Hip problems don’t only affect the elderly who are waiting for hip replacements. They also affect the young and the sporty.
As always, before any treatment is carried out, I take a thorough case history and assess the hip to figure out what the problem could be.
“If you are not assessing you are guessing”
Human anatomy is complicated and the hip is no exception as multiple factors can cause hip pain. Your hip pain could be a result of:
Commonly during sporting events, one of 5 inner thigh muscles can get 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 a major loss of function.
- Femoral neck fracture (rare)
- This is often called a surgical neck fracture
- Avascular necrosis (rare)
This is a congenital condition where the hip is dislocated at a very young age and this damages an artery resulting in the death of that bit of the bone due to a lack of blood supply.
‘Osteo’ means bone.
‘Arth’ 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, called internal rotation.
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 can’t 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.
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 pelvic 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.
This is also known as an inguinal hernia and occurs when the abdominal wall muscles tear from a sporting exercise. This commonly affects football, rugby and tennis players. Due to the tear in the abdominal wall, viscera and or organs can protrude out when the abdomen is placed under the pressure of coughing or sneezing.
Hips matter more than you realise…
Hips can be the main pain generator for lower back pain (even if the hip doesn’t hurt), and they can put excessive strain on its nearby joints and muscles.
Criminal hips can be the cause your pain
My client told me that they had been diagnosed with Sciatica from a “dodgy” disc in their back. I then assessed them only to find that a muscle of the hip was the root cause as it was referring pain down the leg and up into the lower back.
Hips aren’t always the victim. They can just be the criminal who keeps their distance from the crime scene. Piriformis syndrome and gluteal trigger points are two examples where pain refers from the hip to its close neighbours.
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 won’t go into the different theories as to why trigger points do what they do, but ultimately a grumpy muscle refers pain somewhere else. Surprisingly, the 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 biomechanics, I have come to realise that often the bits that don’t move enough are not painful. Joint and muscle restrictions cause overcompensation and it is oftentimes the bits that overcompensate that get grumpy.
“Double-check for hip tightness in everyone presenting with lower 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 lower back that has to pick up the slack.
How do I treat Hip problems?
I have found that hips that are tight respond best to the following treatment methodology:
- Tractioning (decompressing) the hip.
- Strong joint capsule stretches (hips don’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