The hip joint is a ball and socket joint similar to your shoulder. It is a very mobile joint. The more mobile a joint is the greater the opportunity there is for functional problems. The hip joint plays a major role in the development of power in the lower extremity. It is surrounded on all sides by large muscle groups. Fifty percent of the power generated by a professional baseball pitcher occurs at the trunk and hips. The hip joint also plays a major role in stabilization during weight bearing activity. Weakness at the hp will transfer the burden to the lower back or to the knee, thereby predisposing adjacent joints to overuse syndromes.
There are several common dysfunctions of the hip joint:
- Trochanteric bursitis: The trochanteric bursa provides padding and force dissipation to the bony prominence on the femur called the greater trochanter. Increased stress is placed upon the bursa in the presence of hip weakness (especially the gluteals). Rebalancing the strength around the entire hip joint is crucial to alleviating the stresses on painful structures. Stiffness of adjacent structures such as the iliotibial band (the ITB), tensor fascia lata, gluteal muscles (medius and maximus), or the deep hip rotators such as the piriformis can lead to dysfunction as well. We use specialized manual therapy techniques and stretching to alleviate soft tissue restrictions. Genetic structural imbalances such as torsion in the femur bone, abnormal hip joint angles, and flat feet can create excessive torque in the hip joint. We can address biomechanical imbalances through foot orthotic fabrication. Many of our patients have undiagnosed leg length discrepancies which can be addressed with heel lifts. Hip bursitis is very common in the elderly population due to the weakness and stiffness that occurs with a more sedentary lifestyle.
- Hip Impingement Syndrome: As it’s name implies, hip pain can be caused by a “pinch” inside the hip joint. The mechanism of the “pinch” may be due to edema, arthritis, spur formation on the periphery of the joint, congenital abnormality of the ball and socket structure, internal bruising, or cartilage tears. Special testing such as Xrays or MRI’s are helpful in diagnosing these conditions. Physical therapy treatment is very similar to that outlined for trochanteric bursitis. We may also utilize manual traction techniques to decompress the hip joint. Applying a distraction force to the hip joint will help to “pump out” any edema and help to desensitize the affected structures.
- Hip Labral Tears: The labrum is a cartilage ring that lines the circumference of the “socket” of the hip joint. It serves to deepen the “socket” thereby increasing the contact and control of the femoral head or “ball”. Labral tears can be difficult to diagnose. Many of the symptoms of a labral tear are similar to the symptoms of a groin strain or sports hernia. Furthermore, just because a tear is seen in the hip labrum on an MRI, it does not mean the tear is necessarily the cause of the pain. Typical symptoms of a hip labral tear include groin pain, clicking and snapping sensations in the hip, and limited motion of the hip joint. Physical therapy treatment is similar to the treatments for both of the conditions outlined above. Treatment may not be helpful if the labral tear is the definitive cause of the dysfunction.
- Hip Degenerative Joint Disease: Osteoarthiritis and/or degenerative joint disease of the hip is characterized by a narrowing of the joint space with associated abnormal calcifications or spurring. Depending on the severity of the arthritis, this condition will present with pain upon weight bearing as well as painful and limited range of motion. The patient’s gait may be characterized with a limp or a limited stride. Compensations in adjacent joints may lead to concurrent knee or low back pain. In some circumstances, the first manifestation of a hip joint pathology is KNEE pain. Treatment of this condition is similar to the others as well.