Hip pain treatment
Will physiotherapy help hip pain?
When someone sees a physiotherapist about hip pain, the first thing to determine is which biomechanical problems may have contributed to the hip pain. These problems may be local to the hip region, for example poor strength or inflexibility of the hip joint itself. Problems such as excessive knee, ankle or foot rotation may cause compensatory movement faults at the hips.
Once determined, physiotherapists are able to advise on a series of exercises designed to correct the movement pattern. Hip strengthening programs are often prescribed to gradually increase the load on muscles and tendons. This has two advantages in that it may improve problematic biomechanics but also loading soft tissue increases the likelihood of optimal muscle and tendon healing following injury. Common examples are rotational hip exercises known as side lying clam exercises and pelvic bridging exercises.
Stretching programs for muscles may also improve mechanical efficiency of movements as well as release tension in muscles which can be a contributory factor in causing hip pain. Common muscle groups targeted in patients with hip pain include the calf muscles, hamstrings and hip flexors.
Certain manual techniques may also be employed by physiotherapists to improve hip pain. Depending on the cause of hip stiffness, physiotherapists are able to provide hip joint mobilisation techniques, sometimes referred to as mobilisations with movement. These techniques may be conducted using a belt or strap to increase leverage. If the hip stiffness is thought to be due to muscular and soft tissue restriction around the hip then physiotherapists can alternatively work on deep soft tissue release techniques to reduce any overactivity to these tissues.
What types of surgery is available to treat hip pain?
The most common form of surgery used to treat disabling levels of hip pain is a total hip replacement, sometimes referred to as a hip arthroplasty. In recent years, hip replacement surgery has been deemed one of the most successful operations available based on improvements in quality of life. Tens of thousands of these operations are completed each year in the UK.
In recent years there has also been a drive to solve the dilemma of disabling hip osteoarthritis in younger people for whom a traditional hip replacement may be unsuitable due to their more active lifestyle and increased hip replacement wear rates. Hip resurfacing techniques are now sometimes offered in these circumstances which replace the top of the thigh bone (femoral head) with a small metal cap rather than a large, stemmed ball device used in a hip replacement. This allows a resurfaced hip to be converted to a total hip replacement without complications later on in life, reducing the need for more complicated revision hip replacement operations.
Hip cartilage (labral) tears and hip impingement syndromes have also seen a marked increase in operation rates in the last decade. Keyhole operation techniques (hip arthroscopy) are used to access the joint. Surgeons are then able to examine and repair torn parts of the hip labrum, as well as shave excess bone from the area which is causing the impingement.
Other forms of hip surgery may be rarely used to treat large genetic structural variations of the hips to reduce the progression of osteoarthritis or to repair tendon tears around the hip region.
Can orthotic insoles help to relieve hip pain?
Orthotic insoles are medical devices often provided by orthotists, physiotherapists or podiatrists to help with a variety of musculoskeletal problems.
Insoles are designed to provide different forms of materials which may provide more shock absorption or stability for the foot during weight bearing tasks. Secondly, they are able to provide a certain degree of foot arch support or wedging towards the inside and outside of the heel or foot. Depending on the exact structure of the insole this can alter the angle of the foot when in contact with the ground and may also enable better muscular stability around the ankle and foot.
When there is evidence of a biomechanical problem contributing to hip pain, orthotics may therefore be used to restore more normal biomechanics. Insole material high in absorptive capacity may also help to alleviate hip pain caused by significant osteoarthritis.
Insoles are often designed and used as a variety of off-the-shelf designs which clinicians may select depending on the characteristic needed. However, they may also be customised from a variety of methods including from force plate measurements and foam/ plastic moulds. A recent product known as APOS therapy is also used within some musculoskeletal services which provides a form of customised pods on the exterior of the footwear to provide foot wedging to correct faulty biomechanics.
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