Hip Pain

Impingement and labral tear

The hip is a ball and socket joint meaning the ball is the top of the thigh bone which rotates in the socket (part of the pelvis) when you move the hip. The labrum is a ring of cartilage that lines the socket. Problems can occur deep within the hip joint itself where joint surfaces can rub and the labrum can tear. Symptoms can be pain in the groin, over the hip or deep in the buttock. Main activities that aggravate tend to be heavy work, twisting, squatting and prolonged walking and sport. There can be clicking, snapping or feeling of giving way. It is difficult to determine the exact cause of your symptoms without further medical imaging.

Our physiotherapists are able to conduct a full physical assessment. If they suspect that this is the cause of your pain they will recommend a top London hip consultant for you to see.

Groin strain

There are a number of muscles and their tendons connected to the groin that can injured whether it is sudden or over time giving rise to groin pain. These include the rectus abdominis muscle, adductor muscle and iliopsoas muscle. ‘Hernias’ and stress around the pubic symphysis which connects your pubic bones also can cause groin pain. Usually the problem is a kicking sport but the groin can also be strained if performing an activity which causes an excessive stretch to any of the muscles or on strain on the pelvis itself. Often when groin pain is experienced more than one of the above is affected.

It is vital to have physiotherapy as soon as possible if a groin strain is suspected as if you continue to play sport hoping the pain will resolve itself your recovery is likely to take a long time. A physiotherapist can be organised to come to you and take a detailed history and perform a full physical assessment including specific tests. They will then be able to tell where your groin pain is coming from and what is contributing to causing the pain. They can then treat you effectively by taking you through a specific progressive exercise programme and use other treatments such as myofascial release, acupuncture and anti-inflammatory treatment on the affected area. The aim will be to return you to sport painfree as soon as possible. They will also be able to advise you on exercise you can doing during rehab to keep up your fitness.

Strain of rectus femoris

The top of one of the quadriceps muscles on the front of the thigh has a tendon which attaches to the ASIS at the front of the pelvis. If the rectus femoris muscle is tight pain can be found where it inserts at the front of hip or the muscle may be strained when kicking the leg causing pain near the front of the hip.

Physiotherapy can help with advice, anti-inflammatory treatment, massage, acupuncture and soft tissue techniques. It is important to go through an exercise programme to restore flexibility and strength in the muscle before returning to sport.

Bursitis

A bursa is a fluid filled sac that lies between tendon and bone. Their function is to ensure a smooth gliding surface for movement. They can become inflamed and then the smooth gliding cannot occur and pain can result. There are several bursa around the hip. The main bursa is the trochanteric bursa which lies between the greater trochanter (head of the hip) and the tendon of the gluteus muscle. The pain can be burning and worse on lying on the affected side and with activity particularly on walking and uphill climbing. Often pain can be worse first thing in the morning. There is a bursa also lying on the ischium called the ischial bursa and this can cause pain in the upper buttock area particularly on uphill climbing or sitting for a long time.

Physiotherapy can help by working on any problems biomechanically with your walking or running style and stretching any tight muscles and strengthening the gluteal muscles. Core stability exercises are often useful in helping this condition. A corticosteroid injection may be required to reduce the inflammation initially before exercises are tried. We can recommend top doctors to perform this if required.

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Osteoporosis

With osteoporosis the inner part of the bones that make up the hip joint can become break down. This can lead to the bone becoming weaker and fragile therefore prone to fracture. It is not normal to experience pain with osteoporosis unless a fracture is sustained. Fractures of the hip can occur in people with osteoporosis easily following a fall or twist.

Physiocomestoyou has devised a specific programme for people suffering with osteoporosis to help improve their posture and strengthen the body to reduce the impact of osteoporosis. For those who have sustained a fracture of the hip we can provide physiotherapy in your home to help strengthen around the hip and work on your mobility helping you return to same activities you were able to do before the fracture as quickly as possible. Please refer to osteoporosis programmes for more information.

Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis can occur in any joint in the body and is a the process of ‘wear and tear’ where the cartilage covering the area of bone that makes up the joint is gradually worn away over time. Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. In both conditions joints in the body that have the arthritis become painful and stiff. The joints sometimes can also become swollen and hot. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.

We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment which includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function. Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmes, massagetapingacupuncture and mobility programmes.

We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:

  • Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
  • Wheelchair assessments
  • Splinting

Chronic Pain

Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.

Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top London pain consultants who can help you.

Snapping hip

There are a number of causes of a feeling of snapping in the hip. The snapping can result from the iliotibial band or gluteus medius tendon snapping over the outside of the hip or the iliopsoas muscle snapping over the front of the hip. It can also occur deep in the joint itself.

Physiotherapy can help by determining what is causing the snapping and which factors are contributing to the snapping ie. tight or weak muscles etc. They can then treat accordingly with myofascial release, soft tissue therapy, core stability exercises and stretching/strengthening exercises.

Stress fractures

Stress fractures can occur in lower part of the pelvis, the thigh bone and of the hip joint socket. If this is suspected your physiotherapist will recommend a top London hip consultant who will be able to organize a scan and recommend the appropriate treatment and rest required. During healing your physiotherapist can advise on non-weight bearing exercise as allowed and once healed progress you back to full function.

Sacroiliac stiffness or instability

These are the main joints of the pelvis and can be moving too much or be stiff. This can cause stress on surrounding structures leading to buttock or groin pain. The pain tends to be when doing weight bearing activities or turning in bed.

Physiotherapy can help by performing an in depth examination and use specific tests to determine whether the pain is coming from a problem with the sacroiliac joints. Treatments can be used such as manual therapy, tapingacupuncture, stretching any tight surrounding exercises and teaching specific exercises to increase the stability around the pelvis.

Slipped capital femoral epiphysis

This is a problem with the femur which can cause pain on the inside of the knee. It tends to be more common in teenage boys and being overweight can contribute. The slip of the growth plate over the femur can happen suddenly or more gradually.

Perthes disease

This is a breakdown of bone over the femoral head (top of the thigh bone) which particularly affects boys. Symptoms commonly include a limp and ache in the thigh, groin and knee. Some movement of the hip may be stiff and reduced.

Physiotherapy can help with providing appropriate exercises and advice.

Nerve entrapments

There are a number of nerves that pass around and through the groin that can become entrapped. Your physiotherapist will be able to determine if this is suspected and whether a medical referral is required.

Referred pain

Pain in the hip and groin can actually be referred from another area in the body ie the lower back . Trigger points in muscles away from the pelvis and groin can also refer to the area.

Other possible causes

Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:

  • cardiovascular symptoms
  • respiratory (breathing) symptoms
  • gynaecological symptoms
  • urinary or genital symptoms
  • digestive symptoms
  • immune system symptoms
  • lymph system symptoms
  • hormonal symptoms
  • neurological symptoms
  • dermatological (skin) symptoms
  • medication side-effects
  • virus
  • infection
  • cancer
  • disease process
  • psychological problem ie. depression, anxiety