Background

The hip joint contains a “ball and socket”, similar to the shoulder. The socket is located in the part of the pelvis called the acetabulum, the ball is part of the femur. The hip is less mobile and more stable as compared to the shoulder due to the increased coverage of the socket relative to the ball. Many muscles run from the pelvis to the femur and/or play a role in the hip joint. These include the gluteals, piriformis muscle, and the quad muscles.

Diagnoses

Hamstring Strain


A muscle strain is when a specific muscle is overstretched. The severity of a strain can be as mild as simply an overstretch (grade I), to a partial tear (grade II), and as severe as a full tear (grade III). Most hamstring strains are either grade I or II and often occur when running or quickly changing directions. Commonly the pain is either just below the buttocks or in the back of the thigh (1). Risk factors for a hamstring strain are muscle imbalance between your quad and hamstring, poor flexibility, and history of hamstring injury. It is very common to reinjure the hamstring due to returning to sports too soon after the initial injury. Physical therapists are experts at progressing appropriately to a full return to sports participation. There are standardized tests and measures that will indicate when a return is appropriate. The physical therapist will focus on decreasing potential swelling and inflammation, hamstring strengthening, as well as core stabilization. The severity of the hamstring strain will dictate the timeline in which a safe return to sports is appropriate. 

Total Hip Replacement

A total hip replacement (THR or THA) is a result of arthritic changes causing significant pain and limitations in mobility and daily function. Surgery consists of replacing the surfaces of the acetabulum (“socket”) and the femur (“ball”) with a metal material. By replacing the joint surfaces, pain is significantly reduced with activities such as walking, ascending/descending stairs, and prolonged sitting. While hospitalized after surgery, a physical therapist begins with routines of walking and getting in and out of bed. If a surgeon places restrictions on certain movements immediately after surgery, the physical therapist will work to ensure compliance with these restrictions. When ready for outpatient physical therapy, the program will include a strengthening program, maximize quality of movement and mobility, and ensure a return to full range of motion. 

Femoral Acetabular Impingement (FAI)

The hip joint is a “ball and socket” in which the “socket” (acetabulum) has significant coverage of the “ball” (femur). This provides more stability to the joint and allows for high levels of force to transfer through the leg while running or jumping. Femoral Acetabulur Impingement (FAI) is a condition in which there is abnormal bone growth in response to the loads and stresses placed on the hip. This can present as: a) over coverage from the socket (called pincer type FAI); or b) where the ball is less circular (called CAM type FAI). FAI can be diagnosed with an x-ray, CT, or MRI exam. A major risk factor for FAI is participating in sports, especially ones that involve extreme hip motions such as football, hockey, and dancing. FAI can also manifest because of genetic predisposition. Physical therapy will work on improving range of motion without aggravating symptoms. Modifying hip positions during exercise and daily activities can greatly reduce pain. Strengthening the muscles around the hip, as well as strengthening the core muscles are vital for full recovery. If conservative care is not successful, cortisone steroid injections and surgery are the next options for FAI. 

Piriformis Syndrome

One of the most common presentations seen in physical therapy is radiating, painful symptoms down the back of the leg. Physical therapists are experts at determining the root functional cause of that pain. Piriformis syndrome is a frequent cause of these symptoms. The piriformis muscle attaches from the sacrum (base of the spine) to the hip joint and is responsible for rotating the hip. The sciatic nerve runs through or closely around the muscle as it descends through the leg and into the foot. For more information see SCIATICA.

When the muscle becomes overused or tight it can irritate the nerve and cause pain in the buttocks and/or down the leg. Physical therapy will work on decreasing the resultant muscle spasm and releasing tension on the sciatic nerve. It is important to improve the biomechanics of movement such as walking, running, cycling, or squatting to reduce overstretching of the muscle. Once pain is reduced, strengthening the hip and core muscles are vital for long term resolution of piriformis syndrome.