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HIP
Taking Care Of Your Hip
Compared to such complex areas of the body as the back
and the knee, 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.
In this article you will learn:
The basic anatomy of the hip;
Common ailments of the hip region;
Ways to reduce the risk of injury;
Exercises to do at home; and
Physical therapy treatments.
In addition, we will discuss some important information
that is of special interest to people who have had a
hip replacement or may have one in the future.
The Anatomy of the Hip and Pelvis
The hip is a ball-and-socket joint. This means that
the round head of the femur (thigh bone) glides and
rotates within the acetabulum, a deep, scooped-out cavity
within the pelvis. The hip joint, like all joints in
the body, also has a synovial lining, which produces
small amounts of lubricating fluid to aid in the friction-free
movement of the joint.
The pelvis itself is composed of two large, arching
bones connected to the spinal column by the sacrum,
a fusion of small vertebrae at the base of the spine.
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.
The motion and support of the hip is controlled largely
by the muscles of the thighs and lower back. The muscles
of the groin, buttocks, and abdomen are also involved
in the functioning and stability of the hips.
What Can Go Wrong
The tightly constructed hip joint is exceptionally
stable. While a handful of overuse and sports injuries
are associated with the hip, the majority of hip problems
are associated with aging, disease, and fractures in
the elderly. A few growth-related hip problems are found
mainly in male adolescents; women may also face pelvisor
hip-related difficulties during pregnancy.
Though not as common as in other areas of the body,
the muscles and tendons of the hip and groin region
are subject to wear and tear and overuse injuries. Runners
and other athletes are especially vulnerable to stretching
and microscopic tearing of the muscles (muscle strain)
and tendons (tendinitis). The usual causes of muscle
strain and tendinitis are inadequate warm-up and stretching
before physical activity, or a burst of exercise after
being sedentary. The results are minor aches, pains,
and stiffness. This pain is often reported to physical
therapists and physicians as pain in the groin or buttocks.
Women runners are more likely than men to suffer pain
and muscle strain in the groin area. This is because
the wider structure of the female pelvis demands that
a woman turn her foot inward (pronate) more than a man
does during the heel strike phase of the gait cycle-
i.e., at the moment when her foot first hits the ground
while she's running. This tendency to overpronate can
overstretch the muscles that run across the hip, resulting
in a pulled muscle. A pulled muscle is likely to be
sore or painful, and it may limit mobility until the
tissue heals.
A hip pointer- usually a football-related injury- is
a blow to the rim of the pelvis that results in internal
bleeding (bruising of the bone and soft tissue). In
addition to causing swelling and nasty looking bruises,
hip pointers are very sore to the touch.
Sometimes the iliotibial (IT) band - the belt of fibrous
tissue that runs along the outside of the hip to the
knee- becomes too tight and rigid. When the knee is
flexed, the IT band grates against the edge of the hip
bone, causing an irritation known as iliotibial band
syndrome.
The sciatic nerve is implicated in many cases of hip
pain (as well as lower back and leg pain). Sciatica-characterized
by shooting or radiating pain from the lower back into
the back of the legs- is caused by compression, pinching,
or irritation of the sciatic nerve, the longest and
widest nerve in the human body. The sciatic nerve starts
in the lower back, runs underneath the buttock muscles,
between the tiny rotator muscles of the hip (the piriformis),
and down into the legs. Damage to the sciatic nerve
can mimic hip pain or pain from a hip injury. One of
the most common and easily corrected causes of sciatica
in the hip is sitting on your wallet for an extended
period. A physical therapist can identify the exact
source of the pain.
The bursa sacs and other soft tissue around the hip
can also become inflamed and painful. This is called
bursitis. A common problem in the shoulder, knee, and
elbow as well as the hip, bursitis may be caused by
a repetitive motion injury or a traumatic blow. Bursitis
can also be triggered when legs are of different lengths
(a condition that is surprisingly common). Rarely visible
to the naked eye, a difference in leg length can be
enough to disturb the gait cycle- the sequence of motions
that the body goes through while walking or running.
When the gait cycle is altered, your body must compensate
for the resulting imbalances, which puts abnormal stress
and pressure on the hip. In runners and athletes, this
problem is greatly magnified because of the relentless
repetition and force put on the hips and other soft
tissue around the hip.
Adolescents, especially boys, sometimes suffer from
a painful condition known as Legg Calvé Perthe
Disease (LCPD). LCPD is a flattening of the femoral
head, limiting the range of motion of the hip within
its socket. The cause of this disease is not known,
although it's usually found in physically active young
people. Pain is often felt in the inner thigh and knee,
and may come and go. LCPD is usually treated with a
combination of strengthening and stretching exercises
and a special brace known as the Scottish Rite Abduction
Orthosis. Surgery to provide more hip range of motion
and/or to realign the acetabulum (to provide improved
coverage of the femoral head) is an option for advanced
stages of LCPD.
Cycling For Healthy Hips
For many people, cycling is a great way to keep their
hips in shape. Whether you choose to ride outside or
to work out on a stationary bike, cycling helps maintain
muscle tone and fluid joint movement without undue shock
and pressure on the joint. (If you have an existing
hip injury or condition, be sure to get your physical
therapist's approval before exercising.)
Women who have musculoskeletal dysfunctions in the pelvis
or lower back may find these conditions aggravated during
pregnancy. Physical therapists may recommend strengthening
exercises and/or gentle stretching exercises. These
stretches should be static as opposed to ballistic stretches;
ie, there should be no "bouncy" movements,
and once you feel the full stretch you should hold the
position for 30 seconds without moving. General activities
that are appropriate for pregnant women who want to
avoid hip trouble include swimming (using the "flutter
kick"), aquatic exercise, yoga, and bicycling.
A problem most often found in overweight males during
the period of rapid growth in adolescence is a slipped
capital femoral epiphysis (SCFE). This occurs when the
head of the femur becomes displaced from its normal
relation to the femoral neck. Surgery is a must to correct
this condition. Physical therapy during rehabilitation
is necessary to assure a normal range of motion in the
hip.
Pain And Stiffness
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 elderly people- especially those with osteoporosis
-broken hips due to falls can have disastrous consequences.
Osteoporosis is a disease that makes bones weak, porous,
brittle, and prone to fracture. The causes of osteoporosis
involve hormonal, genetic, and lifestyle factors. The
National Osteoporosis Foundation estimates that one
out of every two women and one out of every eight men
over age 50 has had an osteoporosis-related fracture.
Many of these fractures are broken hips, while others
are mostly wrist and vertebral fractures. What makes
a hip fracture so dangerous to an elderly person is
that it often involves major surgery and a long recuperation
period. The effects of osteoporosis can be minimized
by starting in childhood or the early teens to strengthen
the bones through diet, exercise, and a healthy lifestyle.
Consumption of adequate calcium and other minerals that
the body needs to maintain bone mass is essential, as
is regular weight-bearing exercise. Smoking, heavy drinking,
and use of cortisone-type medications can also predispose
a patient toward osteoporosis. But whatever your age
and health, modifying your diet and exercise habits
(under the guidance of your physician and physical therapist)
can lessen the chance of broken hip due to brittle bones.
And if you already suffer from osteoporosis, your physical
therapist can instruct you in special balance and posture
exercises designed to make a fall less likely.
Treating Your Hip Right
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.
For Runners And Other Athletes
Runners and other athletes need to be especially cautious
and sophisticated in their approach to hip pain or dysfunction.
Persistent or chronic pain in the hip region warrants
special attention. Ignore the urge to "run through"
the pain; pain is a warning signal to stop what you're
doing, even if the discomfort is minor. See your physical
therapist or physician and find out what's really going
on: although you may just be experiencing muscle strain
or tendinitis, there's a small but real chance that
you may have something more serious.
The following types of pain may indicate serious problems,
and warrant immediate attention from your physical therapist
or physician:
Groin pain
Progressive loss of motion in the hip
Buttock pain that worsens when you walk
Hip pain in people with circulatory problems
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.
How Physical Therapy Can Help
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.
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