Hip pain management

Hip pain and disability are common and have a telling impact on our community particularly around the Perth Hills area with its undulating terrain. Significantly curtailing the living quality and life expectancy of many residents.

A painful hip invariably requires considerable scanning, a multitude of medical appointments and ultimately a high likelihood of invasive surgery. An accurate diagnosis can be complicated by the often co-existing conditions of hip arthritis, hip tendinopathy and bursitis, as well as back and pelvic pain. Further, there is increasing evidence that hip surgery does not always lead to the anticipated outcomes that patients expect. In contrast, exercise therapy for the hip is non-invasive, cheap, virtually complication free and associated with high levels of patient satisfaction and functional improvement.

Teasing out which structures and to what extent each is involved in hip pain is complex. Despite significant advances in medical technology and diagnostic imaging, this has not always lead to meaningful improvements in patient outcomes. This is in no small part due to the overwhelming reliance on those technologies to direct treatment when it is the patient and not the condition that requires the attention. The critical point is that physicians need both the time and skill to interview the patient and perform an advanced physical examination followed importantly with a discussion with the patient and options for any intervention.

Hip tendon and bursa pain

Any pain radiating along the side of the hip and thigh is almost invariably hip tendon and bursa in origin. It is now known that the bursitis component of the condition is a symptom of the condition and that the gluteal tendon damage is the main pathology. It affects 1 in 4 females and has the same impact on life quality as an arthritic hip. The condition is related to hip (gluteal) tendon damage and weakening of the hip muscles. The pain eventually affects the person’s ability to walk, climb stairs and sleep.  It is distinguished from back pain in which the spreading ache typically runs down the back of the leg, or hip joint pain which shows itself in the groin area. The key signs are:
  • Ache running down the side of the thigh rarely past the knee
  • Difficulty lying on the side, getting out of chair, walking
  • Standing or sitting still often annoys it
  • Tender around the point of the hip on the side of the thigh
  • Feelings of weakness in the leg or imbalance causing a characteristic waddle with walking

How to manage gluteal and bursa hip pain-the top 5 tips:

  1. Sit with cushions under your bottom to sit higher and do not cross your legs;
  2. Use pillows between your knees when lying and if the pain is sharp in nature use ice; otherwise use heat if the pain is an ache;
  3. Try and adopt a symmetrical stance position and prop your foot up on a support
  4. Use a stick in your opposite hand if you limp and try to shorten your steps
  5. Strengthen your hip muscles initially in lying and then progress to upright positions

Top 5 exercises

Hip Roll Outs
Straight leg raise
Hip bridge

Side lie leg raises
Bent knee clams

Groin pain

Depending upon the age of the patient, anecdotal clinical evidence suggests that groin pain could either represent hip joint pathology or a collection of non-degenerative conditions (adductor muscle strain, early direct hernia and abdominal wall strain, osteitis pubis) in the older or younger patient, respectively. Hip joint pathology could further be divided into degenerative and non-degenerative conditions. A degenerative hip will be asymptomatic in about half of that population and often lead to unnecessary hip surgery.Scanning the hip will often reveal joint changes in the older population but not necessary how inflamed or reactive the joint is.

With ageing, the hip joint will demonstrate normal time-related alterations to its anatomy. Whereas a discreet lesion in the hip joint can often be related to the patient’s symptoms through careful clinical testing, more generalised degenerative changes often cannot. The hip will sometimes react to an increase in demand as does all tissues of the body. Directing a patient with an inflamed painful hip joint through a course of hip care and careful controlled movement will allow healing and functional recovery. This process should be aided with adequate pain control methods to allow early intervention to limit the effects of deconditioning and prolonged pain.

Top 5 tips for dealing with hip/groin pain in the mature patient:
  1. Avoid low chairs and sit with pillows under your bottom to open the angle of your hip joint;
  2. Practice getting out of a chair with your knees apart and a straight back to improve the strength of the hip muscles;
  3. Shorten your steps with walking to avoid over-stretching your hip;
  4. Use heat combined with gentle movement exercises in lying to promote early recovery;
  5. A pillow between your knees at night prevents compression of your hip joint.

Spine related hip pain

The lower back can spread pain in predictable patterns depending upon the level of the lumbar/sacral spine that has been injured. Generally, the lower the injury in the spine the more likely it will refer down the back of your buttock and thigh, whereas groin and anterior thigh pain will often originate in the upper lumbar spine. Often the spine is suspected as the source of the hip pain when stressing this area in the patient reproduces their hip pain whereas stress testing the hip does not. Hip pain referred from the spine will often be severe and unremitting and less well localised by the patient.

Top 5 tips for dealing with hip pain referred from the spine:

  1. Reduce any prolonged and sustained sitting and bending activities;
  2. Use your legs to pick up objects and stiffen your spine by tightening your stomach muscles;
  3. Find a comfortable position, usually on your side with pillows between your knees and use a heat pack on your spine;
  4. Perform gentle back and pelvic rolling exercises in the opposite direction to that which creates your hip pain;
  5. Strengthen your spine with gentle lower abdominal and pelvic floor exercises.

Top 5 exercises for back-related hip pain

Pelvic roll into a slight arch in your back
Cobra roll ups
Angry cat
All fours opposite arm and leg

Knee rolls

The core spine strength dilemma

For many years health professionals and others in the health industry heavily promoted the many benefits of a strong core around the spine and pelvis. Unfortunately this strategy has not lead to any meaningful change to the incidence of spine and pelvic pain.

There are a number of core muscle exercises documented in the health literature that are simply too heavy and unsafe particularly in the susceptible patient. Controlled mindful movement, behaviour modification, and functional conditioning are elements that promote better patient compliance and more lasting benefits. Although the exercises are less dramatic than isolated core exercises they nonetheless allow smoother progressions with greater body awareness.