Hip pain – common causes and treatment (Part 2)

In the last section we spoke about 2 common causes of hip pain (osteoarthritis and glute medius tendon pain) – how they can be identified and treated. Here, we’ll talk about 2 further common culprits of hip pain.

Hip impingement

Impingement refers to a ‘catching’ or unwanted pressure on structures within the hip joint, typically resulting in pain in the front of the hip. This can be a result of excess bone growth on one of the bones of the hip joint, or by damage to the cartilage lining the hip joint (‘labrum’). While this might sound like a serious and painful condition, it often has little or no impact on our hip function. In fact, recent research has shown that many people showing ‘hip impingement’ signs on an x-ray have no symptoms at all (1). If your hip is strong and stable enough, and you avoid activities likely to provoke symptoms, it’s very possible that we can have no symptoms despite this impingement.

If you do have symptoms, they will likely present as a ‘sharp’ bout of pain in the front of your hip or pain at the extremes of movement (for example, in a deep squat). Physiotherapy treatment can help in reducing these symptoms, through improving hip mobility and strengthening the muscles around the joint that are key for stability and advising on positions to avoid while your hip recovers.

‘Referred’ pain from your lumbar spine

Often it is the case where you may be experiencing pain around your hip or thigh, but the issue is actually occurring (or ‘referred’) from your lumbar spine (lower back). This happens in two ways primarily:

1) While the ‘injury’ may have occurred in one specific area, the signals sent to your brain about the injury aren’t always 100% accurate about the pain location, and therefore represent a broader pain area (imagine lower back pain with buttock pain, for example).

2) At your lumbar spine, nerves leave your spine and travel to different parts of your legs, where they send signals about sensation, movement, and other important things. If these nerves at your lumbar spine become irritated or sensitive, they can ‘refer’ symptoms (such as pain) in the area that these nerves provide signals for. This is shown in the image to the right of a leg – note how the upper lumbar areas (circled - L1, L2, L3) cover the shaded areas of the thigh. This is referring to the fact that these nerves from your lower back supply sensory information (including pain) to these areas of your thigh.

What is the relevance of this? Well, if we treat this ‘hip pain’ as if it originated from your hip, it won’t be very effective. To alleviate your symptoms in this instance, instead we need to treat your lower back with manual therapy, soft tissue massage and mobility exercises to improve the health of the tissues in your lower back, rather than your hip.

If any of this sounds familiar to you, call in to Medowie Family and Sports Physiotherapy. Mike and Kevin assess and treat these conditions regularly, so they would be happy to help.

1. Mascarenhas, V.V., Rego, P., Dantas, P., Morais, F., McWilliams, J., Collado, D., Marques, H., Gaspar, A., Soldado, F. and Consciência, J.G., 2016. Imaging prevalence of femoroacetabular impingement in symptomatic patients, athletes, and asymptomatic individuals: a systematic review. European journal of radiology, 85(1), pp.73-95.