoms and the activities temporally associated with these symptoms AND ask Ai to give me a preliminary sketch, a draft if you will, of a differential diagnosis listing the most probable causes of the pain.
Because I didn’t want to cause further aggravation of the pain through walking and I needed to move, I also wanted to know, that if I had OA of the hip, what was the least intrusive movement I could do while waiting for the pathologist/doctor report/consult, which by the way has taken two months to land after all the followups. Additionally, clear interventions are still forth coming while waiting for Physiotherapist/Exercise Physiologist recommendations and guidance.
Interestingly, the Ai preliminary sketch of a differential diagnosis list included potential Osteoarthritis.
The X-ray arrives via email. I’m surprised that the radiology lab gives me the two X-ray images before I have my follow-up appointment with my GP. Well let’s see how Advanced Ai interprets these images. We will follow this with the actual radiologist report and compare the two.
My X-ray
Example X- ray of normal hip.
These X-rays are from Radiopaedia
“Radiopaedia’s mission is to create the best radiology reference the world has ever seen and to make it available for free, for ever, for all.” Well that’s impressive. I found this site while doing the preliminary research. Great find.
Example X- ray of significant OA of the right hip.
My Pathologist report
"Cartilage joint space appears well preserved. Minimal evidence of left hip OA. No destructive or aggressive bone lesion. No avascular necrosis. No destructive or aggressive bone lesion." 10th December 2024
Advanced Ai Report
Initial Ai report, word for word, after me asking - Please assess whether these x-ray scans of the left hip of a 70 year old male show any signs of osteoarthritis. However in some ways this is a loaded question ( should ask for report without mentioning OA)
“I am not a medical professional, so this does not replace a formal report from a radiologist or orthopaedic specialist. However, based on typical radiographic indicators of hip osteoarthritis, here are some general observations:
Key radiographic signs of osteoarthritis
Joint-space narrowing (particularly in the weight-bearing region).
Osteophytes (bone spurs) along the femoral head or acetabular rim.
Subchondral sclerosis (areas of increased bone density near the joint surfaces).
Subchondral cysts (cystic areas just under the articular surfaces).
What I see in these images
There appears to be slight narrowing of the joint space in the superior (weight-bearing) portion of the left hip.
The outer edges of the acetabulum and femoral head look slightly more sclerotic (whiter and denser) than normal, which can indicate subchondral sclerosis.
I do not see any pronounced or large osteophytes, though there may be subtle bony ridges at the margins.
There are no large or obvious cyst-like lesions visible in the femoral head or acetabulum on these views.
Overall impression
These x-rays do show mild to possibly moderate degenerative (arthritic) changes, which could be consistent with osteoarthritis in a 70-year-old. The main features appear to be some loss of joint space and mild subchondral sclerosis, both common in osteoarthritis. No obvious severe findings (such as marked joint-space collapse or large osteophytes) jump out from these particular views.
Again, for a definitive interpretation and to correlate with symptoms, one should consult a qualified radiologist or orthopedic specialist.”
Understanding so far…
Well that’s interesting. Carefully reading the Pathologist report, one can conclude that all sounds fine and that all is well and not much to see here. In contrast the Advanced Ai generated report is similar in that nothing major going on, however there are possibilities of “mild to possibly moderate degenerative (arthritic) changes”
Well I still have pain and so far nothing definite.
I decide to give Advanced Ai more information in addition to the X-ray - a simple list of current symptoms and the activities temporally associated with these symptoms AND ask Ai to give me a preliminary sketch, a draft if you will, of a differential diagnosis listing the most probable causes of the pain and, importantly, next steps.
More info for Ai
Here is what I provided and asked…
“Symptoms - Pain in the left groin area deep within when the left leg is raised while standing. This pain is intermittent but becomes very pronounced and worse once walking has begun. Longer the walk more noticible the pain. This has only come about in the last few months. Interesting that if mild jogging is begun, the pain mostly disappears but then quickly comes back when reverting to walking. Stretching helps especially if walking stops but seems to be only temporary relief as walking is continued. Also lot of stiffness and mild diffuse pain and discomfort during the night while sleeping and requires getting up and stretching during the night to relieve the discomfort. Stretching ham strings mostly and gluteal muscle helps.
Associated activities - more walking and some mild jogging had increased in past 6 months. Some weight gain around abdominal and with probable increases in intra abdominal fat - around extra 5 kilos. -
Request - Taking into account the above X-rays and whether if indeed this mild osteoarthritis can cause this pain, can you provide a detailed differential diagnosis indicating most probable cause of pain and discomfort with the most probable cause first followed by other possible causes in order of most probable.
Next Steps - Follow this by an ordered list of extra tests ( in groups to rule out causes sequentially) and imaging to help come to a definitive conclusion.”
In response Advanced Ai provided this Differential Diagnosis (word for word)
Below is a general discussion of possible causes (differential diagnosis) for hip and groin pain, given:
The x-ray findings (mild degenerative changes).
Clinical symptoms (deep groin pain upon raising the leg, aggravated by walking, less so with mild jogging, stiffness at night, temporary relief by stretching).
Lifestyle factors (recent increase in walking/jogging, slight weight gain).
Important: This is for educational purposes only and is not a substitute for an in-person evaluation by a qualified healthcare professional.
1. Most Probable Causes of Pain (in descending order)
Mild to Moderate Hip Osteoarthritis (Coxarthrosis)
Why it fits:
Age 70, mild degenerative changes visible on X-ray.
Groin pain that worsens with weight-bearing and walking is classic.
Nighttime stiffness and pain are also common in osteoarthritis.
Why it might not fully explain everything:
Pain that improves slightly with jogging (a higher-impact activity) can be atypical, although the body’s increased blood flow/warm-up effect can transiently mask discomfort.
While mild OA can indeed cause significant pain, imaging correlation of “mild” changes does not always perfectly correlate with symptom severity.
Femoroacetabular Impingement (FAI) or Labral Tear
Why it fits:
Deep groin pain with hip flexion movements is suggestive of a possible labral issue or FAI (especially if raising the thigh aggravates it).
FAI can occur concurrently with early osteoarthritis or accelerate degenerative changes.
Clinical clues:
Painful “clicking,” locking, or catching in the hip may be associated with a labral tear (though not always reported).
FADIR (flexion, adduction, internal rotation) test or FABER (flexion, abduction, external rotation) test can provoke symptoms in FAI/labral tears.
Iliopsoas Tendinopathy / Bursitis
Why it fits:
Pain is deep in the groin, exacerbated by hip flexion (raising the leg).
Iliopsoas issues can cause discomfort when initiating walking because of repeated flexion.
Relief with stretching the hamstrings and glutes might also indirectly reduce tension on the iliopsoas.
Why it might be secondary:
Iliopsoas problems do not typically cause significant stiffness at night; however, persistent inflammation could still cause nocturnal aching.
Lumbar Spine Referred Pain (e.g., L2–L3 radiculopathy)
Why it fits:
The L2–L3 nerve roots refer pain to the anterior thigh and groin area.
Pain that varies with certain positions and walking distance can be neurogenic.
Why it might be less likely:
Typically, neurological signs like numbness, tingling, or radiating pain down the thigh are seen (though not always).
Groin-centered pain strongly points more toward hip joint or proximal muscles, but the lumbar spine remains a consideration.
Less Common Considerations
Avascular Necrosis (AVN): More common with history of steroid use, alcoholism, or other risk factors. Usually, X-ray changes in mild AVN can be subtle, but your X-rays suggest only mild OA changes.
Adductor Tendinopathy or “Sports Hernia” (Athletic Pubalgia): Usually more medial groin, but can mimic hip joint pain.
2. Recommended Further Workup / Tests
A stepwise, “rule-out” approach can clarify the main pain generator.
Step A: Detailed Physical Examination
Orthopedic Tests for Hip
FADIR test (Flexion, Adduction, Internal Rotation): Often used to detect femoroacetabular impingement.
FABER (Flexion, Abduction, External Rotation) or Patrick’s test: Can stress the hip joint and sacroiliac joint.
Thomas test: Assesses iliopsoas tightness.
Gait Analysis
Observe walking, stance, and jogging patterns to see if mechanical factors (e.g., limp, Trendelenburg sign) are present.
Palpation
Palpate for tenderness in the iliopsoas region, trochanteric region, pubic symphysis, etc.
Step B: Initial Imaging / Tests
(You already have standard AP and lateral [or oblique] X-rays of the hip.)
MRI or MR Arthrogram of the Hip
Rationale: Best next imaging step if a labral tear or subtle chondral lesion is suspected.
An MR arthrogram (with contrast injected into the hip) is the gold standard for detecting labral pathology.
Ultrasound
Rationale: Could evaluate the iliopsoas tendon/bursa (to see if fluid is present), though MRI is generally more comprehensive.
Blood Tests
Rationale: While not always essential, checking inflammatory markers (CRP, ESR) can help rule out inflammatory or infectious processes if there is suspicion of something beyond degenerative changes.
Step C: Further Diagnostic Interventions
Diagnostic Injections
Intra-articular hip injection (local anesthetic ± corticosteroid): If the pain dramatically improves right after an intra-articular injection, that strongly indicates the hip joint itself (OA, labral tear) as the pain generator.
Iliopsoas bursa injection: If suspicion remains for psoas tendonitis/bursitis, a targeted injection can confirm or rule this out.
Step D: Lumbar Spine Imaging
When to consider: If physical exam maneuvers or clinical history suggest possible nerve root involvement or if hip imaging is inconclusive. This can be done via an MRI of the lumbar spine.
3. Putting It All Together
Given your description of:
Pain pattern (worse with walking, temporarily better with mild jogging and stretching).
Night stiffness, mild degenerative changes, and age.
The most likely culprit is hip osteoarthritis, potentially with an element of impingement (FAI) or iliopsoas involvement. Because the pain improves with jogging (possibly from endorphin release, increased joint lubrication, or altered gait mechanics) but flares again with routine walking, you may have an activity pattern that irritates the anterior hip structures more with low-impact, repetitive flexion/extension. There could also be a small labral tear compounding the underlying mild OA.
Priority:
Correlate your clinical exam with MRI (or MR arthrogram if labral pathology is strongly suspected).
Consider a diagnostic injection to confirm the precise source of pain.
Address modifiable risk factors (weight management, targeted physical therapy, muscle strengthening around the hip).
Ultimately, an orthopedic specialist or experienced sports medicine physician could confirm these suspicions via clinical tests and advanced imaging.
Conclusion so far …
I’m off to see my GP for a referral for an MRI (no contrast dye)
In next article…
Things begin to look more positive as I get more informed and collaborate with Radiologist, GP and Advanced Ai. Receive MRI and are sent all (140+) images! (through I-MED Radiology Network in Australia) and begin detailed investigation and non intrusive interventions. Temporary movement and exercise interventions (from Advanced Ai. to start with) start providing pain relief and allowing aerobic and strength exercises. Still waiting to see Physiotherapist/Exercise Physiologist.
Glossary
Adductor Tendinopathy
Definition: Irritation or damage to the tendons of the muscles on the inner thigh (the adductors). It can cause groin pain, especially during activities like running or changing directions quickly.
Arthrogram / MR Arthrogram
Definition: An imaging procedure where contrast dye is injected into a joint before an MRI (Magnetic Resonance Imaging) scan. This helps highlight structures like cartilage and the labrum (rim of cartilage around the hip socket), making small tears or damage more visible.
Athletic Pubalgia (“Sports Hernia”)
Definition: A strain or soft tissue injury in the lower abdomen or groin area common in athletes. Despite the nickname “hernia,” it typically does not involve a true abdominal-wall herniation.
Avascular Necrosis (AVN)
Definition: A condition in which blood supply to the bone (often the femoral head) is compromised, causing bone tissue death and potentially leading to joint collapse over time.
Bursa / Bursitis
Definition:
Bursa: A fluid-filled sac that cushions and reduces friction between bones and soft tissues (e.g., tendons) around joints.
Bursitis: Inflammation of a bursa, leading to pain and swelling.
Chondral Lesion
Definition: Damage or defect in the joint’s cartilage (the smooth covering over bones in a joint).
Coxarthrosis
Definition: Another term for hip osteoarthritis, referring to degenerative changes in the hip joint.
C-reactive Protein (CRP)
Definition: A blood test marker for inflammation. Elevated CRP can indicate infection, inflammatory conditions, or other health issues involving systemic inflammation.
Degenerative Changes
Definition: Gradual “wear-and-tear” of joint components (cartilage, bone surfaces) often seen in osteoarthritis. On X-rays, these can appear as joint-space narrowing, bone spurs, or increased bone density near the joint.
Erythrocyte Sedimentation Rate (ESR)
Definition: A blood test that measures how quickly red blood cells settle at the bottom of a test tube. A faster-than-normal rate can be a sign of inflammation in the body.
FABER Test (Patrick’s Test)
Definition: A clinical exam maneuver involving Flexion, ABduction, and External Rotation of the hip. It helps identify pain originating from the hip joint, sacroiliac joint, or surrounding muscles.
FADIR Test
Definition: A clinical exam maneuver that involves Flexion, ADduction, and Internal Rotation of the hip. It is often used to screen for femoroacetabular impingement (FAI) or labral tears.
Femoroacetabular Impingement (FAI)
Definition: A condition where abnormal contact between the femoral head (top of the thigh bone) and the acetabulum (hip socket) causes pain and can lead to joint damage or labral tears.
Gait Analysis
Definition: The study/observation of a person’s walking (or running) style to identify mechanical or structural abnormalities that may contribute to pain or injury.
Iliopsoas
Definition: A major hip flexor muscle complex (combining the iliacus and psoas muscles). It lifts the thigh toward the torso, and tightness or inflammation (tendinitis/bursitis) can cause deep groin pain.
Impingement
Definition: In orthopedics, this usually refers to two bony structures pinching soft tissue (such as the labrum or tendons) between them, causing irritation or damage.
Intra-articular Injection
Definition: An injection of medication (e.g., anesthetic, corticosteroid) directly into a joint space to reduce inflammation and pain or to help diagnose the source of pain.
Labral Tear
Definition: A tear in the ring of cartilage (labrum) that lines the rim of the hip socket (acetabulum). Labral tears can cause groin pain, clicking, locking, or instability in the hip.
Lumbar Spine / Lumbar Radiculopathy
Definition:
Lumbar Spine: The lower part of the spine (low back).
Lumbar Radiculopathy: Irritation or compression of nerves in the lower spine that can produce pain radiating down into the buttocks or legs (sometimes felt in the groin).
Magnetic Resonance Imaging (MRI)
Definition: A non-invasive imaging technique using magnetic fields and radio waves to create detailed images of the body’s internal structures (soft tissues, bones, organs).
Osteoarthritis (OA)
Definition: A common joint disorder involving the breakdown of cartilage and changes to surrounding bone (bone spur formation, joint-space narrowing, sclerosis). Often associated with aging or repeated joint stress.
Radiculopathy
Definition: Pain and/or neurological symptoms (like numbness or weakness) caused by nerve root compression or irritation, most commonly in the neck or lower back.
Subchondral Sclerosis
Definition: Increased bone density (appearing whiter on X-ray) just below the cartilage surface of a joint, commonly seen in osteoarthritis.
Tendinopathy
Definition: A broad term for tendon injury, encompassing inflammation (tendinitis) or more chronic tendon degeneration (tendinosis).
Thomas Test
Definition: A physical exam maneuver used to evaluate hip flexor tightness (mainly the iliopsoas muscle). During this test, lying on the back with one knee pulled to the chest highlights tightness in the contralateral hip if it lifts off the table.
Trendelenburg Sign
Definition: A physical exam finding where the pelvis drops on the opposite side of a weakened hip abductor muscle (often the gluteus medius). It can indicate hip joint or muscle dysfunction.
