Hip or Groin Pain: Diagnosing and Treatment, Physical Therapy

Hip or Groin Pain

Hip pain can become debilitating, and this condition affects millions of people every single year. The pain can cause minor difficulties during daily life, or it can be a debilitating pain that severely limits the range of motion.

Some people can become incapacitated entirely because of the intensity of the pain. Understanding the sources of hip pain can help people who are suffering from this condition to make informed decisions about the most appropriate steps to take.

Common Sources of Hip Pain

There are multiple causes of hip pain, and the source of the pain should always play a central role in determining the treatment plan. Although there are many variations in individuals experiencing hip pain, our clinical experience has shown patterns as well. For example, one of the most common forms of hip pain is caused by the muscles that originate at the sacral bone and insert at the greater trochanter of the femur, or thigh bone.

These muscles are involved in lateral rotation of the leg, which is necessary because the normal forces of gravity encourage medial rotation. When these muscle groups are dysfunctional, they can entrap a portion of the sciatic nerve before it innervates the muscles of the leg.

Additional types of hip pain might involve the following:

Soft Tissue Tears: The soft tissues of the hip joint can experience tears when the load placed on them exceeds their capacity to withstand the pressure. An example of this is a tearing of the connective tissue within the delicate ring that surrounds the socket of the hip joint. This is called the labrum, and it does not receive a lot of vascular branches. As a result, the blood flow to this area is less than optimal for fast healing. Physical therapy can support the local circulation through indirect strengthening of the supporting muscle groups. The physical therapist can also assist patients in learning new movement patterns that relieve the pressure and reduce the tendency to injure the area during daily activities.

Strains and Sprains: The muscles that adduct the hip can be strained or sprained during quick movements that involve a change in direction. The likelihood of injury increases when velocity is added to this type of movement. In other words, an injury is more likely to happen when the athlete is traveling fast during the sudden change of direction. This is a common injury for people who play football or soccer. Physical therapy can improve the range of motion and help the patient to manage discomfort and pain.

Post-Surgical Pain: Hip replacements are a relatively common solution for arthritis in the hip, yet the recovery process can be extremely slow. Physical therapy assists patients who are recovering from a hip replacement or other procedure.

Accurate Diagnosing

Accurate diagnosis is an essential component of treating hip pain because the therapy will only be effective if it applied to the correct area.

Depending on the source of the hip problem, the patient might experience referral pain down to the knee or foot. Muscle testing is helpful in determining the source of the hip pain, and this allows clinicians to create an effective treatment plan.

Diagnosis

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A clinical exam and diagnostic ultrasound imaging can help your therapist pinpoint the exact location and cause of your hip and groin pain.

Ultrasound enables you and your therapist to view the hip and groin region in real time, while in motion. In addition to ultrasound, video gait analysis can help us identify faulty movement mechanics that contribute to hip and groin pain. Once the exact cause is determined, an effective treatment plan can be initiated.

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Please explore more advanced diagnostic option unavailable anywhere else:

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Hip dysfunction and pain can be a complex issue due to interactions of the trunk, pelvis, low back, groin and hip joint. Physical therapy and rehabilitation that is based only on subjective clinical analysis often addresses the symptoms without resolving the underlying cause.

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At NYDNRehab, our groundbreaking motion analysis technology and high resolution diagnostic ultrasonography have enabled us to develop a battery of tests that perfectly reveal the dynamic functional pathology of the hip joint and pelvis. Our tests are evidence-based protocols that are considered to be the gold standard in the world of research.

Our testing protocol includes:

1

Combined lumbopelvic hip stability test using DLEST methodology with C.A.R.E.N., our computer assisted rehab environment

2

Hip joint stability test using DLEST methodology with C.A.R.E.N.

3

3D star excursion banner test (SEBT) for assessing the involvement of the hip joint and muscles in postural stability

4

3D gait or running analysis

5

3D kinematic joint angle analysis during a squat, lunge, drop jump and pelvis on hip rotation

6

Rehabilitative ultrasonography for viewing intrinsic hip stabilizing muscle activation patterns

We also perform neuromotor testing with DD Robotech for:

  • Proprioception
  • Tracking ability
  • Force sense
  • Critical power
  • Reactive power
  • Flexibility

SEMG

Surface electromyography (SEMG) may be added to any of the above tests when needed.

Based on our experience and evidence-based information, we believe that physical therapy and rehabilitation should be based on objective quantifiable data.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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