HIP AND GROIN PAIN

Femoroacetabular impingement

Known as FAI or hip impingement, this condition relates to a mechanical pinching or compression at the rim of the hip socket (acetabulum) and ball (femoral head). The presence of extra boney growth at the rim of the hip socket or ball makes the pinching more prevalent in people playing sports involving running, twisting, bending and changes of direction.

Pain is usually felt at the front of the hip and groin, and sometimes at the outer hip or buttock. Compensatory pain is common is the lower back and sacroiliac joint.

Diagnosis requires

1) pain associated with the above mentioned activities,

2) positive impingement testing on examination, and

3) radiological evidence of the extra boney growth.

A variety of individual and environmental factors are involved in the development of FAI, and expect consensus currently supports extensive conservative rehabilitation and treatment before considering surgery. In particular modifying aggravating activities and retraining unhelpful biomechanics around the hip and pelvis are essential in persistent cases.

Hip Dysplasia

Sometimes known as Hip Hypermobility, Hip Instability or Developmental Dysplasia of the Hip (DDH), this condition relates to an increased amount of movement or “play” of the hip ball in the socket. This can be from a range of reasons relating to increased laxity of connective tissues or a lack of bone coverage of the hip socket over the hip ball. The instability means an increased sheering force on the surfaces of the hip and surrounding structures, and forces are focused on smaller amounts of contacting surface area.

The pain described can be similar to FAI (ache or sharp pain around the groin, buttock and thigh) and this is a common misdiagnosis. Other symptoms can be mechanical locking, popping, clicking or catching, as well as a feeling of instability of the hip. Quite often manual therapies have minimal impact and what is needed it to address the specific factors involved and retraining the deep stability muscles of the hip and the stabilisers of hip and pelvis.

Trochanteric Bursitis

A condition affecting the bursa and/or tendons around the outside of the hip, Trochanteric Bursitis is a syndrome commonly known by a variety of names used interchangeably. These include Hip Bursitis, Greater Trochanteric Pain Syndrome (GTPS), Gluteal Tendinopathy, and Gluteal Tendonitis.

The main symptoms are pain and tenderness around the outside of the hip. Pain may radiate down the lower buttocks and lateral thigh, and occasionally past the knee. Several structures around the hip can be associated with pain and causes range from a fall onto the outside of the hip, prolonger direct pressure, biomechanical factors, repetitive overload or increases activity (walking or running). Previously thought to be due to swelling of the hip bursa, more recent research indicates the most common pathology stems from irritation of tendons attaching to the outside of the hip (Gluteus Medius and Gluteus Minimus).

In each of these problems an assessment must rule out other possible sources of pain (such as the lumbar spine, nerve tissue, iliotibial band or Osteoarthritis) and diagnose the clinical pattern. Identifying the factors that led to development of the condition then builds the basis of management.

Quite commonly exercises to strengthen around the hip and build capacity in the pathological structures are needed to improve longer term problems. Manual techniques are often useful for settling higher pain levels. Quite often advice on avoiding positions and postures specific to the condition improves things immediately. A plan is most effective when all these components are addressed and when it is tailored to the individual.

Hide