Pain in the…Hip?

BY STEVEN NYSTUEN, DPT, CSCS – As we move into fall, some of our warm-weather outdoor activities may be catching up to our bodies, especially the hips. Hip pain has long been thought of as a problem usually affecting older folks; however, younger people can have hip issues as well. Hip pain has become more prevalent and better understood in recent years as diagnosis and treatment options have improved. Following are three different, common hip complaints and ways to diagnose and treat them.

HIP IMPINGEMENT

Femoral Acetabular Impingement, or hip impingement, is a malformation or defect between the head of the femur (ball) and the acetabulum (socket) in the hip. The hip is a ball and socket joint like the shoulder. However, because the hip joint has much greater coverage than the shoulder joint, our hip motion is limited in comparison to our shoulder motion. With this increased coverage of the ball in the socket, there can often be impingement or pinching occurring within the joint.

In the hip there are three different types of impingement: Pincer Impingement – increased coverage of the acetabulum on the ball of the femur; CAM Impingement – increased coverage of the ball of the femur on the acetabulum; and Combined Impingement – increased coverage of the acetabulum on an enlarged ball of the femur.

Common Symptoms of hip impingement include, but are not limited to:

  • Catching or locking sensations in the hip
  • Pain deep in the hip and groin with hip flexion (bending your knee to your chest)
  • Moving and rotating your leg and hip outward away from your body
  • Pain or catching sensations with running, jumping and quick rotational movements

Conservative Treatment: Modify your activity to limit combined flexion and rotational movements of your hip, avoid deep squatting, and limit painful running, jumping and cutting movements. Physical therapy may also be warranted for further evaluation/diagnosis and prescription of exercises. Exercises will focus on hip, gluteal and quadriceps strengthening as well as increasing lower extremity flexibility.

Surgical Treatment: If your attempts to conservatively treat your hip impingement pain have failed, it might be time to see an orthopedic surgeon who specializes in hip injuries. Surgical intervention may be required to correct the hip alignment to allow the ball and the socket to fit together better, and to allow more freedom of motion. Surgery is usually arthroscopic and requires about 6-12 months for full recovery.

HIP OSTEOARTHRITIS

Hip osteoarthritis (OA) is widely thought of as the “wear and tear” injury. It’s generally seen in older patients (50+ years) and is caused by degeneration of cartilage covering the end of the ball on the femur and the acetabulum on the pelvis. This thinning and loss of cartilage is often caused from overuse and decreased strength, which both lead to more bone and nerves being exposed in your hip joint.

 

Common Symptoms with hip OA include:

  • Decreased hip range of motion and increased pain with completion of daily activities
  • Morning stiffness that decreases with activity but pain with sleeping at night
  • Referred pain into the groin, lateral leg and/or the knee
  • Sensations of catching or locking in the hip joint with activities such as deeper squatting, bending over and crossing your legs
  • Loss of leg strength, endurance and balance

Diagnosis

Hip OA can be diagnosed by your primary care physician or an orthopedic specialist with x-rays and a physical examination. X-rays of an arthritic hip will show decreased joint space between the ball of the femur and the acetabulum.

Conservative Treatment: Physical therapy is often a good starting point to focus on leg strengthening and endurance activities and to discuss activity modifications and movements to avoid such as deep squatting, pivoting movements and end range hip stretching.

Surgical Treatment: A Total Hip Arthroplasty (hip replacement) is done to alleviate hip arthritis and pain. Surgery is typically performed in a hospital by an orthopedic surgeon and can require a 1-3 day hospital stay. To achieve full recovery and full mobility with decreased pain, expect a recovery of 6-12 months.

GREATER TROCHANTERIC BURSITIS

Greater trochanteric bursitis often occurs as lateral hip pain over the most prominent bone on the side of your hip. This is typically caused by irritation or friction over the fluid filled bursa sac from increased activity/overuse or direct trauma to the lateral hip such as a fall. Additionally, the IT Band over your lateral hip/thigh can become tight from activity which can cause increased compression and irritation over the trochanteric bursa. Bursa sacs are found throughout the body and serve as structures to provide cushion to bones and reduce friction between bones, tendons and muscles.

Common Symptoms

  • Point tenderness and pain over the lateral side of the hip
  • Swelling or edema over the lateral hip and increased pain with longer distances of walking and with running/jumping activities
  • Pain with increased hip motion such as knee to chest and moving the hip/leg out away from the body
  • Increased pain or an inability to lie directly on the involved hip

Conservative Treatment: Hip bursitis and pain can usually be managed with rest and ice over the lateral and painful hip, along with limiting painful activities. If pain persists, physical therapy can help to decrease pain and inflammation and increase overall mobility, hamstring and IT Band flexibility, as well as overall leg strength.

Surgical Treatment: When rest/ice and physical therapy do not resolve the hip pain, you should follow up with your primary care physician or see an orthopedic specialist. Further treatments may include, but are not limited to, corticosteroid injections to decrease pain, swelling and inflammation.

If you are experiencing any of these hip conditions, call NRPT today at (406) 543-0617 for more information or to schedule an appointment. We have nine physical therapists and two convenient locations in Missoula to serve all your physical therapy needs.

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