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

 3 Steps To Natural Pain Relief

1. Use This Guide!

My entire diagnostic framework is laid out here in a
flowchart format to help you navigate the process of
figuring out what could be going on.

2. Register For The Free

Workshop
Make the transition from “research mode” and figuring
out the cause of your pain… to learning how you can
begin solving it (using a proven pain relief process).

3. Apply To Work With Me

I work with people worldwide suffering from
unresolved back, butt, and sciatica pains and teach
them how to fix themselves. Apply to work together
and schedule your free Painfree Planning Session to
see if/how I can help.
 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

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…
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 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.

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.
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 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

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”
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 Central lower back pain-
may “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

L5 & S1 nerves most commonly impacted

Pain central or slightly to
one side along the level of
the beltline

Increased pain with

Yikes, that hurts and Herniated Disc (L4-L5 coughing, sneezing,
SCIATICA! What could be causing it? straining
causes my leg pain! herniation most common)

Rollercoaster of back pain-

Back goes out, gets better,
goes out again…
1. Age >48
Do you have lower back pain
(pain along the belt line region) HERNIATED DISC?
2. Leg pain > back pain
with leg pain, numbness, or Is the pain WORSE in the
tingling that travels down the If YES leg(s) than it is in the If YES 3. Leg pain, numbness,
leg BELOW the level of the back? tingling increased with Neurogenic Claudication
knee into the calf, shin, or standing/walking
foot?
A little tight- but no major
Spinal Stenosis? 4. Relief with sitting,
problem
Try this… (Straight Leg Raise) 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 Foraminal or lateral recess
the spine. Does not shift NOPE, just one leg
5. Both sided leg stenosis
sides! Lateral Shift
symptoms
Central canal stenosis
No numbness/tingling Sciatica! (not always, but is
Central lower back pain- 4/5 = 76% chance of the #1 cause)
may “shift” from side to spinal stenosis
side

Is the pain worse first thing

in the morning?

Trouble “straightening” or
standing up after sitting

Facet Joint Pain worse sitting, driving,

Yes, I have lower back
pain (pain along the belt
line region) with or without
leg pain, numbness, or
tingling?
bending, lifting, twisting,
coughing/sneezing
Self Movement Test- Rotation
+ Extension Test. Try Rotating
& Bending Backwards Towards Pain better walking,
Painful Side (as tolerated up to standing, or lying down
10 reps). Does the pain come
on at the end range, and stay
the same or get slightly worse Pain central or slightly to
with reps? If yes, this suggest one side along the level of
facet joint irritation. the beltline
OR Does the pain come on at
Do you have back pain, end range, BUT get better with Increased pain with
butt, or leg pain ABOVE more reps (loosen up) or coughing, sneezing,
the level of the knee
completely go away? This straining
suggests another cause- more
without numbness or likely DISC related pain!
tingling? Rollercoaster of back pain-
Back 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
Hip Arthritis motion
Age > 50
Gradual onset- “Pinchy” painful feeling in
progressively getting groin
worse

Pain/stiffness getting
up from sitting position
My hip is stiff and painful
or out of car

Pain/limp with walking/

increased activity
My painful side is tight
(knee sticks up in air with
figure 4 position and is FAI (Femoroacetabular
stiffer than painfree side) Age < 50 Impingement)- Labral Tear
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 Single Leg Hop Test Other
Sign” and is common with hip joint
problems
Runner/impact sport
Do the Figure 4 Stretch
I don’t have back pain (pain at Test Female
Do you have pain FADIR (Flexion, Adduction,
or above beltline), but I do Internal Rotation) position
“Pinchy” painful feeling in
have one sided groin pain OR that radiates in Bone Stress Injury Irregular Periods groin most painful
pain near front of hip that the shape of “C” (reaction/fracture)
wraps around to the side and from the front side
back of the hip towards the Eating Disorder/Nutritional
of your hip around Deficiency
buttock. Achiness/soreness the side to the
sometimes is felt in shin/ankle back?
area… 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 onset-
progressively getting
Age > 50 worse

Pain/stiffness getting up
from sitting position or out
of car

Pain/limp with walking/ increased activity

Other
“Pinchy” painful feeling in
groin

My painful side is tight

(knee sticks up in air with
figure 4 position and is FAI (Femoroacetabular
stiffer than painfree side) Impingement)- Labral Tear

Age < 50
Other
Do you have back,
buttock, hip and/or leg
pain?
Very tender to touch

Trouble sleeping on that FADIR (Flexion, Adduction,

side Internal Rotation) position
Hip Bursitis
I don’t have back pain (pain most painful
Pain ONLY on outside of hip (does
at or above beltline), but I do Do the Figure 4 Stretch
not refer elsewhere), just behind
have one sided pain on the Test
point of hip bone (greater
outside of my hip… trochanter)

Glute Tendinopathy (most

Should hurt when you contract the Pain going up stairs
Do you have pain locally common being gluteus
glute muscle
on the side of your hip medium muscle tendon)
without groin pain? Pain with standing on one leg
“Pinchy” painful feeling in (painful leg only)
groin

My painful side is
symmetrical or loose (knee
easily flops towards
parallel with floor and has
same or more motion than FAI (Femoroacetabular
painfree side) Impingement)- Labral Tear

I don’t have back pain, but

It’s probably NOT your FADIR (flexion, Adduction,
I do have buttock and/or
back Internal Rotation) position
leg pain…
most painful

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?

If painful/limited = Leg Lift Back To The Right (twist to the right

YES! SCIATICA/nerve irritation! then backbend)
I don’t have back pain (pain at
(ouch that hurts!) PIRIFORMIS Pain Sitting/driving?
or above beltline), butt I do SYNDROME? Carry a cushion with
have buttock and leg pain,
you?
numbness, or tingling down What could be the cause?
one leg… Try This (Straight Leg Sometimes pain
Raise) 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 Bend Backward
it can “switch on” the Back To The Left (twist to the left
buttock pain! If can then backbend)
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 Back Bend Center (bend straight
buttock pain- then back)
probably NOT a back Bend Forward
issue- maybe piriformis?

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?
Do you have pain in your Carry a cushion with
central buttock WITHOUT you?
back pain or numbness/
Sometimes pain
tingling? Back To The Left (twist to the left
walking, with stairs,
running? then backbend)
Move the back to see if Bend Backward
it can “switch on” the
Central buttock pain only buttock pain! If YOU can
clearly make buttock
pain worse by moving
BACK ISSUE? Are you the back- then it’s
sure you don’t have back probably a back problem
pain/problems causing causing your butt pain! If
buttock pain? all these motions are
free and clear and
cause no worsening of Back Bend Center (bend straight
buttock pain- then back)
probably NOT a back Bend Forward
issue- maybe piriformis?

Bend Sideways

Sidebend  Right

Sidebend  Le-

Can you reproduce your

pain doing this (Diver)?

Back Bend Center (bend straight

Back To The Right (twist to the right back)
then backbend)

Bend Backward

Move the back to see if

it can “switch on” the
Can you reproduce your buttock pain! If can
High Hamstring pain doing this (heel dig)? CLEARLY make buttock
Tendinopathy? pain worse by moving
Does it hurt to sit on a hard the back- then it’s
If hamstring problem- you
surface? probably a back problem
SHOULD NOT be able to
causing your butt pain! If
Does it hurt to walk make “sits” bone pain worse
all these motions are
upstairs or uphill, bend by moving the back…
free and clear and
Try the straight leg raise test over (especially with legs cause no worsening of
again to rule out nerve issue (lin straight), walk or run?
buttock pain- AND
this order) contracting hamstring
Pain on your “sits’ bone Onset of pain after recent makes it worse =
where the leg connects to change in training volume
the pelvis. probably Hamstring!
or working out (ex, running
more miles or more
frequently?) Back To The Left (twist to the left
I don’t have back pain (pain at then backbend)
or above beltline), or central
buttock pain, its one sided and
just a tad bit lower right near Bend Forward
my butt bone WITHOUT
numbness or tingling…
Bend Sideways

Sidebend  Right

STEP 2- While holding leg straight, now pull STEP 1- Straighten leg with foot/toes
toes slowly towards nose, you will likely feel RELAXED… if hamstring there should be no Other than pressure from sitting this
more stretch but it should NOT increase pain
in your buttock! If your buttock pain worsens
pain other than possible pressure of sitting… should not make it worse…
BUT if when you pull your foot/toes towards Sidebend  Le-
with the toe up, but goes away/is not there your nose… (see STEP 2)
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…
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 pain-

TIP: DO THIS LEG RAISE ON BOTH SIDES. If your may “shift” from side to
leg raise on the bad side is normal and pretty much side
equal to other side, then you do NOT have sciatica/
nerve issue (90%+ certainty). Is the pain worse first thing
in the morning?
If raising the GOOD leg increases pain on the bad
Trouble “straightening” or
side, then we call this a crossed straight leg raise
SCIATICA! standing up after sitting
and is highly consistent with a disc problem.
Pain worse sitting, driving,
Yikes, that hurts and Herniated Disc (L4-L5 bending, lifting, twisting,
causes my leg pain! What could be causing it? coughing/sneezing
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 Increased pain with

If YES
4/5 = 76% chance of coughing, sneezing,
straining
Is the pain WORSE in the spinal stenosis
leg(s) than it is in the Rollercoaster of back pain-
back? Back goes out, gets better,
Try this… (Straight Leg Raise) 1. Age >48
goes out again…
2. Leg pain > back pain

HERNIATED DISC?
Do you have lower back pain 3. Leg pain, numbness,
tingling increased with Neurogenic Claudication
(pain along the belt line region)
standing/walking
with leg pain, numbness, or
tingling that travels down the A little tight- but no major
Spinal Stenosis?
problem
leg BELOW the level of the 4. Relief with sitting,
knee into the calf, shin, or bending, walking bent Foraminal or lateral recess
foot? forward (walking uphill) or stenosis
leaning on shopping cart
NOPE, just one leg
5. Both sided leg
symptoms
Central canal stenosis Lateral Shift

Sciatica! (not always, but is

Prove it’s NOT spinal stenosis! the #1 cause)
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 Crossed Straight
increases pain because it makes the back work harder. Now, stand perfectly Leg Raise
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!

Lower Back Pain Without Leg Pain,
Numbness, or Tingling
Often described as deep, dull, achy, and hard to pinpoint
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…
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? 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!
Central lower back pain-
may “shift” from side to
side
Is the pain worse first thing Disc pressure is
in the morning? highest in morning!
Trouble “straightening” or
standing up after sitting
Pain worse sitting, driving,
bending, lifting, twisting,
coughing/sneezing
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 pain-
Back goes out, gets better,
goes out again…
Lateral Shift
Sciatica! (not always, but is
the #1 cause)
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!
 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, Pain going from sit-stand
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 rolling over in bed

No numbness/tingling

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…
BONUS Test: SI Joint Belt Test!
Click the video icon below and
I don’t have back pain (pain at give it a go…
or above belt line), but I do
have one sided pain that is
slightly lower in the dimple
area that may or may not Does it hurt to do this
extend into the buttock… motion?
 Hip Pain Difficulty putting on
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. socks
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
Groin pain
Click the video below to see the test…
Other
Morning stiffness that
improves somewhat with
Hip Arthritis motion
Age > 50
Gradual onset- “Pinchy” painful feeling in
progressively getting groin
worse

Pain/stiffness getting
up from sitting position
My hip is stiff and painful
or out of car

Pain/limp with walking/

Take your hand of the side increased activity
My painful side is tight
where you have pain and form (knee sticks up in air with
a “C.” Now put it on the side of figure 4 position and is FAI (Femoroacetabular
your hip. Does this describe stiffer than painfree side) Age < 50 Impingement)- Labral Tear
where you feel pain? If so, we
call this a “C Sign” and is
common with hip joint Single Leg Hop Test Other
problems…
Runner/impact sport
Do the Figure 4 Stretch
I don’t have back pain (pain at Test Female
Do you have pain FADIR (Flexion, Adduction,
or above belt line), but I do Internal Rotation) position
“Pinchy” painful feeling in
have one sided groin pain OR that radiates in Bone Stress Injury Irregular Periods groin most painful
pain near front of hip that the shape of “C” (reaction/fracture)
wraps around to the side and from the front side
back of the hip towards the Eating Disorder/Nutritional
of your hip around Deficiency
buttock. Achiness/soreness the side to the
sometimes is felt in shin/ankle back?
area… Low Bone Density

FAI (Femoroacetabular
Impingement)- Labral Tear

My painful side is
symmetrical or loose (knee Did You Know?
easily flops close to
Female Athlete Triad
parallel with floor and has Signs of a stress
Did You Know? same or more motion than These things together weaken fracture may take
Hip joint problems painfree side) bone and increase risk of 4-6 weeks to show
often refer pain stress fracture. Female up on an X-ray- if
athletes with this “triad” they shows up at all. FADIR (Flexion, Adduction,
into the knee or dealing with hip joint pain
The best tests are an Internal Rotation) position
shin area! should be screened for bone most painful
stress injury FIRST before MRI or bone scan!
considering other diagnoses!
Do you have groin pain?
 Hip Pain
Difficulty putting on
If it’s not a back problem... socks

✅ Not a nerve problem (straight leg raise test normal) Tightness/reduced

mobility
✅ Not an SI Joint problem
✅ Not a problem IN the hip joint Groin pain
Then maybe something outside the Other
Morning stiffness that
hip joint is the source... improves somewhat with
Hip Arthritis motion
Walk through this flowchart to find Age > 50
out! Gradual onset- “Pinchy” painful feeling in
progressively getting groin
worse

Pain/stiffness getting
up from sitting position
My hip is stiff and painful
or out of car

Pain/limp with walking/

increased activity
My painful side is tight
(knee sticks up in air with
figure 4 position and is FAI (Femoroacetabular
stiffer than painfree side) Age < 50 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 FADIR (Flexion, Adduction,
Do the Figure 4 Stretch
outside of my hip… Pain going up stairs Internal Rotation) position
Test
Glute Tendinopathy (most Should hurt when you most painful
common being gluteus contract the glute
medius muscle tendon) muscle Pain with standing on one leg
(painful leg only)

“Pinchy” painful feeling in

groin

FAI (Femoroacetabular
Impingement)- Labral Tear
My painful side is
symmetrical or loose (knee
Do you have pain locally easily flops close to Very tender to touch
on the side of your hip parallel with floor and has directly on side of hip
without groin pain? same or more motion than
painfree side)
Trouble sleeping on that
side
Hip Bursitis
Pain ONLY on outside of hip (does
not refer elsewhere), just behind FADIR (Flexion, Adduction,
point of hip bone (greater Internal Rotation) position
trochanter) most painful
 Piriformis Syndrome + Leg Pain, Numbness, Tingling

Can you reproduce the

pain with these motions on
the painful side? Figure 4 Stretch

If painful/limited = Back To The Right (twist to the right

SCIATICA/nerve irritation! then backbend)
Leg Lift
(ouch that hurts!)
Do you have buttock pain PIRIFORMIS
(zero back pain) WITH Pain sitting/driving?
SYNDROME? Carry a cushion with
numbness or tingling going What could be the cause?
down your leg? Try This (Straight Leg you?
Raise)
Sometimes pain
YES! walking, with stairs,
I don’t have back pain (pain at running?
or above belt line), but I do
have buttock and leg pain, BACK ISSUE? Are you Move the back to see if Bend Backward
numbness, or tingling down sure you don’t have a it can “switch on” the Back To The Left (twist to the left
more upstream back buttock pain! If can then backbend)
one leg…
problem causing buttock CLEARLY make buttock
pain? 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 Back Bend Center (bend straight
buttock pain- then back)
probably NOT a back Bend Forward
issue- maybe piriformis?

Bend Sideways

Sidebend  Right

Sidebend  Le-
 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?
Do you have pain in your Carry a cushion with
central buttock WITHOUT you?
back pain or numbness/
Sometimes pain
tingling? Back To The Left (twist to the left
walking, with stairs,
running? then backbend)
Move the back to see if Bend Backward
it can “switch on” the
Central buttock pain only
buttock pain! If YOU can
clearly make buttock
pain worse by moving
BACK ISSUE? Are you the back- then it’s
sure you don’t have back probably a back problem
pain/problems causing causing your butt pain! If
buttock pain? all these motions are
free and clear and
cause no worsening of Back Bend Center (bend straight
buttock pain- then back)
probably NOT a back Bend Forward Double check to make sure
issue- maybe piriformis? it’s not the back...
If moving the back all these
Bend Sideways
directions DOES NOT make
your buttock problem
worse, then it’s probably not
the back!

Sidebend  Right

Sidebend  Le-
 High Hamstring Tendinopathy

Can you reproduce your

pain doing this (Diver)?

Back Bend Center (bend straight

Back To The Right (twist to the right back)
then backbend)

Bend Backward

Move the back to see if it

can “switch on” the
Can you reproduce your buttock pain! If you can
High Hamstring pain doing this (heel dig)? CLEARLY make buttock
Tendinopathy? pain worse by moving the
Does it hurt to sit on a hard back- then it’s probably a
If hamstring problem- you
surface? back problem causing
SHOULD NOT be able to
your butt pain! If all these
Does it hurt to walk make “sits” bone pain worse
motions are free and clear
upstairs or uphill, bend by moving the back…
and cause no worsening
Try the straight leg raise test over (especially with legs of buttock pain- AND
again to rule out nerve issue (ln straight), walk or run?
contracting hamstring
this order) makes it worse = probably
Pain on your “sits” bone Onset of pain after recent Hamstring!
where the leg connects to change in training volume
the pelvis. or working out (ex. running
more miles or more
frequently?) Back To The Left (twist to the left
I don’t have back pain (pain at then backbend)
or above belt line), or central
buttock pain, its one sided and
just a tad bit lower right near Bend Forward
my butt bone WITHOUT
numbness or tingling…
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 STEP 1- Straighten leg with foot/toes
toes slowly towards nose, you will likely feel RELAXED… if hamstring there should be no Other than pressure from sitting this
more stretch but it should NOT increase pain
in your buttock! If your buttock pain worsens
pain other than possible pressure of sitting… should not make it worse…
BUT if when you pull your foot/toes towards Sidebend  Le-
with the toe up, but goes away/is not there your nose… (see STEP 2)
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…
 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.

You may not realize this yet, but YOU are your own best doctor, and nobody is better equipped to solve your problem than
YOU…
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 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.

© 2021 Physical Therapy & Johnson, LLC

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