Hip Pain

By Rob Barker, Physiotherapist

The hip is a complex ball and socket joint which moves in many directions and absorbs a large amount of force during sporting and everyday movements. Many muscles overlap the hip joint and are critical in providing adequate movement, stability and strength around the pelvis. The hip is also made up of articular cartilage, the labrum (which allows for shock absorption and joint congruency), ligaments, tendons, and bursa (which allow for smooth frictionless gliding of the tendons over bony structures).

If your hip joint is stiff, either through capsular stiffness or muscular tightness, or you have insufficient control and endurance of your associated hip muscles, pain around the hip area can result.  Also, if you have adopted some mal-adaptive or poor movement patterns, this can increase the load and cause strain through your hip joint and certain associated muscles which control the hips.

Pain in the hip can be due to many causes. Some of the more common include:

• Femoral-acetabular hip Impingement
• Greater trochanteric Bursitis
• Osteoarthritis
• Labral tears
• Gluteal tendinopathies
• Adductor tendinopathies
• Sacroiliac joint referred pain
• Lower back referred pain
• Capsule stiffness
• Perthes disease (Effects children)
• Groin, hip flexor and upper hamstring strains
• Pubic bone stress injury (Osteitis pubis)

How can Physiotherapy help?

Physiotherapy can help by performing a detailed assessment, looking at range of motion, muscle length, muscle strength and function, motor control analysis during functional movements, specific hip pathology testing and accurate palpation to pin point the site and cause of your symptoms.

Once an accurate diagnosis has been made and the structures relating to your symptoms have been identified the most appropriate and individualised treatment plan can commence. Skilled physiotherapists will also educate you on your injury and what activity modifications and home management strategies to adhere to. 

How is hip pathology treated?

Your diagnosis will determine how your hip is treated. Treatments of the hip generally focus on regaining pain free range of motion and mobilising the joint if there is underlying stiffness. Overactive and/or shortened tight muscles can be address with myofascial release techniques, trigger point therapy, dry needling, neurodynamic techniques, and a specific stretching program. If you have poor motor control around the pelvis and hip joint contributing to your pain, a specific graded gluteal and lower limb strengthening and functional training program will be devised generally focusing on activation of the deep hip stabiliser muscles and regaining correct functional alignment. Overuse muscle strains and tendinopathies are also common around the hip and groin region and need to be treated with detailed knowledge of tendon structure and muscle specific healing properties. This then allows for an isolated de-loading and graded exercise loading program to be completed and return to pain free function.

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References;

1. Thomas G., Palmer A., Andrade A., et al. Diagnosis and management of femoroacetabular impingement. British Journal of General practice. 2013; 513-515.
2. Brukner P., khan k., & brukner, P. (2017). Brukner & khan’s clinical sports medicine. 5th ed. (pp. 593-621). Sydney: mcgraw-hill.