Hip Pain; causes, treatmment and managment

PAINFUL HIP SYNDROMESOVERUSE 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.

Hip Pain


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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