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Hip Pain?
First let’s find the hip!
by James Wilson BSc (Hons) Ost Med. DO - find out more about James.
There always seems to be a little (understandable) confusion as to where our hips actually are. Maybe this is the result of some rather sketchy teachings of anatomy when we were children - remember the song “...your hip bone’s connected to your thigh bone, your thigh bone’s connected to your knee bone…?” Most of us probably do, so it’s a pity that it’s not particularly accurate when it comes to the hip part!!
Just to prove a point I want you to place your index finger where you believe your hip to be….
Now my experience of this would mean that at least half of you will either be pointing to your Iliac Crest (where our waist is) or to the Greater Tochanter (on the side of your upper thigh.) Now have a look at the diagram below and you can see that the ball and socket of the hip joint itself is actually in between these two points and is actually more in the area that we would term our ‘groin’.
My main reason for pointing this out is that it coincides quite well with what we see in private practice. An awful lot of patients who come in complaining of hip pain thankfully have nothing wrong with the hip joint at all, most commonly it is the various structures around the hip which can cause pain or problems.
So if we take the three most common presentations of “hip pain” and give a few examples of what can be causing each, it will hopefully give you an idea of just how many structures other than the hip joint there are which can be problematic.
1. Lateral Pain (the side of the upper thigh) - Muscle (Gluteal and Tensor Fascia-Latae / Ilio-Tibial Tract,) Ligament (iliofemoral, ischiofemoral,) Bursitis (trochanteric.)
2. Anterior Pain (groin) - Muscle (Psoas, Rectus Femoris,) Inguinal Hernia, Sacroiliac Joint, Kidney, Intestine, Uterus and Ovary.
3. Posterior Pain (buttock) – Muscle (Piriformis, Gluteals,) Sacroiliac Joint, Lumbar Spine, Ligament (iliolumbar, sacrotuberous,) Bursitis (ischial.)
Also, if we consider the above presentations alongside the age of the patient we can get a strong likelihood of what is causing an individuals’ hip pain. So common problems alongside age group might be:
Young – hernias, psoas and adductor muscle strains, problems after Congenital Dislocation of the Hip (CDH) or traumatic dislocation, Perthes’ Disease.
Middle – as above, plus lumbar-spine issues especially disc, sacroiliac joint referred, problems with biomechanics, rheumatoid arthritis (and similar sero-negative arthritis,) early osteoarthritis (eg. after old fracture).
Older – osteoarthritis, osteoporosis related fracture, overuse strain of muscle or ligament from another joint issue, lumbar-spine degeneration, iliac artery aneurysm.
So what does all of this mean?!
As with the knee it is very difficult to give general advice without having satisfied myself as to what is causing each individual case of hip pain. I have already mentioned some of the many structures around the hip, as well as the hip joint itself which can cause problems, but in order to diagnose properly we would have to look deeper still; particularly to the surrounding joints of the foot, ankle, knee and lumbar spine.
Many hip problems are the result of how the joint has been used (eg. occupational factors) whether that be too much or too little, whether the joint has been injured at some point (eg. sporting injuries and riding falls) and whether there is an issue somewhere else which could be adversely affecting the joint (eg poor lower limb biomechanics).
So really what all this means is that there is a lot that can go wrong around the hip and as osteopaths we must therefore investigate many things in order to successfully deal with hip pain. The good news is that most causes of hip pain can be successfully treated.
A few stretches to try:
Toward the end of my topic on Low Back Pain are some simple stretches. Exercises 2, 8 and 9 will be particularly relevant here as they focus on stretching the three main muscle groups which attach over the hip joint, these being the quads, the gluts and the hamstrings.
Additionally Exercise 2 can be adjusted to increase the effect on the gluteal muscles by pulling the knee across the body towards the opposite shoulder (note this shouldn’t pull or pinch in the groin area, only at the back of the hip).
You could try the stretches a few times per day for a couple of weeks and they may well help. As with any new pain though my advice would be to get it investigated properly first!
Oh and one final thing, I apologise if you’re humming the hip bone, knee bone tune for the rest of the day!!
Further information is available on our website www.molfordhousesurgery.co.uk. Alternatively I am always pleased to answer any questions you may have. You can call me at Molford House Surgery on 01769 574830.
The information provided on these pages is intended as a general guide only and in no way constitutes a complete service for diagnosis or treatment. You must not rely solely on this information and it is therefore your responsibility to seek a professional opinion should you be concerned about your particular case.
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