HIPS

Overview:

The hip is a ball (femoral head) and socket (acetabulum) joint. Unlike the shoulder, the hip joint has more bone to bone congruency, leading to stability and better weight-bearing ability. However, with the additional stability, the hip loses mobility, and there is much less freedom of movement than the shoulder joint.

The hip complex is more complicated than the bony anatomy would suggest. During weight-bearing activities (walking, running, etc.), forces are transmitted through the kinetic chain, starting when the foot hits the ground, through the knee, hip, pelvis, and lumbar spine. Movement dysfunction and muscle imbalances throughout the entire lower extremity can play a significant role in hip disorders. Often, hip disorders occur in combination with other issues – patellofemoral knee pain, lumbar pain, and more.

Because of the complexity of hip disorders and the multiple factors that can play a role in hip dysfunction, your medical providers should perform a comprehensive evaluation of the entire kinetic chain. Many common hip disorders can be treated conservatively through the application of a specific physical therapy plan. A Foothills physical therapist will complete a comprehensive evaluation to determine the musculoskeletal causes of your hip injury.

Common hip injuries:

 

Muscle Imbalance/Muscle Strain: 

Many large and small muscles are classified as “hip joint” muscles susceptible to imbalance due to weakness or faulty movement patterns over time. Often, this muscle imbalance leads to pain. Examples of this include: 

• Piriformis Syndrome

• Hip Flexor Strains

• IT Band Syndrome (greater trochanteric bursitis)

• Anterior Hip Pain

• Posterior Hip Pain

• Lateral Hip Pain

• Hamstring Strains

• Quadriceps Strains

• Gluteal Strains

 Physical therapy will look at the entire kinetic chain from the foot to the hip and include evaluation of core strength. Appropriate activity modification, patient education, and patient-specific exercises will be a part of your rehab program, the goal of which is to restore proper movement patterns during functional activities. Additionally, your therapist will be evaluating you for inorganic sources of your hip pain because other structures can refer pain to the hip region.

 

Hip Impingement/Labral Tears:

The labrum in the hip is a ring of fibrocartilage that surrounds the acetabulum rim, effectively deepening the hip socket and, in combination with the fibrous joint capsule, creating negative pressure (suction) in the hip joint. For various anatomic and/or movement reasons, the labrum can become repetitively pinched (impinged) and subsequently damaged. This impingement and subsequent damage of the hip labrum can often become a source of anterior hip pain, posterior hip pain, and groin pain, and it can severely limit function. A goal of physical therapy is the restoration of normal movement patterns and the reduction of muscle imbalances. Your physical therapist will also look at biomechanics to identify any contributing factors to the condition.

• Hip Arthroscopy: An area of orthopedics that has exploded within the last 8-10 years with arthroscopic technology advancements. The surgeon will enter the hip joint arthroscopically to remove bone on the femoral neck, debride damaged tissue and repair the hip labrum using bioabsorbable anchors. Physical therapy following hip arthroscopy follows specific pathways geared towards protecting the repair, restoring normal movement, and a gradual increase in function.

 

Osteoarthritis:

Osteoarthritis (OA) of the hip is a medical condition referring to “wear and tear” arthritis. OA can become extremely painful in the hip, limiting the ability to walk and perform weight-bearing activities. Often, OA of the hip is characterized by significant stiffness of the ball and socket. Therefore, conservative management of hip osteoarthritis can include physical therapy, including joint mobilization and manual therapy to maximize joint accessory motion. The PT will also work with the patient to restore movement and address faulty movement patterns and muscle imbalances.

• Total Hip Arthroplasty (THA): A surgical procedure in which the ball and socket, or the ball only, are removed and replaced with a prosthesis. Various surgical approaches to the hip and advancements in technology have led to muscle-sparing techniques, minimizing hip precautions and postoperative morbidity. Post-operative physical therapy in the hospital will focus on mobility (in and out of bed, chair, and walking) and patient education on precautions. Generally speaking, patients that have undergone a hip replacement feel an immediate reduction in the pain they suffered from before surgery. Outpatient physical therapy will continue with strengthening and improving functional mobility.