MY HIP FLEXORS ARE TIGHT……
At the Injury Hub we have been very fortunate to work with some of the country’s finest professional dancers. From Sadlers Wells, Zoonation, the Royal Ballet, countless backing dancers to Kylie Minogue, Robbie Williams, JLS, Take That and numerous Saturday night TV entertainment shows. For years dancers have presented to us complaining of a “HIP FLEXOR STRAIN” and besides dancers even the local cross fitter, pilates enthusiast, runner , office worker will come in having self-diagnosed a “TIGHT HIP FLEXOR” Quite often the individual has been told this by another clinician or they are bodily aware and know that their hip flexor muscles pass over the groin, so they automatically make the assumption it’s a HIP FLEXOR PROBLEM. In 25 years of working as a physical therapist I have most probably seen “THREE”, yes three tight hip flexors that were symptomatic! Having had a special interest in radiology and now a musculoskeletal sonographer I have been privileged to scan hundreds of dancers with so called tight hip flexors and the overwhelming conclusionthat causes their symptoms is a condition called Femoral Acetabular Impingement (FAI).
Femoral Acetabular Impingement (FAI)
A condition where there is abnormal contact between the bones of the hip joint, leading to pain and reduced range of motion. It occurs when an individual is born with a small mound of bone situated on the neck of their thigh bone known as a CAM lesion. Other individuals may have a small protrusion of bone on the outer part of the hip socket known as a Pincer lesion. Between the head of the femur and the hip socket there is a tissue called the labrum or labral cartilage. This is a ring of cartilage that helps cushion the joint, provides stability by deepening the socket, and helps keep the ball of the joint in place. When a CAM or PINCER lesion is present and the individual performs repetitive hip flexion, running, knee hugs, squats, standing from sitting the small area of bone can start to rub the labrum causing irritation and in some cases the labral cartilage can tear. This can go on for years as a dull ache, fleeting pain and can manifest as a sharp catching or clicking sensation within the groin. We have seen hundreds if not thousands and if your suffering with groin pain it’s a very easy condition to diagnose via physical examination and we can give you all the tips and tricks to help treat it.
See below for other causes of hip pain that we commonly see.
Trochanteric Bursitis of the Hip
This is another very common condition. A bursa is a fluid filled sac that reduces friction and aids cushioning of the tendons as they pass over the top of the bone. The Trochanteric bursa is situated over the outer part of your lateral hip bone. (The part that’s in contact with the bed when you are side lying) Quite often a patient will present with pain at night when trying to sleep on their side. It can also be sore and painful when walking long distances and when performing squats. This type of bursitis is typically irritated due to having very tight gluteal (buttock) muscles. The tendon of these muscles can rub creating friction causing localised pain. It can also be due to an increased spine and hip angle. Easily diagnosed clinically and also seen on imaging. Treatment in the form of hands on manipulation of the muscles, joint articulation works well and in some chronic cases injections in to the bursa work very well.
Osteoarthritis
(OA) of the hip is a degenerative joint condition where the cartilage that cushions the hip joint gradually breaks down over time. This causes the bones of the joint “the femur and the pelvis” to rub against each other, leading to pain, stiffness, and decreased mobility. The key features of osteoarthritis of the hip are: Cartilage breakdown, bone Spurs, Joint Space Narrowing and Inflammation. Quite often a patient will present with pain in the groin but equally pain along the inside of the thigh travelling to the knee. It’s generally treated with hands on manipulation. Advanced OA can respond well to Hyaluronic acid injection and steroid. Chronic cases are referred for an orthopaedic replacement.
Hip Fractures
Common in older adults, especially those with osteoporosis, hip fractures can result from a fall or injury. Quite often can go undiagnosed or diagnosed as an arthritic flare up.
Symptoms are generally of Intense pain in the hip or groin, difficulty walking or bearing weight.
Avascular Necrosis (Osteonecrosis)
This occurs when the blood supply to the hip joint is reduced, causing bone tissue to die, which can lead to pain and joint collapse. This is diagnosed via MRI scan, which we can refer via the Injury Hub.
Snapping Hip Syndrome
A condition where a fibrous band (ilio tibial band), located over the outer part of the hip,moves over a bony trochanter, creating a snapping sensation or sound during activity such as walking, dancing, or running. This is generally not painful but the individual will complain of a clicking snapping sensation. If long standing then it can become inflamed and hence painful. This is easily treated by one of our therapists.
Many of the hip conditions above can overlap, which is why at The Injury Hub we take time to ensure you have the correct diagnosis before starting treatment.
Personal