The ‘hip region’ is the section of your body between your trunk and thigh. There are lots of possible causes for pain in this area of your body, and it is important that hip region pain is accurately diagnosed for successful physiotherapy management and recovery.
Here are the 3 most common causes of pain in the hip region:
The hip joint
The hip joint is where the top of the thigh bone connects to the pelvis of the trunk, and is how our legs connect to our bodies.
It is a joint that is highly mobile and where we require a lot of strength and power even for normal daily movements such as getting up off a chair or squatting down to pick something up off the ground.
At the same time, the joint needs to be highly stable for it to function properly. “Stability” in terms of the hip joint refers to how well the ‘ball’ of the hip moves within the socket of the pelvis, and is determined by the co-ordinated control by the muscles of the hip and trunk during movement.
When hip joint stability is suboptimal, especially in combination with excessive activity, issues can arise with the joint:
This common problem is what they’re referring to. It usually involves an overgrowth of the ‘ball’ of the hip joint (‘cam morphology’), causing an unwanted repetitive abutment of the ball against the rim of the socket.
This becomes painful in the front of the hip and groin with certain movements, particularly twisting, changes of direction, kicking a ball, leaning forwards and sitting for long periods. Many people also report clicking, locking, popping or grinding type sensations with movement.
An X-ray is needed to diagnose this.
Acetabular Labral Tear (ALT)
The labrum can be thought of as a tough rubber covering of the hip joint socket. It deepens the socket to improve hip joint stability, as well as protect the bony surface of the socket.
It can become damaged over time if an impingement is present, as described above. However it can also occur without an impingement. Usually, an MRI can determine if a labral tear is present.
Acetabular labral tear
“Arthritis” as it’s usually known by, is damage to the bony surface of the labrum, and usually is a consequence of hip impingement or labral tears. This can be diagnosed by X-ray, but sometimes an MRI is useful for determining the extent of the hip joint problem.
Hip joint management
These hip joint problems are managed by improving the strength of the hip muscles so that they have better control of the hip during movement, and stability exercises to ensure that the socket is also moving well. A period of relative rest may also be helpful to allow the painful structures to settle down again, but will not ultimately improve the problem without the appropriate muscle retraining. In some cases, an opinion from a sports physician or surgeon may be useful, however this is infrequent as many people go well with physiotherapy management.
Do you have low back pain together with your hip pain? There’s every chance it is coming from the lower back.
Unlike hip joint issues where the pain is usually in the front of the hip or groin, hip region pain coming from lower back can be anywhere in the hip area, including the side of the hip and buttock or glute area. There may also be pain lower down the leg.
Occasionally, people may have no low back pain even if their hip pain is coming from there. An expert physiotherapist will always consider the lower back as the potential cause of the hip pain to avoid a misdiagnosis. A scan is usually not required to make this diagnosis unless it is unclear with physiotherapy testing.
Lumbar spine management
Management of the low back can include treatment and exercises to help settle the symptoms with the aim of ‘centralisation’ - which is where the hip pain (or leg pain) moves back towards the lower back where the cause of the problem is.
Gluteus Medius or Minimus Tendinopathy, Greater Trochanteric Pain Syndrome, Bursitis
These refer to the same problem. The pain arises from the tendon in the side of the hip and that is where most of the pain will be, however it can travel down the outside of the thigh.
People will typically have issues lying down on that side, running, going up stairs and walking after sleeping or after sitting down for a long period. It is also typically worse in the morning after waking up.
Both this problem and lower back pain can cause pain to the side of the hip and outer thigh, but if the pain goes below the knee, then the lower back should be considered as the more likely cause of the problem.
Pain is usually in the side of the hip
The tendon will need to be strengthened so that it can tolerate the demands or load we would like to place on it.
Strengthening can start basic with double-legged exercises, and eventually involve jumping drills for those who wish to return to running or sport pain-free. Shockwave therapy is also very useful for pain relief.
As can be appreciated, hip pain can be tricky to diagnose!
Many patients have come to us following repeated failed management with other health providers, even other physiotherapists! If you want your hip pain to go away, it first needs to be diagnosed accurately.
How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!