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The Tragically hip

Hip pain can arise from soft tissue injuries eg ligament sprains and muscle strains, bone conditions eg. arthritis, or poor movement patterns. It may even be referred from another injury or condition!


It’s extremely important to know when to seek a doctor or hip specialist. Here are some signs to look out for that if present, you should go seek medical attention.


  • Obvious deformity

  • Swelling

  • You heard a “pop” or “snap”

  • Less than the normal range of motion.

  • Greater than the normal range of motion

  • Your hip is “giving way” or “buckling”

  • You cannot weight-bear on that leg.

  • You feel shooting pain down your leg.

  • You feel pain in hips and/or low back.


If you experience any of these please seek medical attention prior to continuation of your fitness schedule!


Anatomy.


The hip joint is a ball-and-socket type joint and is formed where the thigh bone (femur) meets the pelvis. The femur has a ball-shaped head on its end that fits into a socket formed in the pelvis, called the acetabulum. Large ligaments, tendons, and muscles around the hip joint hold the bones (ball and socket) in place and keep it from dislocating. The hip is formed where the femur meets the three bones that make up the pelvis: the ilium, the pubis and the ischium. These three bones converge to form the acetabulum, a deep socket on the outer edge of the pelvis. By adulthood, these three bones are completely fused and the pelvis is effectively a single bone.


The femur is the longest bone in the body. It is important to remember that the actual hip joint lies deep in the groin area. This is important because true hip joint issues are typically associated with groin pain.



The femoral head (ball) fits into the acetabulum (socket) of the pelvis. The large round head of the femur rotates and glides within the acetabulum. Ball and socket joints are able to preform a number of movements:

  • flexion – bend

  • extension – straighten

  • abduction – leg move away from midline

  • adduction – leg moves back towards midline

  • external rotation (allows for the foot to point outwards)

  • internal rotation (allows for the foot to point inward)


There are numerous structures that contribute stability to the hip:

  • The ball and socket bony structure

  • The capsule and its associated ligaments: e.g. iliofemoral ligament, pubofemoral ligament

  • The surrounding muscles including the abductors (gluteus medius and minimus) and external rotators (gemelli muscles, piriformis, the obturators).


Hip Ligaments


The stability of the hip is strengthened by the ligaments that encircle the hip (the iliofemoral, pubofemoral, and ischiofemoral ligaments). These ligaments completely surround the hip joint and form the joint capsule. The iliofemoral ligament is considered by most experts to be the strongest ligament in the body. The ligamentum teres is a small tubular structure that connects the head of the femur to the acetabulum. It contains the artery of the ligamentum teres. In infants, this serves as a relatively important source of blood supply to the head of the femur. In adults, the ligamentum teres is thought by most to serve little function.


Muscles of the Hip


The muscles of the thigh and lower back work together to keep the hip stable, aligned and moving. It is the muscles of the hip that allow the movements of the hip:

The hip muscles are divided up into three basic groups based on their location: anterior muscles (front), posterior (back), and medial (inside).


The muscles of the anterior thigh consist of the quadriceps (or quads): vastus medialis, intermedius, lateralis and rectus femoris muscles. The quads make up about 70% of the thigh’s muscle mass. The main functions of the quads are flexion (bending) of the hip and extension (straightening) of the knee.


The posterior muscles contain the gluteal and hamstring muscles, as well as the external rotators of the hip. The gluteal muscles consist of the gluteus maximum, gluteus medius, and gluteus minimus. The gluteus max is the main hip extensor and helps keep up the support of the fascia lata or iliotibial (IT) band, which is the long, sheet-like tendon on the side of your thigh (the one that’s a b*tch to foam roll!). It helps with motion of the hip, but perhaps more importantly, acts to help stabilize the knee joint.


Gluteus medius and minimus are the main abductors of the hip, they move the leg away from the midline of the body (using the spine as an origin point). They also are the main internal rotators of the hip (i.e. turn the foot inwards). The gluteus medius and minimus are also important stabilizers of the hip joint and help to keep the pelvis level as we walk. The tensor fascia lata (TFL) is another abductor of the hip, which, along with the gluteus maximus, attaches to the IT band. The IT band is a common cause of lateral (outside) hip, thigh, and knee pain (again with the foam rolling!). The external rotator muscles (piriformis, gemelli, obturator internus) of the hip are located in the buttock area and assist in lateral rotation of the hip (turn out and Pilates V).


The medial muscles of the hip are involved in the adduction of the leg (i.e. bringing the leg back towards the midline). These muscles include the adductors (adductor magnus, adductor longus, adductor brevis, pectineus, gracilis). Obturator externus also helps to adduct the leg. Inner thigh anyone?


Common injuries.


For Pilate’s sake, I am not going to be going through a few injuries that I can work with and I see a lot in the studio, I am not a surgeon or a physiotherapist. Therefore I will not be going over full ligament tears or any matters that involve surgical repairs. Pilates is a great continuation of rehabilitation once your doctor and physio have cleared you for further activity! Once you are cleared, you would be treated the same as a sprained ligament.


  • Sprains and Strains

  • Hip Bursitis

  • Arthritis

  • Snapping hip syndrome


Sprains and strains


Sprains and strains are injuries to the muscles and ligaments. The most common injuries of the hip and groin region in athletes are muscle strain injuries. Muscles around the hip joint are especially prone to this type of injury because they are subject to eccentric contraction.


Causes: These injuries usually happen in sports such as soccer, football, and basketball where the knee might experience a sudden twisting motion, a rapid change in direction, or an incorrect landing from a jump. Often a pop or snap is heard followed by swelling. Symptoms also include tenderness along the joint line and pain with walking.


Treatment: Reduce pain and inflammation, Normalize your joint range of motion, Strengthen your hip:all 3 muscle groups, Strengthen your pelvis and lower limb, Improve alignment of spine, knees, and ankles, equal your muscle lengths, Improve your strength, agility, and balance, Improve your movement patterns/ correct your form eg) walking, running, squatting, hopping and landing, and Minimize your chance of re-injury.



Hip Bursitis.


Inflammation of the bursa over the outside of the hip joint, trochanteric bursitis, can cause pain with hip movement. Treatment of hip bursitis is often effective, but the condition has a problem of coming back and sometimes becoming a persistent problem.


Causes: The trochanteric bursa is normally caused by repeated compression of the bursa resulting in inflammation and pain. It is usually associated with weakness of the gluteal muscles, particularly gluteus medius. Researchers have found that gluteal weakness is a side effect of poorly rehabilitated low back pain or hip pathologies.


Treatment: The good news is that muscle weakness can be reversed with exercise! The exercises should be focused on retraining your weak muscles. This is important since different gluteal and hip rotator muscles are strengthened by different exercises!

Reduce pain and inflammation, Normalise your joint range of motion, Strengthen your knee: esp Quadriceps (esp VMO) and Hamstrings, Strengthen your lower limb: Calves, Hip and Pelvis muscles, Improve patellofemoral (kneecap) alignment, Normalise your muscle lengths, Improve your proprioception, agility, and balance, Improve your movement patterns/ correct your form eg walking, running, squatting, hopping and landing, and Minimise your chance of re-injury.



Arthritis and replacements.


The most common cause of hip Arthritis is Osteoarthritis (OA).

osteoarthritis is a degenerative condition where the articular cartilage of your joint gradually wears away, exposing the underlying bone. As your arthritis progresses, bony spurs also develop in and around your knee joint in response to the change in load distribution and biomechanics.

Muscle weakness and the resultant hip joint instability associated is thought to contribute towards the deterioration of your hip joint cartilage. Weaker hip muscles also provide less shock absorption, which increases your hip joint compression. Hip osteoarthritis usually happens gradually over time.

Some risk factors that might increase your likelihood of deterioration include:

  • Being overweight.

  • Age.

  • Previous joint injury.

  • Muscle weakness.

  • Stresses on the joints from certain jobs and playing sports.

  • Poor biomechanics.

  • Malformed joints or a genetic defect in your joint cartilage.


Treatment:


  • Lose weight. You won’t just look better, you’ll feel better, too. Why? Every extra kilogram you carry around translates to added stress to your hip joints. Excess weight can mean more hip pain, no matter which form of arthritis you have.

  • Ice it! When your hip joint is hot and inflamed, applying something cold can decrease pain and swelling by constricting blood vessels and preventing fluids from leaking into surrounding tissues.

  • Exercise - Keep Moving. Exercise helps to lessen your hip pain, increase your hip joint range of movement, reduce fatigue and help you feel better overall. A well-rounded workout (or Pilates!) for people with hip osteoarthritis includes flexibility exercises to increase your hip joint and muscle range of motion, aerobic exercises to improve your endurance and decrease fatigue, and strengthening exercises to improve your muscle endurance and power.

The main goals of pilates for your arthritis are:

  • Reduce your pain and inflammation.

  • Normalize your joint range of motion.

  • Strengthen your hips and your lower limb

  • Improve your alignment and function.

  • Normalize your muscle lengths.

  • Improve your strength, agility, and balance.

  • Improve your technique and function eg walking, squatting.


Snapping hip syndrome.


Snapping hip syndrome is a condition that is characterized by a snapping sensation, and often an audible 'popping' noise, when the hip is flexed and extended. There are several causes for snapping hip syndrome, most commonly due to tendons catching on a bony prominence and "snapping" when the hip is moved.

Many people with snapping hip syndrome feel as though the ball of their ball-and-socket hip joint is coming out of position, a so-called hip subluxation. This is very rarely associated with snapping hip syndrome and usually caused by severe traumatic injuries.


Snapping hip syndrome is not really a diagnosis, but rather a symptom. The symptom of the snapping sensation is caused by an underlying condition. In order to ensure proper treatment, that diagnosis must first be identified.


Causes of Snapping Hip Syndrome


Iliotibial Band Syndrome: The iliotibial band (IT band) is a thick, wide tendon over the outside of the hip joint. The most common cause of snapping hip syndrome is when the band snaps over the greater trochanter (the bony prominence over the outside of the hip joint). If this is the cause of a snapping hip, you may develop hip bursitis (see above) from the irritation of the bursa.


Iliopsoas Tendon Snap: The iliopsoas tendon is the primary hip flexor muscle, and the tendon of this muscle passes just in front of the hip joint. The iliopsoas tendon can catch on a bony prominence of the pelvis and cause a snap when the hip is flexed. Usually, when the iliopsoas tendon is the cause of snapping hip syndrome, patients have no problems but may find the snapping annoying.


Hip Labral Tear: The least common cause of snapping hip syndrome is a tear of the cartilage within the hip joint. If there is a loose flap of cartilage catching within the joint, this may cause a snapping sensation when the hip is moved. This cause of snapping hip syndrome typically causes a snapping sensation, but rarely an audible "pop." This cause of snapping hip syndrome may also cause an unsteady feeling, and patients may grab for support when the hip snaps.


Treatment: Exercise helps to lessen your hip pain, increase your hip joint range of movement, reduce fatigue and help you feel better overall.

A well-rounded workout (or Pilates!) for people with hip osteoarthritis includes flexibility exercises to increase your hip joint and muscle range of motion, aerobic exercises to improve your endurance and decrease fatigue, and strengthening exercises to improve your muscle endurance and power.


Pilates is great at rehabilitating, and preventing injuries because we look at the big picture. With hips for example, not only will the injury be directly addressed, but so will the whole body. One of my goals for all my clients is efficiency. Meaning that the whole body is working together as one to accomplish each and every task. When the whole body is strong, there will be no unnecessary compensations causing injury, no poor movement patterns putting stress on your joints, or underlying weaknesses that are never addressed while rehabilitating just one part of your body. Remember, everything is connected! 💞

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