All too often, patients who come to physio with pain in the hip, have been managed from a one-joint or soft tissue injury concept at another centre.
We firstly treat the hip joint itself if there is any primary joint and bone pathology. We assess and reduce neurological referred pain into the patient’s hip. And thirdly, we add the Gluteus Medius strengthening to ‘the holy trinity’ of a standard hip injury rehabilitation programme.
Is it enough? In a way, it will reduce the pain and get you back to everyday life and exercise.
Is it the best approach? Not always, because a good physio is not just here to get their patients back on their feet after injuries, we want to prevent the same injuries from happening over and over again.
To do so, we need to think outside of the box and look at how the patient’s body function as a whole and understand the relationship between the lower back, Pelvis, hip, and knee, and their relationship to the functional kinetic chain. In other words, we need to look above and below the hip for the weak link. Identifying, correcting, and conditioning the weak link is the key to a better treatment, which is not just getting the patients better, but also successfully prevent the reoccurrence of the same injury.
So, what are these missing links of the hip injuries:
‘My knee is not pointing straight when I run/walk”
The alignment from your foot and leg is often associated with a stiff and over rotated foot and tight calf muscles. Next thing we know, the ankle starts to lock and the leg starts to turn inwards. This prevents the activation of the gluteus medius muscle and it becomes weak and prone to inflammation and micro tears. The patient makes compensations in their running/walking pattern until it is too painful to continue. That’s when they come to see their physio.
‘My pelvis is out of alignment’
Pelvis dysfunction is also frequently seen among the hip injuries. You may have heard people saying “Oh my Pelvic is out of alignment”, which is a common term for the pelvis, in particular, Sacroiliac joint (SIJ) dysfunction. The Pelvis serves as a functional link to transfer load from lower limbs to the spine, and vice versa. Any Strains on the ligaments and imbalance/weakness in the muscles (Especially Glutes Maximus and Piriformis) can have negative impact on this link, causing pain in the hip
‘Weak core and bad posture’
The core stability and Strength is often forgotten or over looked with the hip injury rehabilitation. The core muscles are required to offset the powerful loads that are placed on the spine by the force that is generated in the hip and pelvic during mobilisation. The link among the legs, core, and upper Body allows the power generated by these muscles to transmit through the body to synchronise the motion of our body.
What can we do to eliminate those missing links that prevent you from full recovery and having you coming back for the same hip injuries in a few week/months’ time?
The key is to go beyond the standard hip rehabilitation of the “holy trinity” and identify what is missing, and then to eliminate those weak links.
At Physicocity, we have a 6 steps to success programme to help you to identify your missing links, treat any issues related to your hip injuries and guide you through with a personalised rehabilitation program based on your hip condition.
Functional Examination and differential diagnosis
Address the biomechanics elsewhere in the kinetic chain
Functional Joint mobilisation and soft tissue release to free up the symptomatic and overloaded structures
Functional muscle activation and strengthening in the hip region to address the imbalance between muscle groups
Core strength conditioning
High intensity strength and functional activity programme