The hip is the deepest joint in the body and the 2nd ball and socket joint. It is inherently a very stable joint through its bony and cartilage anatomy. However, pain in the hip region is common and is often felt in the thigh, groin or outside of the hip. Many structures around the hip can cause pain, but some common conditions include hip joint issues such as osteoarthritis, femoroacetabuler impingement and hip dysplasia (shallow hip joint). Common tendon issues include gluteal tendinopathy, Psoas tendinopathy and proximal hamstring tendinopathy. It is also common to strain muscles around the hip through playing sport. Groin strains and hamstring strains for example are very common in football and other sports.
As with other body regions, physiotherapy can first aid in reaching a diagnosis in order to guide appropriate management. We can recommend and send for investigations such as x-rays and ultrasound scans if appropriate and onward for specialist referral if needed. In terms of rehabilitation, physiotherapy has been shown to be effective at improving pain and function in some patients with hip osteoarthritis and femoroacetabular impingement. It has also been shown to be effective as managing gluteal tendinopathy and acute conditions such as groin strain. Usually treatment will include an individualised exercise program strengthening certain muscles around the hip, in addition to education/advice and certain manual therapy techniques if indicated. Please see here for information on physiotherapy management of gluteal tendinopathy.
In male and female patients between the ages of 18-50 with hip joint related pain diagnosed as femoroacetabular impingement research has suggested that 8 physiotherapy sessions over 12 weeks consisting of hip joint manual therapy, specific strengthening exercises targeted to the individual participant’s physical impairments had moderate to large effects at reducing pain and disability.
In 204 patients between the ages of 37-70 with gluteal tendinopathy characterised as pain on the outside of the hip, 14 sessions of physiotherapy over 8 weeks consisting of education and graded strength exercises to the gluteal muscles led to lower pain intensity and higher patient reported global improvement than corticosteroid and a control group at 8 weeks and 1 year. Please see here.
In relation to groin strain, this study concluded that physiotherapy consisting of specific strengthening of the groin muscles 3 times weekly over 6-8 weeks in pre-season training reduced the risk of groin strain by 41% in 339 semi-professional football players, demonstrating the importance of strengthening to reduce risk of injury in the athletic population. Furthermore, additional studies have demonstrated that 14 patients with long-standing groin pain of at least 2 months or more who participated in a 10 week groin strengthening program managed to return to sport and had significant improvements in pain, disability and groin muscle strength.
