Pelvis | Chung Ying Physical Therapy & Acupuncture

HIP

Conditions We Treat:

Bursitis
Femoroacetabular Impingement (FAI)
Fractures
Inflammatory Arthritis
Muscle Strain in the Thigh
Osteoarthritis
Osteonecrosis
Slipped Capital Femoral Epiphysis
Snapping Hip
Strains
Transient Osteoporosis

Bursitis

Bursitis is the swelling and irritation of a bursa. A bursa is a fluid-filled sac that acts as a cushion between muscles, tendons, and bones.

Causes:

Bursitis is often a result of overuse. It can also be caused by a change in activity level, such as training for a marathon, or by being overweight.

Other causes include trauma, rheumatoid arthritis, gout, or infection. Sometimes, the cause can't be found.

Management:

Tips to relieve bursitis pain:

Use ice 3 to 4 times a day for the first 2 or 3 days.
Cover the painful area with a towel, and place the ice on it for 15 minutes. Do not fall asleep while applying the ice. You can get frostbite if you leave it on too long.
Rest the joint.
When sleeping, do not lie on the side that has bursitis.

Posture/lifestyle modification:

Try not to stand for long periods.
Stand on a soft, cushioned surface, with equal weight on each leg.
Placing a pillow between your knees when lying on your side can help decrease pain.
Flat shoes that are cushioned and comfortable often help.
If you are overweight, losing weight may also be helpful.

You should avoid activities that involve repetitive movements of any body part when possible.

Inflammatory Arthritis

Inflammatory arthritis refers to any type of arthritis caused by an overactive immune system. These types of arthritis are also known as autoimmune disorders. Unlike osteoarthritis, inflammatory arthritis affects people of all ages, often showing signs in early adulthood.

Causes:

In a person with inflammatory arthritis, the body's immune system lacks the ability to self-regulate, and the immune system turns on itself. The tissue invasion of immune cells causes inflammation where it is not needed, and the production of chemicals causes damage to the affected tissues.

The exact cause of inflammatory arthritis is not known, although there is evidence that genetics plays a role in the development of some forms of the disease.

Management:

The treatment plan for managing your symptoms will depend upon your inflammatory disease.

Medications: Common medications used to manage inflammatory arthritis include non-steroid anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and injections in the hip, such as corticosteroid, hyaluronic acid, or platelet-rich plasma (PRP)
Physical therapy: Specific exercises may help increase the range of motion in your hip and strengthen the muscles that support the joint. In addition, regular, moderate exercise may decrease stiffness and improve endurance. Swimming is a preferred exercise for people with ankylosing spondylitis because spinal motion may be limited.
Assistive devices: Using a cane, walker, long-handled shoehorn, or reacher may make it easier for you to perform the tasks of daily living.

Muscle Strain in the Thigh

A muscle strain (muscle pull or tear) is a common injury, particularly among people who participate in sports. Once a muscle strain occurs, the muscle is vulnerable to reinjury. It is important to let the muscle heal properly and to follow preventive guidelines from your doctor.

Causes:

Muscle strains usually happen when a muscle is stretched beyond its limit, tearing the muscle fibers. This injury frequently occurs near the point where the muscle joins the tough, fibrous connective tissue of the tendon. A direct blow to the muscle may also cause a similar injury. Muscle strains in the thigh can be quite painful.

Management:

Most muscle strains can be treated with the RICE protocol. RICE stands for:

Rest. Take a break from the activity that caused the strain. Your physician may recommend that you use crutches to avoid putting weight on the leg.
Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
Compression. To prevent additional swelling, lightly wrap the injured area in a soft bandage or ace wrap.
Elevation. To minimize swelling, elevate your leg up above the level of your heart.

Femoroacetabular Impingement

Femoroacetabular impingement (FAI) is a condition in which extra bone grows along one or both of the bones that form the hip joint — giving the bones an irregular shape. Because they do not fit together perfectly, the bones rub against each other during movement. Over time this friction can damage the joint, causing pain and limiting activity.

Causes:

FAI occurs because the hip bones do not form normally during the childhood growing years. It is the deformity of a cam bone spur, pincer bone spur, or both, that leads to joint damage and pain. When the hip bones are shaped abnormally, there is little that can be done to prevent FAI.

It is not known how many people have FAI. Some people may live long, active lives with FAI and never have problems. When symptoms develop, however, it usually indicates that there is damage to the cartilage or labrum and the disease is likely to worsen.

Because athletic people may work the hip joint more vigorously, they may begin to experience pain earlier than those who are less active. However, exercise does not cause FAI.

Management:

When symptoms first occur, it is helpful to try to identify an activity or something you may have done that could have caused the pain. You can modify your activities, let your hip rest, and see if the pain will settle down.

If your symptoms persist, you will need to see a doctor to determine the exact cause of your pain and provide treatment options. The longer painful symptoms go untreated, the more damage FAI can cause in the hip.

Your doctor may first recommend simply changing your daily routine and avoiding activities that cause symptoms.

Physical therapy may be beneficial in some cases. Specific exercises can improve the range of motion in your hip and strengthen the muscles that support the joint. This can relieve some stress on the injured labrum or cartilage.

Fractures

A hip fracture is a break in the upper portion of the femur (thighbone). Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis.

Causes:

Most hip fractures result from low-energy falls in elderly patients who have weakened or osteoporotic bone. In these patients, even a simple twisting or tripping injury may lead to a fracture.

In some cases, the bone may be so weak that the fracture occurs spontaneously while someone is walking or standing. In this instance, it is often said that “the break occurs before the fall.” Spontaneous fractures usually occur in the femoral neck.

Stress fractures or fractures from repeated impact may also occur in the femoral neck. These fractures are often seen in long distance runners, particularly military recruits in basic training. When stress fractures occur in the subtrochanteric region of the hip, they are usually associated with prolonged use of certain osteoporosis medications.

Fractures of the femoral head are rare and are usually the result of a high-impact injury or are part of a fracture dislocation of the hip.

Management:

Most hip fractures require surgical treatment within 1 to 2 days of injury. Only a very small group of nondisplaced fractures in healthy patients can be treated without surgery, while a separate small group of patients may be too sick to safely have surgery.

Most patients are able to get out of bed and start physical therapy the day after surgery. It is important to begin moving as soon as possible. This helps prevent medical complications, such as blood clots, pneumonia, and bed sores. For older patients, it also helps prevent disorientation and deconditioning.

During recovery, you will work with physical and occupational therapists. They will give you exercises and tell you how much weight you can put on your leg. They will also show you how to manage the activities of daily living, such as bathing and dressing.

Osteonecrosis

Osteonecrosis is bone death caused by poor blood supply. It is most common in the hip and shoulder.

Causes:

Osteonecrosis occurs when part of the bone does not get blood flow and dies. After a while, the bone can collapse. If osteonecrosis is not treated, the joint deteriorates, leading to severe arthritis.

Osteonecrosis can be caused by disease or by severe trauma, such as a fracture or dislocation, that affects the blood supply to the bone. Osteonecrosis can also occur without trauma or disease. This is called idiopathic -- meaning it occurs without any known cause.

Possible causes include:

Using oral or intravenous steroids
Excessive alcohol use
Sickle cell disease or any blood condition that causes abnormal blood clotting
Dislocation or fractures around a joint
Clotting disorders
HIV or taking HIV drugs
Radiation therapy or chemotherapy
Gaucher disease (disease in which harmful substances build-up in certain organs and the bones)
Systemic lupus erythematosus (an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue such as the skin, joints, and certain organs)
Legg-Calve-Perthes disease (childhood disease in which the thigh bone in the hip doesn't get enough blood, causing the bone to die)
Decompression sickness from a lot of deep sea diving

Management:

If your provider knows the cause of your osteonecrosis, part of the treatment will be aimed at the underlying condition. For example, if a blood disorder is the cause, treatment will consist, in part, medicine to treat it.

If the condition is caught early, you will take pain relievers and limit use of the affected area. This may include using crutches if your hip, knee, or ankle is affected. You may need to do range-of-motion exercises. Nonsurgical treatment can often slow the progression of osteonecrosis, but most people will need surgery.

Slipped Capital Femoral Epiphysis

Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents. In SCFE, the epiphysis, or head of the femur, slips down and backward off the neck of the bone at the growth plate, the weaker area of bone that has not yet developed.

Causes:

The cause of SCFE is not known. The condition is more likely to occur during a growth spurt and is more common in boys than girls.

Risk factors include:

Excessive weight or obesity — most patients are above the 95th percentile for weight.
Family history of SCFE.
An endocrine or metabolic disorder, such as hypothyroidism or hyperthyroidism. This is more likely to be a factor for patients who are older or younger than the typical age range for SCFE (10 to 16 years).

Management:

The goal of treatment is to prevent the mildly displaced femoral head from slipping any further. This is always accomplished through surgery.

Once SCFE is confirmed, your child will not be allowed to put weight on their hip and will probably be admitted to the hospital. In most cases, surgery is performed within 24 to 48 hours.

After surgery, your child will be on crutches for several weeks. The doctor will give you specific instructions about when your child can start putting their full weight on the hip. To prevent further injury, it is important to closely follow the doctor's instructions.

A physical therapist may provide specific exercises to help strengthen the hip and leg muscles and improve range of motion, when appropriate.

Snapping Hip

Snapping hip can occur in different areas of the hip where tendons and muscles slide over bony prominences (knobs) in the hip bones.

Causes:

Snapping hip is most often the result of tightness in the muscles and tendons surrounding the hip. People who are involved in sports and activities that require repeated bending at the hip are more likely to experience snapping hip. Dancers are especially vulnerable.

Young athletes are also more likely to have snapping hip. This is because tightness in the muscle structures of the hip is common during adolescent growth spurts.

Management:

Reduce your activity level and apply ice to the affected area.
Use nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, to reduce discomfort.
Modify your sport or exercise activities to avoid repetitive movement of the hip. For example, reduce time spent on a bicycle, and swim using your arms only.

If you are still experiencing discomfort after trying these conservative methods, consult your doctor for professional treatment.

Transient Osteoporosis

Transient osteoporosis of the hip is a rare condition that causes temporary bone loss in the upper portion of the thighbone (femur).

People with transient osteoporosis of the hip will experience a sudden onset (start) of pain that worsens with walking or other weight-bearing activities. In many cases, the pain increases over time and may become disabling.

Painful symptoms gradually decrease and usually go away within 6 to 12 months. Bone strength in the hip also returns to normal in most people.

Causes:

Currently, there is no clear explanation for what causes this condition. Researchers are studying this disease and several theories have been proposed, although none are proven.

Some of the causes that have been suggested include:

Obstruction (blockage) of some of the small blood vessels that surround the hip
Hormonal changes
Abnormal mechanical stresses (external load or force) on the bone

Management:

Because transient osteoporosis goes away on its own, treatment focuses on minimizing symptoms and preventing any damage to the bones while they are weakened by the disorder.

Weightbearing restrictions. Your doctor may advise you to temporarily limit or eliminate weightbearing activities. Using crutches, a cane, a walker, or other walking aid, will help relieve the stress of weightbearing on the affected hip, and may prevent a fracture of the temporarily weakened bone.
Physical therapy. To help maintain strength and flexibility in the muscles supporting your hip, your doctor may also recommend a series of exercises that you can do as the pain lessens. Water exercises may be helpful not only because they ease movement, but also because they relieve weight bearing.
Nutrition. Proper nutrition, including Vitamin D and calcium, may help promote the healing process and rebuilding of bone.