Category Archives for "Hip Pain"

Hip Pain Simon Kelly

Mark: Hi, it's Mark from Top Local. I'm here with Simon Kelly. He's a physiotherapist at Insync Physio in Vancouver. One of Vancouver's favourite physiotherapist clinics, many time winners of best Physio in Vancouver. And Simon is going to talk to us today about frontal hip pain. Hip pain. This is really common. So what causes this kind of hip pain in the front of your joint? 

Simon: Hi, Mark, thanks for having me. Yeah. I'll just talk about hip pain sort of a little bit globally. And again, I might bring in a certain client that I saw recently as well, like a case study. But yeah, there's a couple of things that can cause hip pain to be honest Mark.

So this guy in particular, just came in and had pain in front of his hip. No real specific injury as such kind of came on more gradually. So we dug into the history of like how it came on and then he said he had it, I think mid November. So that would have been two months ago from when we recorded this video, he took a break.

He was actually doing a lot of Nordic cross skating, which I wasn't really aware of what that was, but it's almost like you're on the little wheels. Like you're kind of skating, but on ground as you maybe you know what that is Mark? But I never heard of it being from Ireland, but he explained it in good detail, but he was doing a lot more of that and he was in a lot more rowing he was telling me. 

And then he did feel the pain coming on, but he just kind of continued for awhile and he stopped and then the pain didn't go away and he landed in my office here, or in my clinic here. So, you know, the first thing, like, because it was more gradual in nature, you wouldn't be sort of thinking more like a groin strain. It might be overworked or chronic use of the groin, but we have  to kind of rule out the groin, which we kind of do in clinic where you squeeze the knees together. And if there's no pain on that, you kind of pretty sure it's not a groin, but even the mechanism of injury it's unlikely to be a groin. You know, you usually get that in lots of changing of direction.

He does have a bit of changing in your direction in that actually. He further made it more detailed in how this classical, where you just kind of go straight, these wheels are, there's kind of more lateral as he described. So the lateral movement was really making it worse according to him. So that was kind of interesting to see why that was worse for him.

So he came into clinic. We had a look at the front of the, he kind of pointed to the front of his hip, not to the side of his hip and it was more painful that at night time when he was laying on that side. So that's kind of how he presented. So we cleared the groin. Obviously we did the squeeze test where the knees were squeezing together. That was all clear. 

And then we kind of checked his hip flexors. So iliopsoas, that's the name of your hip flexor and then you have rectus femoris, which is actually one of your quads that also crosses the hip joint and it assists in hip flexion as well. So in the clinic here, he had a little bit of pain when he was completing that movement on hip flexion.

And when we started to palpate the front of the hip, you kind of have two bony nodules on the front of your hip. Just a little bit below that, he had a lot of pain in there. So he was also stiff in his hip as well. And he was a little bit older, he's 50 years old. So he has a bit of stiffness in his hip, but this is definitely, I think an overuse injury of the muscle called rectus femoris.

And just from lots and lots and lots of hip flexion. It was a lot of hip flexion. And then he was trying to alternate to something else which was rowing, which was also a lot of that hip flexion. It also was stretching the life out of his hip flexors as well.

So the muscle was really getting no time to kind of recover or heal, so I think he just needed a bit of education really.  I think he was concerned. It hadn't gone away in two months. So my job is to get out the aggravating factors. Just tell him, stop rowing, stop, stretching the life out of his hip. And just maybe cool down at Nordic cross skating just for a week til I settle it. So that's what we done just to start. 

And then we obviously just loaded up to the hip and a little bit more, but more gradually. And because it is chronic, it wasn't specific and some of the chronic stuff can take a little bit longer to heal, like it is a chronic tendinopathy. So you're probably looking at maybe, sometimes take two to three months. But if it's done right, we can introduce it a little bit earlier. So we load it up as hip flexors and we did a couple of exercises just to build up that muscle on the hip, we avoided sort of a lot of this aggravating factors for two or three weeks, and then we started to add it in gradually.

And he's actually after making a pretty good recovery now and he's happy that it's not hip osteoarthritis. So he's back doing his Nordic cross skating. Now I think he's back up to three or four times a week so with no pain. And so that was great. 

Mark: Well, hopefully he puts the skis on and gets out on the snow, which is really what that's training for. I've had this injury from cross country skiing. But it was from wax failing, going uphill, hard uphill and over stretching the rectus femoris. And so, did he have any crepitus in his hip? 

Simon: He didn't actually no, he had no crepitus in his hip. He was very tight in his hips now. And I'd imagine we all know you get a little bit of osteoarthritis as you get older, but certainly he wasn't symptomatic or had no clicking or popping or crepitus. That was good. I think that really eased his mind. I think he kind of thought it was the start of hip osteoarthritis. So he was kind of relieved that it was, I say, just that muscle it's important, but maybe it is better not to have hip osteoarthritis as well. 

But you're right, Mark, you can get more of the acute injuries. His was more chronic from lots of hip flexion, somewhat a more, acute injuries, you know, snowboarders, when they lean back, they can really over that muscle. Kind of like what you were saying when you're really doing a lot of uphill and stretching back, you injury it that way too, for sure.

Mark: Yeah. So what was the treatment protocol? What would be more of a typical thing if somebody had this kind of overuse injury to the rectus femoris or their front of their hip? 

Simon: Absolutely Mark, yeah. So what we do with him, actually, we, a lot of the time it can be just tightness in the quad muscle actually. So we just worked out that muscle with a lot of massage, some needling like IMS treatment or dry needling, it's called that because there's nothing in the needle obviously, but we just reset the muscle and make sure it's long enough. And really, again, it's all about education and just, you're overloading this muscle just too much in the amount that you're doing.

He really wanted an alternative, something alternative to do. He couldn't do it the Nordic cross skating because obviously he's probably training. Someone who does, this is usually really eager to get onto the snow and he didn't want to lose any sort of cardiovascular stuff as well. So I mentioned a little bit of biking to him and a bit of cross trainer if he could, but just really tried to limit, I avoided rowing as well, there's too much hip flexion in that.

I think he was just going to aggressive, a weekend warrior type character. So he was happy to just do a bit of bike for awhile but it was hard to reel him in to avoid the rowing and that cross skating. And then, yeah, we just loaded him up here in clinic as best he could. And yeah, he has no pain at nighttime now. And he's back doing his Nordic cross skating now. And he's looking forward to getting back into the slopes, he can do that now too.

Mark: Absolutely. So if you've got some hip pain, the guy to see is Simon Kelly. You can reach him at Insync Physio in Vancouver at the Cambie Street office. You can call to book your appointment (604) 566-9716. Or check out the website insyncphysio.com. Real easy to book right there online. 

If you're in Burnaby, they have a Burnaby office, (604) 298-4878. Same thing you can book online there. Pick from whichever physiotherapists you want. You can choose Simon, he's busy and he's good at what he does. Inphysio.com. Thanks Simon. 

Simon: Cheers Mark. Thanks very much.

Hip Impingement

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver, many time winners of best physiotherapist office in Vancouver. And we're talking hip impingement. How are you doing Wil? 

Wil: I'm doing great. Thanks Mark. Basically it's when the head of your femur or your femur bone basically pinches up against that part of the socket of your pelvis, which is called your acetabulum. So what they normally refer to it as FAI. Which is femoroacetabular impingement. And there's a few different causes to that. 

There's definitely, you know, like sort of structural genetic component where if you're pelvis and your hips are aligned in a certain way and the neck of your femur is not proportioned, or if it's shorter then you have an increased risk of having this type of impingement happening. 

So aside from looking at sort of the congenital factors, we're looking at more of the other secondary issues of like, imbalances that you develop from sport and activity, to specific injuries. Then you can run the gamut of like, you know, having issues that are caused by like the sacred iliac joint that shifts the alignment of the whole pelvis, which then causes a movement issue in the actual hip. So that's huge because I see that quite a bit too. To where you have like, in your hip, you have cartilage that's called your labral. And so you can sometimes experience sort of an injury into there. And then if you have sort of that kind of stuff going on and that can definitely give you changes in terms of the actual motion and movement of the whole hip. 

So when it comes down to the true FAI, there are a lot of different causes to this. And I think you really want to address what are the biomechanical factors.

So biomechanical factor being like, you know, what are the things that are affecting the way that this joint is moving. Assuming that you account for all the structural issues and that, all that stuff is normal. And you don't have that aspect with regards to that getting in the way. And then you're looking at muscle imbalances. So you have like your lower back joints maybe, your spinal joints maybe contributing to all that. 

Mark: So how would I know? How does this show up when somebody comes into your office, what are they complaining about? 

Wil: Yeah, it's like basically a pain in the front part of your hip. And it's primarily you know, you feel weak in there as well, weak and painful. And it's interesting because I had a fellow who was an avid rock climber recently who had been doing a bit more driving, I guess, just you know, driving around sort of getting to different rock climbing gyms now that there's the winter season and also he's a skier too. And he noticed that he was getting some more hip pain. And he was driving a standard, so he was using that left side. He was getting an impingement on that left side. And that was getting even more trouble as he was like sleeping. And then he was noticing that it was referring down to his knee.

That's when he finally thought he had to get checked out by me. It was when he started getting the increasing in symptoms and it just wasn't going away. So basically that's the biggest symptom right there. It's really that sort of like, you can put your palm of your hand or just your fist on the front part of your hip and that's the area of pain. And especially trying to bring your knee towards your chest and you start to elicit a sharp pain and then if you try and rotate it out, the knee coming outwards, and then that can also elicit a painful response into that interior part of your hip.

Mark: So that's how it shows up. You can't maybe put your socks on as easy without pain. So when you're diagnosing it, what are you looking at? You talked about muscle imbalances and all kinds of other things. How are you diagnosing it exactly to find what's going on? 

Wil: Yeah. So quite honestly, there's marked weakness in that hip. So weakness marked with pain. And then also just in terms of the movement of the joint. So when we get in there and looking at the joint, there's like the kinesiological movement or the anatomical movement of how it's supposed to move. And there's usually a restriction and extension, but then with that extension restriction, you have that accompanying weakness with the fluxion, which is bringing the knee to the chest. With pain. And there's always like, sort of this pinching sensation. And also coming out into the, what we call like an abduction fluxion motion, where you bringing the knee outwards and upwards kind of thing because that puts more sort of a closing in aspect of that hip joint. And then that brings in more of that impingement.

So that's sort of the primary part of it, like, Oh yeah, that's the hip impingement. And then we really look for well what's causing that. And aside from like, you know, the structural and the congenital parts of what I talked about before, you know, then you're really starting to look at, okay, so is this now really like an issue with the sacroiliac joint that's driving this. And then also quite often, in addition to that, you know, we talked about the weakness. You also want to just really work on strengthening specific muscles in that hip flexor area. 

Because strengthening that area helps to support the normal moving patterns in that hip again. Because when it's really weak, then it basically, you know, all the other muscles that are really tight started to take over and then you get all this imbalance and it basically spits it to the front. Spits that joint to the front. And then you can imagine as it does that, then you go to like, bring the need of the chest. If you've got to bend over and you have that motion of fluxion pinching even more when you're having all that imbalance happening. So those are the things that we're looking at addressing is those imbalances, but then primarily, you know, what's driving it. Is it, you know, the sacroiliac joint.

So with this specific client who actually had a sacroiliac joint injury, it was definitely driving that hip impingement. And then now we're also in the process of looking at helping them strengthen his core. Now it's hard to tell, was his core already weak, and then it caused the sacroiliac joint to shift. It's hard to say, but we definitely know that he had this issue with his mobility and his SI joint or a sacroiliac joint. So now we're in the process of trying to help him with his core strengthening and also his hip flexor strength. And I've only really seen him three times. He comes in like he's still really active, still climbs.

And in those three sessions, you know, the first time he came in, he was getting constant pain. You know, it was like nine to 10 on the pain. And it went from nine to 10 out of the pain to like a three to four out of pain out of the second session. And that was like a month later. And, you know, we gave him some exercises, reinforced the stuff that I did manually and doing the releases that we did and all the things that we worked on to try and really restore a more normal movement pattern in that hip.

And then I saw him for the third time, like a month after that. So this has been a span of like almost three months. And he's like at times where he's pain free almost, and he feels it mostly with climbing. And then when he's still driving a little bit, when he's clutching with that left foot.

Mark: Anything else you wanted to say about hip impingement? 

Wil: Well, I think you know, the big thing is that if you're trying to stretch it out, it's not just about trying to stretch things out in there. Like it's, I think the biggest misconception is that I got this really sharp hip pain, you think, Oh, I just stretch it and it's okay.

Sometimes it may be, sometimes it might help, but like if you're stretching and you're noticing very little returns and gains in that, then you want to get it checked out because then you want to get at the root cause of what's actually driving that. And you know, something as simple as like, you know, figuring out that alignment issue and what's causing that and addressing that, you know, can really make the difference of like, like you know, from experiencing a constant nine to 10 out of the pain to making life a little bit more enjoyable. Making your sports and activities a little more enjoyable. And finally being able to pursue the things that you really want to be able to do again. 

Mark: Bottom line. If you want to feel better, if you're tired of being in pain, the guys to call in Vancouver are Insync Physio. If you're in the King Ed, Cambie area, Mount Pleasant, et cetera, et cetera, they get people coming from all over the place actually. They're that good. The Vancouver office is (604) 566-9716 to book your appointment, you got to call and book ahead. They're busy. Or in North Burnaby, there's another office (604) 298-4878. Give Insync Physio a call they will help you out. 

If you want to check out the website, Insyncphysio.com. You can book online there as well. And you'll see there's lots of videos on there for all kinds of types of exercises and stuff that will help. Whatever, if you've got a minor issue that you need to work on, maybe that'll help, but if you want expert help and getting better and moving freer, give them a call. Thanks Wil. 

Wil: Thanks Mark.

Chronic Hip Pain Strain- Forward Lunge Reach Ups

Progressively strengthening your core stability muscles after a hip injury can help you become functionally stronger.

Start by lunging forward with your right foot and reaching up with the opposite arm and hand high up above your head while keeping the low back in neutral position. When you lunge forward make sure your knee stays over your ankle and aligned with your second toe, hip and shoulder and that the low back doesn’t arch. Don’t let your knee fall into the middle or go past the front of your toes and the opposite arm reaching straight up without deviating past the midline or off to the side. Push back up to the start with the forward foot and repeat this for 10 repetitions doing 3 sets for each side.

This exercise is great for returning to activities and sports that require a lunge and reaching motion. If you’re unsure about the exercise or have uncertainty about where you’re at with your hip book an appointment and have one of our Physiotherapists at either our North Burnaby or Vancouver locations to check things out. 

Preventing Cycling Injuries – Hip Flexor Strengthening

Hi, this is Simon Kelly, physiotherapist in the Cambie Village clinic here, Insync. And today I’m just going to show you a simple exercise to really focus on your hip flexors while you're biking.

So I am just going to bring my right leg forward, nice straight back if you can. It’s good to keep your elbows a little bit bent as well when you're biking as well. So obviously the bumps in the road aren't going through straight arm, so I usually keep my arms a little bit bent in this as well just to get kind of re-enact exactly what you're doing on a bike.

So I usually do this maybe 12 sets and that's a nice burn on the right iliospasoas, your hip flexors here. Try to be as steady as possible, bringing the knee up, good! A little bend in the elbows and you would be doing that as I said 12 times, three times a day. Cheers!

What is Trochanteric Bursitis?

Trochanteric bursitis is just one of many common causes of hip pain among athletes. If you have pain on the outside of your hip, you may be suffering from this sports injury.

The Greater Trochanter

This is a part of the femur, the large bone that makes up your thigh. It actually sticks out from the side of the hip, and is surrounded by several different soft tissues.

Because the greater trochanter sticks out, it is susceptible to friction between the bone and the muscles, especially the Iliotibial Band, or IT Band.

The trochanteric bursa is a small fluid filled sack that sits between the muscles and the greater trochanter in your hip. It is there to reduce friction between the muscles and bone as you move your hip.

With activities like running, jumping, and squatting, the muscles repetitively move over the bone, and over time this can cause an irritation of the bursa. Bursitis is an inflammation of the bursa.

Common Causes

Muscle tightness is the most common cause of bursitis. The Iliotibial Band, or IT Band is a big culprit in trochanteric bursitis.

The IT band runs along the outside of the hip, and the tendon actually moves over the greater trochanter everytime you lift your knee and flex your hip.

Think about how many times you do this every time you play basketball, or go for a run. If the IT Band is tight, this increased friction will irritate the bursa, and may cause pain over time.

Another cause is direct injury to the outside of the hip.

Contact sports like football and rugby can cause this type of injury, where you land forcefully or are hit on the outside of your hip. This causes bruising and irritation of the bursa.

Treatment

Rest is the best initial treatment for trochanteric bursitis. This will allow for your body to start healing, and for the inflammation of the bursa to subside. During the first few days, ice will help to reduce your pain and symptoms. Ice massage is the most effective way to ice this injury.

Once your pain has decreased, gentle stretching of the hip muscles can help to reduce the stress on the bursa. A good flexibility program can help treat this injury.

It is also a good idea to see your doctor or athletic trainer if you are having hip pain. This is the best way to know exactly what is wrong, and the appropriate treatment options.

Trochanteric bursitis is an inflammation of the trochanteric bursa in your hip. It can be caused by muscle tightness, repetitive motions, over training, or dirct injury to the hip. Rest, ice, and gentle stretching are good treatments, along with seeing your doctor for evaluation.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.