HIP

Gluteus Medius tendinopathy

The pain due to gluteus medius tendinopathy presents as a pain in the side of the hip. The pain has usually developed gradually over a period of weeks to months. The injury is most commonly developed in long distance runners, or post- menopausal women. In both cases, an assessment of the person’s running or walking pattern and the identification of imbalances of flexibility and strength through the hip, pelvis and lower back is essential in identifying contributing factors. These factors are then addressed through exercises and manual therapy techniques. Special exercises that are designed to stimulate repair in the tendon are central to effective management. In the case of an athlete, careful management of the athlete’s training load, in consultation with any coaching staff involved, is also essential to recovering from this injury and being able to return to the previous level of competition.

hip bone
Gluteus Medius insertion onto the greater trochanter of the femur (hip bone)

Iliopsoas Tendinopathy

The pain due to iliopsoas tendinopathy presents as a pain in the front of the hip or lower abdomen. The pain has usually developed gradually over a period of weeks to months. The injury is most commonly developed in athletes who play sports that involve sprinting, changing directions and kicking and the pain is felt mainly during these activities. The pain is caused by a degenerative change that occurs in the tendon close to, and sometimes including the area on the pubic bone where it inserts. Treatment includes the identification of imbalances in flexibility and strength through the hip, pelvis and lower back and addressing these issues through exercises and manual therapy techniques. Special exercises that are designed to stimulate repair in the tendon are central to effective management. Careful management of the athlete’s training load, in consultation with any coaching staff involved, is also essential to recovering from this injury and being able to return to the previous level of competition.


Insertion of the iliopsoas (combined iliacus and psoas) tendon on to the femur

Osteoarthritis of the hip

Osteoarthritis of the hip is more common in people over 60 years of age. The pain is most often felt in the front and side of the hip, though it is possible for the pain to radiate into the buttock, lower back or knee. The diagnosis of osteoarthritis is given to joints that show signs of degenerative change of the cartilage that lines the joint surfaces and the bone underneath this cartilage. Treatment for osteoarthritis of the hip includes manual therapy techniques and stretching exercises to maximise the pain-free range of movement in the hip, strengthening exercises for the surrounding muscles, and possible modification of daily activities and sitting position.

Plain x-ray of the hip joint showing signs of osteoarthritis
(sclerosis and irregularity of the joint surfaces)

Hip Joint Injuries

Labral Tears
Inside the hip joint there is a thick fibrocartilage rim around the cup part of the hip (acetabulum), this is called the labrum. In some circumstances the labrum can tear. Pain due to a labral tear can be felt in several areas, including the front, side or rear of the hip, front of the thigh, or even the knee. Sometimes a tear in the labrum will cause a clicking sensation with certain hip movements. Labral tears are best diagnosed through Magnetic Resonance Imaging (MRI). An orthopaedic specialist should be consulted to confirm the diagnosis and to determine whether surgery is advisable. Physiotherapy treatment includes manual therapy techniques and stretching to increase the pain-free range of movement in the hip, and strengthening exercises of the deep stabilising muscles around the hip.

Acetabular Labral Tear

Femoro-acetabular Impingement (FAI)

FAI describes a condition where the cup (acetabulum) and ball (femoral head) aspects of the hip joint are slightly mismatched in shape, which results in the two bones pinching against each other when the hip is bent up (flexed). This impingement causes degenerative changes to occur in the labrum (the thick fibrocartilage rim around the acetabulum), cartilage and underlying bone in the involved area of the acetabulum. Pain due to FAI can be felt in several areas, including the front, side or rear of the hip, front of the thigh, or even the knee. FAI is best diagnosed through Magnetic Resonance Imaging (MRI) and 3D Computer Tomography (CT). An orthopaedic specialist should be consulted to confirm the diagnosis and to determine whether surgery is advisable. Physiotherapy treatment includes manual therapy techniques and stretching to increase the pain-free range of movement in the hip, and strengthening exercises of the deep stabilising muscles around the hip.


Illustration of the various profiles of the femoral head and acetabulum that combine to cause femoro-acetabular impingement

Total Hip Replacement
Following hip arthroplasty, it is important to gain guidance from an experienced physiotherapist in developing an exercise programme to maximise the potential from your ‘new hip’. The hip will initially be painful and stiff to move, and the hip muscles will be weak. Our physiotherapists will work with you to develop a rehabilitation programme with the aim of allowing you to return to your work and recreation without any unnecessary limitations.


Illustration of total and hemi (half) hip arthroplasty

Perthes’ disease
Perthes’ disease refers to an Osteochondrosis (degenerative changes in the bone and cartilage) of the femoral head (top end of the thigh bone), which typically affects children (boys more than girls) between the ages of 4 and 10 years. The child will complain of an ache in the thigh, groin or knee and this will often cause them to limp. If one of our physiotherapists suspects this may be the cause of your child’s pain we will refer you to your family doctor for radiographic investigations (xray). When caught early enough this condition can be managed well with modification of activity levels and, when the time is right, some gluteal strengthening exercises.


Plain x-ray showing the flattened femoral head due to osteochondrosis

Slipped femoral epiphysis
This describes a condition wherein the head of the femur (top end of the thigh bone) slips at the growth plate between it and the neck of the femur. This typically occurs in 12-15 year olds. The child will often complain of pain in the groin, thigh or knee. This pain will usually cause the child to limp. If one of our physiotherapists suspects this may be the cause of your child’s pain we will refer you to your family doctor for radiographic investigations (x-ray). When caught early enough this condition can be managed well with modification of activity levels and, when the time is right, some gluteal strengthening exercises.


Plain x-ray (beneath) showing slipped femoral capital epiphysis