Hip Injuries And Disorders

Introduction
Pain And Stiffness
Treating Your Hip Right
How Physical Therapy Can Help

Hip is the joint where your thigh bone meets your pelvis bone. Hips are called ball-and-socket joints because the ball-like top of your thigh bone moves within a cup-like space in your pelvis. Your hips are very stable. When they are healthy, it takes great force to hurt them. However, playing sports, running, overuse or falling can all sometimes lead to hip injuries. These include

• Strains
• Bursitis
• Dislocations
• Fractures

Certain diseases also lead to hip injuries or problems. Osteoarthritis can cause pain and limited motion. Osteoporosis of the hip causes weak bones that break easily. Both of these are common in older people.

Treatment for hip disorders may include rest, medicines, physical therapy, or surgery, including hip replacement

The hip region is a model of straightforward sturdiness. It takes great force to seriously damage a healthy hip, and the large, strong muscles of the thighs and buttocks (which help support and move the hips and knees) are usually able to withstand more than their share of abuse. Sports-related injuries and problems do occur, however, particularly in women runners, and there are problems specific to young men and pregnant women. Elderly people are subject to the most serious problems: life-threatening hip fractures that often are due to osteoporosis, the disease that causes brittle bones.

There are significant differences in the male and female pelvic structures. Among other differences, the female pelvis is wider (to accommodate childbearing) and the bones are lighter and less bulky. The angle of the pubic symphysis is also much wider in the female pelvis.

Stiffness in the hip is usually associated with pain during daily activities, such as when you get in and out of bed, put your socks on, get in and out of your car, etc. Pain that persists may signal a form of arthritis. Limping while walking is also a common hip complaint and may be related to stiffness and pain in the hip joint.

As we grow older, the articular cartilage that covers the ball and socket of the hip joint starts to roughen and deteriorate. This is osteoarthritis, and it's a natural part of the aging process. In time, there may be nothing left to prevent direct bone-on-bone friction within the joint, which can result in pain with movement and weight-bearing activities.

A break in the bone just below the head of the femur (where it fits into the hip socket) is called a hip fracture. Hip fractures in younger people are rare and tend to be caused by falls, car accidents, and sports mishaps. A hip fracture should be considered a medical emergency that usually requires surgery.

A stress fracture at the hip may be more subtle. Sometimes it's a hairline crack in the femur and may not penetrate the entire bone. A stress fracture is brought on by repetitive motion and overuse. Stress fractures are often misdiagnosed as muscle strain or tendinitis. Without proper treatment, the fracture may not heal.

A complication of a hip fracture or dislocation is avascular necrosis. In this case, blood circulation to the head of the femur is cut off and the bone dies. Avascular necrosis also may result from autoimmune diseases such as lupus and sickle cell anemia. In addition, the effects of alcoholism and prolonged steroid use can contribute to this condition.

For people who are middle-aged and younger, the hip usually requires only moderate conditioning exercises to keep it in shape. Major trauma is rare, and repetitive motion injuries usually are confined to serious runners and other athletes. For older people, however, changes in the hip due to aging or disease demand awareness of what can be done to prevent potential injuries.

Stretching and strengthening exercises such as the ones in this article should be part of your regular exercise routine unless you have a special health problem. The hip region is affected positively by exercises for the thighs, lower back, groin, buttocks, and abdominal muscles. You may find that exercises that are already in your repertoire have a "bonus" benefit as hip conditioners.

Older people are most at risk for osteoarthritis, which may cause pain and stiffness. Unfortunately there's no way to predict or prevent the onset of this condition. But maintaining flexibility and range of motion through exercise is a top priority, and your physical therapist is well-equipped to design a program of exercise especially for your needs. Here are some tips for people with hip problems:

• If you use a cane, use it on the side opposite your problem hip to take the weight off the affected area. Your elbow should be nearly straight when you hold the cane.
• Wear shoes with thick soles to absorb shock and weight on the hip;
• If you have osteoporosis or arthritis, talk to your physical therapist about making your home safer and avoiding falls.

You may find yourself in a physical therapist's care for rehabilitation after hip surgery, or for a condition related to a lack of balance, poor posture, or pain in the hip joint. Whatever the reason, your physical therapist will start by taking a detailed history and evaluating your condition. Related conditions such as osteoarthritis, inflammatory arthritis, and osteoporosis are assessed during this initial phase.

Your physical therapist may then proceed to a "hands-on" evaluation of your condition. He or she may assess your balance, gait, posture, and range of motion. Your physical therapist may also perform tests to assess the strength, sensation, and blood circulation in your hip region and lower limbs.

Physical therapists may choose from an array of interventions, including exercises for stability, balance, posture, flexibility, coordination, strength, and restoration of range of motion. You may also benefit from hip mobilization, massage, electrical stimulation, ultrasound, or the application of heat or cold. Your physical therapist will custom-design a program just for you.

Your physical therapist will also want to make sure that your home environment is safe and efficiently laid out, especially if you have limited mobility. There are many techniques and "tricks" that can make life much easier for someone recovering from a hip injury or condition. Your physical therapist wants you to return to your normal activity as quickly as possible, with the knowledge you need to prevent reinjury or disability.