Hip Pain

IT Band Syndrome

Patellofemoral Knee Pain

Knee Pain Prevention Exercises

                                                                                                     

Hip Pain
There has been a large amount of research done in the past 10 years on the causes and improving the surgical procedures for hip pain.  Listed below are some potential causes of hip pain.


Labral tear              Articular cartilage lesions     Trochanteric bursitis      Psoas bursitis     Tendonitis

     Muscle strains       Myofascial pain     Piriformis Syndrome               Local nerve entrapment    

Avulsion injury     Avascular necrosis            Femoral stress fracture     Lumbar spine pathology    

Sports hernia     Sacroiliac joint pathology    Inguinal hernia   Abdominal wall pathology     Femoral hernia

Some of the newer diagnosies include acetabular labral tears, capsular laxity and femoral acetabular impingement.  An acetabular labral tear can be caused from trauma or repetitive stress on the joint.    The trauma will usually be caused by twisting or pivoting motions and forced hyperextension (tackled from behind).   Ligamentous laxity can also be a cause of a labral tear.
Femoral acetabular impingement (FAI) is created when there is decreased joint clearance between the femur and the acetabulum.  The two types of FAI are Cam and Pincer.  Cam is created when there is a femoral head deformity usually at the head neck junction.  Pinching pain is often reported with sitting as the bump engages in the labrum.  The majority of Cam type injuries happens in athletic males aged between 16-30 years.  A pincer type of impingement is created from an acetabular deformity.  FAI often occurs in athletes who have repetitive movements into hip flexion or abduction.  Many times, patients do not present with symptoms until there is damage to the labrum, cartilage or  secondary degenerative changes have already occurred.  Often symptoms of groin pain, persistent adductor and hip flexor tightness and limited ROM will persist in these patients despite physical therapy treatment.  Once diagnosed on imaging studies, arthroscopic surgery becomes the best treatment.

is another very common hip injury.  It can also have variable pain pattern including pain in the outside of the hip, as well as the groin.   There may be snapping aroung the hip and tighness in  the lateral (outside) of the leg.  Treatment will often include but not be limited to, stretching, soft tissue release of the band and exercises to improve the muscle imbalances around the hip. 

Patellofemoral Knee Pain
       

 Patellofemoral pain is one of most commonly treated orthopedic conditions today.   It represents 25% of injuries in the athletic community.  The pain is often felt with  sit to stand, squatting or stair climbing motions, especially when the knee is required to bend greater than 60 degrees.  Athletes will complain of pain with running and some do not complain of pain until their actvity is over.  The pain will often be located in the front of the knee around the kneecap (patella) and will most likely be described as sharp with activity or prolonged bending and aching at rest.  

The original thought in the medical community was that the VMO (one of the thigh muscles located towards the front/inner thigh) was weak and therefore allowing the patella to improperly track or move within the femoral groove (part of the thigh bone).  This maltracking causes excessive friction over one area on the back of the patella and over time creates pain and inflammation to occur.  More recent research using kinematic MRI (MRI with movement) has shown that it is the femur moving under the patella, not the patella over the femur that has caused this excessive friction.  The hip abductors and external rotators are the muscles that directly control the femur's position while squatting, not the quadriceps muscles.  While the hip muscles are important in this scenario, the foot should always be examined as well.  Excessive dropping of the arch while squatting due to weakness in the arch muscles and a lack of ligamentous integrity can also create the same motion indirectly that rotates the femur under the patella.                    
                          

                                                                                                                      

                                          Figure 1                                                               Figure 2


  If you suffer from this type of knee pain perform this test.  In front of a full length mirror, perform a single leg squat while holding onto something for balance.   Upon observation, does your knee move medially (or inward) and the arch of the foot drop? (Figure 1 above)  If it does, the most probable cause for this is weakness in the hip external rotators and/or weakness in the arch supporters of the foot.  A simple change in position by activating the proper muscles can immediately decrease the pain.  To create the proper squat position, make a small arch in your foot (roll towards the outside of the foot slightly creating an arch) and holding that position attempt to squat again.  This should create a position that looks more like Figure 2 above.    All of the pain may not immediately decrease due to the inflammation that has been in the knee for awhile but a mild decrease is often felt.  If you continue to squat in this position during any squatting exercise, over time you will reprogram your muscles to work properly and the symptoms should decrease.  Do not continue squatting if pain becomes worse.  All pain should be assessed by a licensed medical physician before exercising should resume.

References
1)  Wallace DA, Salem GJ, Salinas, R, Powers CM.  Patellofemoral joint kinetics while squatting with and without and external load.  J Orthop Sports Phys Ther 2002; 32: 141-148
2)  Ireland ML, Willson JD, Ballantyne BT, Davis, IM.  Hip strength in females with and without patellofemoral pain.  J Orthop Sports Phys Ther 2003; 33: 671-676
3)  Mascal CL, Landel R, Powers C.  Management of patellofemoral pain targeting hip, pelvis and trunk muscle function: 2 case reports.  J Orthop Sports Phys Ther 2003; 33: 647-659
4)  Powers c.  The influence of altered kinematics on patellofemoral joint dysfunction: A theoretical perspective.  J Orthop Sports Phys Ther 2003; 33: 639-646

All articles above can be found at www.pubmed.com

                                                  

The following are two exercises to work on the hip external rotator and abductor muscle strength.  (Located in the buttocks)

                                          
Figure 3                                                  Figure 4


Figure 3.  The first exercise is called Sidelying Hip Abduction.  Lie on one side and roll your hips slightly forward.  Keeping your hips there, lift the top leg up and back.  Repeat 3 sets with a 30 second rest until fatigue keeping good form.  You should feel the glute (or buttock) muscles working.  If the strain is in the front of the leg or directly on the side, reposition and try again. 

Figure 4.  The second exercise is called Clams.  This should be attempted without an elastic band before adding it for resistance.  Lie on one side with the hips rolled slightly forward.  Bend both hips up about 45 degrees and bend the knees to 90 degrees with the feet together.  Maintaining the position of the top hip rolled forward and the feet together, lift the top knee off of the bottom knee and hold for 2-3 seconds.  Slowly lower.  You should feel the fatigue in the buttock region as well.  Repeat 3 sets until fatigue with a 30 second recovery rest in between each set.  If you feel this exercise is easy, reposition your hips (rolled slightly forward) and make sure they are not rolling backward while you are lifting the top knee.