Hip Pain & Pathology + Physio

a. Labral tears

Labral Tears

This hip is a large and very stable ball and socket joint. The socket (acetabulum) has a labrum around it to deepen the socket and increase stability, distribute load and absorb shock.

How it presents to us:

  • The labrum can become painful in many different hip conditions including: Trauma (eg hip dislocation), FAI (see below, labrum is pinched), capsular laxity, dysplasia (childhood change in bony shape) or degeneration.
  • They are more common in women than men and most of the time can’t be attributed to a specific cause.

It feels like this to you at rest and with sport:

  • Pain presents at the front of the hip and groin and sometimes buttock, there is often clicking and sometimes giving way and stiffness.
  • Pain can be felt with running or brisk walking, twisting the hip and climbing stairs.

 


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b. FAI

It presents like this to us:

  • Femoro-acetabular impingement syndrome is a motion related clinical disorder of the hip with a triad of symptoms, clinical signs and imaging findings.
  • It represents symptomatic premature/ abnormal contact between the proximal femur (femoral head) and the acetabulum. This Typically occurs as a result of the hip joint being placed in a position of repeated flexion and internal rotation or excessive load placed on the joint in particular in stages of early development
  • Cam morphology refers to additional bone being seen at the head-neck junction and Pincer morphology referring to bony change seen in the acetabulum
  • Presence of these lesions occur in up to 30% (22%) of the general population and up to ~66% of the athletic population and ~ 88% of people with FAI will present with both morphologies.

It feels like this at rest and with sport to you:

  • These most often present as insidious onset of pain, intermittently aggravated by sitting, walking, running and specific sporting activities requiring hip flexion, Internal Rotation and adduction such as occurs with squatting and striking a football for example.
  • The primary symptom is a motion related or position related pain typically in the hip or groin, often severe and limiting in everyday life and sporting scenarios.
  • Patients may also describe a clicking, catching, locking, stiffness and restricted ROM or giving way.

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c. Ligament teres

Ligament Teres

The ligament teres is a large ligament in the hip which helps the femoral head (the ball) remain in acetabulum (the socket.) The ligament is joined with nerves and blood vessels that supply the femoral head.

It presents like this:

  • The most common symptoms are localized groin pain, hip instability and altered range of motion.
  • Ligament teres will often be painful after an injury where the ligament has been placed on maximal tension. Mechanisms include sudden twisting mechanism (external rotation), maximal hyperabduction such as ballet or gymnastics or can also occur after complications with hip surgery. Tears can also be caused over time through degeneration.

It feels like this at rest and sport to you:

  • You will experience deep groin and hip pain.
  • With movement your hip feels “unstable” and you may find it difficult to place a lot of load through the leg.
  • You feel weaker on that hip with activity.

 


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d. Hip Joint Synovitis

Synovitis

Synovial tissue is connective tissue which lines the capsule of synovial joints such as the hip, its role is to create synovial fluid which helps lubricate the joint.

It presents like this:

  • Hip Synovitis is a condition in which there is inflammation of the synovial tissue surrounding the hip.
  • The cause of Hip synovitis can be due to many reasons such as arthritis, after acute injury or sometimes can be transient and unknown. The physiotherapist will ask you some questions in the subjective examination to screen for these.

It feels like this at rest and with sport for you:

  • Pain feels deep in the hip and increases with movement in all directions.
  • The hip can also feel quite stiff and be limited with
  • Rest will often decrease symptoms however after bouts of aggravating movements pain can remain at rest again feeling deep in the joint.
  • Pain can also be experienced at night.

 


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e. GTPS

GTPS

Greater Trochanteric pain syndrome which can also be known as Greater Trochanteric Bursitis or Gluteal Tendinopathy is a condition where we get tenderness and pain over our Greater Trochanter. Many structures can influence this pain such as the trochanteric bursa, the Gluteus Medius and Gluteus Minimus tendons or the iliotibial band.

It presents like this:

  • Pain and tenderness in the lateral (side) of hip around the bony prominence known as your greater trochanter.
  • Often pain increases after a bout of increased activity such as prolonged standing, walking running.
  • Common in women, both women and men aged between 40-60 as well as in the athletic population in particular runners.

It feels like this at rest and with sport with you

  • With GTPS you will experience pain and tenderness in the side of your hip which can radiate down the outside of thigh and lower buttocks but mainly concentrates around this area.
  • Your pain becomes more intense at times after greater aggravation or activity.
  • Pain can increase when laying on that side at night, sitting crossed legged or standing for long periods

 


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f. Gluteus Medius Tendon Tears

Gluteus Medius Tendon Tears

How it presents to us:

  • Gluteus medius tendon tears occur when a partial or complete rupture of the muscle in individuals completing high-impact activities such as basketball or runners.
  • The tears commonly occur during quick changes of direction, overuse, age related degenerative changes, or due to traumatic injury from tendinopathy.

It feels like this to you at rest and with sport:

  • You can expect to feel pain on the side of the hip and weakness. Occasionally weakness may be experienced while lifting the leg to the side.

 


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g. Ischiogluteal Bursitis

Ischiogluteal Bursitis

It presents like this to us

  • Ischiogluteal bursitis is the inflammation of the bursa which lies between the hamstring tendon and the bony origin of the ischial tuberosity.
  • The bursa may become inflamed alone or in conjunction with a proximal hamstring tendinopathy.
  • Due to the location of the bursa, similar symptoms to a proximal hamstring tendinopathy in sitting.

It feels like this to you at rest and with sport:

  • You can expect to feel pain with sitting, localised tenderness, pain with activation of the hamstring, difficulty sleeping on affected hip, muscular dysfunction in region, limited mobility, and symptoms may radiate to the lower leg.

 


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h. Quadratus Femoris Injury

Quadratus Femoris Injury

The quadratus femoris muscle moves our hip inwards towards our body (adduction), rotating our hip outwards and stabilising our hip.

It presents like this:

  • The physiotherapist will enquire about the mechanism of injury which is normally through quick change or direction or acceleration, kicking or a stretching mechanism.
  • It’s a rare injury but can often be misdiagnosed as a hamstring injury due to its location.

It feels like this at rest and sport with you.

  • You will have pain in the groin or buttock area which an often be irritated when sitting.
  • The pain eases with rest and increases with activity such as running, changing direction or rotating leg.

 


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i. Piriformis syndrome

Piriformis Syndrome

Piriformis syndrome is when your sciatic nerve is irritated and/or compressed by the piriformis muscle which results in pain.

It presents like this:

  • Usually pain is felt in the buttock which can also radiate down the back of the leg following the path of the sciatica nerve.
  • Pain aggravated by hip activity, e.g. walking, or prolonged sitting.

It feels like this at rest or with sport with you

  • Pain in posterior buttock or leg
  • To avoid pain and pressure in the area you may sit lopsided with your sore buttock tilted up or at times you’ll walk with the foot turned out due to shortening of the piriformis muscle
  • Symptoms such as pins and needles or numbness may also be present due to this irritation of the sciatic nerve

 


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j. Proximal Hamstring Tendinopathy

Proximal Hamstring Tendinopathy

What it presents to us like

  • The hamstrings are a group of muscles that attach from the ‘sit bones’ to the backs of the knees. The tendon is the portion that attaches the hamstring muscle from the ischial tuberosities (sit bones) to the muscle belly.
  • This connective tissue does not like excessive changes in load, or compression. Hence activities that stretch or put high elastic demands on the hamstring tendon, can become aggravating over time, creating a sensitised tendon that does not tolerate loads well, eliciting pain and dysfunction

It feels like this at rest and sport to you

  • What you might be feeling: Pain under the buttocks? Pain with deep lunges, climbing stairs, running up hill, stretching at yoga or sitting for too long. You may feel like you want to stretch it out, but that doesn’t seem to help.
  • You may be experiencing an ache at rest, or pain that lingers after any of the above activities. Increased sensation of stiffness in the morning. You may even notice a ‘warming up’ pattern with the pain, where the pain seems to ease with activity initially before later on increasing again

We look for this is in the assessment

  • We will assess the severity/irritability of the tendon and devise an accurate treatment and graded loading plan to improve the function and tolerance of the tendon
  • Identify other biomechanical factors that are predisposing your tendon to increased loads

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k. Adductor Strain

Adductor Strain

The Adductors are a group of muscles which are responsible for bringing out leg towards and across our body

It presents like this:

  • Localised pain around the groin, the patient will often describe feeling a “pull” or strain at the time of the injury. Common ways on injuring the groin are sudden changes of direction, quick movements of the leg such as kicking or a overstretching mechanism.

It feels like this at rest:

  • Deep pain in the groin region which can feel dull at rest but increase intensity to a sharp pain with activity
  • You will often feel reduced power or strength in your leg when trying to perform certain movements like kicking in football or changing direction during the day.

 


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l. Osteitis Pubis

Osteitis Pubis

Osteitis pubis is when there is inflammation in the pubic symphysis where the both the right and left pubic bones meet at the lower front part of the pelvis.

It presents like this:

  • Osteitis pubis is common after periods of increased activity and common in sports such as soccer, hockey and running and even in women during pregnancy or after childbirth.

It feels like this at rest and with sport to you.

  • It can present like other groin pain with pain normally localising in the front of your pubic bone.
  • feels uncomfortable with movement and may struggle laying down and sitting for periods of time.
  • The pain is often a deep ache and can increase after periods of exercise or activity.
  • Often pain has been there for a long period of time but has gradually increased intensity of an extended period of time

 


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m. Abdominal Wall

i. Posterior inguinal wall weakness

  1. Sports hernia

ii. Gilmores groin

iii. External oblique aponeurosis tear

iv. Inguinal hernia

v. Rectus abdominis injury

Hernia

Common forms of hernias include Sports hernia, hockey players groin, Gilmores groin and inguinal hernia.

It presents like this:

  • These conditions are similar and involve injuries to internal or external oblique muscle fibres and aponeurosis as well as the rectus abdominus muscle which causes some bulging of the internal organ.

It feels like this at rest or playing sport to you

  • Pain occurs often when the abdominal pressure increases such as sneezing, coughing or laughing
  • Pain can also occur with movement of the hip and pelvis throughout the day
  • Often hernias can also increase in sensitivity after eating or drinking.
  • Localised Tenderness and pain in the pubic area
  • Intermittent or persistent Bulging can sometimes be felt around the area.

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n. Obturator Neuropathy & Nerve Entrapments

Obturator Neuropathy & Nerve Entrapments

What it presents to us like

  • Obturator Neuropathy Is a fascial entrapment of the obturator nerve, this occurs in the region where it passes through the adductor (groin) muscles.

It feels like this at rest and sport to you.

  • It will feel initially like you’re having groin pain which than radiates pain down the inner side of the leg in particular with
  • There is some weakness when trying to propel forward at times with running, walking or sporting activities.

 


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o. Stress Fractures

Stress fracture

It presents like this:

  • Stress fractures to the Sacrum, neck of femur or the inferior pubic ramus are rare but can occur with repetitive heavy loading which occurs in sports like distance running. Like all stress fractures those with osteopenia or osteoporosis are at a high risk

It feels like this at rest and sport with you.

  • You will feel deep buttock, hip or lower back pain. This pain is worse with weightbearing and activity and can often improve with periods of rest.
  • Night Pain can also be felt and should be reported to the physiotherapist if this is the case.

 


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