Osteopathy - Leg Pain
 
Hip problems don’t just affect the elderly who are awaiting for a new hip replacement. They also affect the young and the sporty.
 
As always before any treatment is carried out I take a case history and assess the hip to figure out what it is.
 
“If you are not assessing you are guessing”
 
Human anatomy is complicated and the hip is no exception, as there are multiple things that can cause hip pain. Your hip pain could be…….
 
– Groin strain
 
Commonly during sporting events, where one of 5 inner thigh muscles gets torn or ruptured. There are 3 levels of tearing:
 
Grade 1: a fully functioning injury, where a small number of muscle fibres are torn resulting in some pain.
 
Grade 2: a moderate loss of function occurs, as a significant number of muscle fibres are torn.
 
Grade 3: all muscle fibres are ruptured, resulting in major loss of function.
 
– Femoral neck fracture (rare)
 
This is often called surgical neck fractures
 
– Avascular necrosis (rare)
 
This is a congenital condition where the hip is dislocated at a very young age and this damages an artery. So that bit of the bone dies due to a lack of blood supply.
 
– Hip osteoarthritis
 
Osteo means bone.
 
Earth means joint
 
Itis means inflammation.
 
There are various stages of arthritis, each with different characteristics. It is often not until the late stages of degeneration that the hip starts to cause pain. Degeneration is characterised by the inability of the hip to twist inwards, in what is called internal rotation.
 
– Bursitis
 
The most commonly affected bursa is the greater trochanteric bursa. the typical sign that somebody has bursitis here, is when the side of their hip bone (technically femur), is very tender and they cant sleep on that side.
 
– Snapping Hip Syndrome
 
This is a general term for when muscles flick/click over the top of a bone, as it passes over it.
 
– Hip impingement
 
There are 2-types of impingement, one is when the thigh bone has a bit of extra bone protruding out (cam impingement). The other type of hip impingement is when the pelvis bone has a bit of extra bone protruding down (pincer impingement). If someone has a bit of protruding bone, it often causes pain and pinching when people squat deeply.
 
– Sports hernia
 
This is also known as an inguinal hernia, it is when the abdominal wall muscles tear from a sporting exercise. Commonly effecting football, rugby and tennis players. Due to the tear in the abdominal wall, visceral/organ can protrude out when the abdomen is placed under the pressure of coughing or sneezing.
 
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Hips matter more than you realise…..
 
Hips can be the main pain generator for low back pain (even if the hip doesn’t hurt), and they can put excessive strain onto its nearby joints/muscles.
 
———————Criminal hips that cause the pain—————————
 
So my client tells me that they have been diagnosed Sciatica from dodgy disc in their back. I then assess them to find that a muscle of the hip is the root cause, as it is referring pain down the leg and up into the lower back.
 
Hips aren’t always the criminal and the victim. They can just be the criminal who keeps their distance from the crime scene. Here are 2x examples where pain refers from the hip to its close neighbours……
 
-> Piriformis syndrome
 
The sciatic nerve runs by and sometimes passes through the Piriformis muscle at the back of your hip. When this nerve is too tight it can pinch on the sciatic nerve. This is a functional entrapment syndrome as opposed to a mechanical one.
 
-> Gluteal trigger points
 
I wont go into the different theories as to why trigger points do what they do, but ultimately a grumpy muscle refers pain somewhere else. This usually referring muscle sending pain and tension to its neighbours is usually pain-free.
 
—————Criminal hips that cause mechanical compensation—————-
 
Hips can be the grandfather mechanical cause…..
 
After years of studying bio-mechanics I have come to realise that often the bits that dont move enough are not painful. Joint/muscle restrictions cause a compensation and it is oftentimes the bits that compensate that get grumpy.
 
“double-check for hip tightness in everyone presenting with low back pain”.
Was the mantra a past mentor of mine Shane hammered home to me. For if a hip isn’t doing its job then often it is the low back that has to pick up the slack.
 
– Piriformis syndrome
 
The sciatic nerve runs by and sometimes passes through the piriformis muscle at the back of your hip. When this nerve is too tight it can pinch on the sciatic nerve. This is a functional entrapment syndrome as opposed to a mechanical one.
 
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How I treat Hip problems……
 
I have found that hip that are tight respond best to the following treatment methodology.
 
– Tractioning (decompressing) the hip
 
– strong joint capsule stretches (hips dont’t respond much to gentle treatment)
 
– Active Release Treatment (great for addressing muscular tightness)
 
Before I prescribe any exercises I see how the joint responds to the following, research-backed treatment methods………
– Rhythmic PNF
– Reactive Neuromuscular Training
– Isometric Agonist Antagonistic activation