The hip is a complex region due to the large number of muscles either attaching directly to the sacroiliac joint, illuim (the hip bone) or the femur. There are several layers to the hip joint, including the large overlying muscles (glute max), smaller stabilising muscles(glute med, piriformis), deep rotators as well as those which attach and act at different joints (quadriceps and hamstrings). Pain in the hip can also arise from muscle imbalances (weak or tight muscles) and joint stiffness.
Tendon pathologies usually occur due to repeated stressors which load tendons more than they can stand resulting in microtears and inflammation. Hip tendinopathies (commonly Gluteus medius) can occur on one side or both sides.They cause pain with climbing stairs, walking and sleeping on your side. Treatment for this condition involves decreasing initial stress of the tendon affected to improve inflammation, then a graded strengthening program to improve tendon properties.
Impingement usually presents with decreased range of motion and pain following activity. This is due to stress and irritation of the hip capsule and cartilage lining, leading to inflammation. Impingement can occur due to a variety of reasons, the most common being due to bony abnormalities of the ball and socket of the hip joint. Extra bony growth on either portion leads to increased contact of bony surfaces which can damage the joint. The inflammation and bruising in the joint can lead to muscle imbalances. Treatment aims to decrease muscular tension, inflammation and stress applied to the joint. Following this a strengthening and stretching program is developed to assist with long term management.
Bursitis arises when there is a large amount of continuous compression applied to the outside of the femur, or due to an acute injury such as a fall or contact sports. Bursitis refers to inflammation with a fluid filled sac which prevents structures from rubbing on the bony surface of this hip and femur. This inflammation leads to pain which is a dull ache and worsens with activity. The aim of treatment is to reduce tightness which compresses the bursa (the gluteal and hip muscles), and correcting movement patterns which increase compression. Medical management usually is also required to provide anti inflammatory medications and occasional referral for a cortisone injection.
Sciatic pain/piriformis syndrome/deep gluteal syndrome
When the sciatic nerve is compressed at the level of the spinal cord the pain is referred to as sciatica. If the sciatic nerve is compressed further down in the buttock area the condition can be known as piriformis or deep gluteal syndrome. Physiotherapy treatment focuses on decreasing compression and tension on the sciatic nerve, and correcting biomechanics through strengthening muscles surrounding the hip and back.
Avascular necrosis / Slipped capital femoral epiphysis
These conditions are diagnosed with an Xray. They arise during childhood, usually in those that play sport which high compressive loads (basketball and netball). Avascular necrosis refers to a decrease in blood flow to the ball of the hip which can result in death of the bone and a rough appearance rather than smooth. Slipped capital femoral epiphysis is where the bone slips apart at the level of the growth plate. The growth plate is a soft portion of the bone and is the centre for bone growth.
These conditions are treatment surgically initially followed by rehabilitation with a physiotherapist.
Treatment following medical intervention focuses on improving range of motion and decreasing pain. Following this you will begin a graded return to weight bearing, strengthening and in the long term any sport or activity you may have been participating in.