First off, some anatomy. By hips, many people mean the bony areas where we rest our hands. These are actually part of the pelvis & far from the actual hip joints. T
|On the subject of soft tissue...
We often treat people who before seeing us have had regular treatment elsewhere with nothing besides manipulation (clicking of the joints). Often they notice those treatments only seemed to bring temporary relief, which is why they come to us for something different in the hope that improvement will be more long lasting.
We think much better results are possible if we take time to address these irritated and shortened tissues. Left untreated, they are perfectly capable of staying irritated and causing new restrictions in the joints.
Sometimes hip pain can be pinned down to a point midway along the bony ridge of the hip bone. This is an area where a group of nerves called the cluneal nerves cross the bone on their way to the upper buttocks from the area where the low back and mid back meet. These nerves can be irritated by restrictions there or from from tight soft tissues lying over them. Patients with this issue often report feeling much improved after only a single treatment.
An over-strained muscle is painful too, but can usually be linked in the patient's mind to a specific event usually involving an accident or some hard or unusual physical activity. When injured, ankle or knee pain can result in a person having to hitch the hip up on the affected side as part of a limp when walking. This causes tightening of the muscle that does this because the normal use pattern of that muscle has changed dramatically.
Muscle weakness is different. If you overload any muscle with vigorous exercise it becomes sore for a day or two. This is plain old muscle soreness. But if you overload a weak muscle on a daily basis it will feel constantly tight and sore. This is especially true of postural muscles which we can not really avoid using once we're out of bed!
Two causes of actual hip joint pain.
Wear and tear
in the joint itself, usually visible on x ray, but possibly needing an MRI if the damage has been to one of the soft tissue components of the joint, such as the joint capsule.
Note that the wear and tear isn’t always an “age-thing”. It can happen much earlier on in life due to accidents or intense and repetitive sporting activities. A netballer or dancer, for example, may have it from favouring one leg constantly when landing from a jump.
A congenital deformity of the hip.
|Osteopathy often makes a difference, though how much does depend on the amount of damage. In some cases, the patient can be made sufficiently comfortable to feel that they can postpone talk of an operation.
The key here is to gently move the hip joint to stretch the soft tissues and spread the synovial fluid (the joints’ natural lubricant) over all the surface of the joint.
Stretching shortened muscles is part of treatment & self care. Strengthening exercises will help, especially in a non weight bearing environment such as a pool. But maintaining joint-use is critical in preventing the area seizing up.
(DDH) In this scenario the baby is born with a malformation of the hip joint. The ball at the top of the thighbone (femoral head) is not stable in the socket (acetabulum). Also, the ligaments of the hip joint may be loose and stretched. This can worsen with age. Usually this will be diagnosed at birth and the baby will be put in a cast for several months to encourage normal hip development.
However, if this is missed or left untreated it can lead to pain and osteoarthritis by early adulthood. It may cause legs of different lengths or a "duck-like" walk and decreased agility. DDH has a familial tendency & it usually affects the left hip.
Irritable Hip Syndrome
This is a diagnosis for someone with apparent symptoms indicating a true hip problem in the making, but with nothing to show on x rays.
A lot of times the person might notice tightness around the joint when trying to do a particular stretch in Pilates or yoga. They may also complain of occasional catching in the groin area or pain around the upper part of the inner thigh.
|On examination, a muscle imbalance around the joint will usually be found, and when this is treated, the hip enjoys a more normal level of flexibility and mobility with a corresponding reduction in symptoms.
This includes a lot of our patients, and if you or someone you know falls into this category then give us a call because from clinical experience the outlook is good.
Not all 'hip' pain comes from the hip.
Apart from the low back (mentioned earlier) or serious disease, another major cause is the sacro iliac joint (or s.i.j). This can be injured from a sideways fall onto a hip bone, a sudden jolt from a missed step, or from pregnancy.
Pregnancy releases a hormone (relaxin) in the body to soften the pelvic ligaments so that baby can pass through more easily in birth. But relaxin softens all ligaments including those that normally stabilize the s.i.j - not so great when you're left with pain long after childbirth.
Pain may be felt in the groin or inner thigh, and commonly in the area of the joint itself, especially when vacuuming, walking or bending.
|Whatever the mechanism of injury, a loose and unstable sacro-iliac joint can grumble on for a long time. This issue needs very specific strengthening exercises to restore stability.
Happily, we can provide these & they require no specialist equipment.
Friction bursitis. Tight muscles that rotate the thigh outwards can cause a deep toothache-like pain behind the hip joint and may be uncomfortable to lie on. In more extreme cases this results in a friction bursitis as the shortened muscles contract and rub against a fluid filled sac (called a bursa) that separates the muscle tendons from the bone underneath. The job of this sac is to prevent friction of the muscle against the bone, but unfortunately it can get painfully irritated and inflamed too.
Another bursa lies in the area of the groin itself and directly under the muscle responsible for bringing your thigh forwards and up towards your body. This can suffer in the same way.
Those of us moving through mid-life & beyond are more at risk as our tissues are less springy and elastic than they used to be. The repair rate is also worse...yet another perk of ageing!
Deep soft tissue work is effective, though complete resolution of the discomfort can take a while if the condition has been going on for months or years. Some patience will be needed and anti inflammatory medication is helpful in many cases.