Hip Joint Dysfunction
The hip joint can become dysfunctional for a variety of reasons but when the hip capsule and its associated ligaments become very tight and restricts motion, pain will ensue. Many times the pain is either in the front or lateral portion of the upper thigh. Pain can also be referred into the groin. Improving the elasticity of the hip capsule and appropriate exercises can eliminate symptoms and restore full function.
Piriformis Syndrome is an entrapment neuropathy in which a tight and/or inflamed piriformis muscle compresses the sciatic nerve, the largest nerve in the body, producing radicular type of symptoms. There are many causes of this problem to altered foot biomechanics to poor hip joint function. Prolonged sitting and exercises that promote hip flexion and extension repetitively can create these symptoms. Although this mimics sciatica caused by a lumbar disc bulge or herniation, this syndrome is quite different in that the source of pain is the deep gluteal muscle, not the spine. There may, however be instances where a patient has both a spine issue and/or a piriformis syndrome. Once identified correctly, this can be treated conservatively with excellent outcomes.
Sacroiliac Joint Dysfunction
Sacroiliac joint pain can be very severe and easily confused with lumbar disc pain based on the typical referral pattern of pain, often down the posterior thigh. It is also the most common culprit in low back pain in pregnancy. Pain is often worse with a sit to stand motion, walking or stairs and generally better with rest. The SI joint needs to be able to provide optimal stability for the pelvis while also providing an essential amount of motion. SI joint pain can be caused by a variety of muscle imbalances in the lumbopelvic region, or even in the lower extremity. For example in many patients, the larger gluteal muscles (which cross the SI joint at nearly a 90 degree angle) provide an insufficient amount of stability for the joint, while the smaller hip external rotator muscles (which cross the joint line, below the SI) are over active. This can cause compression on the lower SI preventing optimal movement. Other patients, possibly a runner, could have insufficient movement and thus force dampening occurring at the foot and ankle which causes the force to move up the leg and may cause compression at the SI joint, restricting its movement. SI joint dysfunction requires a multifaceted treatment approach that starts with an accurate diagnosis including appropriate diagnostic imaging with a goal of not just figuring out the “what” but also the “why.” Treatment would typically include and functional rehabilitation program, appropriate soft tissue treatment with Graston or other forms of myofacial release, joint manipulation or mobilization and patient education.
Hip (Trochanteric) Bursitis/Bursosis
Trochanteric bursitis occurs when the fluid filled sac that protects the lateral hip muscles become inflamed. This can occur for a variety of reasons from trauma to chronic repetitive stress injuries. Conservative management can be very effective in reducing symptoms and restoring full function.