Recently the Physiotherapists and Myotherapists at The Melbourne Sports Medicine Centre had an interesting and engaging open forum discussion on the management of patients with hip conditions.
Initially the general aim was to share clinical insights and research findings relevant to treating the various hip conditions, throughout the discussions it became clear that there were two key questions that needed to be addressed-
1. How can I recognise the different presenting features that will help form the diagnosis?
2. What is the best treatment and management path for the individual patient?
We recognised that whilst there were many overlapping features in the diagnosis and management of various hip conditions, it was still beneficial to distinguish between various clinical diagnoses. Whilst hip conditions generally share some features such as the location of symptoms and general aggravating factors, there are some features that distinguish specific conditions. For instance osteoarthritic hips are more likely to present with a constant pain which is worse at rest and at night along with significant loss of range of motion, but labral (cartilage) tears are more likely to produce locking and catching symptoms and may well present with full range, yet painful motion.
A key feature in assisting patients to manage their hip condition is to provide useful advice and education on how to protect and unload the sensitive hip structures. Commonly hips are aggravated by a combination of specific movements such as internal rotation, yet many patients adopt sitting and even lying internally rotated postures. Then, for example, many people have a habit of further internally rotating their hip when rising from a chair. The same may apply to a cyclist who has less than ideal bike set up or motor patterns whilst riding. Many patients are performing closed chain exercises such as squatting which inadvertently can produce the internal rotation pattern - this can be corrected with simultaneous gluteal activation cues and careful monitoring. Appropriate advice and education can help patients avoid these aggravating postures with the result of minimising symptoms and potentially further damage.
We discussed the various manual therapy techniques such as mobilisation, massage and dry needling. In certain circumstances they can be expected to produce more favourable outcomes. In particular the treatment of the hip joint and related joint stiffness and muscular hyperactivity can often be often be addressed with manual therapy to produce positive results.
It was recognised that a cornerstone for treatment is an appropriate, progressive and individualised exercise program, taking into account the clinical diagnosis as well as the patient’s specific circumstances and preferences. No recipes. Most exercise programs will aim to address key hip stabilising muscle groups along with general lower limb and trunk strengthening and activation. It is important that stretching is well targeted and avoids placing the hip in a compromised position. At times it can be useful to record a baseline of hip muscle strength using the hand held dynamometer which can help inform and monitor the exercise regime. General, non-aggravating fitness activities are also seen to be an essential part of ongoing management.
Fortunately at The Melbourne Sports Medicine Centre we have a philosophy and capability to provide a multi-disciplinary approach to patient care. Often in managing a patient’s hip condition our Sports Medicine Doctors can be an invaluable source of opinion and potentially imaging and medical interventions or referral that can further enhance patient outcomes.
So if you’ve recently injured your hip or have been tolerating an ongoing hip condition, we’d encourage you to get in contact with us at The Melbourne Sports Medicine Centre so we can assist you with your diagnosis and treatment. Phone us on 9650 9372 or book an appointment online.