Your hip is an articulation between femur and acetabulum (part of the pelvis). It is classified as a ball and socket joint, therefore it can move in multiple directions. The hip is stabilised in and around the joint by muscles, cartilage, and ligaments to stop it from dislocating.
Hip injuries or conditions are normally due to changes in the joint (ie OA), altered gait pattern or high impacted incidents. Some of theses conditions may require surgery as well as Physiotherapy to treat them.
Hip replacements are the second most common joint replacement after knees, which are regularly performed due to osteoarthritis, rheumatoid arthritis, fractures, aseptic necrosis, or avascular necrosis. All of these conditions can cause chronic pain on normal activities and impede on walking, climbing stair, standing from a sitting position and sporting activities.
As this procedure is often an elective surgery, your surgeon will suggest you prepare your body to be at his optimum condition prior to the hip replacement to make recovery easier. Therefore they will suggest you see a Physiotherapist once you have decided on an operation date to provide you with home exercise programme to improve or maintain your range of movement and strength around your hips. The Physiotherapist will also provide you with information regarding equipment you will need after the operation, alterations you may require in your home, hip precautions after the hip replacement and practice the use of elbow crutches to assist with mobility and stairs.
After the operation you will normally stay in hospital for 2-4 days and will see a Physiotherapist daily who will ensure you can mobilise safely with 2 elbow crutches, climb and descend stairs, transfer on and off chair and bed, and are confident with home exercise programme before being discharged. You will then see your Physiotherapist at home or in clinic to progress the exercises and to walking unaided, they will also advise you when you no longer need to follow hip precautions and can return to sporting activities. They may suggest water based exercises if you are struggling with certain movements of the hip or regaining a normal gait pattern.
Your Physiotherapist will be in communication with your consultant at 6 weeks and 3 months post operation to inform them of your progression and any concerns if present, which is when you will have a review with your consultant.
Hip arthroscopy is being more widely used to preserve the hip joint before someone is required to undergo a total hip replacement. As orthopaedic consultants readily tell me “the joint you were born with will always be the best joint to have”.
Hip athroscopy is a procedure that involves small incisions around the hip to insert a camera and instruments to perform shaving, trimming, cutting, stitching or smoothing the damaged area. These changes could be labral tear, hip impingement, articular cartilage injuries or loose bodies. Less common procedures performed through athroscopic technique are ligament or tendon repair, for hip instability, or inflamed or damaged synovium.
Most of the time these procedures are performed as a day case, which means you can return home the same day. You will be discharged by the nursing staff once they feel you have recovered from the surgery and you have seen the Physiotherapist. The Physiotherapist will provide you with post-operative instructions and an exercise programme to start at home. They will also provide you with elbow crutches if your surgeon has informed them that you are not fully weight bearing.
Your surgeon will recommend that you have Physiotherapy after the procedure and depending on your procedure your Physiotherapist will progress your exercise programme and mobility status. These exercise programmes will be dependent on your surgery, goals, sporting activity and limitations after the surgery to ensure you make a full recovery to pre-injury and/or pain.
Lateral hip pain can be due to many different reasons:
Greater trochanteric pain
This includes greater trochanteric bursitis and gluteus medius pathology. Many diagnosis of trochanteric bursitis when the patient was MRI scanned actually showed a tear in gluteus medius, which has similar symptoms. These include pain on the outside of the hip or thigh and in the buttocks, pain on lying on affected side and on palpation, pain gets worse on activity such as standing from a deep chair or walking up the stairs. Trochanteric bursitis is caused by injury to that area of the hip such as falling on to the hip, overuse injury during work or sporting activity, incorrect posture, stress on the soft tissues, previous surgery on the hip, bony spurs or calcium deposits, or other pathology such as osteoarthritis, gout, rheumatoid arthritis or infection. On the other hand, gluteus medius pathology can be a tendon tear or tendinitis.
These can be diagnosed by a specialist hip consultant or physiotherapy, but a MRI scan can assist with this diagnosis.
Iliiotibial band syndrome
This is an overuse injury between the thigh and knee, as your iliotibial band runs alongside the lateral aspect of your leg. You can commonly get this problem from running, cycling or activities which involving repetitive squatting action.
Most people complain of pain around the outside of the knee around the area on attachment, but occasionally it can radiate up the thigh into the hip area resulting in lateral hip pain. They normally have these symptoms on heel strike.
This can be diagnosed by examination by your consultant or physiotherapist who will also examine your lower back and feet to see if there are any contributing factors away from the symptomatic areas. Your consultant may also send you for a MRI scan to observe where the inflamed areas around your knee and rule out any other knee pathology or injury.
This is caused by injury to your lateral femoral cutaneous nerve of the thigh, which commonly is caused by entrapment or compression as it passes via the ilium or inguinal ligament that are situated at the front of your hip. This will cause constant pain over the lateral side of your thigh, and the area is more sensitive to soft touch and it has changes in sensation in the area such as burning, tingling or numbness.
Diagnosis of this problem is largely based on information you provide to your consultant or physiotherapist and sensory differences between your legs in the symptomatic area. They will also perform an assessment on the pelvis and abdomen to exclude any other pathologies.
All of the above pathologies can be treated with Physiotherapy which will include manual therapy, specific exercise programme to alleviate your symptoms and stop reoccurrence of symptoms, and advise in regards to returning to your sporting activity. They may refer you to other healthcare professionals as appropriate if it is necessary to ensure full recovery from your problem.
Your hip consultant will call it Femoroacetabular impingement or FAI, as these are the two structures that are involved in the impingement syndrome. It is normally caused by the femoral head and acetabulum not fitting well together resulting in damage to the joint.
Impingement syndrome can be divided into three groups:
- Pincer – This is when extra bone extends from the rim of the acetabulum causing impingement on the labrum.
- Cam – The femoral head is not round and it can move smoothly inside the acetabulum resulting in bump forming on the formal head that rubs against the cartilage inside of the acetabulum.
People will often complain of hip stiffness especially into hip flexion, adduction and rotation. You will also get pain on these movements as well and usually felt in your groin but not excessively.
This problem can be treated conservatively with Physiotherapy and anti-inflammatories to improve range of movement, muscle strength and pain. Your Physiotherapist will assess your hip and adjacent joints to diagnose the underlying problem and any contributing factors. They will then tailor an exercise programme to your symptoms and provide you with advice regarding activities that you want to continue or return to.
If the symptoms progressively get worse due to changes in hip joint, your Physiotherapist will recommend you seek further investigation and/or intervention from a specialist hip consultant. They will perform appropriate radiological investigation to understand what type of impingement you have and how much it is affecting the soft tissue around and in the joint. Your consultant may recommend a hip arthroscopy to alleviate your symptoms, but they will advise that you have physiotherapy after this surgery to ensure that you gain full recovery to your normal activity level.
- Tailored exercise programmes
- Trigger point release
- SNAGs, NAGs and MWMs
- Postural re-education
- Gait re-education
- Manual therapy
- Soft tissue release