Hip Pain

Overview:

The name itself is pretty self-explanatory; It is pain that arises at the joint that connects our leg and back together. This region is made up of what we call a ‘ball and socket’ joint, involving the top of our thigh bone (ball) and pelvis (socket). Unfortunately, this region is a common source of pain for Australians of all ages and genders. Fortunately, here in Australia we have many trained professionals who have developed a expertise in treating and managing hip pain; including Surgeons and Doctors to Allied Health professionals such as Osteo’s, Physio’s, Chiro’s and Exercise Physiologists and not to mention those who compliment the above such as Pilates instructors, Personal trainers, strength and conditioning trainers and Massage therapist (there are many more that we haven’t listed).

Hip pain comes in many different forms (all of which are discussed below) and present in many different ways. Some people will have mild pain that doesn’t require treatment, and some will be at the other end of the scale where they can barely walk.

Hip pain requires a broad approach from health professionals beyond the point of just identifying and treating symptoms. This is due to the fact that often Hip Pain is a result of poor function/ movements of structures above and below the hip – therefore by understanding this, health professionals are able to better manage your complaint by treating the cause, as opposed to just treating the symptoms.

Symptoms:

Type of pain: Symptoms of hip pain can present in many different ways, is it a structural? And therefore pain directly in/ around the joint, or is it referred? And therefore pain may be felt elsewhere ie. into the knees. In a consultation, your practitioner will spend time talking to you about your symptoms as it’s very important to understand exactly what you are feeling. By doing so this allows us to narrow down what structures may be affected and therefore helping us form a diagnosis. Below is a list of symptoms commonly used to describe the type of pain occurring to the Hip region:

• Limping

• Joint pain

• Groin pain

• Thigh pain / buttock pain

• Loss of motion of the hip

• Swelling / warmth over the hip / redness

• Tenderness of the hip

• Pain on side lying or when sleeping on that side

• Dull ache

• Stabbing pain

• Pain shooting down the leg from the hip

• Catching / grabbing pain

• Numbness and tingling down the leg

• Weakness

Aggravating movements / activities: People suffering from Hip Pain are may be unable to complete activities of daily living, and may even feel pain on simple tasks that would normally be pain free. For example, if when you climb up stairs you not only feel pain but also you may occasionally feel weakness or that your hip is “giving way” – this may indicate that there is nerve involvement. Often, as this happens only occasionally patients might think it is not important and omit the fact when discussing the complaint with the practitioner. However, in reality this is quite the opposite – it is very important! Being able to understand what triggers your symptoms will provide another piece of the puzzle’ in creating an accurate diagnosis.

Below is a brief list of common everyday activities that can aggravate hip pain:

• Walking

• Running

• Bike riding

• Using stairs (going both up and down)

• Standing in one spot for prolonged periods of time

• Sitting at a desk for long hours

• Driving a car/truck

• Rolling over in bed

• Bending down

• Squats with or without weights

• Side lying or sleeping on that side

• Household chores – cleaning, doing the dishes, hanging the washing

• Sports – specifically with a lot of twisting at the hips or contact sports

Red Flags

Red flags relate to the possibility that something appearing quite simple could in fact be quite serious.

Below are some examples of Red flags for Hip pain:

• History of trauma / falls

• Sudden onset

• Any swelling / deformity

• Inability to weight bear

• Constipation or vomiting

• Lower limb neurological symptoms – weakness, numbness or tingling

• Testicular swelling

• Night sweats, unintentional weight loss, appetite loss

• History of malignancy

• Any lumps or bumps felt in the groin

• Fever – intraarticular infection

• Unexplained weight loss

• Burning with urination

• Night pain

• Prolonged corticosteroid use

Conditions of the Hip

There are many conditions that can lead to hip pain. Some conditions that result in damage or irritation of the soft tissue / structures of the hip include, but are not limited to the following:

• Fractures / dislocations

• Femoroacetabular impingement

• Gluteal tendonopathy

• Bursitis

  • Trochanteric

  • Iliopsoas

  • Ischial

• Iliotibial band syndrome

• Snapping hip syndrome

• Hip Osteoarthritis

• Adductor strain

• Hamstring tendinopathy

• Labral tear

• Piriformis syndrome

• Tendonitis of the quadriceps muscle

• Hernia

• Osteitis pubis

• Dislocation

• Perthes’ disease

Who gets Hip Pain?

As mentioned in our intro – many people from different walks of life will/can suffer from hip pain. But who is more likely?

• Age – Hip pain is a common condition from young adults onwards, however the older you are the more likely you will be to suffer from it.

• Gender – Hip pain does not discriminate between the genders; however various studies suggest it may be slightly more common in females.

• OA – due to the wear-and-tear nature of osteoarthritis, you are more likely to receive pain in load bearing joints – hence if you have OA you are more likely to get hip pain.

• Occupation – various jobs may lead to the development of hip pain, such as workplaces where you are exposed to walking long distances on rough surfaces, lifting/ moving heavy weights, sitting for prolonged periods or standing for long periods of time.

• Previous injuries – A history of previous hip pain or injuries to the joint will predispose it to future complications.

• Sports – Depending on the sport, some may predispose you to hip pain. Weather it is through an injury during the game, ie. being tackled during footy; or through physical stress building over time, ie. twisting in netball or golf.

• Altered gait – If our stride/ walk is faulty this means that we are constantly placing unnecessary strain though our hip which can lead to micro-traumas.

Assessment & Diagnosis

When you present to a Health professional such as an Osteopath with hip pain, our practitioners will follow an process; starting with an initial patient/ medical history, followed by a physical assessment that helps us narrow down the possibilities to the most likely diagnosis.

Patient / Medical history: This is where the practitioner will discuss with you about various aspects of your hip pain, finding context to the complaint. This will cover aspects such as when the pain occurred, the location of pain, how it happened, what makes it worse, what makes it better, level of pain, associated symptoms, impacted activities of daily living, lifestyle prior to onset of pain and occupation impact. But it will also include your medical history, for example if you have had previous episodes of the same complaint, other injuries and an other health conditions that may also contribute to your pain.

Orthopaedic testing: Orthopaedic tests involve specific movements of the body with or without muscular contraction, that are designed to provoke familiar pain. Therefore allowing us to narrow down the structure involved and may indicate a specific condition.

Palpation: The use of palpation can give the practitioner more information to help form a differential diagnosis. Palpation can help identify tissue texture changes, tightness, stiffness, temperature changes, differences between left and right side of the body, lumps, knots and swelling.

Range of motion (ROM): Again, this assessment leads us closer to a diagnosis by differentiating between the structure that cause potential restrictions/ pain in active ROM (you moving the joint) verses passive ROM (practitioner moving the joint for you). The movements of the Hip can be broken down into 3 basic plains:

• Flexion / Extension (Bringing your leg forwards or backwards)

• External / Internal Rotation (twisting you leg to the right and left)

• Abduction / Adduction (Moving your leg toward or away from the midline of the body)

Diagnostic imaging: This form of assessment allows us to see what’s going on inside the body without the need for surgery or invasive procedures; enabling us to confirm a diagnosis and then treat accordingly. There are multiple imaging modalities that are used to highlight different structures. X-rays are for broken bones, dislocations, alignment and inflammation; Ultrasounds are for superficial soft tissue such as muscles and tendons; and lastly, MRI’s are often seen as the gold standard a more in depth view of all structures including connective tissue such as ligaments/tendons/cartilage /muscle.

Treatment – What we do

Here at Bay City Health Group our approach to Hip pain is holistic, meaning that we do more than just direct treatment. What we offer involves manual therapy, rehabilitation and tailored exercise programs facilitated though our Osteopaths; in addition to Exercise Rehabilitation facilitated by our Pilates team that is preformed in a highly specific clinical setting. These two models help to decrease pain and improve function/ range of motion. The Osteopaths achieve this though using hands on techniques such as massage, stretching, joint manipulation or adjustments, joint articulation and mobilisation, and myofascial release. Then, complimentary to this, Pilates focuses on developing strength to areas of weakness and educating you on correct movement patterns/ form. Both of which are excellent options for managing Hip Pain.

Management and treatment of Hip Pain is highly dependent on the type of symptoms, level of pain, onset of pain, limitations, and assessment findings, and is therefore very specific to the patient on that day. One thing to keep in mind with treatment is there’s no recipe. In other words, the type of treatment will vary from patient to patient depending on what their presentation is. For example, if someone comes into the clinic with acute Hip Pain and barely able to walk or even sit down, our treatment will be completely different to that of a patient who is a bit sore after a round of golf on the weekend.

Management

What things YOU can do to help hip pain

• Ice / heat packs – a combination of these two are great for relieving symptoms. Ice is generally used to reduce inflammation, swelling and pain whereas heat is used for tight/ restricted muscles and pain.

• Rest – by avoiding movements that place unnecessary stress/ pressure through the hip joints, such as bending forward squatting, side sleeping and sitting for long periods of time. this reduces the continued reaggravation and allows for a more effective recovery.

• Stretches – Stretches reduce tension within the surrounding muscles and therefore take pressure off the joint, therefore improving hip function and pain.

• Exercises, keeping active is key to management of all forms of pain, however the trick is making sure to not aggravate your existent complaint. For hip pain, going for short walks, bike rides, yoga or even swimming (gently kicking) and walking in a shallow pool are great for your hip pain recovery.

Final Notes:

Nothing replaces the knowledge and experience of Health professionals. This blog is for general educational purposes only and is aimed at the general public. If you have back pain and you think it needs to be looked at then please visit or talk a Health Professional.

To make a booking with one of the Health Professionals here at Bay City Health Group please call our friendly receptionists on 03 5229 3220 or head to our online bookings page to book your appointment online.