By Kristen Page (BChiroSc. MChiro)
The hip joint is a strong and very stable ball and socket joint that links the lower limbs to the trunk. Pain in this area can come from the joint itself, the cartilage that lines the articular surfaces of the femoral head (ball) and the acetabulum (socket) and the capsule surrounding and reinforcing the joint. Pain can also arise from the muscles and tendons that surround the joint which allow the joint to move. In addition, a number of structures from the trunk, abdomen, spine and pelvis can refer to the hip area and present as hip pain. Less commonly (but importantly), gynaecological disorders and prostate cancer can be the underlying cause for hip pain.
It goes without saying that diagnosis is the key to managing hip pain, and a good therapist will be able to understand what is causing your pain with a thorough history and physical exam or know when it’s appropriate to refer out for more testing.
When pain in the hip is indeed due to a problem with the hip joint, it is commonly felt at the front of the joint and in the groin. It can often be associated with symptoms like stiffness, pinching, catching, locking or clicking, or even a limp.
Sports and activities that commonly present with hip problems and those that require taking the hip joint into extreme ranges of motion, like ballet dancing and yoga. Kicking sports like football and repetitive loading like running see a lot of hip related pain as well. Regardless of the activity, hip pain is almost always associated with weakness in one or more of the major muscle groups that act on the hip. Specifically, the adductors and hip Flexors, and in woman often the hip abductors.
Interestingly, even though a lot a patients with hip pain suffer from a lot of stiffness and reduced flexibility, stretching often makes the problem WORSE. This is because the underlying cause is not due to lack of elasticity of the tissues in the area. Stretching the hip will just pull on tendons and potentially compress them over the many bony prominences around the pelvis and hip causing further irritation and can in some cases lead to tendinopathy.
A good rehabilitation program for the hip should include the following:
- Hip strengthening
- Trunk (core) strengthening
- Functional and balance training
- A cardiovascular component
- Education, counselling and shared decision making.
Your therapist or provider should identify clearly where impairments in strength and function are and target those specifically with exercises. Over time with the right guidance, you should feel improvements in strength, range of motion and function, and of course a reduction in pain!