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PT for Hip Pain

The hip is a common area for pain as a result of its multidirectional movement and from the force placed on the joint.  This joint is unique since it assists with movement of the lower extremities as well as its effects on the upper body through movement of the pelvis.  This joint is made up of the socket on the hip bone or pelvis and ball shape bone on top of the thigh bone or femur.  This ball and socket arrangement gives the hip its wide range of motion and function.  The hip joint socket is shallow and a cartilage ring around this socket called the labrum deepens the socket adding more stability to the joint.

The nerve that supplies the hip with sensation also supplies the knee.  This can result in knee pain which is actually a result of a hip injury.  Doctor’s call this referred pain and it requires further testing to determine the exact location of the injury.

Actions Of the Hip

The motions of the hip joint are moving the leg forward (flexion), moving the leg backward (extension), moving the leg out to the side (abduction), moving the leg back toward the midline (adduction), rotating the leg inward (medial rotation) and rotating the leg outward (lateral rotation).

Some of the common muscles which act on the hip are the glutes (gluteus minimus, medius and maximus), the piriformis (which connects your tailbone to your hip) and the hip flexors which allow you to lift your leg up onto a step.

Causes Of Hip Pain

• Arthritis
  • The hip joint allows our leg to move in many different directions.  To allow for smooth movement, the socket and head of the femur are covered with cartilage.  As a result of repetitive movement, the cartilage can wear away causing one bone to rub on the other.  This is referred to as arthritis.  When this cartilage wears away, most people experience pain located in the groin as well as muscle weakness.
• Bursitis
  • A bursa is a fluid filled sac that provides a cushion.  The bursa at the hip joint can become inflamed from repetitive movement which can cause pain.  This bursa can be extremely painful if inflamed and even lying on the affected side can be intolerable.
• Fracture
  • A fall can result in a hip fracture.  This term is misleading since the hip refers to the joint itself.  The majority of fractures occur on the thigh bone or femur.  The elderly have to be very cautious since they have frail bones and poor balance.  This makes for a dangerous combination especially in unsafe environments or icy weather.  As a result of the blood vessels which surround the femur, further injury from a hip fracture can result including bone death as a result of a destruction of the blood supply to the area.

 

• Lack of blood flow
  • A less common cause of hip pain is from lack of blood flow to the joint also called osteonecrosis.  This fancy term breaks down to “osteo” meaning bone and “necrosis” meaning death.
• Referral Pain From The Back
  • Occasionally, hip pain can be caused by a back injury.  Injury to the muscles and nerves of the low back can refer pain to the hip area.

What Can I do?

Rest

The best initial treatment for hip pain is to rest and assess your activity over the previous week.  Many people experience aches and pains after increasing their activity levels.  Before beginning any home rehab of your injury consult your physician for appropriate medical evaluation.

Ice

If an injury to your hip occurred in the past 24-48 hours, ice can be applied for 10-15 minutes every 2-3 hours and after activity.  Ice will help to reduce your pain and inflammation.  Crushed ice in a plastic bag or a frozen back of vegetables is a useful ice pack for the hip.

Stretching

If rest and ice help to reduce your pain levels you can begin gentle stretching of the area.  Stretching should be comfortable.  If you experience any increase in pain levels stop immediately.

Hamstring Stretch

The hamstrings are muscles along the back of your thigh.  These muscles attach near the hip and assist with movement at this joint.

• Lie on your back.
• Wrap a towel, bed sheet, belt or even a dog leash around the bottom of your foot.
• Keeping the knee straight, slowly lift the leg until a gentle stretch is felt in back of your leg.
• The opposite knee can be kept straight or bent.
• Hold this stretch for 30 seconds and repeat three times.
• The second stretch is in the same position but pull the leg across your body to stretch the outside of your leg.
  • This stretch is for a muscle called the iliotibial band or ITB.  This muscle runs along the outside of your leg.

Quadriceps Stretch

The quadriceps muscle runs along the front of your thigh.

• Lie on your back in bed.
• Wrap the strap or bed sheet around your leg near the ankle.
• Let the leg drop off the side of the bed.
• Slowly pull the strap, keeping the leg relaxed.
• The strap will bend your knee and you will feel a stretch in the front of your thigh.
• Hold this stretch for 30 seconds and repeat three times.

How Does PT Address This Issue?

A physical therapist will first determine the cause of your hip pain.  This is determined by an evaluation which includes special tests and clinical questions allowing the physical therapist to arrive at a musculoskeletal cause of your pain.

Once your hip pain has been determined your physical therapist will address the pain and inflammation associated with your particular injury.

Your physical therapist will then instruct you in various stretches and strengthening exercises specific for your injury and activity level.

Reasons to Visit Your Doctor

Hip pain can be caused by many factors so proper diagnosis by your doctor is important especially if conservative measures do not decrease your pain.

• Hip feels unstable
• No decrease in pain after a few days
• Pain at night or when not moving
• Swelling that does not decrease with rest and ice
• Unable to place full weight on leg
• Warmth and redness

Sources:

Bennell KL, Egerton T, Pua YH, Abbott JH, et al.  “Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol.” BMC Musculoskeletal Disorders 14 Oct 2010 11:238.

Jonas Franklin, Martin Englund, Torvaldur Ingvarsson, and Stefan Lohmander.  “The Association between hip fracture and hip osteoarthritis: A case-control study.” BMC Musculoskeletal Disorders 26 Nov 2010 11:274.

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