While injuries of the hip and pelvis are not the most common cause of pain in the lower extremities, a hip pain can be quite serious and have significant repercussions for the function and stability of the other parts of the body. While older adults may suffer from degenerative diseases of the hip as they age, middle age individuals who used to be very athletic are especially prone to hip pain due to predisposing factors, excessive seating and carryover of the prior injuries acquired during teenage sporting activities. Athletes in general are more susceptible to injuries of the hip than the average population. Hip injury in runners is 2 to 11 percent higher than in the general population, while the hip is involved in 7 to 14 percent of all ballet injuries. Whatever the source of the problem, patients need the reassurance that they can receive proper diagnosis and practical conservative care such as walking and running specific physical with emphasis on gait and function of lower kinetic chain. The proper function of the hip is so paramount for pain free low back and ability of walking and running.
The hip joint is the largest joint in the body, and also one of the most stable. It derives much of its stability from being a ball-and-socket joint. A ball-and-socket joint is a joint in which the rounded end of one bone inserts into the depression of another. In this case, the “ball” is the head of the femur (the thigh bone) and the “socket” is the acetabulum, a sizable concave depression in the lower part of the pelvic girdle. The acetabulum is lined with a fibrous rim of cartilage known as the acetabular labrum, which deepens and further stabilizes the hip joint by helping to keep the ball in the socket. If the acetabular rim is injured, a patient can develop labrum tears, resulting in pain and stiffness.
The major muscles of the hip region can be divided into four groups according to their various functions: the flexors, the extensors, the abductors, and the adductors. The iliopsoas and rectus femoris are largely responsible for flexion. Along with the hamstrings, the gluteal muscles assist in extension. (The gluteus maximus, which comprises much of the buttocks, helps to rotate the hip and leg.) The abductor muscles, which include the gluteus medius and gluteus minimus, function to pull the legs away from the midline of the body, while the adductor muscles pull the legs towards the midline of the body.
Diagnosing hip disorders may not be an easy job because hip/groin area is anatomically dense terrain where different structures are so functionally and structurally intertwined into a robust lumbo-pelvic engine, which defines human locomotive machine. The groin hip area is also very richly innervated by nerves of the lumbar plexus and is known to be a great mimicker. Although, the use of modern radiology is extremely helpful clinical experience is the key. The recent advances in the high resolution ultrasonography as well as gait analysis today allows the hip the clinician a practical arrival to the right diagnosis on the spot.
Osteoarthritis is one of the most common causes of hip pain in adults, affecting over 15 percent of the world’s population—and the numbers are steadily rising. Typically osteoarthritis develops as a person ages and the cartilage in the joints begins wearing away. Over time this loss of cartilage causes the bones to rub against each other, resulting in considerable hip pain. Osteoarthritis may be exacerbated by obesity or prior health problems, such as hip dysplasia, in which the hip socket does not fully encompass the femoral head.
The femoral neck is the area is just below the “ball” part of the ball-and-socket joint in the hip. If this part of the femur becomes fractured, it’s called a femoral neck stress fracture. It’s a common injury in distance runners, and if treatment is delayed it can have serious consequences for the career of the athlete. While this injury often occurs because of sudden changes in the intensity of a patient’s running or the rate of acceleration, it can also occur because of overuse, poor footwear, or training on unlevel surfaces. Symptoms may include pain in the hip, groin, and thigh, pain at night, and pain when engaging in strenuous activity or bearing weight.
Femoracetabular impingement ( FAI) is a frequent source of hip pain in males but also affects females as well. The causes of FAI are a combination of predisposing structural anatomical variations together with poor gait mechanics and trauma. Hip dysfunction and weakness is also most frequently present in people suffering from low back pain, pelvic pain and foot pain disorders.
Hip flexor strain can occur when a patient is flexing his or her thigh and something happens that forces the thigh to extend. It can also occur when the thigh is flexing and is suddenly struck by an external force, as when an athlete extends her leg to kick a ball and is hit in the leg. Symptoms may include sharp groin pain and pain that increases with rotation or extension.
The most common cause of groin pain in athletes is adductor strain—strain of either the adductor longus, adductor brevis, adductor magnus, pectineal, or gracilis muscles. These muscles can be strained when an athlete suddenly changes direction or is forced to rotate the leg while pulling it towards the body. This injury most commonly strikes hockey and soccer players. It’s sometimes mistaken for femoral neck stress fracture or hip bursitis. Immediately following injury, symptoms may include piercing groin pain, bruising, and swelling. Later, victims may experience tenderness of the adductor muscles and associated tendons and pain when stretching.
Treatment for adductor strain and hip flexor strain typically depends on the severity of symptoms. Physical therapy is recommended following rest for the first one to two weeks after injury. A hip pain specialist will guide the patient in a program of physical therapy to restore motion, recover strength, motor control restore biomechanics of gait and functional alignment. Total understanding of all hip disorders is very important as ignored hip symptoms and functional hip deficit can lead to hip osteoarthritis. Therefore hip prevention is a duty of every hip specialist.
When it comes to osteoarthritis, the goals of a hip pain doctor who is not performing surgery will be to alleviate pain and increase mobility for patients suffering from this incurable condition. This may include both medicinal and non-medicinal treatment modalities. Examples of the former can include NSAIDs, acetaminophen, and right type of hip physical therapy. Examples of the latter include a general program of exercise—lack of strength in the lower extremities is sometimes a contributing factor in osteoarthritis; weight loss; and weight reducing gait therapy which combines aerobic and strength training. Weight reducing therapy such as AlterG treadmill can be especially helpful because it lessens the amount of weight placed on the joints and allows for the performance of exercises that couldn’t otherwise be managed. The other type of most useful hip specific physical therapy is retraining weight-bearing symmetry and gait stability. This type of therapy is highly skilled and requires modern equipment.
Patients struggling with FAI, osteoarthritis, femoral hip pain, anterior and posterior thigh pain, and other hip pain diseases will find help and most advanced care at New York Dynamic Rehabilitation Clinic (NYDNRehab). While there’s no magical hip pain cure for sports injuries, we do offer advanced rehabilitative treatment that can assist suffering patients in getting back on their feet.
The success of our method lies in our ability to incorporate advanced technologies with various manual techniques. Because medical imaging (such as MRI) is limited in its ability to detect problems during movement, we employ computerized gait analysis, a system of viewing and measuring the forces at work when a patient’s body is in motion during walking or running. This not only allows us to see abnormalities, but to understand the complex relationships between the tissues of the body when viewed as part of a moving system. We are the first outpatient clinic in NYC providing a gait analysis lab. When used in conjunction with diagnostic ultrasonography and X-ray imaging, we can obtain a near-complete picture of the mechanics of a person’s gait and the integrity of the tissues surrounding the hip joint.
If this analysis reveals damage to the integrity of those tissues, our doctors for hip pain combine standard rehabilitation techniques with biological treatment. In some cases extracorporeal shockwave therapy (ESWT) may be employed. ESWT sends low-intensity, high-frequency sound waves traveling through the skin at the site of injury to regenerate damaged tissue. In case of myofascial hip syndrome where trigger points and fascial adhesions are the sole source of problem we combine defocused shockwaves with ultrasound guided dry needling.Most importantly, we use Computer Assisted Rehabilitation Environment (CAREN) to resolve problems that have arisen from faulty weight-bearing. Unique in the annals rehabilitation, CAREN creates a simulated, virtual-reality environment, similar to a holodeck, in which a patient is able to perform exercises in an artificial landscape that would not be possible elsewhere. Our clinic is the first in New York City to possess CAREN technology.