Due to a very intricate anatomy and function the hip and groin area the disease of hip and groin can be very confusing and puzzling to physicians and therapist who don’t specialize in this field. Most patient wonder around from doctor to doctor until; they find the right diagnosis and then wonder from therapist to therapist until they find relief.
Dr.Kalika has gone through preceptorship program with the European surgeon who revolutionized the field of hip arthroscopy as well as with prof. Kolar of Prague school who created most advanced non invasive protocol of rehabilitative care for intra and extrarticular pathology in the hip joint. With the help of gait analysis, diagnostic ultrasonography and evidence based expertise we are able to provide precise diagnosis and create successful individualized treatment for those patience who feel lost with their hip complain.We can get you back to walking and doing your favorite fitness activity.
Variety of recent research publications proved that early hip arthroscopy for FAI or Labral tear can be beneficial. The success of hip arthoscopy is dependent on proper patient selection based on the patient’s history and diagnosis.( Byrd et al, 2007) . However, in our experience and experience of many other researchers with post hip arthroscopy patients proper selection does not only depend on structural factors ,but on functional state of the patient prior to surgery. At NYDNRehab we employ the most advanced functional testing utilizing our CAREN (computer assister rehabilitation environment) and gait analysis technology. Based on this data we can either help you avoid surgery or institute a targeted prehab program to prepare you for optimal surgical outcome. So of the top NYC surgeons refer their pre-surgical patients for consultation with us.
Pain in the hip may occur because of several different work- and running-related injuries that afflict the pelvis region. These include osteoarthritis, hip dysplasia, hip flexor strain, trochanteric bursitis, and iliopsoas tendinitis, any of which can cause debilitating and excruciating pain that prevents a person’s body from functioning properly and hinders the performance of daily activities.
Much of the stability of the hip joint stems from the fact that it’s a ball-and-socket joint, a joint in which one bone is rounded and can fit neatly into the depression of another bone. The head of the femur, the thigh bone, fits completely into the round concavity of the acetabulum, a vast depression in the pelvis.
The acetabulum is just one of the forces that helps stabilize the hip and prevent dislocation. Because of its depth and because it surrounds the femoral head, it diminishes the possibility that the femur will become dislocated. The hip’s stability is further strengthened by the acetabulur labrum, a rim of cartilage surrounding the acetabulum that makes it even deeper. This in turn provides a large articular surface that stabilizes the joint.
There are some important muscles within and connected to the hip that allow movement. These movements include flexion, extension, abduction (pulling a structure away from the midline of the body), adduction (pulling a structure towards the midline of the body), and rotation. The muscles responsible for flexion are the iliopsoas, rectus femoris, and sartorius. The hip extends with the assistance of the gluteal and hamstring muscles. The gluteal muscles also assist in the abduction of the hips, while the hip adducts with the aid of the adductors muscles, the pectineus, and the gracilis. Rotation is provided with help from the gluteal muscles, biceps femoris, and hamstrings.
There are over a dozen nerves that pass through the hip and innervate muscles, joints, and tissues in the lower half of the body. Of these, the two most commonly associated with hip injury are the sciatic nerve and the femoral nerve. The sciatic nerve, the longest and widest nerve in the body, passes along the back of the leg towards the knee, where it splits into the tibial and common fibular nerves. The sciatic nerve innervates the muscles of the posterior thigh and is often the site of injury in athletes. The femoral nerve is the largest branch of the lumbar plexus, an important network of nerve fibers located at the side of the first four lumbar vertebrae situated in the lower back. This nerve provides cutaneous innervation to the anterior and lateral thigh, as well as the medial leg and foot.
Over the surface of the femoral head and acetabulum is a layer of articular cartilage, a white, shiny, rubbery material that cushions the joints and allows them to rub against each other without causing friction. They’re assisted in this task by the bursae, small sacs filled with a special lubricating fluid that moisten the soft tissues around the hip joints and make articulation easier.
Hip osteoarthritis, one of the most common causes of hip pain, is a condition characterized by pain and dysfunction of the joints as a result of degeneration of the articular cartilage. Physical symptoms of osteoarthritis include pain in the thigh and groin, pain after prolonged walking. A patient suffering from this condition may also exhibit improper gait, decreased range of motion, stiffness, and continual creaking or popping sounds during movement. Because osteoarthritis is a progressive condition, patients will initially report intermittent symptoms. However, if the symptoms are not treated, they will escalate to the point where he or she may have difficulty sleeping. Osteoarthritis treatment for the hip includes gentle exercises along with ice and heat therapy to relieve symptoms. Non-steroidal anti-inflammatory medications may be prescribed for discomfort and inflammation. In cases where these are not effective, steroidal injections may provide long-term relief.
Sciatica, or sciatic nerve dysfunction, is a condition involving compression of a nerve root in the lower back. Typically it begins with a nerve root leading into the sciatic nerve is compressed, either by a ruptured disc or a bone spur. The rest of the sciatic nerve becomes inflamed and pain radiates throughout the hip and leg. Sciatica can occur either through sudden trauma or the slow degeneration of discs as a result of aging. In both cases a disc in the spinal column becomes damaged, or herniated, and the inner, jelly-like tissue of the disc ruptures out into the vertebral canal.
Although sciatica originates in the lower back, the pain it causes can create repercussions throughout the lower half of the body. Lateral femoral cutaneous nerve entrapment is different because it’s a pinched nerve condition that begins in the femur itself, one of the major bones that compose the hip joint. Symptoms of lateral femoral cutaneous nerve entrapment include loss of sensation, tingling, and pain in the area above the thigh that may necessitate pinched nerve in hip treatment.
Hip misalignment, or hip dysplasia, is a normally congenital condition in which a child is born with or develops a dislocation of the hip joint. Because the joint has not formed normally, it can easily be dislocated. However it happens, the patient’s acetabulum is less deep than is normal, and shaped more like a dish than a cup. The upper part of the concavity is inclined outward rather than oriented horizontally. As a consequence, the femoral head does not fit properly into and is not fully covered by the depression of the acetabulum. In mild cases the head of the femur simply becomes loose; in others it can be pushed out with enough pressure. In the most extreme cases, the femoral head is completely dislocated and hip misalignment treatment becomes necessary.
Hip flexor strain is a condition characterized by tearing of the muscles that assist the hip in flexing. The most prominent of these muscles is the iliopsoas muscle that begins in the lumbar region and inserts into the femur. The hip flexor muscles assist in sprinting and kicking, and feel tension during stretching. Too much tension can cause the muscle fibers of the hip flexors to tear, necessitating treatment for hip flexors. The severity of the injury can range from minor tears with minimal impairment to total ruptures involving severe, agonizing pain. Symptoms include pain on the hip or groin during initial impact, and continual pain when running, going upstairs, or bending the knee towards the chest. Patients may also feel pain and stiffness, especially in the mornings, along with tenderness and bruising. Pulled hip muscle treatment involves rest and rehabilitation within the limits that pain permits. If the muscle becomes torn, it may be necessary to refrain from intense physical activity for between four to six weeks.
Trochanteric bursitis is a form of hip bursitis, a condition in which the small, lubricating sacs that surround the joints become inflamed. The greater trochanter is the bony prominence at the side of the body to which several gluteal muscles are attached. Between these muscles and the greater trochanter lies the trochanteric bursa. When the gluteals contract, friction is brought to bear on the trochanteric bursa, and when this friction becomes excessive, the bursa may become irritated or inflamed, resulting in trochanteric bursitis. This can occur as a result of prolonged or repetitive engagement in activities like running, jumping, walking uphill, or lunging. In some cases bursitis develops because of a direct blow to the tip of the hip. Symptoms may include outer hip pain and pain along the outer thigh running down to the knee. Patients may report aching or stiffness, especially when direct force is applied to the bursa, and a peculiar sensation of weakness in the lower limbs.
Treatment for bursitis of the hip normally begins with alteration of the patient’s existing exercise and activity schedule to minimize the conditions that led to overuse. This may be combined with an exercise program of strengthening and stretching, along with heat and ice applications and, in certain cases, cortisone treatments to reduce swelling.
Snapping hip is a clinical condition in which a patient experiences a loud, painful snapping when flexing or extending the hips. Extra-articular internal snapping hip is often the result of iliopsoas tendinitis, inflammation of the hip flexor tendon that drapes over the hip socket. This tendon can become inflamed with injury or overuse. As the tendon rubs over the bone of the socket, it can cause painful clicking. Treatment for hip tendinitis in this instance may involve modification of an existing schedule to curtail activities, along with anti-inflammatory medication or cortisone injections. In the most extreme cases snapping may be treated by removing the inflamed tissue.
Patients seeking hip strain treatment or hip pain running treatment will find advanced care at the New York DNR. Because successful hip treatment depends on diagnostic precision, we employ computerized gait analysis with advanced technological equipment such as diagnostic ultrasonography and X-ray imagery to assess and treat movement dysfunction. In some cases extracorporeal shockwave therapy may be used to regenerate degenerated or damaged tendons and overused muscles. Finally, and importantly, Computer-Assisted Rehabilitation Environment (CAREN) can detect problems arising from asymmetrical weight-bearing with the assistance of force-plate and motion-capture analysis, along with a feedback/feed-forward facilitation retraining that is unique among newest sports rehabilitation treatments. Last but not least, is our legendary DNS ( Dynamic Neuromuscular Stabilization) therapy which has become the hallmark of hip treatment standard in the industry.