Hip pain

Patients fairly regularly present with pain they describe as being in their hip, groin or pelvic area. There are quite a few causes of hip pain, some of which can be treated effectively by an Osteopath:

• Pain in the hip can be referred from the back, or result from an injury where the muscles or ligaments have been strained or overused

• Osteoarthritis (wear and tear) in the hip which results from a narrowing of the space in the joint and cartilage damage. The patient may experience pain into the groin or down the leg towards the knee. Osteopathic treatment cannot cure the arthritis but it can often help ease the symptoms and prevent progression by gently massaging the hip muscles, stretching the hip joint to improve mobility and releasing secondary problems in the back. Exercises and other advice will also be given. If suspected, GP referral for MRI or XRay scans and investigations may be required.

• Groin strain – often relates to activities such as running or breast stroke where muscles such as psoas and the adductors (on the inside of the thigh) become strained and irritated. It is important to treat such a strain to prevent the build up of scar tissue and chronic shortening which can lead to wear and tear within the hip joint.

• Hip bursitis – results from the bursae (small bags found between bones, tendons and muscles in the hip) becoming inflamed and swollen due to too much friction. Often the patient experiences discomfort lying on the painful side and symptoms tend to be worse in the mornings. Occasionally you can see redness over the side of the hip. Treatment would include the release of the hip muscles and exercise prescription.

• Urinary tract infections/gynaecological problems – can refer pain into the groin. Osteopaths can differentially diagnose these conditions from a structural problem and refer to the GP as appropriate. Once the underlying problem is treated the groin pain should abate.

• Hernia – can present as groin pain particularly when the patient coughs or lifts heavy objects. Inguinal or femoral hernias involve part of the gut passing through the abdominal wall resulting in a bulge in the groin area. GP referral would be required if suspected as it is important to resolve the problem to prevent bowel damage.

• Pubic Symphysis Disorder – patients present with pain and tenderness along the joint margin where the pelvic bones meet in the middle of the pubic area. Often it is aggravated by dropping your knees out. Pregnant and breastfeeding women commonly experience this problem as the hormone relaxin creates ligamentous laxity. Runners, dancers and football players also present with this problem. Treatment aims to improve mobility of the hip and sacro-iliac joints, the back and the leg muscles to take the strain off the pubic joint.

• Snapping hip – creates this clicking sound on hip rotation as the iliotibial band (connective tissue and tendonous tissue that runs down the outside of the thigh) and/or the psoas tendon (running from the front of the lumbar spine to the top of the thigh bone) flick over the bony prominence of the thigh bone. This isn't in itself a problem, but can cause hip bursitis in the long run so it is important to seek treatment to release the muscle(s).

• Transient synovitis – where the capsule around the hip becomes inflamed. Pain is experienced over the side of the hip particularly at night and first thing in the morning. It is aggravated by weight bearing on the affected side. Osteopathic treatment aims to reduce the inflammation and increase lymphatic drainage

• Pinched hip capsule – sharp and short lived pain on the outside of the hip when weight bearing on the affected side. This problem results from the capsule being pinched between the two bony surfaces of the joint. Treatment is effective at stropping the problem and reducing re-occurrence.