Learn About Your Hip

A hip injury and pain can make it hard to walk, go up and down stairs, squat, or sleep on the side that hurts.

Check out this great 3D anatomy tutorial on YouTube by AnatomyZone. It has lots of detail if that’s what you like!

Otherwise, below is a summary of the basic anatomy of the hip:

The hip joint is a ball and socket joint, formed by an articulation between the pelvic acetabulum (socket) and the head of the femur (ball).

It forms a connection from the lower limb to the pelvic girdle, and thus is designed for stability and weight-bearing – more designed for walking on than having lots of movement like your shoulder does.

There are thick ligaments surrounding the hip joint, along with a joint capsule that is dense fibrous tissue that surrounds the entire hip joint.

Lastly, there is a fibrocartilage labrum that sits on the outside parts of the socket which is 2-3 mm thick. It helps to increase the hip joints stability, aids in shock absorption and decreases the contact stress in the joint.

Your hip is designed to flex up, extend back and rotate outward and inward.

The hip ligaments and thick capsule limit the amount of mobility of the hip, along with the main muscles ie hip flexors.

Your hip needs to be able to walk, run, jump, squat, lunge and twist, all the time taking the load of your body weight. It is an impressive joint!

Take Home Message

The Hip Joint is a ball and socket joint, formed by an articulation between the pelvic acetabulum (socket) and the head of the femur (ball).

Your hip is designed to flex up, extend back and rotate outward and inward.

The hip is designed for stability and weight-bearing, it’s a very sturdy joint.

Traumatic Hip Injuries

The hip is prone to several types of injuries. Sometimes these happen in otherwise healthy joints – an automobile accident or fall breaks a bone or forces the femoral head out of its socket, or a sports injury.

In other cases, joints compromised by congenital deformities or osteoporosis, for example, leave the hip vulnerable to injury upon the slightest trauma. The following are some of the more common hip injuries.

A sudden (acute) injury may occur from a fall on the hip, a direct blow to the hip or knee, or abnormal twisting or bending of the leg. Examples of acute injuries that may cause hip pain include:

A broken hip (hip fracture) or pelvis (pelvic fracture)

A broken hip, or hip fracture, can occur at any age, but they are most common in people age 65 and older, particularly women, with osteoporosis. In a younger person with healthy bones it may take a serious injury, such as a car accident, to break a hip, but when osteoporosis weakens bones, even a minor fall can result in a fracture.

A dislocated hip or sprained hip

A dislocation occurs when the ball at the top of the femur slips out of the socket, causing severe pain and inability to move the leg. It usually takes a strong force – from an automobile accident or severe fall, for example – to cause a dislocated hip.

Being born with a shallow hip socket or hip displasia (a congenital deformation of misalignment of the hip joint), however, makes dislocation more likely. Often the ligaments about the hip are damaged if a hip becomes dislocated.

A hip subluxation is where the hip dislocates partially then returns immediately into it’s normal position. The hip capsule and ligaments will then be sprained and painful.

Labral Tear

A hip labral tear is damage to the cartilage that surrounds the bony edge of the socket in the pelvis. This can occur as the result of repetitive use of the hip and can be seen in the early stages of osteoarthritis or can be caused by an injury such as a fall or accident that causes twisting of the joint.

Muscle strain in the groin or buttock

Muscle strains and tears can occur to any of the muscles around the hip. The most common being the gluteals, hip flexors, rectus femoris and the Tensor Fascia Latae.

Muscle strains happen with more rigorous sports such as football, basketball, netball etc, where you run, twist, jump, land and sprint.

Pain will be quite localised to the affected muscle and will be acute.

Severe Bruising (contusion)

Direct blunt trauma can be common in contact sports to the muscles about the hip. This is also known as a ‘corky’ in Australia.

The main muscles corked are the gluteals and the TFL.

A bruised muscle can be quite painful and it won’t like being used and being stretched.

As there is bleeding within the muscle you should start the R.I.C.E.R regime:

The RICER method is an effective procedure used in the initial treatment of a soft tissue injury.

Rest: It is suggested that you take a break from the activity that caused the injury in order to give the injury time to heal.

Ice: The injury should be iced on and off in 20 minute intervals, avoiding direct contact of the ice to the skin.

Compression: Bandaging the injury will compress it, and prevent any further bleeding or swelling to occur.

Elevation: Elevating the injury above your heart while you are resting will aid in the reduction of swelling.

Referral: Referral to an appropriate medical professional for guidance and management.

General Hip Pain Causes

Overuse injuries occur from repeating the same activity.

The repeated activity, such as running or bicycling long distances, may stress the hip joint. This can cause irritation and inflammation.

Examples of overuse injuries include irritation of the large sac (bursa) that cushions the bones of the hip joint (trochanteric bursitis), irritation of the tendons in the hip (tendinitis), muscle strain, and hairline cracks (stress fracture) in the neck of the thigh bone (femur) amongst others.

Below we will cover the main types of non-traumatic hip problems:

Hip Bursitis or Tendonitis Pain

What you need to know about hip bursitis pain:

Outside or lateral hip pain is generally caused by bursitis of the buttock muscle tendons, as they attach to the outside of the hip.

It is more common in females than males (3:1), due to the shape of the pelvis and hormonal changes experienced by women in the peri menopausal period.

It is always due to excessive sideways load and compression around the outside area of the hip joint. This can be due to muscle imbalances (both tightness and strength), overuse and poor postures and positioning.

Reducing the total compression on the lateral hip over each 24 hour period is vital for improving your symptoms.

The bursa may become inflamed by a group of muscles or tendons rubbing over the bursa and causing friction against the hip bone. It can also be aggravated by a direct blow to the bursa i.e. a fall or tackle.

It may also be a gradual onset issue due to repetitive trauma to the bursa. Which can be from running with poor technique or muscle control, cycling with too high a seat or walking to fatigue.

Trochanteric bursitis is the inflammation of the bursa. (a small, cushioning sac located where the tendons pass over the areas of bone around the joints), which lies over the big bone on your hip (femur).

Symptoms can vary but will usually present with pain or swelling directly over the head of the femur. Also referred pain from the outside of your leg to the knee, or pain sleeping on the affected side, pain on climbing stairs or after prolonged sitting.

Common signs and symptoms of hip bursitis pain:

  • Soreness on the outside of the hip, with possible pain down the thigh.
  • Running can elicit pain.
  • Pain when lying on the affected hip or sitting crossed legged.
  • Pain with climbing stairs, getting in/out of the car.

To reduce your hip pain, you need to address all the areas contributing to your pain:

  • Address tight muscles with physiotherapy, foam rolling, massage and stretching.
  • Strengthen key lateral hip stabilising muscles, without causing compression on the lateral hip structures (your physiotherapist will show you how to do this).
  • Lose weight and reduce your abdominal girth to reduce load on your hip and associated muscles.

Change your postural habits:

  • Do not hang on one hip when standing, or carry a load such as a child on one hip.
  • Do not lie on that side to sleep.
  • When sleeping on the other side, ensure that a pillow is placed in between your hips at all times.
  • Do not sit with your legs crossed.
  • Ensure you graduate your return to activities such as walking as guided by your physiotherapist.

By Tim Bass
Sports Physiotherapist myPhysioSA Mount Barker & Payneham

Gluteal Tendinopathy

Gluteal tendinopathy is the most common type of lateral hip pain. A tendon injury may occur suddenly but is more likely the result of a repetitive/overuse type injury.

Tendons are designed to withstand high, repetitive loads. However, when a load applied to the tendon is too great and too often, the tendon can become stressed. This can start to cause pain.

A gluteal tendinopathy presents with increasing pain on activity e.g. running and pain or stiffness first thing in the morning and overnight.

Tendon or Muscle Strain or Tear

In a hip strain, muscles and tendons may be injured. Tendons are the tough, fibrous tissues that connect muscles to bones. Hip strains frequently occur near the point where the muscle joins the connective tissue of the tendon.

The strain may be a simple stretch in your muscle or tendon, or it may be a partial or complete tear of muscle fibres or of the muscle and tendon combination.

Muscle Imbalance/Weakness

Muscle imbalance or weakness can occur in any of the above conditions and is usually an associated factor. When no pathology is present in a person with lateral hip pain, then you can assume it is then caused by a muscle imbalance around the hip. This usually relates to a tightness or pulling of muscles in one direction with the muscles in the other direction being too weak to be able to support the joint. This is common in asymmetrical type of activities e.g. kicking sports, golf or tennis.

Symptoms:

A muscle strain causes pain and tenderness in the injured area. Other symptoms may include:

  • Increased pain when you use the muscle
  • Swelling
  • Limited range of motion
  • Muscle weakness

Hip Flexor Strain (iliopsoas)

Lifting your knee toward your body takes the work of many muscles, which are collectively known as your hip flexors. The hip flexor muscles include:

  • the iliacus and psoas major muscles, also known as your iliopsoas
  • the rectus femoris, which is part of your quadriceps

These muscles and the tendons that connect them to your bones can easily be strained if you overuse them.

The main work of your hip flexors is to bring your knee toward your chest and to bend at the waist.

What does hip flexor strain feel like?

Hip flexor strain’s chief symptom is pain at the front of the hip. However, there are several other symptoms associated with the condition. These include:

  • pain that seems to come on suddenly
  • increasing pain when you lift your thigh toward your chest
  • pain when stretching your hip muscles
  • muscle spasms at your hip or thigh
  • tenderness to the touch at the front of your hip
  • swelling or bruising at your hip or thigh area

You may feel this pain when running or walking.

https://www.healthline.com/health/hip-flexor-strain#symptoms

Gluteus Medius Tear

The gluteus medius is one of the key muscles surrounding the hip. This muscle starts in the buttock and attaches at the greater trochanter, on the side of the hip. Contraction of this muscle allows us to lift our leg to the side (abduct).

Tendonitis or tears of this muscle can occur after injury or with long-term wear and tear. These tears generally cause pain and weakness on the side of the hip.

Hip Joint Capsulitis/Synovitis

Inflammation of the hip joint, it can cause you to limp and usually gives pain into the groin and front of the hip or buttocks area’s.

This is often called a ‘frozen hip’. The correct medical term is Adhesive Capsulitis of the hip.

The pain and stiffness is usually rapid in onset with no apparent reason.

It’s more common in teenagers and often the first complaint is a “catching” of the hip.

The affected will have reduced range of movement and walking, steps and squatting can be limited.

Capsulitis can be eased with Physio, ice and gentle stretching. It will usually slowly improve over 12-18 months. If progress is slow, then a cortisone injection may be worth considering.

Hip Arthritis

Osteoarthritis (OA) is a degenerative condition that can affect any joint, but mainly occurs in lower back, knees, hips, neck, small joints of the fingers and the bases of the thumb and big toe.

See our Arthritis blog on our website, it has tons of useful information including tips and advice that you can start using right away.

A joint in your body usually has a spongy, rubber type tissue called cartilage that protects the ends of bones, and helps them connect to form a joint. The cartilage is usually smooth and provides a cushion for the bones so that they don’t hit together and cause damage.

For example, think about a rubber stopper behind a door. If the two bits of wood (door and skirting board) where to bang against each other all day, there would be damage. The stopper helps to soften to impact of the door to avoid damage occurring.

With OA, the cartilage can first become more brittle, and henceforth start to break down. This can cause significant swelling, pain and reduced range of motion within the joint. As OA progresses (it is a degenerative condition), the cartilage may completely wear away, exposing the bone beneath that can also start to wear away. Small pieces of cartilage and bone that have broken off may then stay and float around within the joint (this is a normal process, and one you shouldn’t be worried about).

The body then starts an inflammation response to try and help repair the damage within the joint, but this can cause bony spurs and can also further damage the lining of the cartilage. Once the cartilage has worn away, bone may start hitting against bone. This happens in the final stage of OA and can be quite painful.

Osteoarthritis is diagnosed through your health professional

They will collect information about family history, symptoms you have, complete a physical test and then refer you to have diagnostic scans if applicable.

The health professional will usually conduct a physical exam, testing joint range of motion while also testing for tenderness, pain, swelling and mechanical joint changes.

A Physiotherapist can also conduct these tests, and then write to your Dr if they suspect OA may be present.

There are a number of treatment options that can help you manage and improve your OA symptoms.

What treatment option may be best depends on the type of symptoms.

For example, if you have no pain, but your knee joint can’t bend and flex as well as what you would like, then there is no use putting you on pain medication or sending off for an injection. What you may need is a structured plan set out by a physiotherapist who can manipulate the joint and structures around it to get more bend.

Similarly, if you are having large amounts of pain, swelling and tenderness in the joint, then you may need to get your pain management under control before adding in any new, vigorous physical activity that could stir pain up more. Plans must be individual to the person, and their symptoms.

Hip & Knee Arthritis Classes

If you have hip & knee arthritis then you should be doing regular strength and flexibility exercises which are proven by research to help manage the symptoms of arthritis and improve the ease of your daily activities.

Stephen, an Exercise Physiologist, at myPhysioSA explains all about our unique Arthritis classes at our Payneham, Mount Barker and Mile End clinics.

They are for people who have knee or hip arthritis that want to manage it better, or people who are preparing for upcoming surgery or have just had surgery and want to maximise their results.

The classes run for a 10 week block and include a Physiotherapy assessment at the beginning and the end, with a home exercise program included.

Hip Impingement or Femoral Acetabular Impingement (FAI)

What is hip impingement?

The hip is a ball and socket joint, that attaches the thigh bone to the pelvis.
FAI stands for femoroacetabular impingement. This means that when the hip moves in the socket, it pinches on the edge of the socket, causing inflammation and pain.

Repeated trauma leads to damage to the labrum, cartilage and inner joint surface.

What causes hip impingement?

There are three causes of femoro-acetabular hip impingement:

  1. Cam lesion – where the ball is not round and hence does not move in the socket normally causing impingement.
  2. Pincer lesion – where the socket has a large lip, again causing impingement when the ball moves in the socket.
  3. Mixed lesion – where both of these occur.

We do not know what causes these structural changes but we think it may have to do with repeated loading of the growth plate when a child and teenager.

What are the symptoms of hip impingement?

Pain and pinching in the groin are the most common symptoms. This usually occurs with twisting and bending motions of the hip towards the chest. Examples include twisting sports such as football and soccer.

How is hip impingement diagnosed?

Physiotherapists have a collection of tests we perform, which we use to accurately diagnose FAI. They will also identify the key contributing causes, which will be important in management.

An x-ray, 3D CT scan or MRI is helpful in assisting in the diagnosis as it identifies any abnormalities in the shape of the bones.

What are the best hip impingement treatments?

Physiotherapy (conservative management) is recommended in most cases of hip impingement.

Treatment may consist of advice, dry needling, massage techniques, joint mobilisation and specific strengthening exercises around the hip and pelvis.

Sometimes surgery is required to correct boney abnormalities and this can now be done with key hole, arthroscopic surgery in most cases.

Full recovery from surgery takes around 3-6 months to return to sport depending on the degree of damage and surgery required.

Blog by Tim Bass
Sports Physiotherapist myPhysioSA. Tim consults at our Payneham and Mount Barker clinics.

Congenital Hip Problems

What is congenital hip dislocation?

Congenital hip dislocation (CHD) occurs when a child is born with an unstable hip. It’s caused by abnormal formation of the hip joint during their early stages of foetal development.

Another name for this condition is “developmental dysplasia of the hip.” This instability worsens as your child grows.

The ball-and-socket joint in the child’s hip may sometimes dislocate. This means that the ball will slip out of the socket with movement.

The joint may sometimes completely dislocate.

According to American Family Physician, one out of every 1,000 infants is born with a dislocated hip.

What are the symptoms of congenital hip dislocation?

There may be no symptoms of CHD, which is why your child’s doctor and nurse will routinely test for the condition.

If your child has symptoms, they may include:

  • legs that turn outward or appear to differ in length
  • limited range of motion
  • folds on their legs and buttocks that are uneven when their legs extend
  • delayed gross motor development, which affects how your child sits, crawls, and walks

How is congenital hip dislocation treated?

If your baby is younger than 6 months of age and diagnosed with CHD, it’s likely they’ll be fitted for a Pavlik harness. This harness presses their hip joints into the sockets. The harness abducts the hip by securing their legs in a froglike position.

Your baby may wear the harness for 6 to 12 weeks, depending on their age and the severity of the condition. Your baby may need to wear the harness full time or part time.

Your child may need surgery if treatment with a Pavlik harness is unsuccessful, or your baby is too big for the harness.

Surgery occurs with general anesthesia and may include maneuvering their hip into the socket, which is called a closed reduction.

Or the surgeon will lengthen your baby’s tendons and remove other obstacles before positioning the hip. This is called an open reduction.
After your baby’s hip is placed into position, their hips and legs will be in casts for at least 12 weeks.

If your child is 18 months or older or hasn’t responded well to treatment, they may need femoral or pelvic osteotomies to reconstruct their hip.

This means a surgeon will divide or reshape the head of their femur (the ball of the hip joint), or the acetabulum of their pelvis (the hip socket).

Source: https://www.healthline.com/health/developmental-dysplasia-of-the-hip

Hip External Rotator Syndrome (Piriformis Syndrome)

Hip external rotator syndrome is a dysfunction relating to the sciatic nerve that originates from the lower back and sacrum. It then travels to the centre of the leg and down to the foot. This injury can occur from a number of predisposing factors.

Such as, poor postural habits, long periods of sitting, muscle imbalance around the hip and poor flexibility around the hip and lower back.

Symptoms can present with a radiating pain down the side of the leg or hip but usually originating around the glutes/lower back.

Check out our video on how to relieve piriformis type pain using a stretch and foam roller combo:

Iliopsoas Bursitis

Bursitis is an inflammation of the bursa.

A bursa is a sac filled with fluid adjacent to the joints that acts like a cushion for the joint.

A bursa is situated between tissues like muscles, tendons, skin and bone that lessens irritation and friction between the tissues.

The iliopsoas bursa can cause pain in the hip when subjected to continual irritation and compression resulting in it swelling and becoming inflammed.
Iliopsoas bursitis is also known as iliopectineal bursitis.

Iliopsoas bursitis is caused due to an overuse injury, which results from repetitive rubbing of the iliopsoas tendon. Iliopsoas bursitis is most common in sports, which involve repetitive activities such as football, athletics, cycling and running.

Symptoms of Iliopsoas Bursitis:

  • Pain is usually experienced deep at the front of the hip.
  • Pain can radiate towards the knee.
  • Radiation of pain into the lower back or buttocks.
  • A snapping or clicking sensation at the front of the hip with hip bending movements.
  • Stiffness and pain after rest or in the mornings.
  • Aggravation of pain while performing squatting, stairs, running, sport or prolonged sitting activities.

Treatment for Iliopsoas Bursitis:

  • Modified rest from any activities that aggravate symptoms of Iliopsoas bursitis These are usually repetitive activities eg running, cycling, sport.
  • You can try using ice over the area a few times a day for relief for 15 minutes.
  • Anti-inflammatory medications may help in reducing inflammation and relieving the pain associated with Iliopsoas bursitis.
  • The most effective treatment for Iliopsoas bursitis is a corticosteroid injection. This is where cortisone, a strong acting anti-inflammatory, is injected into the bursa. This then hopefully reduces the inflammation and pain, and eases the compression on the bursa.

Hip Stress Fractures

Stress fractures are injuries to the bone that result from overuse activity. Usually from a running sport.

A hip joint stress fracture is a serious injury to the ball of the ball-and-socket hip joint.

A stress fracture is due to repetitive micro-trauma to the bone.

Over time, the body cannot keep up with repairing the forces that are acting on the bone, and a stress fracture slowly eventuates.

It differs from a traumatic hip fracture due to a fall.

Or a pathological fracture due to osteoporosis, tumours, or infections.

So how does a stress fracture happen?

Like most tissues in the body, bone is constantly renewing and replacing itself—a process called bone remodeling.

Weight-bearing exercise such as running or sport, places a level of stress on the bones. This will stimulate bone-tissue renewal and increase bone density.

However, if a bone absorbs so much weight and/or impact stress in a short period of time that the normal remodeling process cannot keep up. An imbalance develops between bone cell damage and bone cell generation.

In this imbalance situation, instead of the bone becoming stronger and denser due to weight bearing exercise, the bone becomes thinner and weaker as it becomes overloaded, a phenomenon called bone fatigue.

Bone fatigue is often expedited by muscle fatigue, in which muscles that normally serve a stabilizing role become fatigued and weakened, causing more load that then transfers stress to the bones.

How are stress fractures treated?

Rest from the main cause activities is needed. Reducing the load that caused the stress fracture of the hip is what is needed to let bone healing ‘catch up’ and start winning the repair war.

Sometimes use of crutches, or even if it’s a bad complete rest is required to unload the hip.

You need to be guided by your medical team on this.

Once the fracture has healed then it’s a slow return of increasing the load again. Ensuring the hip is handling the load.

Usually there are imbalances and weaknesses from either the feet, knee’s and hips that lead to the extra stress happening at the hip. These need to be tested and addressed by a skilled Physiotherapist.

Nerve Compression Syndromes

Nerve compression syndrome or compression neuropathy, is a medical condition caused by direct pressure on a nerve.

Its symptoms include pain, tingling, numbness and muscle weakness.

Front nerve compression:

Lateral Cutaneous Nerve Entrapment

Symptoms of a femoral neuropathy may include pain in the inguinal region that is partially relieved by flexion and external rotation of the hip, as well as numbness over the front of thigh and leg.

People complain of difficulty in walking and of knee buckling, depending on the severity of the injury.

The femoral nerve gives rise to the saphenous nerve in the thigh; therefore, numbness in this distribution can be present.

Anterior(front) knee pain may also be present because the saphenous nerve supplies the patella (knee cap)

  • Femoral Nerve Entrapment: pain in inside knee area and lower leg.
  • Obturator Nerve Entrapment: pain in inside thigh.

Back of hip (gluteal area) nerve compression

Deep gluteal syndrome (piriformis syndrome) – pain deep gluteal/buttock area, can refer back of thigh

Pudendal Nerve – pain in lower buttocks area

Treatment for nerve compression

The key is get the correct diagnosis, reduce the nerve pain with rest and sometimes nerve medication, and then plan your slow return back to activities.

Usually it is advised to reduce your aggravating activities e.g sport, running.
Stretching, nerve glide exercises and strengthening are started once the symptoms have started to settle.

Lumbar Referral to the Hip

The lower back can be a common area to refer to the lateral hip due to the complexity of the spinal cord and associated nerves. Compression or irritation of these nerves can cause referred pain towards the hip. Sometimes the pain may only be felt in the hip itself. Symptoms usually occur with prolonged postures e.g. long distance cycling.

It takes a skilled Physiotherapist to test your low back, nerve tension and hip, putting this together with past scans of your back and hip, to determine if you have lumbar referral to your hip area.

Our myPhysioSA Spinal Physiotherapist’s are here to help.

Children & Adolescent Hip Pain

It is important to remember that hip pain in children is unusual and if it’s persisting, it needs to be checked.

Below are some of the possibilities of what could be causing it. These need to be ruled out by your medical practitioner via tests and scans.

Perthes disease

Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the rounded head of the femur (thighbone) is temporarily disrupted. Without an adequate blood supply, the bone cells die, a process called avascular necrosis.

Treatment for Perthes focuses on helping the bone grow back into a more rounded shape that still fits into the socket of the hip joint. The hip may be splintered, and crutches may be needed to unload the hip whilst healing is happening.

The long-term outcomes for children with Perthes is good for most children.

After 18 to 24 months of treatment, most children return to daily activities without major limitations.

Slipped Capital Femoral Epiphysis

This means that the femoral head (the “ball” at the top of the thighbone) has slipped slightly off the thighbone.

Symptoms of SCFE depend on severity and include:

  • Walking with a limp
  • Pain in the hip that may get worse with activity
  • Complaints that the hip feels like it’s “giving way”
  • Walking with the leg turned outward
  • Pain in the knee or thigh (in severe cases, the child may not be able to bear weight)

How is slipped capital femoral epiphysis treated?

Surgery is usually indicated.

During the surgery, the surgeon puts a steel screw through the thigh bone into the femoral head. This screw holds the femoral head firmly in place.

Apophyseal avulsion fractures of the pelvis

Apophyseal avulsion fractures of the hip and pelvis are injuries that usually occur in the adolescent athlete.

They need to be diagnosed via XR, and can be treated by rest and unloading or some may require surgery to re-attach the bony fragment. Your medical practitioners will decide this.

Avulsion fractures involve the main bundle of the rectus femoris insertion at the anterior inferior iliac spine (AIIS), the sartorius insertion at anterior superior iliac spine (ASIS), the hamstring insertion at the ischial tuberosity (IT), the tensor fasciae latae on the iliac crest (IC) and the rectus abdomens insertion on the superior corner of the pubic symphysis (SCPS).

Do you need a scan or investigations for your hip?

The answer is, maybe.

Most hip pain issues don’t require a scan. It takes a thorough assessment by your medical practitioner to decide if scans are required.

Check out some of the below reasons where a scan might be indicated to rule out:

  • Red flag signs: where cancer or infection is suspected.
  • Severe mechanical symptoms: when your hip is locking, or won’t take your weight ie you can’t walk
  • Symptoms not improving over time despite good conservative management: if symptoms aren’t improving over a 6 to 12 week period, then it is often a good idea to check why. A scan might then be suggested.

Usually a simple XR is all that is required. For certain muscle hip problems an Ultrasound may be best. Or if a soft tissue deep joint issue is suspected, then an MRI may be done.

What treatment options are there for general hip pain?

Physiotherapy: HOW CAN WE HELP?

So what can a Physio do for you?

Firstly, a thorough history and assessment will be undertaken to understand the underlying cause of your hip pain as this will determine the type of treatment used.

This may vary from heat/cold therapy, some manual therapy to help loosen tight muscles, relieve inflammation and generally make you feel more comfortable.

Your Physio will then put together a specific exercise program to help strengthen weak muscles and correct any imbalance.

An important factor will also be discussing exercise load as this often is a major factor in hip pain. Striking the right balance in your exercises and fitness program will go a long way to helping you recover faster.

This video from one of our Exercise Physiologists will give you can idea on what type of exercises to expect.

Ensure there is no pain whilst doing them. If there is any pain stop and get in touch with us via our Facebook page or the website contact us page. We are here to help!

If you believe you are suffering from hip pain, call one of our myPhysioSA clinics to get you back to full fitness!

Written by Danielle Tape
myPhysioSA Payneham Adelaide clinic.

Danielle is a Sports Physio who see’s hip pain clients every day at our Payneham Physio clinic.

The best hip stretches to release tightness around the hip area

Do you always feel tight around either the front ,side or back of your hip?

David shows you some awesome ways to release this hip tightness.

If you have hip pain or tightness that won’t go away, then let us check it over for you.

Call 1300 189 289 to book now.

Payneham, Mount Barker & Mile End

Treatment and exercises for outside hip pain (Gluteal Tendonopathy and/or Bursitis)

Gluteal Tendonopathy treatment summary

Gluteal tendinopathy, also known as Hip Bursitis or Greater Trochanteric Pain Syndrome (GTPS) is a very common clinical presentation.

It has a prevalence of 10-15% and can affect 1 in 4 females over the age of 50.

A lot of people will present with various types of symptoms around this area from a dull ache around the outer area of the hip, to pain at night and during activity.

As a result, Gluteal tendinopathy can be a very debilitating disorder and can lead of other issues and clinical presentations.

The good news is that due to its prevalence, Gluteal tendinopathy is a well-researched area.

A recent study in Australia by Mellor, R et al. 2018 has been published comparing the effectiveness of three different treatment options in relation to in global hip improvement rating and pain levels.

These three treatment options were:

  • Education about tendon load management and an associated exercise program
  • A single Corticosteroid injection
  • A wait and see approach

These three groups were measured in the short term (8 weeks) and in the longer term as well (52 weeks). At the eight-week mark, the success rates of each treatment option in relation to global hip improvement rating were:

  • Education and exercise: 77.3%
  • Corticosteroid injection: 58.5%
  • Wait and see: 29.4%

This means that the exercise and education group noted more improvement in their hip function that any other group.

The other amazing thing about this result is that it had improved by 77%!

That is a fantastic result in such a short period of time. In relation to pain, the scores on average for each treatment option after 8 weeks were:

  • Education and exercise: 1.5/10 (baseline score of: 4.8/10)
  • Corticosteroid injection: 2.7/10 (baseline score of: 4.8/10)
  • Wait and see: 3.8/10 (baseline score of: 4.9/10)

What we are seeing here is that the overall pain improvements over 8 weeks by the education and exercise group is also better than the other two treatment options, further reinforcing that Exercise and education is a superior treatment option in the short-term.

So what about the long term results?

This study also looked at these measures a whole year down the track from the initial intervention.

The results for all treatment options in regards to global hip improvement were:

  • Education and exercise: 78.6%
  • Corticosteroid injection: 58.3%
  • Wait and see: 51.9%

And for pain:

  • Education and exercise: 2.1/10 (baseline score of: 4.8/10)
  • Corticosteroid injection: 2.3/10 (baseline score of: 4.8/10)
  • Wait and see: 3.2/10 (baseline score of: 4.9/10)

So as you can see, over the course of the short term period of 8-weeks to a full year down the track, it is suggested that education and exercise is better than corticosteroid injections and the wait and see approach in order to improve overall function of the hip when presenting with gluteal tendinopathy.

At myPhysioSA, our physiotherapists are great at being able to diagnose Gluteal tendinopathy and can provide you with the information and exercise you need in order to help you achieve a fantastic outcome.

If you have any questions or would like some further information please do not hesitate to contact us on 1300 189 289 and ask to speak to one of our Physio’s.

We are more than happy to help.

Michael Wilson
myPhysioSA Senior Physiotherapist and SANFL Physiotherapist

Study reference:

BMJ 2018;360:k1662

http://dx.doi.org/10.1136/bmj.k1662

Outside (Lateral) Hip Pain Exercises and Advice

Don’t let pain on the outside of the hip keep affecting your life:

  • Are you tossing and turning at night due to hip discomfort?
  • Trouble with going to the gym or on those fitness walks due to the pain?
  • Unable to garden or do other household jobs without lots of breaks and hip pain afterwards?
  • Do long drives aggravate your pain?

Pain on the outside of your hip or lateral hip pain, is a common problem in females>males, especially from the age of 50 onwards. Otherwise known as hip trochanteric bursitis, it can become a chronic problem which can cause you to change your lifestyle in order to avoid activities that hurt.

At myPhysioSA we see clients with lateral hip pain all the time. We have a specific testing regime and a targeted rehab program that gives results.

We will check for tightness and weakness in the hip muscles, and identify all the key factors that are causing your pain. Everyone is unique, so it’s important to have an individualised assessment and then a specific plan to be able to guarantee results.

Below is some advice to get started on right away:

  • Change your postural habits
  • Do not hang on one hip when standing, or carry a load such as a child on one hip
  • Do not lie on that side to sleep
  • When sleeping on the other side, ensure that a pillow is placed in between your hips at all times
  • Do not sit with your legs crossed

Try doing the below exercises until you can be individually assessed:

Do 10 repetitions of each exercise daily.

Ensure there is no pain whilst doing them. If there is any pain stop and get in touch with us via our Facebook page or the website contact us page. We are here to help!

Squat

Stand with your feet together and bend your knees and hips to lower yourself.

Keep your weight on your heels and raise your arms overhead.

Your spine must be flat and your head aligned.

From this position, you can lift your toes off of the floor to check if your weight is on your heels.

Quad Roller

Place the foam roller on the floor and lie on your stomach with the front of your thighs over the foam roller.

Roll the entire front of the thighs from the top of the hips to the top of the knee caps in an up and down motion.

You should pull yourself with your elbows and forearms.

Pause at any spots that feel especially tender.

Keep your quadriceps relaxed.

Maintain abs tight and proper low back posture during the exercise.

ITB Roller

Place your foam roller on the floor. Take a side plank position with the outside of one hip over the foam roller and your other leg in front for support.

Roll the entire outside of your leg from your pelvis to your knee in an up and down motion.

Maintain your abs tight and proper low back posture during the exercise.

Clams

Lie on your side with a band around your thighs, just above your knees.

Your hips should be flexed slightly and your head supported.

Keep your feet together and open the top knee to externally rotate the hip.

*Images courtesy of Physiotec

Treatment and exercises for Gluteal Muscle Tears/Strains

Having a tear or strain in one of your gluteal muscles can be very painful, and unfortunately it can take months to ease.

To reduce your hip pain, you need to address all the areas contributing to your pain:

  • Address tight muscles with physiotherapy, foam rolling, massage and stretching.
  • Strengthen key lateral hip stabilising muscles, without causing compression on the lateral hip structures (your physiotherapist will show you how to do this).
  • Lose weight and reduce your abdominal girth to reduce load on your hip and associated muscles.

Here are some gentle basic exercises for you to try.

Ensure there is no pain whilst doing them. If there is any pain stop and get in touch with us via our Facebook page or the website contact us page. We are here to help!

Glute Bridge

Technique: Push through your heels and lift bottom up off the ground. Return to the starting positions

Amount: 10 reps x 2 sets to begin with

Clams

Lie on your side with a band around your thighs, just above your knees.

Your hips should be flexed slightly and your head supported.

Keep your feet together and open the top knee to externally rotate the hip.

Amount: 10 reps x2 sets to begin with

Squats

Stand with your feet together and bend your knees and hips to lower yourself.

Keep your weight on your heels and raise your arms overhead.

Your spine must be flat and your head aligned.

From this position, you can lift your toes off of the floor to check if your weight is on your heels.

Amount: 10 reps x2 sets to begin with

Once the pain starts to settle and you have done the above exercises for at least 6 weeks, then you can try the below targeted strength exercises:

Jacki shows a great strengthening exercise for your side buttock and hip muscles.

She demonstrates 3 variations that increase in difficulty as you get stronger.

*Images courtesy of Physiotec

Treatment and exercises for arthritis of the hip

Can Physiotherapy help Hip Osteoarthritis (OA)?

The answer is a definite yes.

Physios are one of the main professionals to help people in the early stages of hip osteoarthritis (OA). They can provide you with the correct information and the best exercises to help manage your symptoms.

What is hip osteoarthritis (OA)?

Hip osteoarthritis (OA) is a degenerative condition that is most common in the lower limb joints, such as knee, hip and ankle.

The hip joint is a ball-and-socket joint where the thigh bone attaches to the pelvis. The ends of the bones are covered with articular cartilage.

Articular cartilage is smooth and allows movement. In osteoarthritis, the surface becomes frayed and worn, affecting the movement of the joint.

What are the symptoms of hip OA?

The first symptom is usually stiffness in the hip joint and restriction when walking, particularly when taking longer strides, or pivoting and turning on the leg.

Pain in the groin, thigh, and buttock is common. There can also be some referred pain into the knee.

Pain and stiffness is often more pronounced upon first getting out of bed in the morning. It then slowly improves as you get moving and active.

What are the best hip OA treatments?

Physiotherapy (conservative management) is initially recommended in most cases.

A Physio can help settle acute symptoms with the use of manual therapy and dry needling. However, the main form of treatment is activity modification and an exercise program. Our Physios are great at giving specific advice, and prescribing the right type and amount of exercise to help you strengthen the muscles of your hip and manage your symptoms better. Some simple exercises to do in the initial stages are:

Glute Bridge:

Technique: Push through your heels and lift bottom up off the ground. Return to the starting positions

Amount: 10 reps x 3 sets to begin with

Sit to stand

Evidence suggests that consistent resistance based exercise is the best way to help manage symptoms of OA, therefore we aim to give these exercises to all of our patients with hip OA.

We also run OA group classes where you are supervised by one of our Exercise Physiologists as you go through an individualised, resistance-based program in our gym!

We have had some fantastic results from a lot of our clients so far and are looking forward to helping more people in the future. Please follow the link below to hear Stephen, one of our Exercise Physiologists, talk about our OA classes!

Unfortunately, you can’t reverse hip OA but you can usually manage the symptoms to the point where it doesn’t stop you from doing the things that you love.
If you think that you could benefit from Physio for your hip, or would like further information on our OA classes, please get in touch with us on 1300 189 289 and ask to speak to one of our Physiotherapists – we are happy to chat about how we can help.

Reviewed and updated in March 2019 by Michael.

Michael works at our Payneham clinic and has a special interest in all lower limb rehabilitation.

If you have knee or hip arthritis then try these easy basic exercises to keep your joints moving.

If you have arthritis of the knee or hip then a great way to help your pain and get the joints moving again is to try these easy seated exercises.

Arthritis gives joint pain and a proven way to help is to keep the arthritic joint moving to keep the joint lubricated and then to strengthen the muscles that support the affected joint.

Stephen, a myPhysioSA Exercise Physiologist, demonstrates some easy exercises for targeting your hip and knee areas that can be done whilst seated.

Even if your knee or hip arthritis is painful, you may still be able to do these exercises pain free and get a real benefit, give them a try!

Hip & Knee Arthritis Classes at myPhysioSA Adelaide

If you have hip & knee arthritis then you should be doing regular strength and flexibility exercises which are proven by research to help manage the symptoms of arthritis and improve the ease of your daily activities.

Stephen, an Exercise Physiologist, at myPhysioSA explains all about our unique Arthritis classes at our Payneham and Mount Barker clinics.

They are for people who have knee or hip arthritis that want to manage it better, or people who are preparing for upcoming surgery or have just had surgery and want to maximise their results.

The classes run for a 10 week block and include a Physiotherapy assessment at the beginning and the end, with a home exercise program included.

Call us on 1300 189 289 to enquire now!

Treatment and exercises for Hip Impingement and Labral issues

What are the best hip impingement treatments?

Physiotherapy (conservative management) is recommended in most cases of hip impingement.

Treatment may consist of advice, dry needling, massage techniques, joint mobilisation and specific strengthening exercises around the hip and pelvis.

Sometimes surgery is required to correct bony abnormalities and this can now be done with key hole, arthroscopic surgery in most cases.

Full recovery from surgery takes around 3-6 months to return to sport depending on the degree of damage and surgery required.

An easy stretch to start with is:

Starting some basic glute activation exercises is also important, here are a few below to get you started:

Leg and hip muscle weakness is common, even in athletes. It is because of weakness that is more likely to cause a muscle injury than due to being too tight. Strengthening exercises have equal importance to stretching for both injury prevention and also sporting performance.

The below exercises are for strength.

They should be done 3-4 times per week. Each exercise aim for 2 sets of up to 15 repetitions. Select which exercises will target your weak areas from the below list.

*Ensure you get no pain or discomfort during or after these exercises. If you do, cease immediately and seek our advice.

Single Leg Squats

Begin by standing upright on one leg.

Push your hips backward like you’re going to sit down and bend your knee into a single leg squat position.

Slowly return to the starting position.

Keep your knee aligned with the centre of your foot.

Clam shells for outer hip muscles

Lay on your side with a band around your thighs, just above your knees.

Your hips should be flexed slightly and your head supported.

Keep your feet together and open the top knee to externally rotate the hip.

Abductors using a band

Keep back straight and abs tight – Leaning on the chair.

Keep leg and hip straight.

Bridge with ball squeeze for groin muscles

Lay down on your back with knees bent and a ball or pillow between them.

Squeeze the glutes and contract the abdominals to lift the hips off the ground. As you lift, squeeze the ball between the legs.

Hold for a few seconds on top then release as you lower.

Single leg bridge for hamstrings and gluteals

Lay down with knees bent about 90° with a weight on the hips for increased resistance.

Lift one leg up and push the hips upward by squeezing the glutes and lower slowly.

Do not arch the lower back.

Hamstring Curls

Attach an elastic to secure object and to ankle of involved leg.

Lie on your stomach with your knee straight.

Bend your knee through available range without lifting hips.

Return to starting position and repeat.

Nordic curls for hamstrings

Anchor the feet under something heavy or have a partner hold them.

Put a towel under the knees or do the exercise on a mat.

Keep the thighs and the trunk in a straight line as much as possible and hinge only at the knees to lower as much as you can then come back up.

Adductor Side Planks

Start on one elbow/forearm with the top leg on a chair, knee straight, and the bottom leg on the ground as shown in the picture.

Hold the position with the top leg (do not let the hips drop) and lift the bottom leg up to meet the top leg.

Hold 1 second then go back down without touching the ground and repeat.

Do not rotate pelvis or over arch lower back (ie, maintain alignment
trunk/pelvis/knees at all times) .

Calf Raises

Keep back straight and abs tight – Dumbbell on the side of the working leg.

Leaning on a wall to take an inclined position to do the ankle extensions.

* All images courtesy of Physiotec, exercise software.

Treatment and exercises for Hip External Rotator Syndrome (Piriformis Syndrome)

Easing the symptoms of hip external rotator syndrome means stretching the tight muscles, stretching the neural tension for the sciatic nerve, and then strengthening the gluteal muscles.

Easy to do stretches, foam roller and ball release exercises that will help ease tight and sore hip, piriformis & buttock muscles.

Jacki, a Physiotherapist at myPhysioSA, shows 3 techniques for sore hip, piriformis & buttock muscles that you can easily do at home.

If you have pain and tightness behind the hip or in the buttock area, piriformis syndrome or referred pain from your lower back into the buttock then these exercises are a great option to try that can help.

Pain in the buttock or behind the hip area can be caused by many things, including referral from the low back, nerve tension, piriformis syndrome (where a tight piriformis muscle gives buttock pain and mimics sciatica down the leg).

The exercises Jacki shows all help to ease tension and give relief to sore hip, piriformis & buttock muscles.

Give them a go and see how much it can help you!

How to do a nerve stretch

Matt, a Spinal Physiotherapist, teaches how to ease leg pain using nerve flossing stretches.

Doing a nerve stretch is gentle and easy to do.

The first nerve stretch is called the slump nerve flossing stretch, and is performed sitting up. The second option is to do the active knee extension flossing stretch laying on your back. Both are equally as effective, just pick which version suits you best.

Ensure you have no symptoms whilst doing the stretches, they should be gentle and pain free. If they ease your pain then do them regularly. Some people use these stretches up to 4 times per day to relieve their leg pain that is coming from their low back.
Do these stretches slowly and build up to doing ten repetitions each time.

Clam shells for the external rotator hip muscles

Lay on your side with a band around your thighs, just above your knees.
Your hips should be flexed slightly and your head supported.

Keep your feet together and open the top knee to externally rotate the hip.

They should be done 3-4 times per week. Each exercise aim for 2 sets of up to 15 repetitions.

When should I return to sport following a hip injury?

Return to running and cutting sports needs to be well planned and your rehab needs to have progressed well.

The below mile stones through rehab need to be met before a full return to sport is recommended.

Functional Tests of the Hip:

  • Full hip range of movement
  • Hopping and landing L = R hip
  • Squatting pain free with good technique
  • Going up and down stairs one at a time then two at a time
  • Running straight ahead
  • Running and decelerating
  • Running and twisting
  • One-legged hop over 5 metres L=R
  • Jumping is pain free

Once all these can be demonstrated at training then you should be to train at 100%.

After a week of full training, you are hopefully ready to return to playing again. But pace yourself!

What tells you that you need to consider a total hip replacement?

There are a few signs that indicate you are nearly ready for a new hip joint.

Some of them include:

  • Night pain giving you trouble sleeping
  • Functional restriction, including walking, stairs, squatting, driving
  • Not responding to conservative management of Physiotherapy and exercises

Going to have a Hip Replacement? Here are the Best Pre-Surgery Exercises – Advice from Physiotherapist Matthew Ash

Hip arthritis can be a painful and debilitating condition that can have a huge impact on your life.

It can limit some of the basic activities that we often take for granted, such as getting in and out of bed, bending over to put your shoes on, or going for a walk.

If you suffer from hip joint arthritis, it is normal to experience a range of symptoms including pain, stiffness with movement, muscle tightness, and weakness in muscles around the hip and knee.

These symptoms will vary from person to person, and can change depending on the degree of arthritis or changes in soft tissues around the hip joint.
Your body is great at compensating to keep you going, so you may also notice changes in posture or how you are moving.

Having a hip replacement is a great way to reduce pain and disability associated with hip arthritis, but why is it important to do exercises prior to surgery?

  • Firstly, your body is designed to move, and exercise provides natural lubrication to the hip joint, and keeps the tissues as flexible as possible
  • ‘If you don’t use it you lose it!’ Exercise keeps the muscle nice and strong
  • It will address and improve any unhelpful postures and movement patterns, which we want to minimise post surgery
  • It keeps the rest of your body fit and healthy and aims to prevent your function from getting worse leading up to surgery
  • It better prepares you for what to expect post surgery so there are no surprises
  • It reduces the risk falls

In a nut shell, the better your muscles are working before surgery, the easier it will be to get them going again afterwards, and that means you can get back to your daily activities sooner.

myPhysioSA Physiotherapists are experts in getting you moving, and making sure you are doing the right exercise program relevant for you.

Here are a few basic exercises to get you started. It is important that these exercises are comfortable, and do not increase your pain.

Make sure you are safe by holding onto a chair or bench for support where required.

For a program specifically tailored to you, then book an appointment now on 1300 189 289.

Matthew Ash
myPhysioSA Associate Physiotherapist

New faster recovery anterior approach total hip surgery:

An interview with Dr Mandziak Adelaide

Tim interviews OrthopaedicSA Surgeon, Dr Mandziak, on the newer total hip replacement surgery anterior technique.

The anterior approach avoids the need to cut through the gluteal muscles and allows a faster recovery, and earlier return to normal activities.

Listen to Dr Mandziak explain more about the new surgery and who it would suit.

The below is quoted from the Orthopaedics SA website, and helps to explain the anterior approach:

Anterior Hip Replacement

Anterior hip replacement is one of three common approaches (anterior, lateral and posterior) used to place a total hip replacement. It involves approaching surgery from the front of the hip joint (as opposed to the side or back of the joint).

Selection of the most appropriate and safest approach to surgery depends upon a number of factors, some of which relate specifically to the patient. These can include the patient’s condition, body shape and the anatomy of the patient’s hip joint.

The main determinants of a good outcome following your hip replacement include appropriate patient selection, skilled insertion of a prosthesis, appropriate wound care, and following the recommended recovery and rehabilitation program.

With care taken in the decision-making at the outset and education provided to
the patient of their surgery and journey to recovery, excellent results are usually obtained through all of these three approaches.

The surgeons at Orthopaedics SA are all fellows of the Royal Australasian College of Surgeons in Orthopaedic Surgery, having undergone 8 – 12 years of further orthopaedic specialty study after medical school. We pride ourselves on using the best available medical evidence to treat our patients, and have surgeons trained in all approaches to the hip joint.

If you have hip arthritis, please arrange a consultation with one of our highly qualified joint replacement surgeons to discuss how we can optimise treatment for you.”

Here is the link to their website for more information:

http://www.orthosa.com.au/anterior-hip-replacement/

Hip Pain Summarised

  • Check out this great 3D anatomy tutorial on YouTube by AnatomyZone. It has lots of detail if that’s what you like!
  • The hip joint is a ball and socket joint, formed by an articulation between the pelvic acetabulum (socket) and the head of the femur (ball).
  • Your hip is designed to flex up, extend back and rotate outward and inward.
  • The hip is designed for stability and weight-bearing, it’s a very sturdy joint.
  • The hip can suffer traumatic injuries, such as fractures and dislocations.
  • More common are overuse injuries such as outside hip pain (bursitis) ,gluteal tears, hip impingement and arthritis of the hip.
  • It takes a skilled medical practitioner, such as a Physio, to help properly diagnose and then treat hip overuse problems.
  • The myPhysioSA team have given you a head start with advice and starter exercises for each type of major problem with the hip.
  • This is only general advice. Tailored advice is way better. So if you are in our town of Adelaide, then get in touch and we can fully assess your problem and help you manage your hip to recovery