By Dr. Stephen Szaro, DC & Dr. Tanuj P Palvia, MD
Hip pain, often insidious, can happen to anyone at any time, taking many forms. You can experience pain in the front of your hip, the sides or even the back around your buttocks. The pain may be more intense when engaging in physical activities or if maintaining a certain position for extended periods. Walking, running or participating in other vigorous activities could exacerbate the pain.
The source of the pain often determines how intense the pain is and where you feel it. In this article, we wish to describe what you need to know about hip problems, and some Physio Logic Methods that can help.
The Causes of Hip Pain
Usually, hip pain isn’t the result of a single problem. More often than not, it has several origins, including:
- Bursitis – A fluid-filled sac called the bursa surrounds your joints. It helps to reduce friction and cushion the joint, but when it becomes inflamed it results in bursitis. This can also be due to an imbalance between the anterior/posterior or medial/lateral muscle sets that stabilize the joint.
- Osteoarthritis – This is a degenerative process of the cartilage around your joints, often the result of normal wear and tear. This is further exacerbated by obesity
- Overuse or muscle strain – If you are physically active or athletic, this is a common problem. Putting your body through the same movements for long periods can cause muscles in the hip to become bruised, overstretched or torn. Typically, those with an imbalance between the anterior/posterior or medial/lateral muscles will be of particular risk.
- Labral tear – The hip labrum is the ring of cartilage that follows the outside rim of your hip joint socket, which is called the acetabulum. Besides cushioning the hip joint, the labrum acts like a rubber seal or gasket to help hold the ball at the top of your thigh bone, called the head of the femur, securely within your hip socket. The labrum can be torn due to injury/overuse, structural problems such as femoral acetabular impingement (FAI) or degenerative changes. Pain is usually felt in the groin area and can cause a significant decrease in range of motion.
- Transient osteoporosis – This is a reversible but painful condition that impacts some pregnant women and middle-aged men. Loss of bone density in the joint will predispose this population to hip injury.
- “Non-hip” causes – There are several structures that run through the hip area that can mimic hip pain. These include, but are not limited to, sciatica, lumbar spine disc herniations, spine facet disease/osteoarthritis, piriformis syndrome and peripheral nerve conditions such as meralgia paresthetica, to name a few.
We at Physio Logic believe in an integrated approach to solving deep joint issues. For the toughest hip problems, a combined approach with chiropractic care and interventional orthopedics can aid in improving joint and soft tissue mobility, strength and pain reduction.
Chiropractic and Rehabilitative Solutions
- Spinal Manipulative Therapy (SMT) – The goal of SMT is to restore proper range of motion of joints that are not moving properly or through the full range of motion. When there is a loss of range of motion and pain in the hip joint, there is often decreased motion in the joints of the thoracic and lumbar spine and the sacroiliac joints. SMT is also helpful in decreasing pain almost immediately.
- Active Release Technique (ART) – ART is the gold standard in soft tissue manipulation or deep tissue release. With any of the hip conditions described earlier, there is often a decrease in extensibility of one or more soft tissues (muscle, tendon, ligament, connective tissue (fascia) or nerve) that attach to the hip due to the formation of deep, dense scar tissue. Scar tissue forms due to injury from acute conditions (pulls, tears, collisions, etc), accumulation of small tears (micro-trauma) and tissues not getting enough oxygen (hypoxia). ART is so effective because it disrupts the cumulative trauma cycle by utilizing active motion with deep tissue release.
- Graston Technique (GT) – GT is an instrument-assisted soft tissue mobilization technique that uses stainless steel instruments to break up scar tissue and myofascial adhesions, or scar tissue that forms between the muscle and connective tissue layers.
- Traction/decompression – One of the most beneficial and pain relieving treatments for hip osteoarthritis is traction or decompression. The treatment involves a mechanical table to stretch the hip joint open and can relieve years of pressure and compression. The traction is intermittent and can aid in healing damaged cartilage. It is especially useful when combined with traditional pain management procedures and regenerative medicine treatments such as cortisone injection to reduce inflammation and/or the use of stem cell and platelet rich plasma (PRP) injection.
- Exercise and stretches – Your chiropractor can offer you a personalized exercise and stretching program to help increase the range of motion of your hips and strengthen the muscles, both of which can help to speed healing.
- Activities of daily living – If you are participating in a behavior that may be the cause of your hip pain, your chiropractor can help you to identify it in order to offer real solutions to help you change this behavior for better health.
- Nutrition – Nutrition is a big part of overall health and reducing inflammation. It can also assist you to maintain a healthy weight which can reduce the strain on your hips and help speed your recovery. Inflammation is also a major reason for degenerative joint conditions. There are many ways to optimize your nutrition which can significantly improve and speed up the healing process.
Interventional Orthopedic and Regenerative Care
While the purpose of chiropractic care is to improve your function and movement, it is also important to address the ongoing inflammation which limits these goals and also worsens pain. In these cases, having an interventional orthopedist work to minimize the inflammation and healing damaged structures can improve overall recovery, and enhance your success with your chiropractor. Here is what you can expect from an interventional orthopedist:
- A short course of anti-inflammatories, commonly known as non-steroidal anti-inflammatory drugs (usually abbreviated as NSAIDs or NAIDs), can aid to reduce inflammation as a result of gluteal tear or tendonitis, labral tear, synovitis, or erosion to due to cartilage loss.
- A simple, one time cortisone injection, to the inflamed area can help with a much more focused and potent intent. We use methylprednisolone, which is a safe corticosteroid that provides an efficient and effective anti inflammatory action in inflamed tissues. Intra-articular Injections are made directly into the hip joint that can provide relief. With Ultrasound or fluoroscopy guidance, the medication can be delivered to the chronically inflamed tissue with maximal precision. The same therapy can be provided to the psoas muscle or trochanteric bursa for similar purposes.
- Prolo-ozone injections can be performed in cases where anti-inflammatory alone is not sufficient. Prolotherapy offers stimulation of blood vessels to damaged tissue to promote healing, and ozone therapy has known antimicrobial effects to decrease inflammation and promote immune strengthening. When performed under direct distention with the aid of a skilled chiropractor, this is very useful for mobilizing a tough capsule and breaking down any built-up scar tissue due to chronic inflammation
- Stem cell and or platelet-rich-plasma therapy is useful for strengthening a chronically worn joint by promoting healing and allowing regeneration of damaged tissues. This phase of care is important for maintenance of joint strength, restoration of function, and promotion of overall performance of the joint, minimizing chances of future reinjury.
Our integrated approach, including chiropractic care, interventional therapy, and regenerative medicine, enables reduction of pain to your particular injury. This safe approach requires no downtime and significantly increases your chances of avoiding surgery. Once recovered, we are able to guide you through an array of alternative treatments often include acupuncture, manual manipulation, massage therapy, nutrition, and various forms of exercise, such as pilates, to maintain joint resilience and prevent re-injury or further injury.
If you’re experiencing hip pain and want to know you’re getting every available option to recovery, give us a call or start by filling out the form below.