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Please help with the following case, Im a bit stuck. A 15 year old female presents with R groin pain. present hx- sharp pain acute in groin only, p felt walking and lifting leg (eg getting into car), No other areas of tenderness or pain in leg prior hx- pain began late last year gradual onset no specific incident recalled. Has had on and off since then. Feel "clicking like" sensation in groin then pain begins and last several days (not actual click though). Now episodes occurring more frequently. occasionally gets so bad, she has to drag the leg Occasionally Thoracic pain, but apparently not related Meds: antiinflammatories help but pain always comes back. o/e hip flexion p at 90 degrees (this is worst direction of movement), hip abduction (with straight leg) tight, some discomfort. Standing R SIJ level higher than L but subtle difference, knee creases uneven, R higher: probably leg length discrepancy but not hugh. Mild scoliosis in stand (concave in mid Tx region (very subtle again) swimmer x3 per week and gala weekend (not highly competative): worse during and after swimming. Lumbar mvts: p end of range extension and stiff. palpation only L5/4 tender PA SLR reduced on R and reproduces groin pain hip accessory movements -nil detected Palpation: "stringy like" texture of groin mm (definitely different texture from other side) and very tender to palpate (medial to fem artery and one quarter way down thigh medially) good general health physio Rx: mobs PA Lx (made little immediate difference to SLR), then tried PA mabs in L side flexion (again little difference to SLR)- grade 3 mobs soft tissue mass tender mm hip mobs (simple Flexion)- no difference to hip Flexion home programme of stretch all muscles surrounding hip (bilateral because generally tight even on good side) ultrasound over groin mm advised cease swimming My conclusion is appears to be adverse neural tension related, perhaps aggravated by leg length discrepancy, but not responding to my treatment Now had 5 treatments and not much change with these treatments. Wondering if she is just too acutely inflamed at the moment and needs antiinflams again to settle and then physio while on antiinflamatories or after course of antiinflams. Am I missing something here? Other techniques? Do I suggest heel raise for such subtle difference? ??suggest MRI-could there be something else (these are very expensive here-orthos very reluctant to do) Thanks Tambu %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%