The hip is a deep ball and socket joint that connects the pelvis and the femur, the long thigh bone. It is a very stable joint and is closely related to the stability of the lower back and pelvis, the buttock muscles and thigh muscles. It has a great impact also on the alignment and function of the knee.
Osteoarthritis is the slow erosion of the cartilage lining the joints. It is a wear and tear degenerative type of disorder and hips and knees are commonly affected.
Hip pain due to osteoarthritis has a typical referral pattern with pain most often reported deep inside the hip, the groin or outside the hip. The pain is mostly dull and achy, however it may be associated with a clicking or catching sensation. Pain associated with osteoarthritis may be worse in the mornings or after activity.
Physiotherapy treatment of the arthritic hip involves restoring good alignment of the pelvis and hip regions, gentle movement and strengthening of the muscular support around the hip, pelvis and leg. A good balance between some exercise but not too much is really the key.
These injuries are typically very sudden and are often injuries involved with sports that require twisting, turning, sprinting and kicking. Appropriate physiotherapy assessment and treatment can lead to a rapid recovery, however ignoring symptoms and returning too quickly back to sport can lead to long standing hip and groin pain.
These injuries are typically ‘easier’ to diagnose as there is a direct and obvious cause to the injury, localised bruising and tenderness to touch in the muscle involved. Contracting or activating the muscle involved will also produce pain.
Management of the strained or ‘pulled’ muscle involve early settling of early inflammation, massage and gradual stretching and strengthening of the muscle. Rehabilitation specific to your everyday demands on that muscle must follow to prepare the muscle for a return to sport or pain free daily activity. This involves strengthening the muscle in all positions, in weight bearing, for change of direction and of course, the pelvis and core muscles sitting above.
The iliotibial band (ITB) is a superficial muscle and tissue that runs down the outside of the thigh from the pelvis to the outer knee, attaching to the knee cap. Its role is stabilise the knee and the hip when weight-bearing and is under great loads when running or cycling. It is the one of the leading causes of both hip and knee pain in runners and walkers.
Pain is typically localised to the outer hip or knee and there is often great tenderness over the hip joint. Movements of the hip such as getting out of a car are commonly painful or difficult.
Physiotherapy treatment of this injury includes deep tissue massage of the ITB and buttock muscles. This along with a home program of stretches can lengthen the muscle and cause less friction, and therefore pain across the hip and outer knee. Medium to long term management involves a strict pelvic, hip and core stability program. This can ensure good muscular balance about the hip and knee to prevent further tightening or overuse of the ITB tissue when back to running or cycling.
Pain deriving from nerve pathways and referred sources are common to the hip. These can originate from the lower lumbar vertebrae (L4 to S1) or from the deep buttock muscles such as the piriformis muscle.
Pain from these sources can again present as achy or sharp pain in the groin, deep or outside hip areas.
Physiotherapy assessment, management and re-assessment for change is often required to conclude the likely source of the nerve referred pain. Treatment involves joint re-alignment, improved nerve dynamics, trunk, pelvic and hip stability strengthening programs to target muscle imbalances about the region.
A bursa is a small fluid filled cushion that sits between soft tissue such as a tendon and adjacent bone. It prevents friction and rubbing of the soft tissue on the bony hard surface. Bursae can become swollen and painful if rubbed or compressed overly by tight tendons and muscles of which they cushion.
Two bursae commonly suffer from this type of irritation in the hip. Long distance runners (or others!) can feel quite a sudden and acute pain in the outer hip that may radiate down the outside thigh. Localised tenderness to touch is common on the outside hip.
Physiotherapy management aids inflammation and pain relief, accompanied by rest. Programs to improve hip and pelvic stability and strength about this region play an important role.
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