Hip and groin complaints make up a large percentage of clients I treat here in the clinic. Due to the vast number of anatomical structures at the hip and groin, there are a wide range of possible diagnoses.
To help guide my clinical reasoning when coming to make a diagnosis and finding the source of pain or dysfunction, I try to break hip diagnoses down into 3 different, but sometimes overlapping categories:
Articular (happening within the joint): This includes conditions such as osteoarthritis, hip impingement (femoroacetabular impingement, or FAI for short) and labral issues.
Extra-articular (outside/around the joint): This usually involves, but is not limited to the surrounding muscles and tendons. Common conditions in this category include, adductor related groin pain, hip flexor strains and gluteus medius tendinopathies.
Referred pain – pain arising elsewhere and referring to the hip region, such as the lower back and sacroiliac joint
When assessing my clients, it is important for me to take a good history of the problem, as this can help to guide me in my physical examination, and can also give clues to what the most likely cause is.
When I begin my physical assessment of the hip, I will always start with a quick check of the lower back, to rule it in or out, and will then move on to more hip specific testing.
I like to incorporate a combination of different evidence based techniques when treating hip and groin pain.
Education is very important in helping my clients understand what the issue is. Also giving them tips on things they can do between treatment sessions to help give themselves some relief and also things to try avoid/do less of to help prevent aggravating the hip and giving it time to heal and recover. For example, certain clients may benefit from avoiding positions of excessive hip flexion, so sitting in a higher seat.
Using mobilisations at the hip joint to help improve range of movement and also provide input to help with pain relief.
Myofascial release and soft tissue massage to help reduce muscular tightness and deactivate myofascial trigger points that may have developed. The main muscles I would look at here would be – the adductors, hip flexors, hamstrings, quadriceps and gluteal muscles.
I find that using Medical Acupuncture, including dry needling, a very useful modality to help with tissue healing and pain relief. It also works well to help with muscular restriction and myofascial trigger points. Especially with hip pain, I would commonly see clients with a lot of tightness around the gluteal muscles, and find that this type of treatment very useful.
A specific home exercise programme is important to build up strength in the local hip muscles, to gain good local control in the deep abdominals, hip flexors and hip external rotators. Then to also improve strength and control in the global musculature.
I find it is important not to overload my clients with a long list of exercises, instead focusing on 2-3 key exercises, and progressing as pain reduces and strength with mobility improve.
The markers for progressing exercises and rehabilitation may not be time based. It depends more on their pain levels, hip control, stability and endurance. I find it is important to keep my clients motivated throughout their treatment out lining clear markers for progression and having functional or sporting goals to achieve.
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- PhysioEdge 053 & 054, Hip and Groin Pain with Benoy Mathew
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