Hip Pain

There are a lot of injuries that can affect the hip joint and surrounding musculature.  There are two common injuries in athletics that affect the structural integrity of the pelvis: hip rotations and labral tears.  The pelvis is made up of three joints: sacroiliac, pubic symphysis, and the acetabulofemoral joint  There are two innominate bones (right and left)(Hip Anatomy Image 1,Image 2 ) that are fused together by the sacrum that form the pelvic girdle. Hip rotations most commonly involve the innominate bone on each side being rotated either anteriorly or posteriorly (forwards or backwards).  All types of variations of rotations are found for different reasons.  This most commonly occurs in athletic positions that are one side dominant such as kickers, swimmers (pushing off the wall), divers, pitchers, and high jumpers.  These positions force the entire hip girdle to function independently from side to side, leading to muscular imbalances.  Muscular imbalances indicate that some muscle groups become tight and others become weak.  The tight musculature takes over and pulls an innominate bone forward or backwards causing a unilateral rotation. Rotations that are not fixed can cause misalignment throughout the entire kinetic chain which causes pain due to increased pressure on joints.   Over time, some joints can become inflamed and disrupted.  The joints most prone to this inflammation are the sacroiliac joint, pubic symphysis and vertebral joints in the lumbar spine.  A thorough evaluation is needed when treating patients with a hip rotation.  Athletes are more prone to hip rotations due to their specific position in the sport they play, however rotations can also be caused by genetic factors.  Realignment is achieved by balancing out the hip musculature so that the muscles can function in a manner that allows full range of motion and strength without compromising the integrity of the surrounding joints.

Labral tears (Image) are also very common in athletics.  The labrum serves as a lining in the hip socket (acetabulum) that provides stability and cushioning for the hip joint.  A labral tear often results in repetitive movements that cause degeneration and breakdown of the labrum.  The most common symptoms are a catching or clicking sensation in the hip joint and anterior hip pain (pain in the front of your hip).  An exercise program that maximizes hip range of motion and strength is normally initiated first as a means of conservative treatment.  Surgery is typically selected if conservative treatment does not relieve symptoms over time.

Common exercises your therapist may prescribe for these injuries to rehabilitate or decrease symptoms:

For those with Hip Labral Pathologies:

– Running in a pool with a buoyancy belt

– Core stability exercises: Pelvic tilts and bridges

– 4 way hip strengthening: (SLR x4)

– Single leg balance

For those with Hip Rotations:

– Isometric exercises: Quad and Hamstring

– Dynamic exercises: lunges, RDL’s, Single Leg Squats

– Stability exercises: Quadriped with alternate raised arm and leg, donkey kicks

 

Labral Tear Links

http://ptjournal.apta.org/content/86/1/110.full

http://advancedortho.net/diseases/hiplabraltears.php

Hip Rotations Information

http://www.oefentherapie.be/archief/beenlengteverschil.pdf

http://w3.palmer.edu/robert.cooperstein/publications/tcc/pelvic%20torsion%20tcc.pdf

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