RUNNING, WALKING and HIP pain!

Have you experienced any hip pain, after taking up running or walking since the COVID-19 lockdown. This blog by our resident physio Lakshmi Varma gives an insight into some of the causes of hip pain.

If you have experienced hip pain, getting the right diagnosis in addition to a good management plan is not only important to manage the current injury and get back to the activity you love but also to make sure you don’t reinjure yourself.

So what causes hip pain?

There are many causes of that can lead to or present as hip pain. Such as a sudden increase or decrease in the exercise you do, like walking or running, can result in many changes in the tissues/structures in and around the hip joint. Therefore, the causes of pain can be multifactorial and can include, gluteal tendinopathy/bursitis, progression of osteoarthritis of the hip joint, hip impingement, stress reactions of head of femur etc.

Gluteal tendinopathy ^(1-5):

Gluteal tendinopathy can present predominantly as pain on the lateral side of the hip, and at time as lateral thigh pain. This condition is also often associated to GTPS or greater trochanteric pain syndrome or what was known as trochanteric bursitis. It can present with symptoms like pain on weight-bearing on the affected limb, pain with sleeping especially on the affected side, stairs etc. It generally affects people who have been inactive and have suddenly increased or taken up walking or running. It is the more common in females, with one in four females over 50 years of age likely to be affected.

Osteoarthritis of the hip joint (hip OA) ^(6-9):

Hip OA commonly presents as pain and stiffness around the hip joint (groin/thigh, buttocks). The pain can either develop gradually over time or can be sudden onset due to change in loading through the joint. How hip pain and stiffness presents, can vary depending on the stage of osteoarthritis, but can often be eased with right exercise or movement. If not managed well, it can also lead to walking/gait abnormalities, other joint issues due to abnormal loading (e.g knee and back pain) and poor quality of life. While ageing and genetic factors are important contributors in the progression of hip OA, the mechanical loading through the joint form another important factor.

Hip impingement (FAI) related hip pain ⁽¹⁰⁾:

Hip impingement or FAI is a frequent cause of hip pain and stiffness especially around the hip and groin area. It can be said to be a movement related disorder which is characterised by specific imaging findings, pain and clinical signs. It is thought to be caused due to  altered morphology or shape of the two end of the hip bones (femur and acetabulum). Therefore, creates aberrant joint forces during movement and can result in damage of intra-articular structures like joint cartilage, especially with changes or sudden increase in exercise routines. Activities like running, acceleration sports, squatting, stairs and prolonged sitting can commonly aggravate the symptoms. Hip OA can also be often associated with this condition.

Femoral neck stress fractures/reactions ⁽¹¹⁾:

Stress reactions or fractures are overuse injuries in athletes that are caused by repetitive submaximal loading on a bone over time and associated with increased volume or intensity of training workload. A stress reaction can occur over a period of time and continual overload lead to stress fracture or complete fracture. Femoral neck stress fractures make up approximately 11% of stress injuries in athletes and more common in running and jumping related activities. There are 2 types of femoral neck stress fractures: tension-type and compression-type fractures. Early detection and identification of the type of femoral neck stress fracture is important as tension-type fracture involving the superior-lateral (top-outside) aspect of the neck of femur are at high risk for complete fractures. The more common type of injury is seen in the younger population who are runners and involves the inferior-medial part of the neck of femur. The common symptoms include hip or groin pain which is worse with weight bearing and some turning movements of the hip, especially internal rotation.

How physiotherapy and myotherapy can help you …

Our physiotherapists and myotherapists can help you:

• Manage your pain.
• Improve range of motion and function.
• Provide you with the appropriate strength and control program.
• Above all guide you on a load management program to return to what you love doing and to prevent further injuries.
• Refer you to other specialist like our sports physicians or surgeons if further interventions are needed.
• Guide you or refer you if further imaging if required.

Lakshmi Varma is a Title musculoskeletal physiotherapist with an additional Master’s degree in Clinical and sports biomechanics. She has over 18 years of  experience as a Physiotherapist and is currently a PhD student looking at hip replacements.

If hip pain is interfering with life and sport, book in below to come and see us

 

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References

1. Grimaldi, A., Mellor, R., Hodges, P. et al.Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Med 45, 1107–1119 (2015). https://doi.org/10.1007/s40279-015-0336-5
2. Redmond JM, Cregar WM, Gupta A, Hammarstedt JE, Martin TJ, Domb BG. Trochanteric micropuncture: Treatment for gluteus medius tendinopathy.Arthroscopy techniques. 2015 Feb 1;4(1):e87-90
3. Allison K, Vicenzino B, Wrigley TV, Grimaldi A, Hodges PW, Bennell KL. Hip Abductor Muscle Weakness in Individuals with Gluteal Tendinopathy. Medicine and science in sports and exercise. 2016 Mar;48(3):346-52
4. Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. journal of orthopaedic & sports physical therapy. 2015 Nov;45(11):910-22.
5. Speers CJB, Bhogal GS. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. British Journal of General Practice. 2017;67:479-480
6. American Academy of Orthopaedic Surgeons. Diseases and conditions: Osteoarthritis of the hip.https://orthoinfo.aaos.org/en/diseases–conditions/osteoarthritis-of-the-hip
7. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett LL, Jones G, Cicuttini F, Osborne R, Vos T, Buchbinder R, Woolf A, March L (2014). The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 73:1316–1322. https://doi.org/10.1136/ annrheumdis-2013-204627.
8. Finch CF, Kemp JL, Clapperton AJ. (2015). The incidence and burden of hospital-treated sports-related injury in people aged 15+ years in Victoria, Australia, 2004-2010: a future epidemic of osteoarthritis? Osteoarthritis Cartilage. 23:1138–1143. https://doi.org/10.1016/j.joca.2015.02.165
9. Griffin DR, Dickenson EJ, O’Donnell J, Agricola R, Awan T, Beck M et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016; 50(19):1169-76.
10. Kiel J, Kaiser K. Stress Reaction and Fractures. [Updated 2019 Jun 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507835/