The hip and pelvis is such an important region of the body. It is the foundation for the lower limbs below, as well as for the trunk and upper body above and is critical for transfer of forces between the upper and lower body. It is not surprising then, that problems with the hip or pelvis can have a marked impact on your ability to sit, stand, walk, squat, bend or and even use your upper body. At PhysioTec, we understand the impact that hip pain can have on your quality-of-life, and how hard it can be sometimes to get answers for ongoing issues you might be experiencing around the hip and pelvis. Our physiotherapists are all highly trained by Dr Alison Grimaldi in the assessment and management of hip, groin, buttock and pelvic pain, making PhysioTec your choice for physio for hip pain in Brisbane.
Hip pain, the hip joint and bones of the hip
The hip is a ball-and-socket joint, offering movement in all three planes. The hip is formed by the head of the femur (ball) and the acetabulum (socket) shaped within the bones of the pelvis. It is the deepest joint in the body and the deep socket usually provides great stability for the hip joint. In some cases however, the socket may not develop fully resulting in a shallow socket. This is referred to as acetabular dysplasia. This shallow socket allows greater range of motion which can be an advantage for some, like dancers and gymnasts. However, stability is reduced and higher loads are then transferred to the passive and dynamic stabilisers of the hip. Others may have a deeper than normal socket or develop additional bone around base of the ball (the neck of the femur), usually in response to high levels of field or court sports in the teenage years. This extra bone may result in hip impingement (Femoroacetabular Impingement - FAI) and in some people this may become painful (Femoroacetabular Impingement Syndrome - FAIS).
Hip pain, hip ligaments and the acetabular labrum
For those with acetabular dysplasia (shallow sockets), the other ligamentous and muscular stability systems will be extra important. The hip joint is surrounded by a system of strong ligaments, reinforcing the capsule (like a sleeve around the joint). Within the joint the ligamentum teres helps resist distraction and rotary forces. Some people have more stretchy ligaments than others. These more flexible people are usually diagnosed with hypermobility, a hypermobile spectrum disorder, or hypermobile Ehlers Danlos Syndrome (HEDS). As with acetabular dysplasia, those with hypermobility will have reduced passive stability systems and may also require better function in the dynamic muscular stabilisers of the hip.
The labrum is the other important passive stability structure. The labrum is a fringe of fibrous cartilage that lines the edge of the socket, adding the joint stability and protection. Because of its position around the edge of a very busy joint, it is common to find small tears in the acetabular labrum. Acetabular labral tears are present in almost as many people without hip pain (54%) as in those with hip pain (62%). This means that most of the time these tears are not painful and even when painful, the issue can be managed without surgery by a physiotherapists experienced in management of labral tears, like those at Physiotec.
Those with acetabular dysplasia, FAI and hypermobility are all at higher risk of developing hip osteoarthritis. Even if you have been diagnosed with osteoarthritis there is plenty physiotherapy can do to help. Sometimes people are told there is nothing that can be done, but that's not correct. Physiotherapy has so much to offer at all stages of osteoarthritis, even when surgery is inevitable. So, don't suffer unnecessarily - reach out and let us help.
Hip pain and the muscles and tendons of the hip
The hip and pelvis also has a sophisticated system of muscles that surround the hip joint and the joints of the pelvis - the sacroiliac and pubic symphysis joints. Deep muscles providing dynamic support to the ball-and-socket joint of the hip include:
- the deep hip flexor muscles at the front of the hip: the iliacus and iliocapsularis muscles,
- the deep hip abductor muscles at the side of the hip rotators: gluteus minimus, and gluteus medius muscles
- the deep hip rotators at the back of the hip: obturator internus and externus, superior and inferior gemellus, and quadratus femorus.
It has been shown that insufficient control and reduced strength of these muscles may contribute to overloading passive tissues and increased hip pain. Conversely, these muscles are able to improve joint stability, particularly important for those with acetabular dysplasia or hypermobility, and control the direction of forces that cross the hip - super important muscles! These muscles can't be observed with the naked eye and most can't to palpated (felt with the fingers). This is why at Physiotec all our physiotherapists are skilled in the use of real time ultrasound for assessment and training these important muscles.
Over the top of these deep muscles there are other larger or longer muscles, such as gluteus maximus in the buttock and other muscles that run into the thigh such as Tensor Fascia Lata, Sartorius, Rectus Femoris and hamstring muscles. These more superficial muscles are important for power generation and transferring forces down the limb. Muscles can be a source of hip pain and muscles like the rectus femoris and hamstring are subject to acute muscle tears usually in sprinting or kicking, and tendon injuries where the muscles joint on to the pelvis. The other most common tendon condition around the hip is gluteal tendinopathy - painful tendons of the deeper gluteal muscles - gluteus medius and minimus. The older diagnosis for this condition is trochanteric bursitis. The pain is felt over the bone at the side of the hip particularly when lying on the side in bed and standing on one leg to dress or climb stairs. Dr Alison Grimaldi is one of the most well known physiotherapy researchers in this field and developed a management program that what shown to be highly effective in a high quality randomised clinical trial. All the Physiotherapists at Physiotec are trained in this management program.
Hip pain may present also present in the groin and pubic area. Soccer players are at higher risk of injury to this area due to repetitive kicking and the lateral movement and rapid changes of direction involved in the sport. A common injury in the groin region is an adductor muscle strain or adductor related groin pain. This may occur due to rapid stretching of the muscle and may be felt as sharp pain when moving the legs far apart. Groin pain can also reduce performance by limiting sprint and cutting speed, and kicking power. Recurring groin injuries are also very common, so it is best to rehabilitate these injuries early and completely to reduce the risk of ongoing problems.
Sacroiliac joint or pelvic pain
At the base of the spine, lies the Sacroiliac joint (SIJ), joining the spine and the two bones of the pelvis, and underneath lies the coccyx or tailbone. While the sacroiliac joint is the most stable joint in the body, it can still be a source of pain and pain referral into the hip, buttock and groin. The joint itself is incredibly stable from robust attached ligamentous structures and large gluteal muscles providing added dynamic support, however during pregnancy, the SIJ can be painful due to a short-term increase in laxity of ligaments required for childbirth. Long term management involves improving strength of dynamic hip and pelvic stabilisers to reduce load on the joint tissues.
Nerve related pain of the hip and pelvis
Finally, nerves can cause hip pain, most commonly the sciatic nerve as it passes from the back, through the buttock to the back of the thigh. Pain from the sciatic nerve is referred to as sciatica, and irritation of this nerve in the buttock is sometimes referred to as Deep Gluteal Syndrome or Piriformis Syndrome. The sciatic nerve travels from the lumbar nerve roots into the leg passing through or between many deep structures within the hip making it susceptible to painful irritation from surrounding tissues. Deep gluteal syndrome or Piriformis syndrome results in pain often described as tingling, burning or aching deep within the buttock area and can travel down the leg to as far as the toes. Proper assessment to determine the root cause of nerve-related pain is of great importance prior to choosing the appropriate management plan.
Some common acute or traumatic hip injuries may include:
Some common non-traumatic causes of hip pain may include:
- Gluteal Tendinopathy - Gluteus Medius/ minimus Tendinopathy, Trochanteric bursitis, Greater Trochanteric Pain Syndrome
- Proximal Hamstring Tendinopathy
- Myofascial Pain
- Ischiofemoral Impingement
What can I do about my hip pain? Tips and general Information:
- Sleeping position is an important factor for offloading painful tissues. Try putting one or two pillows between your knees if sleeping on your side. If sleeping on your back, try putting a pillow under your knees.
- Try sitting on a pillow to lift the hips a little higher than the knees - great for the car.
- Reduce the amount of time spent sitting with your knees crossed, or standing hanging on one hip.
- Avoid long striding 'power walking', reduce your step length and walk more quietly.
- Use of microwavable heat packs and/or ice can help to decrease the sensitivity of soft tissues around the hip. Try 10 minutes on and 10 minutes off as required
- Beginning a daily routine of gentle muscle strengthening exercises will aid in improving your hip health, decreasing pain and reducing the risk of reinjury.
- Get early advice from a physiotherapist experienced with hip and pelvic pain.
How can a physio help my hip pain?
PhysioTec is your choice for physiotherapy for hip pain in Brisbane. The PhysioTec team, under the guidance of Dr Alison Grimaldi, is highly qualified in the assessment and management of hip, groin, buttock and pelvic pain. There are many potential options for management depending on your condition and your personal needs and goals. Physiotherapy for hip pain at PhysioTec may include:
- A thorough patient interview and physical assessment
- An evaluation of possible underlying causes, particularly important for long standing or recurrent conditions (Please book a 1 hour session)
- Education and personalised advice about how to best manage your condition and speed your recovery
- A tailored and progressive exercise program, including video-based exercises on a free App and/or colour photographs and typed text instructions
- Real time ultrasound assessment and training of hip and pelvic muscles
1. Why does my hip hurt when I sit cross-legged?
While sitting cross-legged, the angle of the hip joint is closes down at the front which may lead to pain for those with hip osteoarthritis, labral tears or those with Femoroacetabular Impingement Syndrome. Furthermore, the tissues on the outer aspect of the hip may be compressed from being pulled to length and held under tension. Those with gluteal tendinopathy (trochanteric bursitis) may find this position provocative.
2. Why does my hip hurt more at night?
In cases of Gluteal Tendinopathy, prolonged stretching of the gluteal tendon and compressing over the greater trochanter becomes provocative. While sleeping sideways, the hip is in position to stretch the gluteal tendon the entire night. Also, the pressure of laying on the bottom hip can add compression to tender tissues. One method to try improving hip pain at night is to put a pillow between the knees to decreased the hip angle and offload the tissues.
3. What is hip dysplasia?
Hip Dysplasia or Acetabular Dysplasia refers to a shallow socket with decreased coverage of the ball (head of the femur by the bony socket (acetabulum). In most cases the person is born with hip dysplasia or it develops during infancy. The inadequate coverage can lead to increased chance of dislocation and joint instability. Screening of infants is critical as there is much that can be done to correct this bony issue in babies. In adults, choosing appropriate strengthening exercises for the hip and avoiding provocative activities is very important for long term management.
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