Hip/Thigh

HIP/THIGH

Arthritis
Arthritis is inflammation of one or more joints. The most common type of arthritis is osteoarthritis and involves wear-and-tear damage to the joint’s cartilage. Cartilage normally protects a joint, allowing it to move smoothly, and provides shock absorption when pressure is placed on the joint, such as when walking. If enough of the cartilage degenerates, it can result in bone grinding on bone, which can cause pain, inflammation, stiffness and restricted movement. This wear and tear can occur over many years, or it can be triggered by a joint injury or infection. 

Arthritis often causes pain during movement. In order to avoid the pain, many individuals will avoid movement of the arthritic joint. Unfortunately, lack of movement in the joints can make the condition worse. Joints were meant to move! Movement helps to flush out inflammation, lubricate the joints, and condition the muscles. Successful treatment to help manage arthritis involves maintaining strong muscles, joint mobility, flexibility, endurance, and a healthy weight – all of which can be accomplished through conservative treatment.
Hip (Trochanteric) Bursitis
Bursitis is caused by inflammation of a bursa, a small fluid-filled sac that functions as a gliding surface to reduce friction between muscles, tendons, and joints during movement. There are 160 bursae located throughout the body. The major bursae are adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, knees, and heels. 

The bony point of the hip is called the greater trochanter. It is an attachment point for muscles that move the hip joint. The trochanter has a fairly large bursa overlying it that occasionally becomes irritated, resulting in hip bursitis (trochanteric bursitis). Bursitis can also result in pain in the groin area, when the iliopsoas bursa on the inside of the hip is irritated, but this is much less common. The main symptom of hip bursitis is pain at the point of the hip. The pain usually extends to the outside of the thigh area. In the early stages, the pain is usually described as sharp and intense. Later, it may feel achier and spread out. 

Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while. It also may get worse with prolonged walking, stair climbing, or squatting. 

The following risk factors have been associated with the development of hip bursitis:
  • Repetitive stress (overuse) injury. This can occur when running, stair climbing, bicycling, or standing for long periods of time.
  • Hip injury. An injury to the point of your hip can occur when you fall onto your hip, bump your hip on the edge of a table, or lie on one side of your body for an extended period of time.
  • Spine disease. This includes scoliosis, arthritis of the lumbar (lower) spine, and other spine problems.
  • Leg-length inequality. When one leg is shorter than the other by more than an inch or so, it affects the way you walk and can lead to irritation of a hip bursa.
  • Rheumatoid arthritis. This makes the bursae more likely to become inflamed.
  • Previous surgery. Surgery around the hip or prosthetic implants in the hip can irritate bursae and cause bursitis.
  • Bone spurs or calcium deposits. These can develop within the tendons that attach to the trochanter. They can irritate the bursa and cause inflammation.
Piriformis Syndrome
Piriformis Syndrome is an impingement syndrome that occurs when the piriformis muscle compresses the sciatic nerve. This causes pain in the buttocks region and may even result in referred pain in the lower back and thigh or leg. In addition to pain, weakness and even numbness or tingling may be felt in the same regions. 

The piriformis muscle is a small muscle deep in the buttocks that rotates the leg outwards. It runs from the sacrum (the base of the spine) and attaches to the top of the femur (thigh bone). The sciatic nerve runs under this muscle and down the leg, although in about 10% of the population it actually runs through the muscle fibers. 

Piriformis syndrome is predominantly caused by a shortening or tightening of the piriformis muscle. This can occur when the piriformis muscle is overloaded from activities such as exercising on hard surfaces or uneven ground, increasing exercise intensity too quickly, or sitting for long periods of time. Biomechanical inefficiencies can also lead to piriformis syndrome. This can include faulty foot and body mechanics, gait disturbances and poor posture or sitting habits.
Iliotibial Band (ITB) Syndrome
Iliotibial band syndrome is a repetitive strain injury that occurs when the iliotibial band (ITB) becomes inflamed causing knee pain. The ITB is a thick band of fibrous tissue that runs down the outside of the leg. It attaches at the hip and to the tensor fascia latae muscle, and extends down the leg, inserting on the outer side of the tibia (shin bone), just below the knee joint. 

The band functions in coordination with several of the thigh muscles to provide stability to the knee and to assist in flexion of the knee joint. The main problem occurs when the tensor fascia latae muscle and iliotibial band become tight. This causes the tendon to rub against the outside of the knee, at the lateral epicondyle, which results in inflammation and pain. ITB syndrome can be caused by overload, as is the case with endurance athletes or those who rapidly increase their activity levels, or by biomechanical inefficiencies, such as uneven leg length, tight or stiff muscles in the leg or hip, muscle imbalances, foot structure problems, or gait and running problems.
Sprains & Strains
A sprain is a stretch and/or tear of a ligament, the fibrous band of connective tissue that joins the end of one bone to another. Ligaments stabilize and support the body’s joints. A sprain is caused by direct or indirect trauma (a fall, a blow to the body, etc.) that knocks a joint out of position, and overstretches, and in severe cases, ruptures the supporting ligaments. Typically this injury occurs when an individual lands on an outstretched arm, slides into a base, jumps up and lands on the side of the foot, or runs on an uneven surface. 

A strain is an injury of the muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone. Chronic strains are the result of overuse (prolonged, repetitive movement) of muscles and tendons. Inadequate rest breaks during intensive training precipitates a strain. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction. In most cases the mechanism of injury resulting in a sprain or a strain may be the same, it’s just a matter of which tissues are damaged in the injury.

Hip sprains are injuries of the joint capsule and ligament structures that support and hold the joint in place. These injuries often are associated with trauma where the hip joint gets forced beyond its normal range of motion, resulting in the ligaments of that joint and joint capsule tearing. Sprains can have lasting complications such as laxity of the joint or instability when not treated properly. Sprain symptoms will often present most during passive stretches of the injured joint.  

Hip strains when compared to sprains are injuries to the muscles and tendons surrounding and acting upon the joint itself. Common hip strains include a pulled quad or hamstring, but any muscle of the hip can be strained. Hip strains often occur during a dynamic activity with rapid changes in tissue length resulting in a tear of that muscular/tendinous tissue. Strain symptoms will often present most during activation of the injured muscle.

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