Hip Pain Treatment
Click the video below to hear Jennifer Craft, DPT, physical therapist at Therapydia Lake Oswego explain the causes of hip pain and how physical therapists can utilize hand-on techniques to pinpoint the root cause and relieve hip pain.
Understanding The Causes Of Hip Pain
The hip joint is unique in that it’s almost always being put to use and bears weight with every step you take. Since it’s constantly moving, the hip joint is the second most commonly affected large joint in the body. The size and the mechanical complexity of the hip joint also makes it prone to injury. Although a ball-and-socket joint provides a wide range-of-motion, there is a trade off between mobility and stability. Due to the lack of stability, ligaments and muscles that surround the joint work to provide stability. However, if there are imbalances with these muscles, they can lead to pain in the area.
With hip pain, it’s important to determine whether the pain is the result of a long-term condition of the joint or an acute injury. Pain could be due to lifestyle, physical injuries, mechanical problems, or a type of musculoskeletal condition. Even the type of shoes you wear can lead to hip pain. Your age, previous injuries, and types of physical activities you engage in all affect your risk for hip pain. In the United States, 7% of all adults report having hip pain. With adults aged 65 or older, about double the amount (15%) report having hip pain throughout the day.
Chronic Hip Pain
Long-term hip pain usually develops due to overuse with repetitive and demanding movements or any past trauma to the joint. If you have tight hip flexors or weak glutes, they are common precursors to chronic hip pain.
There are typically 2 reasons why your muscles may be tight. They may be compensating for weakness elsewhere or they are held in a shortened position for a long period of time. If your job requires you to sit for most of the day, your hip flexors, located in the front of your leg, are in a constant shortened position. Additionally, your glutes are not activated while your are sitting and may not know how to “turn on” when needed.
Your gait can also affect your hip flexors. Many of us over rely on our knees and quads to walk or run and we don’t engage our glutes. For runners who are more quad and hamstring dominant, rather than glute dominant, your body compensates for this imbalance with tightening your hip flexors. Weak glutes causes your hip and pelvis to be off, leading to wear and tear of the hip joint.
Other chronic hip pain conditions include:
- Sciatica and piriformis syndrome: Hip pain related to sciatica is caused by 2 forms of inflammation: 1. inflammation resulting in the compression on the sciatic nerve on the lower spine and 2. inflammation of the piriformis muscle near the back of your hip resulting in the compression of the sciatic nerve in that region. If sciatica is caused by an inflammation in the L4 and L5 vertebrae, you may feel radiating pain down the back of the leg to the knee. If it’s caused by piriformis inflammation, you may feel a more localized pain in the hip and gluteal region.
- Snapping hip: Similar to pulling back on a rubber band, the same tension relationship happens with your muscle and a snap can occur when the muscle rubs on a bone. External snapping hip occurs when your IT band snaps over the greater trochanter, near the top of your femur. Internal snapping hip occurs when your tight hip flexor rubs on the bony part of your hip.
- Trochanteric bursitis: Unlike snapping hip where a tight IT band snaps the greater trochanter area, with trochanteric bursitis, the IT band puts pressure on the bursa sac that lies underneath it. The inflammation of the bursa sac leads to hip pain.
- Femoroacetabular impingement (FAI): FAI is caused by bone overgrowth, or bone spurs, at the top of your femur, the femoral head or at the edge of the acetabulum, the hip socket. Where your femoral head meets with your pelvis at the hip joint and is covered by a tissue called articular cartilage and a strong fibrocartilage called the labrum. The overgrowth causes friction in your ball-and-socket joint leading to tears in the labrum and the breakdown of articular cartilage (osteoarthritis). Impingement occurs with certain movements and without treatment, long-term range-of-motion will be lost.
SI joint: The sacroiliac joint (SI joint) is located below the lumbar spine and above the tailbone and acts a shock absorber. If there are muscle imbalances around the your SI joint, this can lead to hypermobility or hypomobility of the joint. If the joint is hypermobile, or moves too much and is not stable, you will feel pain in the lower back and hip. If the joint is hypomobile, or moves too little, you may feel pain in your buttock and down your leg and the sensation is similar to sciatica.