Joe, a software engineer, came into the office complaining of right groin pain extending into the front of the thigh. The pain started a year ago and progressively worsened. He noted pain and stiffness upon standing after long periods of sitting or when trying to kneel down to tie his right shoe.
An X-ray showed mild changes in joint congruity without significant arthritic change. A physical-therapy examination revealed a limited range of motion and pain in the right hip, most notably with inward rotation and when crossing the bent right leg toward the left shoulder, the quadrant position.
Additionally, tight and weak leg musculature, compensatory muscle activity and a stiff right hip joint with a springy end-feel were noted.
While specific numbers are unavailable, it is believed that a fair percentage of the population has hip impingement, in which tissues between the ball and socket of the hip joint are being pinched.
Many believe the onset of hip impingement is related to genetics and/or added stress to the hip joint.
Because there is usually no significant pain in the early stage, many people do not realize they have hip impingement until the problem has progressed. Left untreated, hip impingement will likely cause cartilage damage and early arthritic change.
Fortunately, there are early signs of hip change that can be felt, such as difficulty stretching or stiffness in one hip with daily activities or sports.
Physical therapy is a conservative and frequently helpful approach – the physical therapist can quickly determine if someone will benefit from this type of care.
The most common and successful sequence of treatments is to strengthen the weak hip muscles, correct the faulty mechanics, directly mobilize the hip joint and stretch the tight muscles.
Muscles that often need strengthening include the gluteals and deep hip rotators in the buttocks. Strengthening the abdominal and thigh muscles is often indicated because weakness in these muscles can leave the hip joint without proper support, with excessive force placed at the ligaments/joint capsule and/or cartilage of the hip.
Prolonged stress to a joint has been associated with arthritic change.
Strengthening should include correction of faulty muscular forces. While certain muscles need to be strengthened, others need to be inhibited. Without inhibiting overworked or inappropriately used muscles, faulty mechanics at the hip may still be present even after strengthening. Functional exercises can be developed to achieve the desired outcome.
Mobilizing the hip joint and stretching are the final components of the treatment program. Direct mobilization of the hip, most notably in the quadrant position, can result in significant improvements in hip mobility, and such improvements can often be observed immediately following treatment.
Mobilizing the hip should precede stretching because hip-joint stiffness can limit the ability to stretch the muscles properly around the hip. Stretching helps relieve stress on the hip and helps keep the joint mobile after treatment.
Joe responded well to physical therapy due to early and appropriate intervention. If he had not progressed well, further diagnostic studies and possible surgery would have been considered.
Taylor Miller, P.T., has practiced sports and orthopedic physical therapy for 16 years. He works at Taylor Physical Therapy in Los Altos. For more information, call 559-0011 or visit www.taylorpt.org.