HIP and Groin Pain

Posted by Dr. Lev Kalika on Wednesday, April 4, 2012 · Leave a Comment

Hip pain is a very a frequent musculoskeletal complaint that affects all age groups. Most frequently hip joint pain occurs due to structural and functional misalignments in the hip joint

Normal Hip Joint Anatomy

itself or in combination with neighboring articular structures suffering from compensatory overuse, muscle strains, tendinosis, hip bursitis, femoral acetabular impingement (FAI), labrum tears and finally damage to the hip joint cartilage.

Hip joint is the deepest and the biggest joint in the human body. The increased depth of this joint in combination with its perfectly round shape provides most stability while allowing great degree of mobility in multiple directions and in different planes simultaneously.

Hip joint is second to shoulder joint in its versatility and motion complexity. Just like the shoulder joint, the hip joint is, in evolutionary terms, the newest structure of the body and developed to accommodate the need for vertical locomotion. Hip joints versatile mobility is what makes it so susceptible to injuries of its extra-articular structures (ligaments, tendons, muscles and fascial tissue).

Hip joint is frequently affected later in life due to the structural misalignments occurring at the early stage of life because of the abnormal bone formation. These are not so infrequent as the scientific community thought before.

In adult stages of life hip misalignment usually occurs due to ever increasing demand for the weight bearing stability. Also many sporting and fitness activities cause hip joint pain by nature of excessive movement produces through the hip joint. Most frequently it occurs in: soccer, hockey, figure skating, martial arts, ballet and yoga.

It has been recently established that even a little misalignment or any deviation of the anatomical structure of the hip joint can lead to the development of the degenerative hip disease.

The following is a list of the predisposing factors:

Congenital hip dysplasia
Prominent femoral head-neck junction
Elliptical femoral head
Femoroacetabular anteversion
Femoroacetabular retroversion
Coxa valga
Coxa Varum
Coxa profunda
Protrusio acetabulum

WHY HIP JOINT DYSFUNCTION DOES NOT READILY CONVERT INTO PAIN AND THE DIAGNOSIS OF DEGENERATIVE HIP DISEASE IS ALMOST ALWAYS TOO LATE?

Even though, radiological examination of the hip joint is used to confirm the diagnosis of degenerative joint disease, it cannot predict or define the degree of dysfunction or pain with which the patient is affected. For example, radiological examination in-patient without symptoms may discover moderate to severe degree of degeneration, while patients with minimal degenerative changes in the hip joint can be in extreme pain and disability. Therefore, the relationship of degree of degeneration to degree of disability is not predictable. This is due to multiple extrarticular and regional factor involved in hip pain syndromes.

Due to unique anatomical shape of the hip joint and its proximity to other joints of the lumbopelvic region, hip joints movement dysfunction is initially well compensated by the structures located above and below the ailing area. This compensatory freedom of movement in the state of the hip joints dysfunction is notable however by the excessive movement (hypermobility). The hip joint might stay unaffected for a long time under these conditions until stresses created by inefficient repetitive hypermobility build up, eventually compromising the stability of the entire lumbopelvic region.

Another reason for the hip joint pain syndrome symptomatology delay is because stiffness of the dysfunctional hip joint elements and tissues is greater than the stiffness of the knee and the lumbopelvic joints. In the compensatory effort, the main burden of the hip movement is transferred to the less-affected articular structures of the region. This brings loading and shearing forces exerted by powerful contractions of long levered muscles of the upper leg to the knee and lumbo-pelvic joints.

And for these forces neither the knee nor lumbo-pelvic joints have been designed. Consequently tremendous new stresses exerted on the compensating structures will wear them out first. Therefore the dysfunction of the hip joint will initially cause pain in the neighboring joints long before the hip joint itself shows any pathology symptoms.

This is exactly why so many hip joint problems are discovered only when pain appears. Unfortunately, when that is the case, radiological images of the hip joint already show some degree of degeneration (hip arthrosis), which usually means eventual hip replacement.

THE NEW APPROACH TO DIAGNOSTICS AND TREATMENT OF THE HIP PAIN

With advancements in radiological, arthroscopic and functional clinical examination methodology of the hip, a new model of the hip joint disease has been established. This model enables doctors and practitioners to diagnose hip joint pain and dysfunction at a very early stage. The early diagnosis allows commencing the treatment at the stage when hip joint degeneration has not yet set in and is therefore reversible. For those patients who already have developed some early signs of hip degeneration, further progression can be arrested or significantly slowed down. Unfortunately, this recent scientific development, has not reached the majority of clinicians or therapists yet. WHAT ARE THE EARLY SIGNS OF HIP JOINT DISEASE?

The most distinct early sign of the hip joint dysfunction is not the pain but the abnormal movement in the hip joint area. Abnormality can manifest itself in the variety of ways. The hip movement could be limited, excessive or imprecise. The patient however rarely notices these developments, as the compensation will be provided by other articular structures in the lumbo-pelvic region.

Hip joint pain may occur in seemingly unrelated areas causing patients to look for medical advice. Unfortunately the vast majority of the doctors rely solely on the MRI and other imaging diagnostic procedures and movement examination of the hip joint is rarely, if ever, conducted on the patient complaining, for example, of the low back pain.

Another very frequent complaint is pain radiating down the thigh known as sciatica. In almost every case of the true sciatica it is the abnormal movement of the hip joint that either is the cause or one of the causes of the shooting pain down the leg.

WHAT ARE THE CONDITIONS, WHICH AFFECT VARIOUS REGIONS OF THE HIP?

True hip joint pain and pain in the groin area:

Hip Osteoarthritis
Labrum Tear
FAI (Femoroacetabular Impringement)
Avascular Necrosis also known as Asceptic Necrosis
Iliopsoas Bursitis or Tendonosis
Groin Pull
Adductor Tendinosis
Hip Fracture
Hip Stress Fracture

Direct local pain or pain irradiating into the side of the hip:

Greater Trochanteric pain syndrome (GTPS) (Bursitis or Tendinosis)
Piriformis Syndrome
Obturator Syndrome
Gluteus Medius Syndrome
Pelvic Floor Myalgia

Posterior Hip Pain

Gluteal Bursitis
Hamstring Tendinosis
Hamstring Ruptures

HOW IS HIP PAIN ADRESSED AT THE DYNAMIC NEUROMUSCULAR REHABILITATION?

We maintain that the right treatment depends on the diagnostic precision. We use diagnostic ultrasonography and X-ray imagery to analyze the integrity of the tissues around the hip joint as well as to rule out bone anomalies and anatomical misalignments. If, however, these procedures fail to explain patients symptoms we may opt to ordering the MRI or CT scan study.

The most precise imaging diagnosis of early hip disease at this time is CT-scan. However, the specific CT-scan of hip series has an enormous dose of radiation. It should not be used initially, unless surgery is considered. The newest ultrasonography methods of diagnosis combined with X-ray and MRI and good clinical examination should be sufficient to establish proper diagnosis and treatment plan.

Because of the limited ability of medical imaging to reveal all causes of the hip joint problem, we conduct Gait analysis with highly advanced technological equipment. Our Gait analysis Lab is the first outpatient facility in NYC providing these types of services. The various data acquired through Gait analysis allows very precise diagnosis of movement dysfunction in the hip join and pelvis. We also use some of our Gait lab equipment for training precise hip movement. Based on Gait analysis data our treatment focuses on elimination of the faulty movements and rebuilding strength and coordination of the hip, lumbo-pelvic area using DNS method, Shirley Saharmann method, Chris Power’s hip strategy method as well as video and force plates feed-back training. Our extensive rehabilitation program integrates the aforementioned methods with various manual techniques. If the integrity of the tendons or the muscle tissues is affected, we combine our rehabilitation protocols with biological treatment. Excorporeal shockwave therapy is used to regenerate damaged tendons and muscles. When proper movement is re-established we use some of the most advanced weight bearing rehabilitation technologies like the alter-g treadmill to build the strength and movement coordination to the pre-disease level. Please check out our pages for the running gait lab, the alter-g treadmill, and shockwave therapy to see how these technologies can help you.

Our extensive rehabilitation program integrates the aforementioned methods with various manual techniques. If the integrity of the tendons or the muscle tissues is affected, we combine our rehabilitation protocols with biological treatment. Excorporeal shockwave therapy is used to regenerate damaged tendons and muscles.

When proper movement is re-established we use some of the most advanced weight bearing rehabilitation technologies like the alter-g treadmill to build the strength and movement coordination to the pre-disease level.

Please check out our pages for the running gait lab, the alter-g treadmill, Biofeedback motor control training with real time force plate analysis, and shockwave therapy to see how these technologies can help you.