You’re Just ONE Motion Away…
Better Than An MRI
DIY Diagnostic Guide
How To Narrow In On the Source Of Your
Pain Using Simple Self Movement Tests &
A Step-By-Step Approach Without Needing
Expensive Images Or A Specialist
DR. CHARLIE JOHNSON, PT, DPT, OCS
INTRODUCTION
HOW TO USE THIS GUIDE
For those who don’t know me yet, my name is Dr.
Charlie Johnson. I am a Doctor of Physical Therapy
and a Board Certi ed Orthopedic Specialist.
Why I created this guide: I want to save you the time, energy, and money expense of X-rays, MRIs, and other expensive diagnostic tests- because for 99% of people with
back, butt, and/or sciatica pain they simply aren’t needed, are a waste of resources, and can actually make you worse! I want to quench your thirst for knowing “what it is”
while also helping you move past your diagnosis and closer towards natural relief, so that you can get back to normal.
Where it all began: When I rst started my career as a PT, back in 2013, I was hungry to help as many people as possible- through motion as medicine. I realized pretty
quickly that traditional medicine had other plans. Most people were pushed down the “Healthcare Rabbit Hole” and offered pills, shots, and surgery as the rst line of defense
for their aches and pains. Most of my patients felt unheard, frustrated, and confused by the lack of attention and education given by their providers. It made me angry…
I’ve always been interested in learning, and decided I needed to do everything I could to be an advocate for people in pain. I applied and got accepted to the University of
Southern California Orthopedic Residency Program- a speciality program that breeds the top 1% of PTs in the world. What I gained here was insider access to nearly every
type of specialist in the arena of pain management… orthopedic spine surgeons, hip surgeons, neurologists, pain management physicians, radiologists, as well as osteopathic
physicians, massage therapists, yoga and pilates instructors, and of course other physical therapists. Through constant interaction and working alongside these professionals
as a student, teacher, and researcher- I began to think and see things differently. One thing became clear… despite all the combined knowledge and experience, no one knew
how to best help people with back, butt, and sciatica pain.
I made it my duty to ll in the gaps and travel the country to study all the various approaches… and even still, there was something missing. I thought, “there's got to be a
better way…”
Suddenly, it hit me… all us “doctors” were doing what we know, but it’s actually YOU who knows BEST. In other words, because you’re the one in your body, feeling what you
feel, only you can heal yourself. Doctors and specialists can give recommendations from experience, but because we’re not experiencing what you're feeling, we can only DO
so much. Notice the emphasis on DO. Traditional medicine is focused on doing things to people in an effort to reduce pain vs. teaching people how to help themselves. BIG
difference. So, while it may seem like a stretch right now, the real problem is that up to this point, you likely have not been given the tools to begin solving your own problem.
As a teacher, it all goes back to this quote…
“Give a man a sh, and you feed him for a day. Teach a man to sh, and you feed him for a lifetime.
-Lao Tzu
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This is my mission: To teach as many people as possible how to solve their own pain problems naturally using education and motion by granting them the tools, knowledge,
and understanding needed. My hope is that this guide kickstarts that journey, and opens your eyes to the power of education and allows you to be your own best advocate on
your path to healing. I believe in you…
HOW TO USE THIS GUIDE
WHAT THIS GUIDE WILL AND WILL NOT DO FOR YOU
This guide was created from many years of experience, late nights, and hours upon hours of study to guide you on the path to better understanding what could be going on with your body.
It’s going to walk you step-by-step through my thought process, as if you were standing right in front of me, when trying to determine the source of symptoms. A word of wisdom and caution:
Please keep in mind that the source of symptoms isn’t always the cause. For example, your back might be the source, but the cause could be due to an old injury or compensation happening
in your hips, trunk, or legs. Determining the cause requires a more in-depth analysis. This guide will give you all the information you need to determine the most likely source of your issue.
I’ve titled it “Better Than An MRI DIY Diagnostic Guide” because it truly is just that- more telling than any image you’ll ever receive. Not to mention, it’s completely free. How can I say that with
such con dence? It’s pretty well understood that MRIs and other diagnostic tests are unable to accurately determine the source of someone’s pain. In simple terms, they pick up all kinds of
scary stuff, but can’t pinpoint which (if any) of these things are causing the pain. MRI’s don’t tell the whole story because, well, as the old saying goes, “behind every picture hides the true
story.” Without the story, the meaning behind the image is unclear. This guide changes everything…
In my experience, by simply listening to what’s going on with you (your story) and putting your body through certain motions, we can get a rough idea of what’s going on. And here’s the cool
thing, you don’t need have an exact “diagnosis” to solve your problem (unless you want shots or surgery). Using simple motions and a step-by-step approach we can get a “ballpark”
estimate of where things are originating, as well as the motions that aggravate your issue - and that’s enough. This helps us establish a “movement diagnosis.” Another term for this is
something I call your “movement pain relationship.” Once we have this, we can begin studying this relationship between what motions feel good vs. those that don’t and begin solving the
problem.
KEEP THIS GUIDE HANDY
I offered a digital version of this guide so that you could download & keep it on your computer or on your phone/tablet.
My goal is that this will become a reference for you, and for your healthcare providers, as you navigate your healing journey. The information provided in this guide shall not be taken
as absolute or nal, but instead, it was designed to give you a tool which provides the most up-to-date collection of knowledge and understanding around the “diagnosis” of these issues- so
that you can be your own best advocate.
HOW TO GET THE MOST OUT OF THIS GUIDE: PLAY BY THE RULE
Think of your diagnosis like a deck of cards. It’s often challenging (and sometimes impossible)
to arrive at an absolute. No worries, for real, don’t stress. Thankfully, we’re not doing brain
surgery here. Using this guide, the most likely diagnosis should rise to the top of the deck and
will give you an idea of what’s going on.
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The majority (99%) of back, butt, hip, and sciatica pains aren’t life threatening. Contrary to what
most have been told, the real value of an MRI or another image is to determine what IS NOT the
cause of pain. Knowing this, images are really only useful to RULE OUT big, ugly, scary things
as the source of pain: things like cancer, fractures, infection, or severe nerve damage. For 99%
of people who do NOT have these things, this guide will provide more clarity and
understanding in what’s going on than any MRI or other test. If your current situation matches
the cluster of ndings consistent with cancer, fracture, infection, or nerve damage (refer to
infographic —>) please seek immediate medical attention.
HOW TO USE THIS GUIDE
Before we get too far into this, I want to quickly break down how pain works
Rivers ow downstream, so does pain. An upstream problem with the lower back can not only be felt in the back, but can
affect anything below- making it seem as though there are “many causes/problems” at play. Because the back is the most
upstream source of back, butt, hip, and sciatica pains, it should be considered FIRST as the most likely source. Further, a
hamstring problem will NOT cause pain above the level of the hamstring into the back. A source of pain downstream will NOT
send pain signals upstream. Remember, source = actual tissue source in the body resulting in pain. This is potentially
different than the cause of why things hurt.
Start at the most upstream location (the back) and work page by page through the guide and owcharts. Once you’ve
cleared the back and nerves, travel downstream to the next most likely source, ruling them in or out, one by one.
The guide is organized to help you evaluate possible issues in an upstream to downstream fashion, in this order:
Lower back -> SI Joint -> Hip -> Piriformis -> Hamstring
The most upstream problem consistent with what you’re feeling and dealing with should be considered THE MOST LIKELY
and PRIMARY source of symptoms, until proven otherwise. Once this is discovered, there is no reason to continue searching
downstream. While it is possible that there is more than one source of your issue, the primary issue often ‘muddies the water'
and the cause of this issue needs to be discovered and addressed before considering other possibilities.
YOU ARE NOT YOUR DIAGNOSIS: This guide was not created to take your focus off of solutions. Often people become so
obsessed with “ guring out” what’s going on, thinking it will lead them to the best treatment… when instead, it drains them of
their time, energy, and attention- distracting them from focusing on what they can control (which is their own knowledge and
understanding of what triggers their pain and how certain body movements impact their symptoms). This will ALWAYS be
more important than the exact diagnosis. Many people spend months or years searching for answers via expensive tests and
imaging only to realize that something as simple as this guide provides them with more clarity. While some tests may be
necessary given your current situation, do not be trapped by any given diagnosis. Simply use this guide to get a rough idea
of where symptoms might be originating, so that you can move beyond “ guring it out” and shift gears as quickly as possible
towards learning what you can do to naturally solve the problem. Because… diagnosis does NOT = treatment.
WHAT SHOULD I DO FOR TREATMENT
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To kickstart your healing and show you how simple learning to treat yourself can be… I created a free workshop: The 4 Simple Secrets
That Skyrocket Your Chances For Relief And Unlock Natural Healing Without Pills, Shots, Surgery, Or Needing Others To “Fix You”
Central lower back painmay “shift” from side to
side
Is the pain worse first thing
in the morning?
Trouble “straightening” or
standing up after sitting
Pain worse sitting, driving,
bending, lifting, twisting,
coughing/sneezing
Pain better walking,
standing, or lying down
Pain central or slightly to
one side along the level of
the beltline
L5 & S1 nerves most commonly impacted
Yikes, that hurts and
causes my leg pain!
SCIATICA!
Increased pain with
coughing, sneezing,
straining
Herniated Disc (L4-L5
herniation most common)
What could be causing it?
Rollercoaster of back painBack goes out, gets better,
goes out again…
1. Age >48
Do you have lower back pain
(pain along the belt line region)
with leg pain, numbness, or
tingling that travels down the
leg BELOW the level of the
knee into the calf, shin, or
foot?
If YES
HERNIATED DISC?
2. Leg pain > back pain
Is the pain WORSE in the
leg(s) than it is in the
back?
If YES
3. Leg pain, numbness,
tingling increased with
standing/walking
A little tight- but no major
problem
Try this… (Straight Leg Raise)
Spinal Stenosis?
Neurogenic Claudication
4. Relief with sitting,
bending, walking bend
forward (walking uphill) or
leaning on shopping cart
One sided at or above level
of belt line, just off the side of
the spine. Does not shift
sides!
NOPE, just one leg
5. Both sided leg
symptoms
Foraminal or lateral recess
stenosis
Central canal stenosis
No numbness/tingling
Central lower back painmay “shift” from side to
side
Lateral Shift
Sciatica! (not always, but is
the #1 cause)
4/5 = 76% chance of
spinal stenosis
Is the pain worse first thing
in the morning?
Trouble “straightening” or
standing up after sitting
Facet Joint
Yes, I have lower back
pain (pain along the belt
line region) with or without
leg pain, numbness, or
tingling?
Pain worse sitting, driving,
bending, lifting, twisting,
coughing/sneezing
Self Movement Test- Rotation
+ Extension Test. Try Rotating
& Bending Backwards Towards
Painful Side (as tolerated up to
10 reps). Does the pain come
on at the end range, and stay
the same or get slightly worse
with reps? If yes, this suggest
facet joint irritation.
Pain better walking,
standing, or lying down
Pain central or slightly to
one side along the level of
the beltline
OR Does the pain come on at
end range, BUT get better with
more reps (loosen up) or
completely go away? This
suggests another cause- more
likely DISC related pain!
Do you have back pain,
butt, or leg pain ABOVE
the level of the knee
without numbness or
tingling?
Increased pain with
coughing, sneezing,
straining
Rollercoaster of back painBack goes out, gets better,
goes out again…
No leg pain or limitation in
motion with Straight Leg
Raise…
One Sided Pain
HERNIATED DISC?
No pain above belt line (no
back pain)
Lateral Shift
Pain going from sit-stand
Pain rolling over in bed
No numbness/tingling
I don’t have back pain (pain at
or above beltline), but I do
have one sided pain that is
slightly lower in the dimple
area that may or may not
extend into the buttock…
Does it hurt to do this
motion?
SI Joint? (18-30%)
Do you have one sided
(right or left) pain here?
Here’s another pic…
Does it hurt to do this
motion?
Difficulty putting on
socks
Tightness/reduced
mobility
Groin pain
Other
Morning Stiffness that
improves somewhat with
motion
Hip Arthritis
Age > 50
“Pinchy” painful feeling in
groin
Gradual onsetprogressively getting
worse
Pain/stiffness getting
up from sitting position
or out of car
My hip is stiff and painful
I don’t have back pain (pain at
or above beltline), but I do
have one sided groin pain OR
pain near front of hip that
wraps around to the side and
back of the hip towards the
buttock. Achiness/soreness
sometimes is felt in shin/ankle
area…
Pain/limp with walking/
increased activity
My painful side is tight
(knee sticks up in air with
figure 4 position and is
stiffer than painfree side)
Take your hand of the side where you
have pain and form a “C.” Now put it on
the side of your hip. Does this describe
where you feel pain? If so, call this a “C
Sign” and is common with hip joint
problems
FAI (Femoroacetabular
Impingement)- Labral Tear
Age < 50
Single Leg Hop Test
Other
Runner/impact sport
Do you have pain
that radiates in
the shape of “C”
from the front side
of your hip around
the side to the
back?
Do the Figure 4 Stretch
Test
Female
Bone Stress Injury
(reaction/fracture)
FADIR (Flexion, Adduction,
Internal Rotation) position
most painful
“Pinchy” painful feeling in
groin
Irregular Periods
Eating Disorder/Nutritional
Deficiency
Low Bone Density
FAI (Femoroacetabular
Impingement)- Labral Tear
My painful side is
symmetrical or loose (knee
easily flops towards
parallel with floor and has
same or more motion than
painfree side)
FADIR (Flexion, Adduction,
Internal Rotation) position
most painful
Do you have groin pain?
Difficulty putting on socks
Tightness/reduced mobility
Groin pain
Morning Stiffness that
improves somewhat with
motion
Hip Arthritis
Gradual onsetprogressively getting
worse
Age > 50
Pain/stiffness getting up
from sitting position or out
of car
Pain/limp with walking/ increased activity
Other
My painful side is tight
(knee sticks up in air with
figure 4 position and is
stiffer than painfree side)
“Pinchy” painful feeling in
groin
FAI (Femoroacetabular
Impingement)- Labral Tear
Age < 50
Other
Do you have back,
buttock, hip and/or leg
pain?
Very tender to touch
Trouble sleeping on that
side
Hip Bursitis
I don’t have back pain (pain
at or above beltline), but I do
have one sided pain on the
outside of my hip…
FADIR (Flexion, Adduction,
Internal Rotation) position
most painful
Pain ONLY on outside of hip (does
not refer elsewhere), just behind
point of hip bone (greater
trochanter)
Do the Figure 4 Stretch
Test
Glute Tendinopathy (most
common being gluteus
medium muscle tendon)
Do you have pain locally
on the side of your hip
without groin pain?
Should hurt when you contract the
glute muscle
Pain going up stairs
Pain with standing on one leg
(painful leg only)
“Pinchy” painful feeling in
groin
My painful side is
symmetrical or loose (knee
easily flops towards
parallel with floor and has
same or more motion than
painfree side)
I don’t have back pain, but
I do have buttock and/or
leg pain…
FAI (Femoroacetabular
Impingement)- Labral Tear
FADIR (flexion, Adduction,
Internal Rotation) position
most painful
It’s probably NOT your
back
Can you reproduce the
pain with these motions on
the painful side?
Figure 4 Stretch
Do you have buttock pain
(zero back pain) WITH
numbness or tingling going
down your leg?
Leg Lift
If painful/limited =
SCIATICA/nerve irritation!
(ouch that hurts!)
YES!
I don’t have back pain (pain at
or above beltline), butt I do
have buttock and leg pain,
numbness, or tingling down
one leg…
PIRIFORMIS
SYNDROME?
Back To The Right (twist to the right
then backbend)
Pain Sitting/driving?
Carry a cushion with
you?
What could be the cause?
Try This (Straight Leg
Raise)
Sometimes pain
walking, with stairs,
running?
BACK ISSUE? Are you
sure you don’t have a
more upstream back
problem causing buttock
pain?
Move the back to see if
it can “switch on” the
buttock pain! If can
CLEARLY make buttock
pain worse by moving
the back- then it’s
probably a back problem
causing your butt pain! If
all these motions are
free and clear and
cause no worsening of
buttock pain- then
probably NOT a back
issue- maybe piriformis?
Bend Backward
Back To The Left (twist to the left
then backbend)
Back Bend Center (bend straight
back)
Bend Forward
Bend Sideways
Sidebend Right
Sidebend Le-
Can you reproduce the
pain with these motions on
the painful side?
Figure 4 Stretch
PIRIFORMIS
SYNDROME?
Back To The Right (twist to the right
then backbend)
Leg Lift
Pain Sitting/driving?
Carry a cushion with
you?
Do you have pain in your
central buttock WITHOUT
back pain or numbness/
tingling?
Sometimes pain
walking, with stairs,
running?
Move the back to see if
it can “switch on” the
buttock pain! If YOU can
clearly make buttock
pain worse by moving
the back- then it’s
probably a back problem
causing your butt pain! If
all these motions are
free and clear and
cause no worsening of
buttock pain- then
probably NOT a back
issue- maybe piriformis?
Central buttock pain only
BACK ISSUE? Are you
sure you don’t have back
pain/problems causing
buttock pain?
Back To The Left (twist to the left
then backbend)
Bend Backward
Back Bend Center (bend straight
back)
Bend Forward
Bend Sideways
Sidebend Right
Sidebend Le-
Can you reproduce your
pain doing this (Diver)?
Back Bend Center (bend straight
back)
Back To The Right (twist to the right
then backbend)
Bend Backward
High Hamstring
Tendinopathy?
Can you reproduce your
pain doing this (heel dig)?
Does it hurt to sit on a hard
surface?
Try the straight leg raise test
again to rule out nerve issue (lin
this order)
Pain on your “sits’ bone
where the leg connects to
the pelvis.
Does it hurt to walk
upstairs or uphill, bend
over (especially with legs
straight), walk or run?
Onset of pain after recent
change in training volume
or working out (ex, running
more miles or more
frequently?)
If hamstring problem- you
SHOULD NOT be able to
make “sits” bone pain worse
by moving the back…
Move the back to see if
it can “switch on” the
buttock pain! If can
CLEARLY make buttock
pain worse by moving
the back- then it’s
probably a back problem
causing your butt pain! If
all these motions are
free and clear and
cause no worsening of
buttock pain- AND
contracting hamstring
makes it worse =
probably Hamstring!
Back To The Left (twist to the left
then backbend)
I don’t have back pain (pain at
or above beltline), or central
buttock pain, its one sided and
just a tad bit lower right near
my butt bone WITHOUT
numbness or tingling…
Bend Forward
Bend Sideways
Sidebend Right
STEP 2- While holding leg straight, now pull
toes slowly towards nose, you will likely feel
more stretch but it should NOT increase pain
in your buttock! If your buttock pain worsens
with the toe up, but goes away/is not there
when you point your toe (relaxed foot like in
step 1) then it’s likely a nerve issue, NOT
hamstring! Remember: Nerve issues usually
also cause numbness and tingling…
STEP 1- Straighten leg with foot/toes
RELAXED… if hamstring there should be no
pain other than possible pressure of sitting…
BUT if when you pull your foot/toes towards
your nose… (see STEP 2)
Other than pressure from sitting this
should not make it worse…
Sidebend Le-
Start most upstream at the lower back. Move downstream as
needed. But remember, the most upstream problem causes
everything downstream to become muddy. So, I recommend
stopping when you find the most upstream issue, as it is usually
the most likely source of your pain.
PRO TIP: Try not to take any one test or sign as diagnostic. The
best diagnoses are made by stepping back, looking at the big
picture and considering a cluster of findings taken from both
the story given by the person in pain AND the movement exam.
(This is why Images and other tests alone are very poor at
determining the source of pain AND why this guide will forever
be “Better Than An MRI.”)
Lower Back + Leg Pain, Numbness, or Tingling
Often described as sharp, shooting, burning, electric, just “cut my leg off” type pain
Learn which nerve is the problem & check your nerve
health- click the video below to watch!
Central lower back painmay “shift” from side to
side
TIP: DO THIS LEG RAISE ON BOTH SIDES. If your
leg raise on the bad side is normal and pretty much
equal to other side, then you do NOT have sciatica/
nerve issue (90%+ certainty).
If raising the GOOD leg increases pain on the bad
side, then we call this a crossed straight leg raise
and is highly consistent with a disc problem.
Is the pain worse first thing
in the morning?
Trouble “straightening” or
standing up after sitting
SCIATICA!
Yikes, that hurts and
causes my leg pain!
What could be causing it?
Pain worse sitting, driving,
bending, lifting, twisting,
coughing/sneezing
Herniated Disc (L4-L5
herniation most common)
L5 & S1 nerves most commonly impacted
Less pain walking,
standing, or lying down
Pain central or slightly to
one side along the level of
the belt line
If YES
If YES
Is the pain WORSE in the
leg(s) than it is in the
back?
Increased pain with
coughing, sneezing,
straining
4/5 = 76% chance of
spinal stenosis
Rollercoaster of back painBack goes out, gets better,
goes out again…
1. Age >48
Try this… (Straight Leg Raise)
2. Leg pain > back pain
Do you have lower back pain
(pain along the belt line region)
with leg pain, numbness, or
tingling that travels down the
leg BELOW the level of the
knee into the calf, shin, or
foot?
3. Leg pain, numbness,
tingling increased with
standing/walking
A little tight- but no major
problem
Spinal Stenosis?
4. Relief with sitting,
bending, walking bent
forward (walking uphill) or
leaning on shopping cart
5. Both sided leg
symptoms
HERNIATED DISC?
Neurogenic Claudication
Foraminal or lateral recess
stenosis
NOPE, just one leg
Central canal stenosis
Prove it’s NOT spinal stenosis!
TRY THIS: Stand sideways and look in the mirror. Are you tilted slightly
forward? Many people with back pain walk slightly tilted forward, which often
increases pain because it makes the back work harder. Now, stand perfectly
straight up, and try holding this position when you walk. If it feels better, then
spinal stenosis is NOT the likely cause of your problem. Standing more
upright SHOULD make symptoms of stenosis WORSE!
Lateral Shift
Sciatica! (not always, but is
the #1 cause)
Crossed Straight
Leg Raise
Central lower back painmay “shift” from side to
side
Lower Back Pain Without Leg Pain,
Numbness, or Tingling
Is the pain worse first thing
in the morning?
Trouble “straightening” or
standing up after sitting
Pain worse sitting, driving,
bending, lifting, twisting,
coughing/sneezing
Often described as deep, dull, achy, and hard to pinpoint
Less pain walking,
standing, or lying down
Pain central or slightly to
one side along the level of
the belt line
Increased pain with
coughing, sneezing,
straining
Rollercoaster of back painBack goes out, gets better,
goes out again…
HERNIATED DISC?
One sided at or above level of
belt line, just to the side of the
spine. Does not shift sides!
No numbness/tingling
No leg pain or limitation in
motion with Straight Leg
Raise…
Lateral Shift
Do you have back pain (pain at or
above the level of the belt line)
WITH associated butt or leg pain
ABOVE the level of the knee and
WITHOUT numbness or tingling?
Sciatica! (not always, but is
the #1 cause)
Facet Joint?
Self Movement Test- Rotation
+ Extension Test. Try Rotating
& Bending Backwards Towards
Painful Side (as tolerated up to
10 reps). Does the pain come
on at the end range, and stay
the same or get slightly worse
with reps? If yes, this suggest
facet joint irritation.
OR Does the pain come on at
end range, BUT get better with
more reps (loosen up) or
completely go away? This
suggests another cause- more
likely DISC related pain!
PRO TIP: This test is often
also painful with SI joint
problems. The difference will
be the location of where pain
is felt when rotating +
extending. Facet joint issues
will be felt just above the
level of the belt line on one
side, but SI joint pain is
lower below the belt line in
the “dimple” area and WILL
NOT send pain upstream
into back/facet region. BUT
Facet joint issues may refer
pain down into SI Joint
region. ALWAYS look
upstream!
Disc pressure is
highest in morning!
Sacroiliac Joint Pain (SI Joint)
One Sided Pain
No pain above belt line (no
back pain)
If you feel pain above the level of the SI Joint near the level of the belt line,
then chances are HIGH that you do not have pain coming from the SI Joint.
The problem is more than likely something upstream in the lower back...
Pain going from sit-stand
Pain rolling over in bed
No numbness/tingling
Does it hurt to do this
motion?
Do you have one sided
(right or left) pain here?
I don’t have back pain (pain at
or above belt line), but I do
have one sided pain that is
slightly lower in the dimple
area that may or may not
extend into the buttock…
SI Joint? (18-30%)
Here’s another pic…
BONUS Test: SI Joint Belt Test!
Click the video icon below and
give it a go…
Does it hurt to do this
motion?
Hip Pain
Difficulty putting on
socks
By this point, you should have ruled out more upstream problems like the lower back, with or without nerve pain (sciatica), as well as the SI Joint.
If you haven’t, you should do so now. If you have ruled out more upstream sources of pain and you’re still searching, work through this flowchart to see if the hip could be the issue.
There are two big types of hip problems: those that occur within the hip joint (think bone/cartilage problems) and those that affect things outside the hip joint (muscles, tendons, bursa)
Tightness/reduced
mobility
BONUS Test: Hip Joint Problems Hate This Log Roll Test
Click the video below to see the test…
Groin pain
Other
Morning stiffness that
improves somewhat with
motion
Hip Arthritis
Age > 50
Gradual onsetprogressively getting
worse
Pain/stiffness getting
up from sitting position
or out of car
My hip is stiff and painful
Take your hand of the side
where you have pain and form
a “C.” Now put it on the side of
your hip. Does this describe
where you feel pain? If so, we
call this a “C Sign” and is
common with hip joint
problems…
I don’t have back pain (pain at
or above belt line), but I do
have one sided groin pain OR
pain near front of hip that
wraps around to the side and
back of the hip towards the
buttock. Achiness/soreness
sometimes is felt in shin/ankle
area…
“Pinchy” painful feeling in
groin
Pain/limp with walking/
increased activity
My painful side is tight
(knee sticks up in air with
figure 4 position and is
stiffer than painfree side)
Age < 50
Single Leg Hop Test
FAI (Femoroacetabular
Impingement)- Labral Tear
Other
Runner/impact sport
Do you have pain
that radiates in
the shape of “C”
from the front side
of your hip around
the side to the
back?
Do the Figure 4 Stretch
Test
Female
Bone Stress Injury
(reaction/fracture)
“Pinchy” painful feeling in
groin
Irregular Periods
Eating Disorder/Nutritional
Deficiency
Low Bone Density
FAI (Femoroacetabular
Impingement)- Labral Tear
Did You Know?
Hip joint problems
often refer pain
into the knee or
shin area!
Do you have groin pain?
My painful side is
symmetrical or loose (knee
easily flops close to
parallel with floor and has
same or more motion than
painfree side)
Did You Know?
Female Athlete Triad
These things together weaken
bone and increase risk of
stress fracture. Female
athletes with this “triad”
dealing with hip joint pain
should be screened for bone
stress injury FIRST before
considering other diagnoses!
Signs of a stress
fracture may take
4-6 weeks to show
up on an X-ray- if
they shows up at all.
The best tests are an
MRI or bone scan!
FADIR (Flexion, Adduction,
Internal Rotation) position
most painful
FADIR (Flexion, Adduction,
Internal Rotation) position
most painful
If it’s not a back problem...
✅
Not a nerve problem (straight leg raise test normal)
✅
Not an SI Joint problem
✅
Not a problem IN the hip joint
Hip Pain
Difficulty putting on
socks
Tightness/reduced
mobility
Groin pain
Other
Then maybe something outside the
hip joint is the source...
Morning stiffness that
improves somewhat with
motion
Hip Arthritis
Age > 50
Walk through this flowchart to find
out!
Gradual onsetprogressively getting
worse
“Pinchy” painful feeling in
groin
Pain/stiffness getting
up from sitting position
or out of car
My hip is stiff and painful
Pain/limp with walking/
increased activity
My painful side is tight
(knee sticks up in air with
figure 4 position and is
stiffer than painfree side)
Age < 50
FAI (Femoroacetabular
Impingement)- Labral Tear
Other
I don’t have back pain (pain at
or above belt line), but I do
have one sided pain on the
outside of my hip…
Do the Figure 4 Stretch
Test
Glute Tendinopathy (most
common being gluteus
medius muscle tendon)
Pain going up stairs
Should hurt when you
contract the glute
muscle
FADIR (Flexion, Adduction,
Internal Rotation) position
most painful
Pain with standing on one leg
(painful leg only)
“Pinchy” painful feeling in
groin
FAI (Femoroacetabular
Impingement)- Labral Tear
Do you have pain locally
on the side of your hip
without groin pain?
My painful side is
symmetrical or loose (knee
easily flops close to
parallel with floor and has
same or more motion than
painfree side)
Very tender to touch
directly on side of hip
Hip Bursitis
Trouble sleeping on that
side
Pain ONLY on outside of hip (does
not refer elsewhere), just behind
point of hip bone (greater
trochanter)
FADIR (Flexion, Adduction,
Internal Rotation) position
most painful
Piriformis Syndrome + Leg Pain, Numbness, Tingling
Can you reproduce the
pain with these motions on
the painful side?
If painful/limited =
SCIATICA/nerve irritation!
(ouch that hurts!)
Do you have buttock pain
(zero back pain) WITH
numbness or tingling going
down your leg?
I don’t have back pain (pain at
or above belt line), but I do
have buttock and leg pain,
numbness, or tingling down
one leg…
Figure 4 Stretch
Back To The Right (twist to the right
then backbend)
Leg Lift
What could be the cause?
PIRIFORMIS
SYNDROME?
Pain sitting/driving?
Carry a cushion with
you?
Try This (Straight Leg
Raise)
Sometimes pain
walking, with stairs,
running?
YES!
BACK ISSUE? Are you
sure you don’t have a
more upstream back
problem causing buttock
pain?
Move the back to see if
it can “switch on” the
buttock pain! If can
CLEARLY make buttock
pain worse by moving
the back- then it’s
probably a back problem
causing your butt pain! If
all these motions are
free and clear and
cause no worsening of
buttock pain- then
probably NOT a back
issue- maybe piriformis?
Bend Sideways
Sidebend Right
Sidebend Le-
Bend Backward
Bend Forward
Back To The Left (twist to the left
then backbend)
Back Bend Center (bend straight
back)
Piriformis Syndrome Without Leg Pain,
Numbness, or Tingling
✅ Back seems fine...
✅ Not SI Joint...
✅ Hip seems okay...
🤔
Could it be something in the butt?
Piriformis Syndrome?
Can you reproduce the
pain with these motions on
the painful side?
Figure 4 Stretch
PIRIFORMIS
SYNDROME?
Back To The Right (twist to the right
then backbend)
Leg Lift
Pain Sitting/driving?
Carry a cushion with
you?
Do you have pain in your
central buttock WITHOUT
back pain or numbness/
tingling?
Sometimes pain
walking, with stairs,
running?
Central buttock pain only
BACK ISSUE? Are you
sure you don’t have back
pain/problems causing
buttock pain?
Move the back to see if
it can “switch on” the
buttock pain! If YOU can
clearly make buttock
pain worse by moving
the back- then it’s
probably a back problem
causing your butt pain! If
all these motions are
free and clear and
cause no worsening of
buttock pain- then
probably NOT a back
issue- maybe piriformis?
Bend Sideways
Sidebend Right
Sidebend Le-
Back To The Left (twist to the left
then backbend)
Bend Backward
Bend Forward
Back Bend Center (bend straight
back)
Double check to make sure
it’s not the back...
If moving the back all these
directions DOES NOT make
your buttock problem
worse, then it’s probably not
the back!
High Hamstring Tendinopathy
Can you reproduce your
pain doing this (Diver)?
Back Bend Center (bend straight
back)
Back To The Right (twist to the right
then backbend)
Bend Backward
High Hamstring
Tendinopathy?
Can you reproduce your
pain doing this (heel dig)?
Does it hurt to sit on a hard
surface?
Pain on your “sits” bone
where the leg connects to
the pelvis.
Try the straight leg raise test
again to rule out nerve issue (ln
this order)
Does it hurt to walk
upstairs or uphill, bend
over (especially with legs
straight), walk or run?
Onset of pain after recent
change in training volume
or working out (ex. running
more miles or more
frequently?)
If hamstring problem- you
SHOULD NOT be able to
make “sits” bone pain worse
by moving the back…
Move the back to see if it
can “switch on” the
buttock pain! If you can
CLEARLY make buttock
pain worse by moving the
back- then it’s probably a
back problem causing
your butt pain! If all these
motions are free and clear
and cause no worsening
of buttock pain- AND
contracting hamstring
makes it worse = probably
Hamstring!
Back To The Left (twist to the left
then backbend)
I don’t have back pain (pain at
or above belt line), or central
buttock pain, its one sided and
just a tad bit lower right near
my butt bone WITHOUT
numbness or tingling…
Bend Forward
Bend Sideways
Still not sure? Check this
video out for one final test!
Click video below…
Sidebend Right
STEP 2- While holding leg straight, now pull
toes slowly towards nose, you will likely feel
more stretch but it should NOT increase pain
in your buttock! If your buttock pain worsens
with the toe up, but goes away/is not there
when you point your toe (relaxed foot like in
step 1) then it’s likely a nerve issue, NOT
hamstring! Remember: Nerve issues usually
also cause numbness and tingling…
STEP 1- Straighten leg with foot/toes
RELAXED… if hamstring there should be no
pain other than possible pressure of sitting…
BUT if when you pull your foot/toes towards
your nose… (see STEP 2)
Other than pressure from sitting this
should not make it worse…
Sidebend Le-
CONCLUSION
THE MOST NATURAL NEXT STEP
Congrats on nishing this guide! Sorta like trying to navigate a corn maze (in the dark without a ashlight), you can see just
how challenging and interconnected the body really is. There are many things to consider when it comes to nding the
source of pain, especially in this area of the body. Right now, you’re probably experiencing one of three feelings (or a
combo of them):
1. Hope. For people who have seen various professionals (many of whom have not done a thorough evaluation) there
is often a sense of clarity that comes from being educated and having a new/organized way of viewing their issue.
2. Confusion. Often times, pain patterns overlap and despite having a step-by-step owchart, you may still be unsure
about the exact cause of your pain. You’re not alone. Even MRIs can’t accurately determine the source of pain for the
majority of people dealing with problems in this area. Luckily for you, the diagnosis is NOT the most important part of
the equation when it comes to healing. For 99% of people, this diagnostic guide will likely be as good as (if not better
than) any examination you receive from a professional. That being said, you’re probably not “missing” anything, it
could just be that your diagnosis is not that clear, and that’s okay (trust me).
3. Anxiety. From a newfound understanding of what it “could be” or anxiousness in the form of excitement to discover
what you can do to get relief.
These are all totally normal feelings. One thing I need you to understand is that it’s not so much what you have (diagnosis)
going on with you, it’s what you do about it. Hopefully this guide has helped you get a better idea of where things may be
coming from, and can put to rest your quest for a diagnosis. Now, from this point on, there is no going back… what I want
you to do is start taking action! Begin to take charge of your own care and begin seeking solutions that put you in the
driver’s seat.
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You may not realize this yet, but YOU are your own best doctor, and nobody is better equipped to solve your problem than
YOU…
NOW, WHAT’S NEXT?
By this point, you probably have a better idea of what’s going on. But, do you know how to
solve it naturally so that you can feel better and get back to life?
I’m running a free “Beat Butt Pain” workshop for people with back, butt, and sciatica pain.
Attend our FREE Workshop And Learn The Weird (Almost Backwards) But Totally Simple
Secrets That Will Restore Hope And Unlock Natural Healing For YOU
!
:
Here’s some of what we’re going to cover
• How “Doctor Hopping” And Hunting For A Medical Diagnosis Can Actually Keep You From
Healing
• Healing By Subtraction: How To Heal More By Doing Less
• How To Scan Your Body And Pinpoint The Right Exercises For Your Problem (instead of
wasting time on things that don’t work)
• Your 4 Treatment Options And The One Power You Have That Doctor’s Don’t, Which (Once
Discovered) Can Shortcut Your Path To Relief
DISCLAIMER
All information in this guide is intended for instruction and informational purposes only. The authors are not responsible for any harm or injury that may
result. Signi cant injury risk is possible if you do not follow due diligence and seek suitable professional advice about your injury. No guarantees are
made or implied by this guide.
The information in this guide is property of Dr. Charlie Johnson, PT and should not be reproduced in whole or in part without express permission.
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© 2021 Physical Therapy & Johnson, LLC