By Hans de Wit
July 6, 2023
Therapy
Introduction
I have many clients coming into the practice, and so do my fellow stretch therapists, with pain and or discomfort in and around the hips or originating from the hip and radiating down the leg(s). It is often difficult to find the cause, however, once you know how the hip works, and what factors are important in diagnosing hip pain, it will be easier for you as a patient to explain to your stretch therapist or other healthcare provider what you are feeling. First, a little explanation about how the hips work and why it is important to have healthy hips. Then we’ll look into what can go wrong i.e. types of pain and issues and what might cause them, diagnosis and treatment and lastly how to keep your hips healthy.
How your hips work and the importance of healthy hips
The hips are made up of joints, bones, ligaments, tendons, muscles and other connective tissues. A joint is where two bones get together and there is usually movement between them. The hip joint is a ball and socket joint, the ‘ball’ is the top of the thigh bone and the socket is part of the hip bone (pelvis). Another joint concerning the pelvis is the sacroiliac joint (SI) joint where the pelvis connects with the spine. Various ligaments connect bone to bone in the hip and tendons, that connect muscle to bone. Lastly, there is fascia, a thin casing of tissue holding bones, muscle, nerve fibre and blood vessels in place. In addition, you will also find bursa, a liquid-filled sac that provides cushioning and a smooth surface for joints to move easily, synovium a thin cover for bones making fluids so bones move easily and also cartilage, a smooth substance covering the bones such as the top of the thigh bone that absorbs impact when you walk. Muscles of the hip include the gluteal, hip rotators (underneath glutes) adductor muscles (inside of thighs), iliopsoas muscle (hip flexors), quadriceps (front of thigh) and hamstrings (back of thigh).
You can see that the hips are very complex structures that can make it difficult to diagnose and treat hip problems. In future articles, we will look more closely at how each of the above components are working. The complex nature of the hips also highlights why it is so important to look after your hips and prevent the many issues you can have or develop as listed below.
Causes of pain and/or discomfort
Genetic, lifestyle, injury and disease (infection), are factors that can cause the following conditions of the hips:
Sciatica – pain, weakness, numbness or tingling in the leg caused by an injured sciatic nerve or pressure on the nerve. The sciatic nerve runs from the spine through the side of the hips down each leg at the back. The nerve can be pressured or injured in the spine (e.g. slipped disc etc.) or by tight muscles in the hip, especially the piriformis muscle.
Tendonitis and tendinosis – tendonitis refer to inflammation of the tendons causing pain and tendonitis is more degeneration of tendons, without inflammation.
Bursitis – Inflammation of the fluid-filled pads (bursae) that act as cushions at the joints, it can be very painful.
Hip impingement – more often a problem in men than women, is when the ball (top of thigh bone) of the joint, does not fit properly into the socket (hip bone) at the hip joint. This can prevent proper movement and cause pain.
Arthritis – One of the most common issues in the hip includes different forms of arthritis i.e. osteoarthritis, rheumatoid arthritis, gout, septic arthritis, ankylosing spondylitis, systemic lupus erythematosus and psoriatic arthritis. The most common is osteoarthritis which is mainly caused by wear and tear on the bones at the joints causing inflammation and degeneration and is thus more common in older people. It can however develop at a quicker pace in people with uneven bones. Most other types of arthritis are also inflammatory conditions, but may rather be caused by infection-causing auto-immune disorders.
Dislocation, dysfunction and fractures – accidents or conditions such as osteoporosis can cause hip dislocation, dysfunction (specifically the si joint) and fractures. Dislocation is when the joints are out of place, there are many types. This can cause a lot of pain and discomfort.
Labral tear – this is damage to the connective tissue that holds the ball and socket of the hip joint together. This can cause reduced movement, pain and the feeling of hip locking.
Muscle strain – damage to muscle fibres and tendons around the hips can include just strain or minor tears and can cause pain in the hip area.
Spinal Stenosis – a narrowing of the spinal canal, when this happens in the lower back, it can cause pain at the back of the hip.
Diagnosis and Treatment
Your first thought should be to rule out any fractures, if you are not sure, always see a doctor first to rule that out. A doctor will then refer you to an appropriate specialist. However, once you are sure you have no fractures or any other serious medical problem, it is always best to start with the most non-invasive treatment. Here, your stretch therapist should be your first address. Active Isolated Stretching is a great technique in treating most issues related to hip pain and or discomfort and can realign the hips and surrounding areas and restore hip functionality and or manage pain associated with inflammatory conditions. AIS can restructure and restore the bones, connective tissues and muscles to a certain extent and improve circulation in the body to speed up the healing process and drain any toxins and inflammation from the body.
How to keep hips healthy
Apart from treating your hips when needed, it is important to take steps to prevent any future issues. An overall healthy lifestyle is of course important with factors such as getting proper nutrition, eating a balanced, anti-inflammatory diet, being aware of your posture during sitting, standing and other activities, getting quality sleep, balancing stress levels etc. Regular self-stretching at home and therapy sessions with a stretch therapist can help with better sleep, managing stress, draining inflammation, managing the effects of overused muscles (if you cannot avoid this), proper posture and also in helping the body absorb minerals and vitamins from your healthy diet.
This is by no means an exhaustive list or advice on how to keep your hips healthy, but I hope this can give you guidance on where to start in your journey to healthy hips and preventing any issues in older age, so you can go through life with one less thing to worry about.
