physical therapy for hip joint pain

 Introduction:

One of the most common musculoskeletal problem is the hip joint pain, worldwide the incidence of hip pain is increasing in part because of the ageing of population. In the united states only 84% of women suffer from hip joint pain significantly more than men. Multiple factors contribute to the increasing incidence of hip pain such as Osteoporosis or either a sudden twisting motion of the lower extremity or the impact from a fall can all leads to hip area pain. To overcome all this incidence Physical Therapy should be the first line of treatment of hip joint pain supported by medication and lifestyle changes.

In this article you would come to know about Physical therapy treatment of hip joint pain,its management and prevention.

 

Structure of Hip Joint:

The hip joint is a ball and socket joint which offers stability during weight bearing and free mobility during activities. Forces from the lower limb extremities are transmitted upward through the hips to the pelvis and trunk during walking or other lower extremity activities. The hips also support the weight of the head, trunk and upper extremities. Stability of the hip joint is provide by the following structures-:

➤ Articular capsule

➤ Bony configuration 

➤ Muscles

➤ Ligaments

The two hip joints are linked to each other through the bony pelvis and to the vertebral column through the sacroiliac and lumbosacral joints. Hip joint has its strength from the thick articular capsule and strong ligaments like Iliofemoral, Pubofemoral, Ischeofemoral and glenoid labrum.

During normal walking hip goes through a range of motion of 40 degrees of flexion and extension. When there is musculoskeletal disorder of hip region, bone and joint deformities change alignment of lower limb extremity and mechanics of gait. Painful conditions cause antalgic gait patterns, which are characterised by minimum stance on the painful side to avoid the stress of weight bearing.

The muscles of hip joint are iliopsoas, rectus femoris, obturator externus, gluteal muscles, sartourius, all these muscles play an important role in the movement if hip joint along with stability.

The hip joint capsule is richly supplied with mechanoreceptors that respond to variations in position, stress, and movement for control of posture, balance, and movement. 

The major nerve of the hip joint region is sciatic nerve which forms in the posterior region of the pelvis from the sacral plexus and leaves the pelvis across the lower edge of the greater sciatic notch. Sciatic nerve entrapment results in the sensory changes along the lateral and posterior portion of the legs and dorsal and plantar surface of the foot. Progressive weakness also develop in the hamstring muscles, a portion of the adductor magnus muscle, and all the muscles of the leg and foot as shown in the image below

Hip joint impairments interface with many weight bearing and ADL activities, therefore a careful analysis of the factors involved in the mechanics of hip joints play a prominent role in the planning and implementation of the objective Physical therapy program.

In the early stage of hip joint disability one can feel the progressive pain with continued weight bearing and gait or at the end of the day after repetitive lower extremity activities. The pain may interfere with work (job specific) or routine household activities that involve weight bearing, such as meal preparation, cleaning, and shopping.

With the progressive degeneration of hip region there is increased difficulty in rising up from a chair, climbing stairs, squatting, and other weight bearing activities. Restricted routine ADL, such as bathing, toileting, and dressing (putting on pants, hose, socks) .

Physical Therapy for hip joint pain Management: 

 The important and basic objective of physical therapy treatment is to regain maximum possible range of motion at the affected hip along with strength to achieve physical independence. With the combination of electrotherapy and exercise therapy a wide range of hip joint pain conditions were treated by physical therapy. The therapeutic approaches includes-

➤ At hip joint to gain pain free motion mobilization with movement (MWM) technique is applied along with myofascial release technique by the Physical Therapist. 

➤ For muscle spasm and tightness passive stretching is performed by qualified licensed physical therapist.

➤ Electrotherapy modalities were also applied for pain reduction such as LASER, Tens machine, ultrasound machine, hot or cold pack according to acute or chronic stage of hip joint pain.

➤ For maintaining the muscle tone isometric exercises were performed under the supervision of physical therapist.

➤ As healing progresses and symptoms subside strength training around the hip musculature especially gluteus maximus, gluteal medius, and rotators and that improve stability and balance when performing weight bearing activities. Therapist begin with submaximal isometric resistance and then progresses to dynamic resistance.

➤ Now therapist progress to functional exercises as tolerated using Theraband and weight bearing activity as shown in the video below.

Here are some exercises shown in the video's for hip joint pain region under the supervision of physical therapist

➤ Physical therapist also educate the patient to establish a balance between activity and rest and learn the importance of minimizing stressful deformity forces by maintaining muscle strength and flexibility in the hip region.

Precautions and Ergonomic changes: 

During the hip joint pain and impairment there are some ergonomic changes and precautions which has to be taken by patient in performing daily activities, such as 

👉 When ascending stairs lead with the sound leg and when descending lead with the affected leg which has pain around hip joint.

👉 Avoid activities in standing that involve rotating the body toward the painful hip joint leg.

👉 Sleep in supine with an abduction pillow and avoid sleeping or resting in side lying position.

👉 Transfer to the sound side from bed to chair or chair to bed.

👉 Do not sit in cross leg position for a long time if you had hip joint pain.

👉 When sitting keep the knees slightly lower than the hips and also avoid sitting in low, soft chairs.

👉 Use a raised toilet seat to avoid hip joint region pain.

 👉 For bathing, take showers or use a shower chair in the bathtub.

Also read- can exercise cycle reduce belly fat

Conclusion:

Hip joint is an important part of our body and should not be ignore in any kind of disease or deformity, when required always consult a Physical therapist.

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