The Hip
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The Hip

By October 16, 2014February 3rd, 2023One Comment

Often Mis-diagnosed and left far too long! 

 

The hip is a stable joint, reinforced by strong ligaments, and several powerful groups of muscles. It is much easier to harm the shoulder, knee, and ankle than to injure the hip. Even so, hip problems can be highly disabling.

Daily activities such as walking down stairs, and turning in bed can be uncomfortable or painful for patients with a hip problem. The hip links to the lower extremity kinetic chain, transferring ground-reaction forces from the legs to the trunk.

Some hip problems are due to trauma, while many other conditions are due to overuse or misuse. Muscle imbalance impairs the normal joint function, limiting the functional range of motion. Degenerative and pathological hip conditions can be challenging to diagnose. Many times, patients who complain of pain and discomfort in the lower back, the buttocks, or the legs can be traced to a hip condition. And conditions such as hernia or aneurysm, without an obvious hip connection, may also prompt pain in the hip or groin.

Often, hip disease manifests as pain in the groin radiating all around the thigh and the knee. In such cases, the real challenge is to ensure that the hip and thigh pain is a pathology of the hip, as opposed to intra-abdominal or retroperitoneal pain. The majority of hip conditions are related to biomechanical issues. For example, when a patient strains a knee, and has knee or ankle problems, the gait is affected, causing hip pain. A change in gait may include carrying a baby or small child on the hip. People may also complain of hip pain when they are sitting differently. Basically, asymmetry of motion can cause a hip problem.

Doctors of Chiropractic see many hip conditions develop over a period of time, such as trochanteric bursitis, recurrent muscle strains, Piriformis syndrome, and chronic degenerative changes in the hip joint (degenerative joint disease). Chiropractors have thorough knowledge of hip joint function, its involved muscles, and the adequate exercise regimen to help patients with hip problems.

Hip muscles

 

The hip has many muscles attaching to it.  There is a very close relationship to the lower back vertebrae, sacro-iliac joint, knee and foot joints.
 
Biomechanically when there is hip pain of any kind the lower back, sacro-iliac, hip, knee and foot all need to be examined.
 
Different hip issues
Gentle stretching of specific muscle groups can be performed even right after an injury. Gradual movements of the joint should also be employed in order to prevent the formation of adhesions. In addition, vigorous exercise of the contralateral (opposite) leg muscles helps create a neurological stimulus in the injured muscles that offsets atrophy. In the case of an acute injury with muscle swelling, however, an initial period of rest may be needed.
 
Piriformis syndrome and trochanteric bursitis may benefit from specific stretching exercises. Piriformis syndrome develops when the piriformis muscle inflames the sciatic nerve, causing hip aches down the back of the leg. Treatment should include gentle stretches of the piriformis muscle.
 
Trochanteric bursitis brings pain to the lateral part of the hip. Localized pain in this area indicates the need for stretches to lengthen this segment of connective tissue.
 
Weakened or injured muscles can be strengthened with the use of isotonic resistance exercises from a machine, elastic tubing, weights, or the body’s own weight.
 
Since biomechanical alignment issues are linked with chronic hip complaints, patients must be screened for leg-length discrepancies and pronation (flat feet) of the feet. The failure to address these factors may cause recurring hip complaints, or symptoms in other locations. The lower extremities must be properly aligned to ensure the hip joints work smoothly.  
 
Once the under-lying problems are identified advice can be offered to a patient that will allow them to start living a pain-free life! Many different options are available for treatment and as well for home therapy and changes to life style. These are on a case by case basis.
 
If hip issues are caught early the degenerative changes can be lessened and often avoided!

 

The hip is closely linked to the lower back, sacro-iliac joints and tailbone and is affected by knee and foot motion as well!
Piriformis Syndrome
The piriformis is a muscle that travels behind the hip joint. The piriformis muscle is small compared to other muscles around the hip and thigh, and it aids in external rotation (turning out) of the hip joint. The piriformis muscle and its tendon have an intimate relationship to the sciatic nerve–the largest nerve in the body–which supplies the lower extremities with motor and sensory function. The piriformis tendon and sciatic nerve cross each other behind the hip joint, in the deep buttock. Both structures are about one centimeter in diameter.
 
What do people think happens in piriformis syndrome?
Piriformis syndrome
It is thought that the piriformis muscle tendon may be tethering the sciatic nerve, and causing an irritation to the nerve. While it has not been proven, the theory supported by some physicians is that when the piriformis muscle and its tendon are too tight, the sciatic nerve is choked. This may decrease the blood flow to the nerve and irritate the nerve because of pressure. 
 
What else may be causing this pain?
Sometimes referred to as “deep buttock pain,” other causes of this type of pain include: spine problems – including herniated discs, spinal stenosis, sciatica, and tendonitis. The diagnosis of piriformis syndrome is often given when all of these diagnoses are eliminated as possible causes of pain. 
 
Other signs of piriformis syndrome include examination manoeuvres that attempt to isolate the function of this muscle and the finding of pain directly over the tendon of the piriformis muscle. 
 
Is there treatment for piriformis syndrome? Yes!
Some treatment suggestions are: 
  • Chiropractic adjustments – for the vertebrae, hips, and sacroiliac joints
  • Physical Therapy – Emphasis on stretching and strengthening the hip rotator muscles 
  • Rest – Avoid the activities that cause symptoms for at least a few weeks 
  • Anti-Inflammatory Medication – To decrease inflammation around the tendon 
  • Active Release Technique – is very beneficial for the muscles, nerves, tendons, ligaments.
  • Massage – A general Swedish massage is helpful
  • Acupuncture – is very helpful for decreasing pain and promoting the healing response.
  • Interferential current therapy – sends electrical impulses in to heal the muscle, decrease pain and reduce inflammation
The Hip Anatomy
There are many muscles in the hip! 
Hip stretching
 
 
Bursitis of the hip
Hip bursitis is a common problem that causes pain over the outside of the upper thigh. A bursa is a fluid filled sac that allows smooth motion between two uneven surfaces. For example, in the hip, a bursa rests between the bony prominence over the outside of the hip (the greater trochanter) and the firm tendon that passed over this bone. When the bursal sac becomes inflamed, each time the tendon has to move over the bone, pain results. Because patients with hip bursitis move this tendon with each step, hip bursitis symptoms can be quite painful. This can be treated, ask us how!
 
Daily Activities to avoid; ensuring that hip problems do not happen:
• Sitting on a wallet
• Carrying a child on your hip
• Sitting with your legs crossed at the knees
• Sleeping on your stomach
• Sleeping on your side without a pillow between the knees
• Driving with your foot rotated on the gas pedal
• Sitting at your desk without a foot stool
• Not using back support when sitting
 

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