Hip & Si Joint Pain
Hip & SI Joint Pain:
A hip injury is one of the most serious injuries a person can suffer through, and one that can lead to long-term health problems if not addressed correctly or inevitably prevented. Athletes who play active sports like football, soccer, and rugby are more prone to suffering hip injury than athletes in other sports. Hip injuries can also occur by accident, whether through a bad fall or quick and awkward movement
Trochanteric Bursitis of the Hip:
Where friction occurs between muscles, tendons, and bones, there is usually a structure called a bursa. A bursa is a thin sac of tissue that contains fluid to lubricate the area and reduce friction. The bursa is a normal structure. The body will even produce a bursa in response to friction.
Sometimes a bursa can become inflamed (swollen and irritated) because of too much friction or because of an injury to the bursa. An inflamed bursa can cause pain because movement makes the structures around the bursa rub against it.
A common spot for bursitis is on the side of the hip. Here a large tendon passes over the bony bump on the side of the hip called the greater trochanter. This problem is common in older individuals. It may also occur in younger patients who are extremely active in exercises such as walking, running, or biking.
Friction can build in the bursa during walking if the long tendon on the side of the thigh is tight. The gluteus maximus attaches to this long tendon. As you walk, the gluteus maximus pulls this tendon over the greater trochanter with each step. When the tendon is tight, it rubs against the bursa.
The rubbing causes friction to build in the bursa, leading to irritation and inflammation. Friction can also start if the outer hip muscle (gluteus medius) is weak, if one leg is longer than the other, or if you run on banked (slanted) surfaces.
Most cases of trochanteric bursitis appear gradually with no obvious underlying injury or cause. Trochanteric bursitis can occur after artificial replacement of the hip joint or other types of hip surgery. The cause may be a combination of changes in the way the hip works, the way it is aligned, or the way scar tissue has formed from the healing incision.
A fall on the hip can cause bleeding into the bursa, forming a hematoma. The bleeding is not serious, but the bursa may react to the blood by becoming inflamed. The inflammation causes the bursa to become thickened over time. This thickening, constant irritation, and inflammation may result in the condition becoming chronic, or long lasting.
At Physioflow Physical Therapy, treatment of trochanteric bursitis usually begins with simple measures used to calm inflammation. Dr. Trinh uses hands-on treatment and stretching to help restore your full hip range of motion. Improving strength and coordination in the buttock and hip muscles enables the femur to move in the socket smoothly and can help reduce friction on the bursa. Time required for recovery and rehabilitation varies for each patient, but as a guideline, you may expect to attend Physical Therapy sessions for four to six weeks before full motion and function return.
Although the vast majority of our patients with trochanteric bursitis never require surgery, if you do, Dr. Trinh can provide a personalized post-surgical Physical Therapy program to help speed your recovery so that you can more quickly return to your active lifestyle.
Femoracetubular Hip Impingement (FAI):
Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket).
With FAI, the head of the femur essentially butts up against the cartilage rim around the acetabulum and pinches it. We know that some subtle changes in the shape of the femoral head may be the cause of FAI. Other anatomical changes in the angle of the hip may also contribute to this problem. An alternate type of femoral acetabular impingement causes abnormal jamming of the head-neck junction.
Normally, the femoral head moves smoothly inside the hip socket. The socket is just the right size to hold the head in place. If the acetabulum is too shallow or too small, the hip can dislocate. In the case of FAI, the socket may be too deep. The rim of the cartilage hangs too far over the head. When the femur flexes (bends) and internally rotates, the cartilage gets pinched. Over time, this pinching or impingement of the labrum can cause fraying and tearing of the edges and/or osteoarthritic changes at the impingement site. At the same time, with changes in the shape and structure of the hip, there are changes in normal hip movement.
Physical Therapy at Physioflow Physical Therapy can be very helpful for FAI. Based on your individual assessment findings, we will design a program of stretches and strengthening exercises specifically for you to help improve the biomechanical function of the hip, the range of motion of the hip, and alter any muscle imbalances that may be present.
Dr. Trinh will perform manual therapy techniques to distract or create space in the hip joint. Tight muscles around the hip can contribute to pinching between the femoral head and acetabulum in certain positions. Dr. Trinh will give you stretches for both the front and back parts of your hip which includes, in particular, the hip flexors and the external rotators and abductor muscles (deep gluteals) of the hip. A program of flexibility for the joint and stretching exercises won’t change any bony abnormalities present but can help lengthen the muscles, correct muscle imbalances, and reduce bony contact and subsequent impingement in the hip.
Strengthening exercises will focus on correcting any muscle imbalances that have developed as a result of your injury. It is most common that the gluteal muscles, which are the major supporters of the hip as well as rotators, abductors and extensors of the hip, are weak in comparison to other muscles around the hip. This can contribute to the impingement at the hip.
Dr. Trinh will discuss your lower limb alignment, overall posture, and any abnormal movement patterns you may have developed. Sometimes even small changes in your posturing particularly as you walk, such as changing your foot or knee position, can make a significant difference in the pain you feel and how quickly your hip improves.
SI Joint Dysfunction:
A painful sacroiliac joint is one of the more common causes of mechanical low back pain. Sacroiliac joint dysfunction can be a nuisance but it is seldom dangerous and rarely leads to the need for surgery. Most people who suffer from this problem can reduce the pain and manage the problem with simple methods.
At the lower end of the spine, just below the lumbar spine lies the sacrum. The sacrum is a triangular shaped bone that is actually formed by the fusion of several vertebrae during development.
Several large, very strong ligaments hold the SI joint together. Because the pelvis is a ring, these ligaments work somewhat like the hoops that hold a barrel together.
There are many different causes of SI joint pain. Pregnancy may be a factor in the development of SI joint problems later in life. Also, if a person has one leg is shorter that the other, the abnormal alignment may end up causing SI joint pain and problems. Often, an exact cause leading to a painful SI joint condition can’t be found.
The SI joint is a synovial joint, similar to all joints such as the knee, hip and shoulder. Because of this, different types of arthritis that affect all the joints of the body will also affect the sacroiliac joint.
When movement of a joint is limited, the pain and symptoms of SI joint dysfunction may worsen. Getting more motion can give you the relief you need for daily activities. If you don’t have full range of motion, Dr. Trinh has several ways to help you get more movement including joint mobilizations, stretching, and exercises. We commonly prescribe a set of stretches to improve flexibility in the muscles of the trunk, buttocks, and thighs.
If the SI joint has too much mobility and problems keep coming back, you may need extra help to stabilize the SI joint. You’ll learn some exercises to help you build strength, muscle control, and endurance in the muscles that attach around the SI joint. Unfortunately, few muscles actually connect to both the sacrum and the pelvis. Key muscles to work are the gluteus maximus, as well as the abdominal and low back muscles.