HIP PAIN
Although not as common as knee pain, hip pain affects many individuals from young to old. Arthritis and fractures are more commonly associated with the elderly, while injury and overuse are more commonly associated with athletes. Hip pain can be caused by a wide variety of problems, and the location of your symptoms can provide valuable information about the underlying cause.
Lateral Hip Pain and Conditions
Iliotibial Band Syndrome (ITBS)
This syndrome occurs when the wide, tough band of tissue that extends from the outside of your hip to the outside of your knee (iliotibial band) becomes so tight that it rubs against the outer portion of your hip bone as well as the insertion point on the lateral knee. Marines in training (20%), distance runners (12%), and cyclists are especially susceptible to iliotibial band syndrome.
Symptoms can be in the lateral thigh, lateral knee, or both. A snapping sensation may also be felt. Many people confuse this lateral pain with hip arthritis or hip joint pain, which most often causes pain to the inside of your hip or groin and not over the outside of the hip.
Symptoms
Hip pain: Your iliotibial band repeatedly rubs against your greater trochanteric in your hip. Your greater trochanteric is where the bone widens near the top of your femur. The friction causes inflammation in your tendon and pain in your hip. You might hear a snapping sound over the greater trochanter.
Knee pain: Occurs in 25% of adults. Your lateral epicondyle is on the outside of your knee near the bottom of your femur, where the bone widens. Your tense iliotibial band repeatedly rubs against your lateral epicondyle of the knee when you flex and extend your knee. The friction causes inflammation in your tendon and pain in your knee. The outside of your knee might look discolored and feel warm to the touch. You might feel a snap, pop or click on the outside of your knee.
At first, the pain will start after you exercise. As the syndrome worsens, you’ll feel it before and after you exercise, and ultimately the entire time you exercise and, eventually, also when you’re resting.
Elite Physical Therapy & Sports Medicine’s Treatment
Restoring normal tissue extensibility and mobility of the Iliotibial band are key, as well as improving the stability of the hip. Identifying the source of tightness (which can also be caused by the other side of the body) through Applied functional science is also considered. Excessive foot pronation and hip abductor weakness can be contributing factors for ITBS that can be evaluated.
Graston, Dry Needling, Kinesiotaping, and manual therapy are all helpful with this condition. We also offer lower extremity compression therapy that is beneficial in improving blood flow and returning the muscle to its normal tissue extensibility.
For runners who need to continue to train for their upcoming race and can’t afford to stop training, our AlterG is perfect for unloading stress to the iliotibial band while avoiding further injury.
Trochanteric Bursitis
Another condition that creates lateral hip pain is Trochanteric Bursitis. Similar in location to lateral hip pain caused by ITBS, this pain is associated with the lateral bursa located between the greater trochanter (bone) and the iliotibial band. A bursa is a fluid-filled sac located near a joint that helps with lubrication and movement. When the bursa becomes inflamed or irritated, it causes pain.
Common Causes
- Trauma or injury: Falling onto the outside hip, bumping into an object, or lying on one side for an extended period of time
- Recreational or Overuse Injury: Repetitive running up the stairs, climbing, or standing for prolonged periods of time
- Poor Posture: Scoliosis, arthritis, and other spine issues associated with the lumbar spine
- Surgery: Previous surgery around the hip or after total hip replacement
- Deposits: Bone spurs or calcium deposits that attach to the trochanter
Symptoms
- Pain on the outside hip, thigh, or buttock
- Pain when lying on the affected side
- Pain with palpation to the outside hip
- Pain with activities such as stairs, getting up out of a chair and getting out of a car
Elite Physical Therapy & Sports Medicine’s Treatment
As with ITB Syndrome, restoring normal tissue extensibility and mobility of the Iliotibial band is important, as well as improving stability of the hip and reducing irritation of the bursa. Identifying the source of irritation thru Applied functional science is also considered. Excessive foot pronation and hip abductor weakness can be contributing factors for Trochanteric Bursitis similar to ITBS.
Graston, Dry Needling, Kinesiotaping, and manual therapy are all helpful with this condition. We also offer lower extremity compression therapy that is beneficial in improving blood flow and returning the muscle to its normal tissue extensibility. Injections from MD may also be beneficial.
For runners who need to continue to train for their upcoming race and can’t afford to stop training, our AlterG is perfect for unloading stress to the lateral hip and trochanteric bursa while avoiding further injury.
Tears of the Gluteus Medius and Minimus
Tears of the gluteus medius and gluteus minimus are common causes of chronic lateral hip pain, with gluteus medius tears affecting up to 25% of late-middle-aged women and 10% of middle-aged men. Due to the vagueness of symptoms, tears are often misdiagnosed and may be found incidentally during fracture fixation or hip arthroplasty. While the cause remains unclear, tears are generally believed to be degenerative in nature, particularly at the insertion site of the tendon onto the trochanter. The majority of these patients have a long history of lateral hip pain. Acute traumatic tears in asymptomatic patients are extremely rare.
In most cases, chronic injuries are far more common than acute tears. Because of the nonspecific and slowly progressive symptoms, patients are often misdiagnosed with radiculopathy, osteoarthritis, or trochanteric bursitis. Patients typically present to the clinic with an insidious onset of dull pain over the lateral hip.
Symptoms
As described above, gluteus medius and gluteus minimus tears most often present with pain on the outer side (lateral aspect) of the hip. Pain is progressive in nature, and most patients have a long history of pain. This pain is aggravated by increased activity, such as walking, going up and down stairs, or direct pressure applied to the side of the hip, such as when lying on the side of the hip. In more severe or chronic cases, a limp may develop.
Elite Physical Therapy & Sports Medicine’s Treatment
Many gluteus medius and minimus tendon tears can be treated using non-surgical measures, including activity modification, non-steroidal anti-inflammatories, and physical therapy. In some situations, an injection next to the tendon may be helpful in relieving symptoms. In severe cases where none of these treatments are able to resolve the pain and a full-thickness tear is present, the tendon can be repaired surgically using either open surgery or endoscopic surgery (minimally invasive).
Manual techniques such as Graston Technique, Cupping, and Cross Friction Massage can be helpful in reducing pain. Dry Needling can also be effective. Stretching and Strengthening will help maintain the hip’s mobility and stability.
Anterior Hip Pain and Conditions
Iliopsoas Conditions
The iliopsoas muscle is the strongest hip flexor muscle in the body and also assists in the external rotation of the femur. While playing an important role in maintaining the strength and integrity of the hip joint, the iliopsoas muscle also acts as a stabilizer of the lumbar spine and pelvis.
Pathologic conditions of the iliopsoas have been shown to be a significant cause of hip pain and/or dysfunction and include asymptomatic tendonitis, bursitis, and impingement. Other symptoms associated with the iliopsoas muscle can be low back and gluteal pain, intense groin pain particularly in the athletic population, as well as anterior thigh and knee pain.
Iliopsoas tendinopathy refers to a condition that affects the insertion of the muscle on the femur and can occur with repetitive hip flexion and biomechanical issues resulting in chronic degenerative changes of the tendon.
Iliopsoas bursitis and Iliopsoas tendon inflammation have similar symptoms of gradual onset pain deep in the groin. The bursa is a small sack of fluid that reduces friction between the tendon and bone.
Iliopsoas impingement, also known as an internal snapping hip syndrome, is a condition characterized by inflammation and pain in the iliopsoas muscles resulting in abnormal movement of the hip.
Symptoms
- Hip pain
- Difficulty in walking
- Groin pain
- Popping sensation in the hip
- Tightening of the hip muscles
- Inflammation
- Muscle weakness
Elite Physical Therapy & Sports Medicine’s Treatment
Dry Needling can be very effective in treating the above conditions. Stretching and manual therapy would also be included in the treatment of this condition. Assessing any abnormal body biomechanics through applied functional science can also be helpful in determining the cause of the impingement or tendinopathy.
Hip Osteoarthritis and Total Hip Replacement
Osteoarthritis, also known as degenerative joint disease (DJD), is the most common type of arthritis, affecting millions of people worldwide. The changes in osteoarthritis usually occur slowly over many years and are more likely to develop as people age.
Although symptoms can be managed, damage to the joint cannot be reversed. Inflammation and injury to the joint cause bony changes, deterioration of tendons and ligaments, and a breakdown of cartilage, resulting in pain, swelling, and deformity of the joint.
There are two main types of osteoarthritis:
Primary: Most common and primarily affects the fingers, thumbs, spine, hips, knees, and the big toes.
Secondary: Occurs with a pre-existing joint abnormality from injury or trauma, such as repetitive or sports-related; inflammatory arthritis, such as rheumatoid, psoriatic, or gout; or from genetic joint disorders, such as Ehlers-Danlos
Symptoms
- Pain: Typically anterior, groin-type pain. Affected joints might hurt during or after movement.
- Stiffness: Joint stiffness might be most noticeable upon awakening or after being inactive.
- Tenderness: Your joint might feel tender when you apply light pressure to or near it.
- Loss of flexibility: You might not be able to move your joint through its full range of motion.
- Grating sensation: You might feel a grating sensation when you use the joint, and you might hear popping or crackling.
- Bone spurs: These extra bits of bone, which feel like hard lumps, can form around the affected joint.
- Swelling: This might be caused by soft tissue inflammation around the joint.
When to see a Doctor or Physical Therapist
It is best to see a physical therapist when you first start to experience any hip pain in hopes to decrease pain and prolong life of the hip joint. If the pain becomes more severe and interferes with normal life, you should see your physician and get x-rays. If severe enough, a total hip replacement will likely be recommended. Expect to begin rehabilitation 2 days following your hip replacement.
Elite Physical Therapy & Sports Medicine’s Treatment
Restoring joint mobility and hip flexibility in a pain-free range is optimal. In addition to reducing pain, strengthening the surrounding hip musculature is key. Increasing strength and stabilizing the joint can help reduce pressure and stress on the arthritic joint, Dry Needling can also help reduce pain.
Posterior Hip Pain and Conditions
Piriformis Syndrome
The piriformis is a flat, narrow muscle that runs from the lower spine descending under the sacrum and attaches superiorly near the greater trochanter. Your piriformis muscle aids in almost every movement of your lower body.
The Sciatic Nerve, the longest and largest nerve in the body, most commonly runs underneath the piriformis muscle. In 15-20% of people, the sciatic nerve runs through the piriformis muscle, making these people more prone to this syndrome.
Symptoms
Mistakenly diagnosed as sciatica originating from the spine, piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks.
Pain can be severe and extend down the length of the sciatic nerve, creating sciatica. The pain is due to the piriformis muscle compressing the sciatic nerve, such as while sitting or running.
Pain may also be triggered while climbing stairs, applying firm pressure directly over the piriformis muscle, or sitting for long periods of time.
Elite Physical Therapy & Sports Medicine’s Treatment
Stretching and deep-pressure manual therapy has been successful in treating this condition. Dry Needling has also been quite successful. Restoring normal mobility and stability to the hip is essential.
Sacroiliac Joint Pain
Also described as low back pain, sacroiliac (SI) joint pain is typically very specific in location and in its symptoms. It can originate from inflammation (sacroiliitis), arthritis, or mal-alignment/dysfunction.
Sacroiliitis: The inflammation of one or both of the sacroiliac joints. These two joints are located where the sacrum (the triangular last section of the spine) meets the ilium (a part of the pelvis).
Sacroiliitis is a common source of lower back pain or pain in the buttocks or thighs. It is estimated that between 10-25 percent of people who report low back pain may have sacroiliitis.
SI Joint Dysfunction: The SI joint can become painful when the ligaments become too loose or too tight, in addition to when the muscles become too tight or too weak. This can occur as the result of a fall, work injury, car accident, pregnancy, childbirth, or spine surgery (laminectomy, lumbar fusion).
Sacroiliac joint pain can occur when movement in the pelvis is not the same on both sides. Uneven movement may occur when one leg is longer or weaker than the other or with arthritis in the hip or knee problems. Due to the ligament and muscle imbalances, the pelvis can shift or become out of alignment, creating pain in the SI joint area.
Symptoms
The signs and symptoms of SI pain start in the lower back, buttocks, and groin. While the pain is usually one-sided, it can occur on both sides. Symptoms may worsen with sitting, standing, and transitional movements, such as getting up from a seated position or climbing stairs. Pain can vary throughout the day as well as day-to-day as the SI joint moves in and out of alignment.
Elite Physical Therapy & Sports Medicine’s Treatment
Addressing the body’s muscle tightness and weakness, along with any ligament and fascial restrictions, is essential. The use of Graston Technique, cupping, and Dry Needling can help reduce tightness, and a core strength program along with Applied Functional Science can help address the muscle tightness and ligament restriction. If the ligaments are severely stretched and loose, it may be difficult to maintain normal alignment, and fusion may be necessary if pain is too great.