PHYSIOTHERAPY FOR HIP PAIN

There are several common causes of hip pain, treatable with physiotherapy

Hip pain is a common complaint that physiotherapists are requested to treat. The cause isn’t always clear and discomfort in this region can hinder a person’s ability to participate in physical activity, as well as performing simple daily tasks. A thorough examination can help determine what is the likely cause, as well as developing an appropriate and effective treatment plan. There are several common causes of hip pain that are described below.

HIP ARTHRITIS (OSTEOARTHRITIS):

This is one of the most common causes of hip pain, especially in the older population. Osteoarthritis means there are changes to the structure of the joint, which can cause pain and discomfort when the joint is loaded (i.e. when weight bearing). It is important to note that arthritic changes are common to see on x-rays. To an extent this is a normal part of ageing and does not always cause pain or dysfunction, but sometimes will lead to issues and when severe can be debilitating.

FEMOROACETABULAR IMPINGEMENT (FAI):

The hip is composed of a ball and socket joint. The ball (femoral head) sits inside the socket (acetabulum). Normally these two fit perfectly within one another, allowing for smooth movement of the ball inside the socket. When there is a mismatch, impingement can occur. This can lead to pain and reduced function of the hip joint. The three main types of FAI’s are:

• Cam: where the ball has an abnormal ‘bump’ on its surface, which rubs against the socket of the hip joint.

• Pincer: where the socket is larger than normal, impeding the freedom of the ball movement.

• Mixed: typically, a combination of the two aforementioned abnormalities.

GLUTEAL TENDINOPATHY:

Tendons are the strong tissues connecting your muscle to bone. A tendinopathy typically develops over an extended period of time, where micro-tears build up and lead to weakening of the tendon. Inflammation can also be present and will also add to pain in the affected region.

TROCHANTERIC BURSITIS:

Many joints in our bodies have little sacs filled with fluid. This sac is known as a bursa. Its purpose is to allow smooth gliding of tendons along its surface. If this bursa becomes inflamed, the smooth gliding mechanism can become compromised, causing pain with movement. Repetitive trauma or overuse are common causes of this issue. This can also be present in conjunction with a tendinopathy.

SCIATICA:

Sciatica refers to pain that is felt anywhere along the path of the sciatic nerve. This nerve runs from your lower back, all the way down to your lower leg (passing your buttock and hamstrings along the way). Hence, irritation of this nerve can present as ‘hip’ pain as the nerve passes along the buttock. Pressure on the sciatic nerve caused by disc bulge is a common

occurrence, as well as facet joint irritation or compression of the nerve from various surrounding structures.

HOW CAN PHYSIOTHERAPY HELP?

Initially, physiotherapists can help distinguish between the potential diagnoses. This will ultimately determine the best course of treatment. Sometimes additional input will be required, such as referral back to your GP to organise an X-ray or ultrasound if it is deemed necessary. This is typically sought, if initial treatment is not very effective. A number of treatments can be utilised to initially reduce pain symptoms. This includes electrotherapy, ultrasound, passive mobilisations or soft tissue massage, as well as simpler modalities such as heat and ice. Additionally, lifestyle advice and education will play a key role in recovery, as sometimes it is certain habits or activities in our daily routine that are part of the problem. Once pain is improved, a gradual increase in physical activity is likely to be incorporated. This will generally be in the form of a specific exercise program, either supervised, to be done at home or both. A variety of the above treatment options can be done in combination. Each person is treated individually and therefore treatment is determined on a case by case basis.

Justin Balbir has a Bachelor of Health Sciences & Masters of Physiotherapy Practice. He has worked for five years as a sports trainer for the Ajax Football Club, with experience in soft-tissue massage & injury management. Justin specializes in manual therapy & sports injuries and may be contacted via website.