Arthritis occurs when cartilage within a joint wears away, leading to inflammation and irritation from bone on bone contact. In the hip, this occurs between the head of the femur and the acetabulum on the pelvis. Hip arthritis can occur from normal aging, previous hip injury, increased stress on the hip joint and genetics.
As hip arthritis worsens, patients may develop osteophytes (bone spurs) in the joint leading to increased pain. The main symptoms of hip arthritis are stiffness and pain, especially when getting out of bed in the morning.
Symptoms may be associated with clicking and popping, and walking may become more and more challenging. Physical therapy can help improve your functional abilities by addressing any mobility or strength deficits associated with arthritis.
A bursa is a fluid filled cushion within the body that helps reduce friction between different surfaces. Bursitis occurs when these cushions become irritated and inflamed. In the hip, the most common type of bursitis is called ‘Trochanteric Bursitis’. Trochanteric Bursitis occurs when the bursa for the bony projection of your femur, called the greater trochanter, becomes irritated and inflamed.
This can be caused by running or walking on uneven terrain, increased tension in the iliotibial band (IT band), leg length discrepancies, and muscle imbalance. Pain occurs on the outside of your upper thigh, an can be aggravated by running, walking, ascending stairs and rolling onto your side.
Physical therapy can help by increasing mobility in tight structures around the bursa, strengthening any weak muscles in the area, improving your biomechanics when moving and educating you on ways to protect the bursa to avoid further irritation.
Hip impingement (femoroacetabular impingement) occurs when a bony growth rubs against the soft tissue or cartilage structures causing pain, irritation, and possibly tearing. There are two types of bony growths, cam lesions and pincer lesions. Pincer lesions occur when the acetabulum on the pelvis has an overgrowth over the femoral head. Cam lesions occur when the femoral head is aspherical and larger than normal.
Over time both of these can lead to labral tears. Pain with impingement usually occurs in the front of the hip and groin region, but can also occur on the side of the thigh, and in the buttock region. Pain may worsen with walking, sitting, running, squatting, twisting, or jumping. Other symptoms include a loss in range of motion, weakness, spasms, and painful clicking or popping.
Physical therapy can help by improving joint and tissue extensibility, reducing pinching in the joint. Strengthening exercises will also be provided to increase strength of the surrounding musculature and improve functional ability.
The labrum is a cartilaginous structure in the acetabular socket of the pelvis. The role of the labrum is to increase the depth and reinforce the socket making for better contact with the femoral head. Tears in the labrum occur when it gets continuously pinched or pushed against by the head of the femur or when it is pulled away from the bone. These can be caused by repetitive activities, overuse, trauma, or arthritic changes within the hip.
Biomechanical factors may also play a role, including tight hip flexors, tight back extensors, weak hip muscles, and weak core muscles. Pain usually occurs in the front of the hip and groin region. Symptoms also include stiffness, locking/catching, and pain with everyday activities such as ascending/descending stairs, walking, squatting, and sitting.
The goal of physical therapy treatment is to restore proper joint motion, improve soft tissue extensibility, strengthen the surrounding musculature, and address any biomechanical factors that led to the tear.