Pain felt in the hip can be caused by many different anatomical structures all the way from the lower back and pelvis down to issues of alignment in the knee and foot. Hips are a common area where muscle imbalances occur, for example the front musculature of the hip is tight while the back muscles are weak. This type of imbalance can lead to many common pathologies like tendinopathies, bursitis’, muscle strains and even degenerative changes or osteoarthritis. In any case, it is important that you have your hip pain assessed by a medical professional be it a Physiotherapist and/or Chiropractor. It is important to seek treatment for your hip pain as early as possible to ensure a quick recovery and prevent your body from developing stubborn compensations strategies that take longer to overcome.
What Makes the Hip Joint Unique?
The hip is a ball and socket joint, with a deep socket, making it a much more stable joint in comparison to the ball and socket joint of the shoulder. The hip joint does have some unique features.
The hip joint has over 17+ muscles that cross it and that play a role in alignment and movement of the hip. The coordination, flexibility and strength of these muscles are integral to a healthy hip. The hip is closely connected to the movement of the pelvis and lower back. Tightness and dysfunction in these areas can impact the hip and vice versa.
What are the Causes of Hip Pain?
Hip Pain due to Muscle Strains and Tendinopathy
This is the most common reason people seek treatment for hip pain at Sunup Physiotherapy. There are numerous muscles each with their own tendons (a tendon is the aspect of the muscle that attaches to the bone). When excessive demand is placed on one or more of these muscles they can become strained and an inflammatory response will ensue. A muscle strain may occur with a sudden demand that the muscle cannot withstand and fibers of the muscle get torn. On the other hand, excessive loads that are repeatedly placed through a tight muscle will lead to tugging of the tendon which leads to micro tears, inflammation and eventually a tendinopathy. Tendinopathies occur over time with repetitive movements and demands that are irritating. Please read our previous blog to learn more about treatment of proximal hamstring tendonopathy.
Hip Pain due to Bursitis
The bursa usually found in between the muscles and bones are meant to reduce friction as muscles slide back and forth over boney structures. When the muscles are too tight, they can squish the Bursae which lead to inflammation and ultimately a painful bursitis. The most common area of bursitis around the hip joint is at the greater trochanter called “Trochanteric bursitis” which can be found on the outside of the hip.
Hip Pain and Snapping Hip Syndrome
This sensation and sound of snapping typically occurs at the front or side of the hip and is caused by abnormal muscle tension or altered joint mechanics. One source of snapping can occur from tight tendons flipping over one another or flipping over bony prominences of the hip. Working on strength and flexibility around the hip will be important to resolving the issue. Please click here to learn more about Snapping Hip Syndrome.
Hip Pain due to Labral Tears
The labrum, a cartilaginous structure that deepens the hip socket, can tear or start to wear down. This type of injury may create the feeling of a deep click or clunk within the hip joint. This injury can also be associated with a locking sensation meaning the hip feels stuck and may need to be “worked out” for the range to return. Individuals with this injury will also complain of a pain deep in the hip and groin area. When the labrum is torn or worn down, it’s integrity will be compromised and as such no longer vacuum seals the hip bone. This makes it challenging to have a centred hip and may lead to earlier degenerative changes. In more severe cases an arthroscopic hip surgery may be indicated. Please click here to learn more about Labral Tears.
Hip Pain due to Anterior Hip Impingement
Anterior hip impingement refers to a condition where the connective tissues at the front of the hip joint get pinched with certain movements of the hip bone. You may be prone to impingement if your hip socket has a unique shape, based on genetic or developmental factors. You may also get impingement when you have imbalances of the muscles around the hip joint. If some muscles are tight, they can pull the hip bone out of the ideal centred position making pinching more likely at end ranges of movement. In some cases, an abnormal bony growth has formed on the front lip of the hip socket which can lead to pinching. Generally, anterior hip impingement leads to pain with deep hip flexion noticeable with a deep squat. Improving the muscle imbalances around the hip joint with a skilled physiotherapist can be very helpful at resolving impingement. Please click here to learn more about Femoral Acetabular Impingement (FAI).
Hip Pain due to Degenerative Changes or Osteoarthritis
Osteoarthritis (OA) of the hip can occur with age, typically around 60 years of age or possibly earlier if someone has experienced a traumatic injury to the hip. Osteoarthritis is a term that describes a sequela of events that occur as a result of the wearing of a joint. This process results in thinning (or complete wearing down) of the joint cartilage which leads to bone on bone pressure. This process can stimulate thickening of the bone and bony outgrowths (osteophytes) which is a reaction to the bone on bone pressure. A key symptom with osteoarthritis is gradual loss of hip motion and increasing pain with weight bearing activities. To prevent and also manage the pain it is important that you keep your hips strong and flexible. It also is helpful to maintain a healthy body mass and active lifestyle. A total hip replacement (a surgical procedure where a prosthetic joint is inserted) is a treatment approach that can be helpful when all conservative measures have been exhausted. Physiotherapy is the first line of defense and can be very successful in managing osteoarthritis.
Hip Pain due to Hip Dysplasia
Newborn and very young children are often tested and monitored for hip dysplasia. In hip dysplasia, the socket of the hip joint is underdeveloped which means it does not form deep enough to hold the ball portion of the hip bone snug in all directions. Babies, children and individuals with hip dysplasia are more prone to dislocation and can cause issues with the blood supply to the hip. Often surgical interventions are considered. This may continue to be a chronic issue. Hip pain can occur throughout your life and it is important to keep your hips strong avoid demanding exercises that create pain.
Hip Pain due to a Fracture
A hip fracture is an injury, crack or break in the bones of the hip. This type of injury is often a result of some sort of trauma, such as a fall or a car accident where the knees contact the dashboard. It is more likely to occur in elderly populations or other groups of people who have frail, weak bones. This painful condition will require a period of immobilization so that the bone can heal successful. In some cases, surgical intervention or a hip replacement will be required. Physiotherapy management will be an important part of the rehabilitation process once individuals are medically cleared for exercise. Your physiotherapist will help restore your movement and help you build your strength and stamina back up so that you can get back to pre-injury status.
Hip Pain Caused by a Lumbar Radiculopathy
Sometimes pain that is felt around the hip and groin region can actually be originating from the low back as a result of compression of a nerve root. If this is the case, you may also experience pain and/or stiffness in your back and you may notice that certain postures change the pain. If treatment is targeted at the wrong source, it will not be successful. This is why it is important that you are assessed by your trusted Physiotherapist or Chiropractor to rule out the low back as a source of pain.
Hip Pain Caused by Pelvic Floor Musculature
The muscles that make up your pelvic floor can refer directly into the hip region and can be a source of pain when they are tight or have trigger points within them. These muscles are not only in close proximity to the hip, but they share common nerve innervations and some of them even cross or connect to the hip bones. If you experience incontinence, painful intercourse, difficulty with urination, difficulty with bowel movements and/or constipation, these may be signs that indicate your pelvic floor may be involved. An assessment with a Pelvic Health Physiotherapist is recommended to evaluate this region as the source of your hip pain.
How can Physiotherapy, Chiropractic, and Massage Therapy Help your Hip Pain?
A team of healthcare professionals can personalize your treatments to address your specific injury and help you return to your personal lifestyle goals. Each member of the team has its role. Treatments with a Physiotherapist and/or Chiropractor will help to control your pain with therapeutic modalities, acupuncture or dry needling. Your physiotherapist or chiropractor will also help improve range of motion of the joint with hands on manual therapies and will guide you through an individualized exercise program to build up your strength and normalize any muscle imbalances. Soft tissue release is also an important aspect of your treatment and you may require adjunct massage therapy treatment to address this. Education in regards to lifestyle modifications or orthotics maybe recommended. Referral to Physician will be made for additional diagnostic testing and alternative medical interventions if your treatment does not progress as expected. If you are experiencing hip pain that does not resolve on it’s own within 1-2 weeks or is getting worse from its initial onset, we highly recommend having your hip assessed by a trusted health care professional.
How Long Does it Take to Recover from Hip Pain?
There is no simple answer to this question. There are several factors that need to be considered when evaluating a realistic timeframe for recovery. First and foremost, the origin and cause of the pain needs to be determined. Then, other factors such as duration of symptoms, severity of symptoms and your commitment to get the proper treatment will also influence recovery timelines. In broad terms, recovery can take a few weeks up to a few months. In some cases, such as large labral tear (requiring arthroscopic surgery) or advanced OA (requiring a total hip replacement) recovery timelines may be extended based simply on wait times for the surgical procedure itself. Your physical therapist or chiropractor will have a better idea of timelines once they conduct a thorough assessment and have a chance to follow your response to treatment after a couple of visits. Some things take time to respond, especially strengthening exercises. Muscle changes can take up to few weeks with daily and consistent work. Remember to be patient and consistent with your exercise program. Keep in mind that your trusted physiotherapist or chiropractor sees these types of conditions regularly and will be the best person to advise you on the best course of treatment. They will inform you if your symptoms are not progressing as expected and if you should book a consultation with a physician for further investigations or treatment options.
What are the Best Exercises to Help with your Hip Pain?
A well-rounded program should address lower back and hip range of motion as well as a graduated strengthening and flexibility program. These exercises should be individualized to your particular needs and goals.
Some of the most common exercises are described below to help you get started. These exercises should be performed in a pain free range and modified or stopped if pain increases during or after. For motor co-ordination it is imperative that you perform the exercises, paying close attention to good form, in a slow and controlled fashion. Aim for 3 sets of 10reps.
How to Treat Hip Pain at Home?
If your hip pain does not improve with these strategies and/or you are unable to return to your pre-injury status, consider booking in to see one of our experienced Physiotherapists or Chiropractors who will be able to help you get a head start on your recovery contact us today.
Snapping Hip Syndrome
Snapping hip syndrome is a condition characterized by a snapping sensation, or an audible snap or click in the hip when it moves through certain motions. The snap can be felt along the front or side of the hip, or deep within the hip joint. The snap is usually felt with repetitive bending and extending of the hip joint – for example with running, core exercises (i.e. leg raises), high kicks in dance etc.
There are three different types of snapping hip syndrome – diagnosed based off of where the “snap” is occurring. The first occurs when the Iliotibial band (IT band) snaps over the greater trochanter (a bony protuberance) on the outside of the hip. The second is when the Iliopsoas (a hip flexor) tendon snaps over a protuberance in the front of the pelvis. Lastly, and least commonly, the snap can be intra-articular (inside the joint). This could be caused by a tear of the cartilage in the hip joint, or a loose body – a small piece of cartilage that can float around in the hip joint.
What Causes Snapping Hip Syndrome?
In general, snapping hip syndrome is caused by a tightening of the muscles around the hip joint. There is a greater occurrence of this condition in activities that cause repetitive flexion and extension of the hip, such as dance, soccer, gymnastics and running. Shortening of these muscles can also be caused by postural dysfunctions, for example – people who sit at a desk for the majority of the day where the hip flexors are in a shortened position. Many people also have a number of muscle imbalances around their hips that may pre-dispose this problem – for example weak glute and core muscles that lead to an over activation of the hip flexors with sport and activity.
How can Physiotherapy, Chiropractic and/or Massage Therapy Treatment Help with Snapping Hip Syndrome?
A physiotherapy or chiropractic assessment will determine the location and underlying cause of the “snap”. This assessment will also rule out other, more problematic injuries involving the hip – for example a labral tear in the hip. Treatment of this condition may involve stretching of the anterior structures of the hip, manual therapy and massage of the surrounding muscles and joints to normalize their position and function. A comprehensive strengthening program will also help to identify and treat muscle weaknesses and improve proper muscle activation and control around the hip and pelvis.
The knowledgeable staff at Sunup Physiotherapy can help to relieve that annoying snapping, and prevent it from developing into something potentially more problematic – such as a tendinopathy, bursitis or irritation of the surrounding nerves.
What are Some Safe Home Exercises for Snapping Hip Syndrome?
For most people snapping hip syndrome is not painful, but more of an annoying sound with certain activities; however, there are some things you can start to do to relieve that sensation. Start by avoiding core exercises that involve repetitive leg raises. To learn more appropriate core-progressions a physiotherapist or chiropractor at Sunup Physiotherapy can help! Contact us today.
Some safe stretches to start now would be:
Sports Hernia (a.k.a. Athletic Pubalgia)
What is a Sports Hernia?
‘Sports hernia’ is a term used to describe an injury to the muscle or tendon in the lower abdomen or groin region where it attaches onto the pubic bone. Although the name can be misleading, this type of injury does not involve the bulge associated with typical hernias.
This type of injury is more common in males, and it is often acquired in sporting activities that involve planting the feet and twisting or over-stretching of the trunk and hip with maximal exertion. Kicking a ball, taking a slap shot, skating or sprinting are examples of this type of movement.
Sports hernias are usually quite painful immediately following injury. The pain is localized over the groin area and it is made worse with sporting activities and relieved by rest. There is no visible or palpable bulge in the groin with a sports hernia.
If you suspect you might have a sports hernia, a registered physiotherapist can conduct a physical examination to help determine if this is the case. They will do a number of tests to check for pain and weakness with resisted hip and trunk flexion, and they will also check for tenderness of the lower abdominals and hip musculature. After the physical examination, the physiotherapist may refer you to a doctor to get diagnostic imaging done to help determine the nature and severity of the injury.
Generally the initial treatment for a sports hernia is rest and physiotherapy. Physiotherapists at this stage can guide you through exercises aimed at improving the strength and flexibility of the injured area. They can also use anti-inflammatory modalities such as ice and ultrasound to help with tissue healing. If these measures do not relieve your symptoms, then surgery is generally indicated. Surgery for this type of injury is often very successful, and a physiotherapist can guide you through a rehabilitation program aimed at returning you to your chosen sport.
If you are suffering from a sports hernia and would like to see one of our registered physiotherapists, please contact us today.
Hip Labral Tears
The labrum is a thick, fibrocartilaginous structure around the hip joint (acetabulum) that functions to deepen the socket, absorb shock, lubricate the joint and distribute pressure. Secondly, it also helps to provide ligamentous stability for the hip joint. When there is fraying or tears in the labrum, this often causes pain in the hip and groin and can cause the hip to feel “unstable”. As a result, pressure is more concentrated on the joints surfaces and can lead to early onset of osteoarthritis. An MRI is often required to determine if there is a tear, its severity and if surgery is indicated.
What Causes a Hip Labral Tear?
Labral tears often occur due to the following; high velocity trauma (MVA, falls, dislocations), Femoral acetabular impingement (FAI), degeneration of the joint over time due to repetitive loading. They are commonly seen in sports that involve repeated hip hyper extension, external rotation and twisting/ pivoting such as ballet, soccer, running and sprinting due to the repetitive stress on the hip joint over time.
The symptoms usually start as a dull ache in the front/side of the hip but can be sharp or “snap” in specific movements. In certain cases, the frayed ends of the labrum can get caught and pinched in the hip joint causing the hip to lock and spasm around the hip. As osteoarthritis progresses and wears down the joint cartilage, the labrum is more prone to wear and tear as it’s the ideal pressure distribution is compromised.
Physiotherapy, Chiropractic and Massage Therapy Treatment for a Hip Labral Tear?
The rehab team at Sunup Physiotherapy can assist with both conservatively managing the symptoms as well as post-arthroscopic surgery. The goals will be to reduce the pain by stretching the tight muscles at the front of the hip, mobilizing/stretch the hip joint to restore normal joint mechanics and strengthen muscle imbalances to increase stability at the hip. Core strength and balance may also be helpful to promote proper loading and mechanics at the hip.
What Should be Avoided with a Hip Labral Tear?
Positions of pain such as excessive hip extension, jumping and pivoting should be avoided as it can cause impingement of the hip joint and spasm of the surrounding musculature.
Safe Home Exercises for a Suspected Hip Labral Tear?
How Long Does it Take to Recover From a Hip Labral Tear?
Through conservative management (physiotherapy/chiropractic), it can take 6-8 weeks to decrease the pain, increase the flexibility of tight muscles while strengthening weaker muscles to ensure the femur bone stays centered in the socket. For athletes, it may take an additional 2-4 weeks for sport specific exercises and progress balance, agility and speed training.
In some cases, depending on how large the tear is and if it causes locking at the hip, arthroscopic surgery may be required to remove large fragments, flatten the frayed edges or suture the labrum down. The recovery process will take about 12-16 weeks and will often have weight-bearing restrictions for 4 weeks requiring crutches for mobility immediately following surgery.
The first phase of recovery will focus on restoring the hip range of motion and gentle strengthening with isometric exercises. As the hip mobility improves, strengthening exercises can be progressed to more dynamic movements and work towards balance, agility and power by the end of the 16-week period similar to the conservative management with sport specific retraining. Contact us today!
Femoral Acetabular Impingement (FAI)
The hip joint has become one of my favourite joints in the entire body. This seemingly simple ball-and-socket joint created for mobility, load-bearing, and stability plays a critical role in linking the trunk with the rest of the leg. Thus, any issue with the hip joint can affect structures below, the knee, ankle, and foot, and/or structures above, the pelvis and low back. For some people pain in these adjacent areas can occur prior to any pain, discomfort, or limitations in the actual hip are noticed.
What is Femoral Acetabular Impingement (FAI)?
Most people associate issues in the hip with arthritis and hip replacements; however, there is another common issue in the hip that can affect people of any age and activity level. Femoral Acetabular Impingement or FAI for short. To understand what an FAI is you need a basic understanding of the anatomy of the hip. As mentioned, the hip is a ball-and-socket joint. The “ball” is the head (top) of the femur (thigh bone). It would akin to a tennis ball stuck on the end of the blade of an upside-down hockey stick. The “socket” is comparable to an ice-cream scooper in shape and is located in each pelvic bone. The proper name for the socket is acetabulum. Impingement refers to pinching together, and in this case, the of head of the femur and the acetabulum are pinching together.
Normally, the shape of the ball-and-socket allow for free movement of the hip joint; however, with an FAI the actual anatomy of the hip joint changes. The cause of these anatomical changes can vary. Changes can be congenital, meaning they are present at birth. More often, these changes are occur as a result of repetitive stress, strain, and non-optimal loading through the hip joint during participation in sports; therefore, these changes occur over time. Changes can also occur based on the anatomy of your pelvis as that may pre-dispose you to increased load or altered force transmission through the hip joint with everyday activities like walking. Regardless of the cause there are 3 types of bony changes that occur:
The femur and acetabulum have to come together for pinching to occur and this typically only happens during mid to end range movements. When the bones pinch together it can result in pain in the groin, hip, or buttock areas, stiffness, and/or clicking, clunking, or giving way. Some people may go through life with no symptoms or awareness that these changes exist, while others may experience one or all of the above symptoms on a daily basis or with certain movements or activities. As mentioned at the beginning, the hip links the low back and pelvis to the rest of the leg. Therefore, for some their body may adapt to these changes and they may never feel pain in the hip region but instead experience low back pain or knee pain secondary to a compensatory strategy they have unconsciously adopted in order to avoid the pinching of the bones.
An X-ray can be used to diagnose an FAI; however, there are a cluster of tests your physiotherapist or chiropractor can complete to determine whether an FAI is likely. However, imaging results typically do not change the treatment approach as it is based on your specific symptoms, mobility, and strength.
It depends a bit on what your symptoms are, what activities you do or would like to get back to, the strength of your core muscles and the muscles surrounding your hip, and the mobility of your hip, pelvis, and low back. Based on your individual presentation some or all of the following may be used:
The main areas that typically require strengthening in those with an FAI are the gluteal and core muscles and adding some balance training doesn’t hurt.
If you think you have femoral Acetabular Impingement, contact us today to see one of our trained professionals.
Proximal Hamstring Tendinopathy
What is Hamstring Tendinopathy?
The hamstring muscles originate from the sitting bones and attach just below the back of the knee. Proximal hamstring tendinopathy (PHT) or high hamstring tendinopathy is a common, and frustrating pathology experienced among runners as a result of repetitive strain. Often, it is caused by an increase in load such as running at a higher speed, running uphill, or performing deeper lunges. It is aggravated when the hip is working in a flexed position, which may put a compressive load on the tendon.
Signs and symptoms of Hamstring Tendonopathy
Diagnosis Of Hamstring Tendinopathy
Clinical diagnosis is made by a detailed physical examination paired with the subjective history. If required, MRI can detect tendon thickening, inflammation, and swelling.
Your physiotherapist will also assess the surrounding joints, nerves and muscles. Lumbar spine pain referral, sciatic nerve, sacroiliac joint, pelvic floor dysfunction can all cause pain in the area therefore creating the proper diagnosis is crucial for successful treatment.
Treatment of Hamstring Tendonopathy
What To Avoid?
The most important piece in the treatment of PHT is load modification to avoid aggravating factors. With PHT, the tendon becomes sensitive and overworked. As a result the tendon’s capacity to accept load decreases. This capacity can be improved with gradual loading. Stretching the hamstrings may also compress the tendon, thus prolonging the symptoms. Positions or exercises involving hip flexion (bending hip forward) such as sitting, driving, lunging, cycling, sprinting should be avoided in the early phases of rehabilitation. Swimming or water jogging may be substitutes at this stage.
Exercises For Hamstring Tendonopathy
Our physiotherapists will assess and help you find the optimal starting point in the gradual loading program. Isometric exercises are recommended in the early stages and they should be performed 3x 15 sec 3x a day, as they can help with pain relief. As the symptoms progress, further strengthening exercises can be added. These should be performed 4x a week.
Hamstring exercises for runners in early stages and advanced hamstring exercises for runners:
Shockwave therapy, dry needling and manual therapy techniques can also aid in the recovery of PHT. At Sunup Physiotherapy, our physiotherapists will create an appropriate treatment plan tailored to your injury and your specific goals.
Hamstring Tendinopathy and Running
When are you ready to run?
Returning to running can be a complex decision therefore guidance by your physiotherapist/ health professional is strongly recommended. Typically a period of rest, followed by hamstring and glute strengthening is recommended before returning to regular running. Cross training like water jogging is a great way to continue with cardio fitness while avoiding aggravation to the hamstring. In some cases, runners are able to continue with running throughout PHT by reducing mileage and speed. Mild pain is acceptable during running/exercising, however it should settle entirely within 24 hours.
Over striding, and running with a forward trunk lean can be a possible factor leading to PHT. Increasing running cadence (taking shorter steps), and running a bit taller may help with the symptoms. Our trained physiotherapists will be able to analyze and provide you with feedback on your running form if needed.
If you think you have proximal hamstring tendinopathy, contact us to see one of our trained professionals.