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Self-Assessment and Treatment of Common Hip Disorders

Now and then, I may go back a little in time, and republish a newsletter not found on my website, after editing and adding up to date information, if called for. Today’s topic covers hip pain and common disorders, which I wrote some years back, and which is still current information.

We know that hip pain can either be caused by the hip joint itself, the low back, or the sacroiliac joint, not counting e.g. sudden muscle strains. Sacroiliac joint problems are rare in people over the age of 50, in particular in men, unless there has been a major trauma, such as a significant car accident.

When it comes to the hip joint, there are certain self-tests, which if positive, may give you a suspicion that the pain is coming from the hip itself.The more of these tests that are positive, the more likely it is that the hip joint is the source of trouble.These tests include the following:

1. Pain and loss of hip mobility if sitting with the legs crossed, or with the ankle on top of the opposite knee.
2. Pain and reduced hip motion if in lying, pulling the knee up to the chest and across to the opposite shoulder.
3. With all the weight placed on the involved leg in standing, pain in the hip if twisting the trunk and pelvis to the right or left.
4. Hip pain with squatting on the involved leg only.
5. Pain predominately in the front of the hip, and “deep inside”.

The most common musculoskeletal hip problems include hip arthritis (osteoarthritis), femoroacetabular impingement, and developmental dysplasia of the hip. Pain and inflammation in the bursa sac on the outside of the hip, which becomes painful to touch, is not covered here.

Hip arthritis describes wearing and thinning of the cartilage that covers the bony ends in the hip socket, causing low grade inflammation in the joint, and over time tightening (fibrosis) of the capsular soft tissues which enclose the joint. This typically is seen in people over the age of 50, although it can develop earlier, e.g. after trauma, and conditions mentioned below.

Femoroacetabular impingement is diagnosed when anatomical factors cause an impingement between the area around the “ball” of the hip joint (femoral head) and the socket in the hip (acetabulum). This can occur already in young adults, in particular athletes in certain sports, and make them predisposed to developing early hip arthritis. These people may also develop tears or fraying of the labrum, a cartilage ring inside of the hip socket, which can also produce sharp catching pain in the hip.

Developmental dysplasia refers to hips which have deficient bony coverage by a shallow hip socket over the femoral head, leading to increased concentration of forces on top and in front of the hip joint. With time, but often in young adulthood, this may result in labral tears, hip instability, and early hip arthritis. X-ray examination and evaluation by an experienced orthopedic hip specialist, is the key to establishing a proper diagnosis.

In cases of hip osteoarthritis and mild to moderate hip impingement cases without significant labral tears, physical therapy by a well trained orthopedic manual therapist can be very beneficial. Such manual treatment and specific hip rehabilitation exercise quite commonly produces significant pain relief and improvement in functional capacity, and even in the case of advanced arthritis, may postpone the need for joint replacement surgery.

Medical treatment may consist of anti-inflammatory medications, injections with viscoelastic solutions to lubricate and enhance the shock absorbing capacity of the remaining hip cartilage, or surgery.

People with advanced osteoarthritis typically will eventually require a joint replacement surgery, whereas younger people may be candidates for joint resurfacing surgery, to preserve as much bone as possible, and allow the individual to stay more active afterwards. Even after a total hip replacement, you can usually return to an active life style and recreational exercise, as long as there is not excessive impact on the prosthesis (replaced joint components) such as from running and jumping.

Femoroacetabular impingement can be successfully treated with hip arthroscopy in cases without significant arthritis, to shave off protruding bone which caused impingement, and shaving or repairing the labrum, if involved.

Developmental dysplasia of the hip is most effectively treated in younger individuals with periacetabular osteotomy, in which the pelvis is cut and rotated in such a fashion that a stable hip joint is created with weightbearing on healthy joint cartilage.

Following mentioned hip surgeries, physical therapy rehabilitation by an experienced clinician is very important, to first prevent complications and allow for optimal healing, and subsequently to recover functional mobility, normal movement patterns, coordination, endurance and strength.

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