Hip Pain

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Femoro-acetabular/ Anterior Impingement

Some people have an irregular shaped hip joint, where extra bone growth narrows the space for the hip joint to move. This can cause friction in the hip. The abnormal contact between joint surfaces is known as Femoroacetabular impingement (FAI). Movement of the hip will be painful and restricted. In a healthy, “normal” hip joint, the head of the femur fits snuggly into the hip socket. Bone abnormality or overgrowth will alter the interaction between the femoral head and the socket. With time, the hip joint may become damaged and develop osteoarthritis.

Normal hip development during childhood can cause impingement, joint damage and pain later on in life. Some people may have an irregular hip joint and live happy, active lives without any symptoms. When symptoms develop, however, significant damage may have already occurred. Symptoms of FAI may include pain, hip joint stiffness, and difficulty walking or limping.

Hip Pain

Typically, a dull ache is felt in the outer hip area or in the groin. Any activity that causes twisting or deep flexion of the hip may give you sharp pain.

You may need to take anti-inflammatory medication initially if the impingement has caused significant irritation and inflammation of the tissues. Persistent symptoms should be treated properly to avoid further damage to your hip joint. Physiotherapy can help reduce your symptoms and delay the need for surgery. We will teach you ways to modify your daily activities and manage your pain. Ultrasound, electrotherapy, hip joint mobilisations, soft tissue release techniques and dry needling may be effective here. We will also develop an exercise plan for you to address any muscle weakness or tightness issues to relieve the stress on your hip joint.

Labrum injuries

Our hip joints are made up of the top part, or head, of our femur (thigh) bone and a deep socket known as the acetabulum. Covering the outer part of the acetabulum is a ring of cartilage called the labrum. The labrum helps to deepen and thus stabilise the socket where our femur head needs to move.

The labrum can be damaged in various mays. Femoroacetabular impingement is one example of a labrum disorder and is discussed separately. The labrum can also be torn when there is excessive force at the hip joint, such as when we twist or pivot on our leg. Such an injury can occur once-off with a single, forceful twisting or pivoting movement, or it can tear little bits at a time with repeated movements like these. Direct trauma to your hip like when you fall or have a car accident can also result in a labrum tear. Some people who have childhood disorders of the hip may also have labrum problems later on in life. Women are more likely to suffer from hip problems than men, as well as runners and athletes who need to rotate, twist and pivot on their legs repeatedly.

A torn labrum will alter the way your femur moves within the hip socket and this can result in damage to the joint and joint instability. You will typically experience a dull aching pain at the front of your hip and in your groin. Occasionally pain will be located in the buttock area. You may hear clicking or popping sounds when moving your hip. Your hip might not move smoothly, and can feel stiff or unstable. Pain will commonly worsen with activities such as running, fast paced walking, or stair-climbing. In advanced cases, you may have pain at night.

At Just Physio, we will discuss with you the history of your symptoms and how they came about. If we suspect a possible labrum injury, we will perform a thorough assessment of your hip. Of course, the earlier you seek treatment, the better. Hip labrum disorders should always be treated with physiotherapy first. A labrum injury typically needs 10 to 12 weeks of treatment to fully recover. During this time, you may need to take anti-inflammatory medication to manage your pain.

Our treatment will aim to relieve your pain and encourage healing of the labrum. We can help do this through modalities such as ice and/or heat, ultrasound and electrotherapy, as well as joint mobilisations, gentle stretches and massage to release any surrounding soft tissue stiffness. We will provide you with the proper advice on how to go about your daily living. Thereafter, we will guide you through a progressive exercise program that will help to restore the mobility, stability and strength of your hip and surrounding areas.

If you do not get better within a few sessions, we will refer you to an orthopaedic surgeon for further evaluation. Our aim at Just Physio is to empower people toward healing, and therefore help you get the right treatment. If you need to go for surgery, following up with us to commence your rehabilitation is crucial. Post-surgery rehabilitation will consist of specific exercises to gradually improve your mobility, strength and functionality.

Arthritis

As with any joint, the hip joint can develop arthritis. Pain associated with arthritis typically develops and worsens over time, and is felt most commonly in the groin. You may also feel stiff in or around your hip joint in the morning or after a long time of inactivity. Women have higher incidence of hip osteoarthritis (OA) than men, and the chance of getting OA increases as we age. Sometimes after an injury to the hip, the joint can overreact and cause post-traumatic OA, usually a few years after the actual injury. Other risk factors for developing OA in your hip include obesity, genetics, hip joint abnormalities, high impact sport or occupational exposure, menopause, sedentary lifestyle, and diets low in vitamins D, C and K.

Pain may also radiate to your buttocks, thigh or knee, and you may have pain at night and with cold weather. As hip OA progresses, walking becomes difficult and the movement of your hip can become significantly restricted. However, having arthritis in your hip is definitely not as bad as it sounds, especially if you seek help early. There is so much you can do to manage the pain and stiffness associated with hip OA, and to prevent the progression thereof.

Along with some medical management, physiotherapy is highly effective in the management of arthritis. Firstly, we can help you understand your condition, and teach you ways to manage it. We can help manage your pain through various treatment modalities including electrotherapy, ultrasound, massage, and gentle joint movements. A very important part of our treatment will be therapeutic exercises, or movements, to preserve the integrity of your hip joint. Since the joint is affected, the surrounding muscles, ligaments, and connective tissue must be strengthened and/or stretched to allow better joint movement. We will develop a program suited to your specific needs and goals.

Even those people who will need hip surgery will benefit from a duration of physiotherapy treatment prior to surgery. We will help you improve your hip mobility and strength, as well as improve your full body strength and conditioning to allow for better recovery after surgery. We will prepare you for what to expect with surgery, what to do and what to avoid after surgery, how to get around and do your daily activities and teach you how to walk with an assistive device.

Bursitis

Hip bursitis is when the bursa around the hip joint becomes inflamed, causing pain. The bursa is a fluid-filled sac that protects the joint by providing cushioning for the bony and soft tissue structures around the joint. It allows for smooth movement of muscles, ligaments, and bony structures in relation to one another and even acts as a shock absorber. When the bursa is irritated due to trauma, repetitive friction or pressure, it can become inflamed. There are 3 major bursae that may become inflamed around the hip joint.

Bursitis is a term often used to describe pain around the outer hip region. Diagnosis is complex, and we will take your full history about the onset of your symptoms, as well as do a thorough physical examination. The cause of pain in this area may be multifactorial and not simply inflammation of the bursa. However, if a definite cause is not known, we can still help to relieve your pain and reduce your discomfort.

The pain usually develops over time and your outer hip may feel tender. Typically, the most uncomfortable things to do when you have bursitis is to climb stairs or lie on your affected hip.

Our treatment will initially be focused on reducing your pain. We will achieve this by suggesting ways to modify your daily activities to reduce pain, as well as hands-on treatments such as ice/heat application, ultrasound, gentle massage, or electrotherapy. Stretching and strengthening exercises will be included to address any joint restrictions or muscle imbalances we may find during the physical examination. Generally, a course of physiotherapy is effective in the treatment of hip bursitis. However, if we see that you are not improving with treatment, we will refer you to the appropriate healthcare professional for further management such as a corticosteroid injection.

Post-surgery Rehabilitation

For any hip surgery, the rehabilitation that follows is crucial. If you want to recover fully and be able to use your hip, to move, and to get along with life after hip surgery, you must follow a rehabilitation program. Just Physio offers rehabilitation programs for all types of hip surgery including arthroscopy, fracture fixation and total hip replacements. We also offer pre-operative programs consisting of advice and exercise program that will prepare you for your surgery.

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