hip pain

Home / Posts tagged "hip pain"
All you need to know about hip labral tears

All you need to know about hip labral tears

Have you ever experienced a deep pain in the front of the hip or groin region? You may also experience a locking, clicking or catching sensation when you move your leg. Whether this is from a fall, a sporting injury, if it has been going on for a while, you may end up getting a scan, often an MRI - a magnetic resonance imaging scan. If you look through the scan report, you may see the words “labral tear”. This blog is going to take you through what a hip labral tear is, its signs and symptoms, causes and contributing factors, and the recent evidence on effective management.

Let’s have a look at the anatomy first!

What is a hip labral tear?

A labral tear of the hip joint is an injury to the labrum. The labrum is a tough, fibrous cartilage that lines the rim of the hip socket (called the acetabulum). The hip joint is a ball-and-socket joint, where the ball of the thigh bone (femur) inserts into a socket in the pelvis. The labrum acts as a suction seal for stability of the hip joint, as well as a shock absorber for distributing pressure during movements.

What are the symptoms of a hip labral tear?

More than 90% of people diagnosed with labral tears report pain at the front of the hip and groin.1 In some cases, the pain may radiate to the knee.2 People with labral tears are less likely to experience pain over the side of the hip or in the buttock.3 Clicking of the painful hip is another possible sign of a hip labral tear, but there are many other reasons why a hip might click. Other symptoms such as locking, catching or giving way may also be noticed by those with a labral tear.

For the majority of people with hip labral tears, their symptoms start to become noticeable slowly over time.1 Patients seeking help from a health professional commonly report a constant dull ache with episodes of sharp hip or groin pain. Activities like walking, stair climbing, pivoting, sitting for long periods of time (more than 30 minutes) and running often bring on the sharp pain. In addition, patients with hip labral tears may find themselves limping when walking. Their ability to walk longer distances on inclines or uneven surfaces may also be reduced.

Is a hip labral tear always painful?

Hip labral tears are common in both people with and without hip pain. One review reported that on average, 62% of those with hip pain have labral tears present on imaging, while 54% of those without hip pain also had hip labral tears.4 What this means is that it is possible to have a hip labral tear but no hip pain. It also means that although a labral tear may cause pain, just because a hip labral tear is reported on scans, it does not necessarily mean it is the source of pain. Information provided by the patient and a physical examination are required to determine if the imaging results are likely to be related to the current pain. It has been reported that it takes on average more than 2 years to obtain an accurate diagnosis of a hip labral tear. So it’s important to ensure you have a thorough clinical examination by a health professional experienced with hip conditions.

What causes hip labral tears?

Traumatic hip labral tears

 

Injury to the labrum is frequently observed if trauma to the hip is experienced, such as during a motor-vehicle accident, falls and sudden impact to the hip during contact sports. These types of labral tears can occur with other injuries, like hip joint dislocation.1 Although a tear sounds like it would always be associated with some form of trauma, in fact most labral tears develop over time secondary to natural bony shape or flexibility and/or repetitive activities.

 

Hip labral tears and Femoroacetabular Impingement

It is very common to have a variation of bony anatomy of the hip in healthy populations. The natural formation and alignment of the hip joint may increase the likelihood for some people to have a hip labral tear. It could be the bone structure of the thigh bone (femur) or the socket (acetabulum) that creates natural restriction in hip flexibility, called femoracetabular impingement or FAI. This kind of restriction may result in compression and shearing of the hip labrum. The labrum is more prone to injury during extremes of movement, particularly bringing the knee to the chest and with full rotation of the hip. In some people with this bony anatomy, pain related to a hip labral tear may develop – this condition is then called Femoroacetabular Impingement Syndrome (FAIS).5

Hip labral tears and acetabular dysplasia or hip dysplasia

The bony shape of the socket or acetabulum can also increase the risk of hip labral tears. People who have a shallow socket or a change in the natural orientation of the hip socket are also more likely to develop hip labral tears. Up to 90% of people with hip dysplasia and a painful hip will have a labral tear.6 This is due to less bone in the socket available to absorb forces and therefore a greater amount of force is absorbed by the labrum that lines the edges of the socket.

Hip labral tears and hyper-mobility

 

People who are naturally very flexible in their early years, may be at higher risk of sustaining hip labral tears. Instead of reduced hip motion like in people with hip FAI, these patients usually have greater than normal hip flexibility due to more relaxed capsule and ligaments around the hip. In this situation, the labrum may again need to absorb larger forces, increasing risk of injury.

 

 

Hip labral tears, repetitive motion and age

Repetitive and forceful motion into the extremes of hip joint range may over time cause changes in the labrum. Court and field sports involving lots of hip rotation and sports involving large ranges of motion such as dance and gymnastics may cause increased stress at the hip joint and the acetabular labrum. These stresses are normal, but high repetition of strong forces may eventually result in a labral tear and in some people the tear may become symptomatic. This does not mean these sports are necessarily dangerous for your hips – it depends on many factors like your bony shape and natural flexibility as mentioned above, how much of certain activities you do, how you do them, and your age. Over the years, our body is naturally exposed to more repetitive forces and so it is not surprising that age is also related to development of labral tears.

 

What is the treatment for hip labral tears?

Activity modification and exercise for hip labral tears

The first line of treatment is education and exercise, and physiotherapy plays a significant role in this management approach. A physiotherapist may advise how to appropriately minimise aggravation of the hip. A graduated exercise program is developed to address any weakness around the hip and improve the ability of muscles to absorb the forces travelling through the hip joint. This can help reduce forces placed on the labrum.

Corticosteroid injections for hip labral tears

Corticosteroid injections into the hip joint can help reduce pain in the short term but do little to help the condition in the longer term. There are also concerns about adverse effects that cortisone may have on the hip cartilage, particularly in younger individuals. For this reason, trying at least 3-6 months of activity modification and rehabilitation is usually recommended prior to undertaking more invasive procedures such as injections or surgical interventions.

Surgery for hip labral tears

Surgical treatment for hip labral tears is most commonly performed through keyhole surgery (hip arthroscopy). The surgeon generally ‘debrides’ - trims up - any flaps or rough areas at the site of the labral tear. It is important to be aware that such treatment does not ‘fix’ the labrum or restore its normal function. Sometimes a surgeon may attempt to repair the labrum but this is less common as the labrum naturally has poor blood supply and is not so easy to repair.

Surgery can help with reducing pain and improving ability to perform normal activities and sport, but many people do not return to sport or to their previous level of sporting activity. Some can be no better or even worse after surgery – this is more likely to occur in those who already have some osteoarthritis within the hip joint.

Scientific research has not yet determined which people will have the best outcomes from surgery, so it is always wise to try an extended period of physiotherapy treatment prior to opting for surgery. If surgery is then required, you will be much better placed for a quicker recovery if you have done a good period of ‘pre-habilitation’ before surgery. Rehabilitation after surgery is recommended for a minimum of 3 months, but this may be longer depending on what activities you need to return to.

Getting help for your hip labral tear?

If you have a hip labral tear or think you may have a tear, please book a consultation with one of our physiotherapists at Physiotec. All of our Physiotec staff have higher level experience in the treatment of hip pain and injuries. We will provide a thorough examination and an evidence-informed treatment program to give you the best chance of returning to the things you need to do and the things you love to do! We can also assist you with modifying activities to keep your hip as happy and healthy as possible for the longer term, and if surgery is required, we can assist you through this process to ensure the best result.

Ph: (07) 3342 4284    Email: [email protected]

 

Developed hip pain during your covid isolation? Avoid these 3 exercises!

Developed hip pain during your covid isolation? Avoid these 3 exercises!

Have you developed some new aches and pains or aggravated some old ones after following free online exercise classes? Or perhaps you have increased your normal activity level by doing more walking, running, stair or hill climbing to try and stay fit and healthy during the COVID-19 restrictions. At Physiotec, we have seen an increasing number of people who have developed or aggravated their hip pain during the covid-crisis. In fact, pain over the outer side of the hip is one of the most common problems we see. This is usually related to a condition called gluteal tendinopathy, also sometimes referred to as trochanteric bursitis.

There are some challenges with going it alone with a new exercise program. If you do have a pre-existing or new injury, how do you know:

  • which exercises or programs are the best options for you?
  • what are the correct techniques to use?
  • how do you make the exercise harder or easier if you need to?
  • how do you alter your program if you develop pain?

If you are struggling with any of these challenges, a physiotherapist can assist with either a telehealth or face-to-face consultation. For many painful conditions, good education and advice will help you stay active while minimising the risk of pain or injury.

For specific hip conditions such as gluteal tendinopathy or trochanteric bursitis, many factors influence the health of the tendons and bursae at the side of the hip. Either too much or too little stimulus may result in changes in tendon health and consequently, your ability to perform normal activities without pain. Too little load may be associated with a sedentary lifestyle where the muscles and tendons aren’t working enough. Too much load may be associated with a quick increase in activity (either a new or existing activity). Particular sustained positions or repetitive movements may also contribute to reduced tendon health or the development of pain over time.

3 Exercises to avoid when you have gluteal tendinopathy

 

So, who is most affected with this condition and why? 18% of the population aged over 50 suffers with this type of hip pain, and women are 3 times more likely to develop the condition than men. While the causes are often multifactorial, a change in hormones is thought to contribute to the development of tendon changes. A common story we hear from our patients is that there was an onset of pain associated with a combination of the following:
• Peri or post menopause and the associated hormonal changes
• Weight gain during this time, and
• A sudden increase in activity levels to counteract the weight gain

It should be said that changes in the health of tendons and bursae are not necessarily painful. Pain may develop if weakened tendons are unable to cope with their workload. Pain is often triggered by sudden increases in activity levels, where the tendons have not been given adequate time to adapt to the new loads. Examples include taking up a new sport or activity, or returning to activity after illness, injury or pregnancy. Going on holidays and walking lots of hills or stairs or for long distances along the beach may cause a problem. Sudden loads on the tendon during a slip or fall can also result in pain and injury, or a gain in weight may add more load to these tendons that support your bodyweight when standing on one leg.

How do you know if you have a gluteal tendinopathy or trochanteric bursitis?

Pain over the side of the hip due to gluteal tendinopathy or trochanteric bursitis

Do you have pain over the side of the hip with any of the following?
• Lying on your side
• Walking up hills or stairs
• Standing on one leg
• Sitting in low chairs especially with crossed legs
• Getting up from chairs and during the first steps

If you answered yes to most of these, you may have gluteal tendinopathy or trochanteric bursitis. The good news? Education and exercise provided by a physiotherapist provides an 80% success rate, with significantly better outcomes than a corticosteroid (cortisone) injection or a wait and see approach (i.e. basic advice and monitoring the condition)*. The even better news? Dr Alison Grimaldi was instrumental in the development of this successful program and all physiotherapists at Physiotec have been trained in the protocol.

We are now back in clinic for face to face consultations – if you have flared or developed hip pain (or any other pain), give us a call to book in! We are also still offering Telehealth consultations for those who are continuing to isolate or those who find it more convenient to attend an appointment ‘virtually’. You can read more about our Telehealth service here.

 

*Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B., 2018. Education plus exercise versus cortico- steroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. May 2;361:k1662. doi: 10.1136/bmj.k1662.

Osteoarthritis and Running

Osteoarthritis and Running

Does running accelerate the developing of osteoarthritis?

There are so many misconceptions about running and how bad it can be for your joints. You may have heard many friends and family members comment on this and they may have even tried to convince you to stop running and go swimming instead. Here is what the scientific research tells us so far:

Osteoarthritis (OA) is a musculoskeletal condition that involves degeneration of the joints and impact during weightbearing exercise such as running and may contribute to joint loads. There is very little evidence however, that running causes OA in the knees or hips. One study reported in 1985 by Sohn and Micheli compared incidence of hip and knee pain and surgery over 25 years in 504 former cross-country runners. Only 0.8% of the runners needed surgery for OA in this time and the researchers concluded that moderate running (25.4 miles/week on average) was not associated with increased incidence of OA.

In another smaller study of 35 older runners and 38 controls with a mean age of 63 years, researchers looked at progression of OA over 5 years in the hands, lumbar spine and knees (Lane et al. 1993) . They used questionnaires and x-rays as measurement tools. In a span of 5 years, both groups had some participants who developed OA- but found that running did not increase the rate of OA in the knees. They reported that the 12% risk of developing knee OA in their group could be attributed to aging and not to running. In 2008, a group of researchers reported results from a longitudinal study in which 45 long distance runners and 53 non-runners were followed for 21 years. Assessment of their knee X-Rays, revealed that runners did not have a higher risk of developing OA than the non-running control group. They did note however, that the subjects with worse OA on x-ray also had higher BMI (Body Mass Index) and some early arthritic change in their knees at the outset of the study.

Is it better for your joints to walk than to run?

It is a common belief that it must be better to walk than to run to protect your joints. In a recent study comparing the effects of running and walking on the development of OA and hip replacement risk, the incidence of hip OA was 2.6% in the running group, compared with 4.7% in the walking group (Williams et al 2013). The percentage of walkers who eventually required a hip replacement was 0.7%, while in the running group, it was lower at 0.3%. Although the incidence is small, the authors suggest the chance of runners developing OA of the hip is less than walkers.

In the same study, Williams and colleagues reinforced that running actually helped keep middle-age weight gain down. As excess weight may correlate with increased risk of developing OA, running may reduce the risks of OA. The relationship between bodyweight and knee OA has been well-established in scientific studies, so running for fitness and keeping your weight under control is much less likely to wear out your knees than being inactive and carrying excess weight. 

How much is too much running?

Recent studies have shown that we should be doing 30 minutes of moderate exercise daily to prevent cardiovascular disease and diabetes. But with running, researchers still have not established the exact dosage of runners that has optimal health effects. Hansen and colleagues’ review of the evidence to date reported that the current literature is inconclusive about the possible relationship about running volume and development of OA but suggested that physiotherapists can help runners by correcting gait abnormalities, treating injuries appropriately and encouraging them to keep the BMI down.

We still do not know how much is “too much” for our joints. However, we do know that with age, we expect degenerative changes to occur in the joints whether we run or not. Osteoarthritis is just as common as getting grey hair. The important thing is that we keep the joints as happy and healthy as possible.

What is the best way to start running?

If you are not a runner and would like to start running, walking would be a good way to start and then work your way up to short running intervals and then longer intervals as you improve your fitness and allow time for your body to adapt.

Therefore, running in general is not bad for the joints. It does not seem to increase our risk of developing OA in the hips and knees. But the way you run, the way you train and how fast you change your running frequency and distance may play a role in future injuries of the joints.

But that’s another story. Watch this space for more running gems....

Are you just starting to run?

Do you have pain during or after running?

Would you like a running assessment?

Our sports physiotherapists can provide you with a thorough assessment to assess your 'run-readiness' and help you build or re-build your running routine.

References:

Cymet and Sinkov 2006. Does Long Distance running cause OA. The Journal of the American Osteopathic Association, June 2006, Vol. 106, 342-345.

Hansen et al 2012. Does Running cause osteoarthritis in the hip or knee?. Physical Medicine and Rehabilitation. 4 (5) 117-121.

Lane et al. 1993. The Risk of OA with Running and Ageing. Year Longitudinal Study. Journal of Rheumatology (20) 461-468

Sohn et al. 1985. The Effect of Running on pathogenesis of OA in hips and knees. Clin Orthop Res (9) 106-109

Williams 2013. Effects of Running and Walking on OA and Hip Replacement Risk. MedSci Sports Exerc. 45 (7) 1292-1297