PAINFUL HIP SYNDROMES/ OVERUSE SYNDROMES:
Related Pathologies and Etiology of Symptoms
Tendinitis or Muscle Pull
Overuse or trauma to any of the muscles in the hip region can result from excessive strain while the muscle is contracting (often in a stretched position) or from repetitive use and not allowing the injured tissue to heal between activities. Common problems include hip flexor, adductor, and hamstring strains. Poor flexibility and fatigue may predispose an individual to strain and injury during an activity or sporting event; and sudden falls, such as slipping on ice, may cause a strain.
Trochanteric Bursitis
Pain is experienced over the lateral hip and possibly down the
lateral thigh to the knee when the iliotibial band rubs over the trochanter.
Discomfort may be experienced after standing asymmetrically for long periods
with the affected hip elevated and adducted and the pelvis dropped on the
opposite side. Ambulation and climbing stairs aggravate the condition. Muscle
flexibility and strength imbalances and the resulting faulty posture of the
pelvis may be the predisposing factors leading to bursal irritation.
Psoas Bursitis
Pain is experienced in the groin or anterior thigh and possibly
into the patellar area. It is aggravated during activities requiring excessive
hip flexion.
Ischiogluteal Bursitis (Tailor’s or Weaver’s
Bottom)
Pain is experienced around the ischial tuberosities, especially when
sitting. If the adjacent sciatic nerve is irritated from the swelling, symptoms
of sciatica may occur.
Common Impairments and Functional
Limitations/Disabilities
Pain. Symptoms occur when the involved muscle
contracts, when it is stretched, or when the provoking
activity is repeated.
Gait deviations. Slightly shorter stance occurs on the painful
side. There may be a slight lurch when the
involved muscle contracts to protect the muscle resulting in
impaired gait.
Imbalance in muscle flexibility and
strength. Muscle flexibility or
dominance in use may be the precipitating factor in many painful hip syndromes.
Decreased muscular endurance. Muscle fatigue may lead to faulty postures,
stress, and flexibility imbalances
Management: Protection Phase
Control Inflammation and Promote Healing
When there is chronic irritation or inflammation from an acute
injury, follow the guidelines with emphasis on resting the involved tissue by
not stressing or putting pressure on it. Have the patient avoid the provoking
activity; and if necessary, decrease the amount and time walking or use an
assistive device.
Develop Support in Related Areas
Initiate exercises to develop neuromuscular control for alignment
of the pelvis and hip. Avoid stressing the
inflamed tissue. Patient education and cooperation are necessary
to reduce repetitive trauma.
Management: Controlled Motion Phase
Develop a Strong Mobile Scar and Regain
Flexibility
Remodel the scar in muscle or tendon by applying cross-fiber
massage to the site of the lesion followed
by multiple-angle submaximal isometrics in painfree positions.
Develop a Balance in Length and
Strength of the Hip Muscles
Stretch any muscles that are restricting motion with gentle,
progressive neuromuscular inhibition techniques. Instruct the patient to do
self-stretching with proper
stabilization to ensure that the stretches are performed safely
and effectively.
Begin developing neuromuscular control to train the involved
muscles to contract and control alignment of
the femur. Initially, the emphasis is on control, not
strengthening. Once the patient is aware of proper muscle control and is able
to maintain alignment, progress to strengthening the weakened muscles through
the range.
Patient Education
Initiate a home exercise program as soon as the patient has learned
neuromuscular control techniques and correct stretching, strengthening, and
aerobic activities. Provide follow-up instruction for modification and
progression of the program.
Management: Return to Function Phase
Progress Strength and Functional Control
Progress closed-chain and functional training to include balance
and muscular endurance for each activity. Use specificity principles; increase
eccentric resistance and demand for controlled speed if necessary for returnto-
work activity or sporting events. Progress to patterns of motion consistent
with the
desired outcome. Use acceleration/deceleration drills and plyometric
training; assess the total body functioning while doing the desired activity.
Practice timing and sequencing of events.
Return to Function
Prior to returning to the desired function have the patient practice
the activity in a controlled environment and for a limited period. As
tolerated, introduce variability in the environment and increase the intensity
of the endurance activities.
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