Learn About Your Hip
A hip injury and pain can make it hard to walk, go up and down stairs, squat, or sleep on the side that hurts.
Check out this great 3D anatomy tutorial on YouTube by AnatomyZone. It has lots of detail if that’s what you like!
Otherwise, below is a summary of the basic anatomy of the hip:
The hip joint is a ball and socket joint, formed by an articulation between the pelvic acetabulum (socket) and the head of the femur (ball).
It forms a connection from the lower limb to the pelvic girdle, and thus is designed for stability and weight-bearing – more designed for walking on than having lots of movement like your shoulder does.
Source: https://teachmeanatomy.info/lower-limb/joints/hip-joint/
There are thick ligaments surrounding the hip joint, along with a joint capsule that is dense fibrous tissue that surrounds the entire hip joint.
Lastly, there is a fibrocartilage labrum that sits on the outside parts of the socket which is 2-3 mm thick. It helps to increase the hip joints stability, aids in shock absorption and decreases the contact stress in the joint.
Your hip is designed to flex up, extend back and rotate outward and inward.
The hip ligaments and thick capsule limit the amount of mobility of the hip, along with the main muscles ie hip flexors.
Your hip needs to be able to walk, run, jump, squat, lunge and twist, all the time taking the load of your body weight. It is an impressive joint!
Take Home Message
The Hip Joint is a ball and socket joint, formed by an articulation between the pelvic acetabulum (socket) and the head of the femur (ball).
Your hip is designed to flex up, extend back and rotate outward and inward.
The hip is designed for stability and weight-bearing, it’s a very sturdy joint.
Traumatic Hip Injuries
The hip is prone to several types of injuries. Sometimes these happen in otherwise healthy joints – an automobile accident or fall breaks a bone or forces the femoral head out of its socket, or a sports injury.
In other cases, joints compromised by congenital deformities or osteoporosis, for example, leave the hip vulnerable to injury upon the slightest trauma. The following are some of the more common hip injuries.
A sudden (acute) injury may occur from a fall on the hip, a direct blow to the hip or knee, or abnormal twisting or bending of the leg. Examples of acute injuries that may cause hip pain include:
A broken hip (hip fracture) or pelvis (pelvic fracture)
A broken hip, or hip fracture, can occur at any age, but they are most common in people age 65 and older, particularly women, with osteoporosis. In a younger person with healthy bones it may take a serious injury, such as a car accident, to break a hip, but when osteoporosis weakens bones, even a minor fall can result in a fracture.
A dislocated hip or sprained hip
A dislocation occurs when the ball at the top of the femur slips out of the socket, causing severe pain and inability to move the leg. It usually takes a strong force – from an automobile accident or severe fall, for example – to cause a dislocated hip.
Being born with a shallow hip socket or hip displasia (a congenital deformation of misalignment of the hip joint), however, makes dislocation more likely. Often the ligaments about the hip are damaged if a hip becomes dislocated.
A hip subluxation is where the hip dislocates partially then returns immediately into it’s normal position. The hip capsule and ligaments will then be sprained and painful.
Labral Tear
A hip labral tear is damage to the cartilage that surrounds the bony edge of the socket in the pelvis. This can occur as the result of repetitive use of the hip and can be seen in the early stages of osteoarthritis or can be caused by an injury such as a fall or accident that causes twisting of the joint.
Muscle strain in the groin or buttock
Muscle strains and tears can occur to any of the muscles around the hip. The most common being the gluteals, hip flexors, rectus femoris and the Tensor Fascia Latae.
Muscle strains happen with more rigorous sports such as football, basketball, netball etc, where you run, twist, jump, land and sprint.
Pain will be quite localised to the affected muscle and will be acute.
Severe Bruising (contusion)
Direct blunt trauma can be common in contact sports to the muscles about the hip. This is also known as a ‘corky’ in Australia.
The main muscles corked are the gluteals and the TFL.
A bruised muscle can be quite painful and it won’t like being used and being stretched.
As there is bleeding within the muscle you should start the R.I.C.E.R regime:
The RICER method is an effective procedure used in the initial treatment of a soft tissue injury.
Rest: It is suggested that you take a break from the activity that caused the injury in order to give the injury time to heal.
Ice: The injury should be iced on and off in 20 minute intervals, avoiding direct contact of the ice to the skin.
Compression: Bandaging the injury will compress it, and prevent any further bleeding or swelling to occur.
Elevation: Elevating the injury above your heart while you are resting will aid in the reduction of swelling.
Referral: Referral to an appropriate medical professional for guidance and management.
References:
https://www.healthlinkbc.ca/health-topics/hin11https://www.arthritis.org/about-arthritis/where-it-hurts/hip-pain/causes/hip-injury-fracture.php
General Hip Pain Causes
Overuse injuries occur from repeating the same activity.
The repeated activity, such as running or bicycling long distances, may stress the hip joint. This can cause irritation and inflammation.
Examples of overuse injuries include irritation of the large sac (bursa) that cushions the bones of the hip joint (trochanteric bursitis), irritation of the tendons in the hip (tendinitis), muscle strain, and hairline cracks (stress fracture) in the neck of the thigh bone (femur) amongst others.
Below we will cover the main types of non-traumatic hip problems:
Hip Bursitis or Tendonitis Pain
What you need to know about hip bursitis pain:
Outside or lateral hip pain is generally caused by bursitis of the buttock muscle tendons, as they attach to the outside of the hip.
It is more exercises for stroke recovery common in females than males (3:1), due to the shape of the pelvis and hormonal changes experienced by women in the peri menopausal period.
It is always due to excessive sideways load and compression around the outside area of the hip joint. This can be due to muscle imbalances (both tightness and strength), overuse and poor postures and positioning.
Reducing the total compression on the lateral hip over each 24 hour period is vital for improving your symptoms.
The bursa may become inflamed by a group of muscles or tendons rubbing over the bursa and causing friction against the hip bone. It can also be aggravated by a direct blow to the bursa i.e. a fall or tackle.
It may also be a gradual onset issue due to repetitive trauma to the bursa. Which can be from running with poor technique or muscle control, cycling with too high a seat or walking to fatigue.
Trochanteric bursitis is the inflammation of the bursa. (a small, cushioning sac located where the tendons pass over the areas of bone around the joints), which lies over the big bone on your hip (femur).
Symptoms can vary but will usually present with pain or swelling directly over the head of the femur. Also referred pain from the outside of your leg to the knee, or pain sleeping on the affected side, pain on climbing stairs or after prolonged sitting.
Common signs and symptoms of hip bursitis pain:
Soreness on the outside of the hip, with possible pain down the thigh.Running can elicit pain.Pain when lying on the affected hip or sitting crossed legged.Pain with climbing stairs, getting in/out of the car.
To reduce your hip pain, you need to address all the areas contributing to your pain:
Address tight muscles with physiotherapy, foam rolling, massage and stretching.Strengthen key lateral hip stabilising muscles, without causing compression on the lateral hip structures (your physiotherapist will show you how to do this).Lose weight and reduce your abdominal girth to reduce load on your hip and associated muscles.
Change your postural habits:
Do not hang on one hip when standing, or carry a load such as a child on one hip.Do not lie on that side to sleep.When sleeping on the other side, ensure that a pillow is placed in between your hips at all times.Do not sit with your legs crossed.Ensure you graduate your return to activities such as walking as guided by your physiotherapist.
By Tim Bass
Sports Physiotherapist myPhysioSA Mount Barker & Payneham
Gluteal Tendinopathy
Gluteal tendinopathy is the most common type of lateral hip pain. A tendon injury may occur suddenly but is more likely the result of a repetitive/overuse type injury.
Tendons are designed to withstand high, repetitive loads. However, when a load applied to the tendon is too great and too often, the tendon can become stressed. This can start to cause pain.
A gluteal tendinopathy presents with increasing pain on activity e.g. running and pain or stiffness first thing in the morning and overnight.
Tendon or Muscle Strain or Tear
In a hip strain, muscles and tendons may be injured. Tendons are the tough, fibrous tissues that connect muscles to bones. Hip strains frequently occur near the point where the muscle joins the connective tissue of the tendon.
The strain may be a simple stretch in your muscle or tendon, or it may be a partial or