Hip pain has become a significant issue that we see at BTF. Since we deal with soft tissue injuries, a number of our clients feel comfortable having us evaluate their hip complaints. Hip pain can come from a number of different sources. When participating in sports, getting hit on or around the hip or falling hard on the hip can cause a hip bursitis or hip pointer injury. Hip flexor strains can occur from overstretching or from contracting a muscle that is not properly warmed-up or is deconditioned. Also, the sacroiliac (SI) joint or low back joints and muscles can refer pain to the hip. Most of these injuries are fairly easy to correct and will usually not lead to any long-term disability or loss of significant sport participation. The hip injury that is proving to be the most troublesome is called hip impingement.
Hip impingement is caused by a friction rub between the ball and socket of the hip joint. Poor standing and sitting posture can cause an abnormal wear pattern of the ball and socket, leading to asymmetry. The result can be bony growth in the form of degenerative spurs on the outer rim of the ball and/or socket of the hip joint. Usually, this will cause pain in the front of the hip, but some people will feel pain in their groin area or in their back or buttock regions as well. Typically, the hip will feel like it has a limited range of motion. Sometimes it will feel like it needs to “pop” to provide temporary relief.
Hip impingement can also lead to cartilage and labrum damage of the hip joint. Cartilage is found at the end of bones to make them slide and rotate smoothly. The labrum is a soft tissue layer that runs from the outer rim of the socket and helps hold the ball of the hip joint in place. Both the cartilage and the labrum can be worn down and torn by excessive friction caused by hip impingement. Untreated, hip impingement could eventually lead to severe hip degeneration and the need for surgical hip replacement.
Hip impingement can be diagnosed by a healthcare provider that is educated about this type of injury. Typically, the diagnosis can be made from the history of the injury and certain hip tests that your healthcare provider will perform. X-rays and MRIs can help confirm the diagnosis and quantify the extent of damage to the surrounding structures.
The first step in recovering from this type of injury is specific stretching and strengthening exercises to bring some symmetry back to the hip joint (see videos below). The goal of exercise should be to decrease the intensity and frequency of hip pain. A combination of visual pain scales and hip-related questionnaires can be used to monitor progress. If after 3 months of consistent rehabilitation the client isn’t showing progress, then a surgical consultation should be considered. At BTF, we have good relationships with some of the best orthopedic professionals in the area and refer to them whenever we feel that this will be in the best interest of our client.
At BTF, we strive to provide treatment protocols and training routines that not only will boost your performance, but will keep you healthy and injury free. Specific core stabilization and hip/shoulder mobility and strengthening protocols are built into every exercise program. This approach will help maintain the health of your hip joints, and if you are already having hip pain, should help reduce your symptoms. Below are a few of the hip exercises that you should try if you are having hip impingement pain. Remember to seek guidance from your healthcare provider before trying these exercises. If you have a hip complaint, please contact our office at 310-534-1900 to schedule an evaluation with one of our doctors at BTF.
Video #1 Hip Flexors Stretch with Gluteal Activation: It is important to lengthen the hip flexors around the hip impingement. Tight hip flexors will cause hip asymmetry and many people have extremely tight hip flexors! Do 10 3-second contraction stretches for each hip 3-4 times daily.
Video #2 Standing Posterior Capsule Stretch: Do 8 breaths in/out while holding this stretch position on each side. You should feel this in your backside!
Video #3 3D Reach Sequence: Do 8 reaches for each position daily.
Video #4 Hip Circuit: Keep your trunk muscles active and stable to reap the benefits of this exercise. Do 12 slow repetitions for each side/position daily.