Understanding the Causes of Hip Pain
Hip pain can be a common and discomforting issue, often requiring attention and care. Despite the broad scope of treatments available, it's essential to delve into the specific causes and diagnostic methods related to hip discomfort.
Hip Labral Tear
A hip labral tear often presents with groin achiness upon sitting, sharp pains, clicking, or a catching sensation during end-range hip motion. The Anterior Hip-Impingement Test (FADIR) proves valuable in diagnosis. This test involves supine positioning with the hip and knee at 90° of flexion, internally rotating the hip while applying an adduction force. A positive result, indicated by pain provocation in the anterolateral hip or groin, suggests a labral tear.
Tips for Relief:
Mindful sitting positions, avoiding knees lower than hips or crossed legs.
Sitting on the edge of seats to reduce pressure on the femur and alleviate hip joint pain.
Addressing excessive hip internal rotation and extension through mobility exercises.
Proximal Hamstring Strain
Ischial tuberosity pain, commonly seen in a younger, athletic population, can be identified through the Hamstring Drag Test or “Take Off Shoe Test” (TOST). This test requires a standing patient to remove the shoe of the injured leg while holding it on the ground with the unaffected foot.
Tips for Relief:
Tailoring rehabilitation based on the proximity of the hamstring injury to the ischial tuberosity.
Incorporating trunk stabilization and progressive agility drills in rehabilitation programs.
Gluteal Tendinosis
Local achy pain along the posterior greater tuberosity characterizes gluteal tendinosis. The Hip Lag Sign is a valuable diagnostic test, performed with the patient in a side-lying position where the chiropractor stabilizes the pelvis while passively moving the hip into abduction, extension, and internal rotation. The patient is then asked to actively hold the leg in this position.
Tips for Relief:
Eliminating modifiable risk factors and avoiding sleeping on the affected hip.
Early and progressive restorative loading exercises to enhance tendon integrity.
Adductor Strain
Localized groin pain associated with multiplanar sports can be diagnosed using the Thigh Adductor Squeeze Test. This test involves forceful adduction of the thighs to compress an object between the knees.
Tips for Relief:
Initiate strengthening with pain-free isometric adduction and progress to resistance exercises.
Gradual return to sport-specific activities based on pain-free range of motion and strength criteria.
Femoroacetabular Impingement (FAI)
Deep groin pain exacerbated by hip flexion activities indicates FAI. The FABER test is a common diagnostic tool for assessing hip joint pathology. The patient lies supine and is instructed to flex one hip, bringing the knee toward the chest. The flexed hip is then abducted, the knee moving outward, and the hip being externally rotated by turning the knee outward while keeping the ankle on the opposite knee.
Tips for Relief:
Consider conservative care before surgery, including patient education and activity restriction.
Incorporate proprioceptive training, manual therapy, and stability/strengthening exercises.
Hip Osteoarthritis
Vague deep groin pain with hip internal rotation and flexion points to hip osteoarthritis. The Hip Scour Test is used for diagnosis where a chiropractor guides the patient through flexion and internal rotation of the hip, followed by extension and external rotation. The patient is in a supine position, and downward force is applied along the femur during these movements.
Tips for Relief:
Focus on restoring motion and avoiding aggravating factors.
Consider hip manipulation, supported by research indicating reduced pain and improved function.
A nuanced approach to identifying and addressing the diverse causes of hip pain is paramount for effective management. By employing precise diagnostic tests and implementing tailored strategies, patients can find relief and enhance their hip health for improved overall well-being.
