Hip
Iliotibial Band Syndrome (ITBS)
Description: ITBS is often referred to as hip or trochanteric bursitis. In this condition, the thick fibrous band which travels from the crest of the hip bone down the outside of the leg to the knee becomes inflamed. The IT band can also compress the bursa (a fluid filled sack), which is located over the bony knob on the outside of the hip. This condition is most common in middle-aged women, and can be very stubborn to treat if treatment is delayed.
Symptoms: Pain is usually felt on the outside of the hip, over the bony knob, which is called the greater trochanter. Going up/down stairs, squatting, sleeping on either side, and sitting for prolonged periods of time typically increase symptoms. Sitting for long trips in a car and getting up from the ground are two activities which can be especially painful.
Treatment: The most important component of treatment is identifying the cause of the irritation at the hip. Faulty biomechanics, such as overpronation (flat-feet) and weak hip muscles, are very common findings. Custom-fit orthotics, stretches, and strengthening exercises help alleviate pressure on the involved tissues. Modalities such as electrical stimulation, heat/ice, ultrasound, and iontophoresis (anti-inflammatory medication delivered by an electrode) are used to reduce inflammation and pain. Exercise in a pool is often a good way to strengthen muscles while minimizing strain on healing tissues.
Description: Hip OA is degeneration of the ball and socket part of the hip. This condition becomes more prevalent as we age. The degree of degeneration can range from very mild to extremely severe. More severe cases usually require a surgical procedure called a Total Hip Arthroplasty (hip replacement).
Symptoms: Pain is usually felt deep in the hip near the groin. Pain typically increases with prolonged walking, standing, and sitting. Hip range of motion often decreases, especially during rotational movements. Activities such as golf and walking for exercise can be especially painful.
Treatment: As with other arthritic conditions, activity modification and graded exercise are important for improving function. Musculoskeltal balance must exist on all sides of the joint for the hip to function optimally. Therefore, targeted stretching and strengthening exercises are key to treatment. These exercises are often performed in a pool to minimize strain on the joint. Modalities such as electrical stimulation, heat/ice, ultrasound, and iontophoresis (anti-inflammatory medication delivered by an electrode) may be used for pain control.
Description: Pain originating in the groin can be challenging to treat and diagnose. Excessively tight muscles which cross the hip and groin, strained tendons, pelvic misalignment, stress fractures of the bone, and degenerative arthritis can all manifest as pain in the groin area. It is often necessary to rule out a hernia as the source of pain. The patient's age and activity level are factors which can help a clinician determine the source of pain. The pain may come on progressively without a specific cause, but it may also be the result of an injury, such as a fall during sports.
Symptoms: Pain described as aching or burning may be present at the front of the hip or deep in the groin. Pain at the very front of the hip may be from a strained tendon of the iliopsoas muscle (hip flexor strain). Pain located where the 2 pelvic bones meet just above the genitals is usually caused by misalignment of the large flat hip bones. Pain felt deep in the groin which is made worse by prolonged weight-bearing may be osteoarthritis of the hip. Walking up/down hills, running, and walking on uneven surfaces can be especially painful.
Treatment: Once the source of the pain is localized, treatment is directed at the strictures thought to be involved. Activity modification and a gradual conditioning program are initiated early to treat stress fractures and osteoarthritis. Tendon and muscle injuries usually respond best to modalities and muscle balancing and stretching exercises. The goal of these exercises is to direct force away from the injured structure and dissipate it more evenly around the associated body regions. Modalities such as electrical stimulation, heat/ice, ultrasound, and iontophoresis (anti-inflammatory medication delivered by an electrode) may be used to control pain and inflammation whenever groin pain is present.
Sciatica or Piriformis Syndrome
- The term sciatica is often used very broadly to describe any form of pain that radiates into the leg.
- True sciatica occurs when the sciatic nerve is pinched or irritated
- There are several structures which can irritate the sciatic nerve, including the piriformis muscle
Symptoms
- Pain, numbness, tingling, or burning which radiates from the buttock down 1 leg
- Weakness in lower extremity muscles
- Increased pain when sitting for long periods which is alleviated when standing
Treatment
- Stretching of tight muscles and strengthening of weak muscles
- Finding ways to alleviate pressure over the sciatic nerve
- Nerve glides to improve the mobility of the sciatic nerve
- Modalities such as electrical stimulation, moist heat, massage, and ultrasound