Hip injuries are a common problem encountered in an osteopaths clinic. A detailed clinical evaluation is needed to enable effective management.
When looking at the history of the condition its important to note the duration, location and character of pain. The character of pain is particularly important as this can help identify if there is any intra-articular pathology at the hip.
The mechanism of the injury is important, was it an acute injury? Was it insidious? This again can help develop an idea as to whats going on. Issues like femoracetabular impingement generally occur gradually over time.
It is important to note what makes the pain worse. How is the patient when they are getting in and out of a car, twisting/turning or going up the stairs. Defining what positions or activities cause the problem can provide an insight into what the cause of the injury is.
Are there any neurological symptoms? This would be less likely as a result of a problem with the hip but could indicate a problem with the lower back.
What is the patients history with injuries to the hip? Are they a regular occurrence, do they have a prominent sporting background? What sorts of jobs have they done in the past?
Family history can be significant when there has been a history of Osteoarthritis and a family member has had a joint replacement at an early age.
Your osteopath will examine your hip in a number of ways, these can include active and passive joint movements, gait, pain provocative testing of the muscles, strength testing and palpation. There are also a number of special tests/orthopedic tests that the osteopath can perform to help identify a painful structure.
The hip can be investigated effectively in a number of ways. Initially, x-rays are thought to be the best imaging modality. Ultrasound is less commonly used as its hard to view the intra-articular structures of the hip. MRI and MRI arthograms are commonly the second choice for investigating the hip.
Treatment wise there are a number of approaches you can take with hip injuries. Hands on treatment can be used that can look at addressing activity modification, strengthening, balance and co-ordination. The osteopath can also look at changing the position of various joints and improving their range of motion.
Specific Injuries – now some info on some common injuries to the hip seen in osteopath clinics.
Femoracetabular impingement (FAI)
This can be found in around 20% of the general population. It can be split into three types. Type 1 is a CAM impingement, mainly seen in young, active males. This type involves a bony projection from the head of the femur that causes a pinching sensation on movement. The second type is a pincer type, this is refering to a bony change in the acetabulum where the socket is deeper. The third type is the most common and is a mixture of the two where there are findings in both the acetabulum and the femur.
Diagnosis of this is important as the repeated contact can generate synovitis at the joint, and longer term lead to a labral tear and damage to the cartilage. Most commonly symptoms appear insidiously with pain at the front of the hip. Its generally worse on activity and with movements that require flexion and rotation. Examination wise, the osteopath will most commonly note a loss of internal rotation at the hip. X-rays can be indicated when there has been suspicion of FAI but no improvement in the symptoms
Treatment can involve a number of approaches. These can include specific hip strengthening, proprioception, modifications to the loading that is going through the hip and modified training strategies.
The acetabular is a ring of cartilage that surrounds the acetabulum of the hip. Labral tears often develop gradually due to microtrauma at the joint. The main symptom is pain aggravated by movement. The pain is described as deep and located at the front of the hip in the groin area. An examination will look at movements of the hip with flexion, adduction and internal rotation commonly producing pain. Like FAI, x-rays and MRI’s are the most commonly used forms of imaging.