Common injuries we can treat at the hip.
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.
Muscle strains such as of hip flexor (ilipsoas), groin, hamstring and quadriceps
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.
Iliotibial band syndrome
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.
Referred pain from the lower back and pelvis
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
Pain from these sources can again present as achy or sharp pain in the groin, deep or outside hip
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
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
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.