The hip joint is an important connector of the spine and pelvis to the lower extremity. It is one of the most stable but mobile joints in our body, with seven movement directions, and a huge role in weight transfers. The head of the femur has a ball shape, which fits into the socket-shaped acetabulum of the pelvis, with lubricating synovial fluid and smooth cartilage surrounding both structures for easy movement. The labrum of the acetabulum is a ring of cartilage that deepens the socket to increase stability and acts as a shock absorber. A strong fibrous capsule and ligaments support the whole joint. There are many conditions and injuries involving the hip, including hip impingement and labral injuries, osteoarthritis, hip bursitis, and tendinopathies, which will be briefly outlined below.
Hip impingement, otherwise known as Femoral acetabular impingement (FAI), is a condition where the femoral head pinches against the acetabulum of the hip, causing friction and compression of the labrum and cartilage. This contact is due to abnormal morphology of the femur and/or the acetabulum, which can present as anterior hip and groin pain, decreased mobility, and painful walking and/or prolonged sitting. These symptoms are often position or motion-related, and hip flexion and internal rotation are most aggravating. If the cartilage is disrupted, labral tears can occur. This fraying and damage can be due to traumatic causes such as dislocation/subluxation and falls, or degenerative causes such as repetitive hip motions and structural abnormalities (i.e. FAI). Symptoms are similar to FAI and include a constant dull ache made sharp with increased activity, a deep pressure sensation, and a click or locking sensation. Conservative treatment, including physiotherapy, is usually the first line of treatment, as there is limited evidence that surgery is more effective for reducing symptoms. However, physiotherapy can reduce pain, improve hip mechanics, stability, strength, and gait, and is essential for recovery post-operation if surgical treatment is required.
Osteoarthritis (OA) of the hip is a degenerative condition that leads to structural changes such as thickening of the subchondral bone, osteophyte formation, inflammation, and cartilage degradation. As a result, a loss of joint space occurs, resulting in painful and functionally limiting symptoms such as pain in groin and thigh regions, pain with weight-bearing, morning stiffness, decreased mobility, and popping or crackling sounds. OA is most common in populations over 50 years of age. Treatment is initially conservative, with physiotherapy to improve strength, mobility, pain, and function. If conservative treatment is unsuccessful, total hip replacement surgery may be required, and physiotherapy is crucial for post-operative rehabilitation.
Hip bursitis is a condition where there is inflammation of the bursa, a fluid-filled packet that decreases friction of tendons on bones. There are three main bursae in the hip: trochanteric (lateral hip), iliopsoas (anterior hip), and ischial (posterior hip). Inflammation of the bursa is typically due to irritating repetitive movements or direct trauma to the bursa region. Symptoms include pain and tenderness in the region of the bursa, snapping with movement, and pain with specific hip movements. Treatment is conservative, and physiotherapy will reduce pain, correct irritating movement patterns, provide preventative strategies, and improve hip strength and mobility.
Tendinopathies of the hip are irritation and/or inflammation of the muscular tendons that insert into or cross over the hip joint. The hamstrings, adductors, and hip flexors are the most common muscle groups susceptible to tendinopathies in the hip. Overuse, a sudden increase in activity, or impaired strength of these muscle groups can lead to degeneration and injury of the tendon, which presents as pain with activity and tenderness. Physiotherapy treatment includes pain reduction, activity modification, manual therapy to improve mobility, and strengthening exercises.
If you have hip pain, book in to see a licensed physiotherapist who will assess your injury or condition and provide effective treatment that is based on the most recent evidence and literature.