Hip

Your hip joint is composed of three pelvic bones (namely the pubis, ischium and ilium) merging together to form a tight, cup-like socket called the acetabulum. This articulates with the head of the femur to provide a strong load bearing structure that is able distribute weight from the lumbar spine whilst providing enough movement required to rotate during walking, running and sitting.

Like many joints in the body, the hip is known as a synovial joint which means that it is wrapped in a tight capsule of ligaments. This provides the joint surfaces with essential nutrients to help maintain healthy bones whilst providing enough lubrication to stop the hip from becoming stiff.

In addition to this, your hip joint is also the centre for many muscular attachments which allow for a stable but highly moveable joint. There are also numerous nerve structures that pass through this region, most notably the sciatic and femoral nerve branches that descend from the lower back.

Whilst we use our hips every day; we rarely take into consideration their importance until they become painful. With several complex structures contributing to what we know of as the hip joint, there are many reasons why you can experience pain especially within the context of sport and exercise. A physiotherapist can examine the movements at your hip, assess nerve integrity and develop the muscles that may be under active.

Below are a few common conditions that are seen in clinic:

Arthritis

A widely used term, which ideally needs to be broken down into two parts to understand how it affects us:

• Arthr(o) -: meaning joint or articulation
• -itis: meaning inflammation

Most commonly, it causes the stiffness in one or more of our joints which is the accompanied by additional pain and swelling. What causes this condition can vary, however our team here at Sano Physiotherapy can help you understand it, guide you on self management and talk you through appropriate exercises which will help with your symptoms.

Osteoarthritis: This is known to be the most common form of arthritis. The pain and inflammation of this condition is caused by the breakdown of cartilage on the surfaces of your joints. Ideally, this should manifest on a smooth surface, however the joint articulates to a rougher and less stable surface which can increase the tenderness and swelling in the area, resulting in stiffness and less movement. This condition is more probable in the ageing population, it can also be present in the younger generation of those with reduced bone density or play regular intensive sport.

Treatment: Your physiotherapist can develop the muscles around the hip and stimulate healthy bone development by providing a programme of strengthening, loading and stretching in addition to maintaining range of movement depending on your needs. This is the first port-of-call and gold standard in most cases of hip arthritis, replacement or key hole surgery is only considered in severe cases. Whilst arthritis cannot be cured it can certainly be managed. With correct intervention, this can allow a return to a normal lifestyle.

Osteoporosis: This is a condition more commonly found in females, however it can still be present in males. It is characterised by the breakdown of bony micro structures, which result in a bone becoming brittle and prone to damage. Your physiotherapist can advise on a number of areas including self-management, how to protect from further arthritis developing and keeping joints mobile.

Soft Tissue Problems

Labral Tear: An extremely tender condition whereby a strong rotatory, downward shearing force creates a tear in the labrum – a small cartilaginous structure that lines the socket of the hip. Often seen in sporting injuries but also in traumatic falls or road traffic accidents this can be prevalent for several months or even years. Often detected upon physiotherapy assessment with a follow up CT or MRI scan, this small tear can create a block within the joint which can limit movement.

Your physiotherapist can work alongside surgical interventions to reduce these symptoms and build the stability of the joint whilst focusing on a particular sport.

Irritable/snagging tendon syndrome: Excessive movement at a joint can instead cause a loss in function and excessive pain. This can occur at any joint but in the hip this can be very debilitating. In many cases this affects individuals at a young age due to poor development of the hip capsule and the muscles that support it. Progressive loading and active physiotherapy combined with functional strengthening exercises is typically the best treatment and continued home exercise can keep this from progressing further.

Bursitis: A painful condition that affects the small, fluid-filled sacs — called bursae — that cushion the bones, tendons and muscles near your joints. Bursitis occurs when bursae become inflamed due to repetitive movements. The most common locations for bursitis are in the shoulder, elbow and hip. Treatment typically involves resting the affected joint and protecting it from further trauma. In most cases, bursitis pain goes away within a few weeks with proper treatment, but a focus on education, pain/symptom avoidance and self-management is key.

Nerve Related Problems

Sciatica: This refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body. Sciatica most commonly occurs when a herniated disk, bone spur on the spine or narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes inflammation, pain and often some sensory deficit in the affected leg.  Most cases resolve with non-operative treatments in a few weeks.