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April 15, 2013 at 10:19 AMComments: 3 Faves: 0

Non-arthritis Hip Pain

By Jeffrey VanWingen M.D. More Blogs by This Author

There's an annual run in my city each spring that brings together thousands of athletes from the community. I've run and spectated the run several times, taking note each year of a curious sight left after the runners have all crossed the start line. Scores of two-liter bottles filled with water litter the sidewalks, but the runners aren't using them to hydrate before the run. Instead, they are "roller pinning" the sides of their legs to prevent a common hip problem called illiotibial band syndrome from acting up later down the path. This and a few other non-arthritic hip problems are commonly seen in the day-to-day patient flow of my office.  

The Hip

We take thousands of steps per day in order to get where we need to go. Our legs move in fluid fashion, and we usually give it very little thought. Among the joints involved in this process, the hips are the ones that actually propel our body, extending our legs out and then flexing to bring the body forward. When this breaks down, real problems develop. No hips, no movement.

Years of chronic overuse can cause arthritis to restrict and cause pain in the ball and socket of the hip joint. Acute injuries can cause a tear in the cartilage of the capsule of the socket. There are a few common injuries that lie between these acute and super chronic problems that are much more common and that don't involve the ball and socket, per se, but rather the important structures surrounding them.

Sacroiliac Strain

The pelvis is a rigid bony structure that makes up half of the hip joint. There is some flexibility to the pelvis, however, thanks to the sacrum (or tailbone) which comes together with the two pelvic bones. These bones come together like pieces of a puzzle. Ligaments and muscles atop the adjacent bones join them, offering some dynamic movement. This ability is capitalized upon when we twist and bend at the waist simultaneously.

However, injury often occurs with this motion (e.g. picking up a wiggling child while getting out of a car). Women are more susceptible to this injury because of the increased potential for strain with wider hips. Often, the injury is not noticed until later when the muscles spasm about the joint causing pain. Typically, the pain is described as a throbbing, aching in the buttocks to one side, behind the hip.

Prevention and treatment of sacroiliac strain revolves around keeping the muscles overlying the joint flexible. One nice stretch that I recommend involves getting on hands and knees in a tabletop position (back parallel to the floor). Slowly wag the buttocks back and forth feeling the strain on both sacroiliacs. At the point of strain, hold the stretch for 30 seconds. Stretch in the morning, evening, and before activity.

Trochanteric Bursitis

We have bursas all around our body. They are sacks filled with slippery fluid aimed at cutting down on friction over highly used areas of the body (knees, elbows, etc). Bursas cut down significantly on wear and tear over these areas. Unfortunately, they can become tempermental when they are injured or overused due to poor mechanics. The main hip bursa is found over that knob on the side called the greater trochanter. The greater trochanter is a tremendously dynamic attachment point for muscles and tissue with the potential to create a lot of friction.

Common causes of bursitis (or bursa inflammation) at the greater trochanter include injury such as prolonged laying on the side or mechanical issue of the lower leg (knee injury, ankle injury, flat feet, or anything causing a limp).
Fixing trochanteric bursitis involves fixing the underlying cause of the mechanical dysfunction. Arch supports can help flat feet, and braces or assistive devices can help repair the gait until the body heals. Surgery may be required to fix a structural issue such as a cartilage tear in the knee. To help with inflammatory pain, medications such as ibuprofen can help.  For more significant or chronic pain, a steroid injection is often needed.

Iliotibial (IT) Band Syndrome

As stated earlier, a lot of tissue attaches on to the greater trochanters. One tissue is a band-like ligament that extends from the trochanter down to the side of the knee. Like bursitis in this area, increased strain can cause inflammation in this tissue and its attachment to the trochanter. Women, again, are more susceptible to IT band issues because of their wider hips. 

Treatment and prevention involve keeping the IT bands limber. The best IT band stretch involves starting in a seated position. Cross one knee over the other, grabbing the crossed knee, pulling it toward the opposite shoulder. Hold for 30 seconds. Additionally, roller pinning the IT band can help. A roller pin or an elbow over the IT band (lotion helps reduce friction) can break up any knots and extend the tissue, relieving tension.

In Conclusion

The hip is an oft-used and commonly injured part of the body. Beyond arthritis and acute traumatic injury, the issues of sacroiliac strain, trochanteric bursitis, and iliotibial band syndrome are frequent occurrences. Stretching and attention to body mechanics are crucial in preventing and solving these problems.

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  • I tried your stretching exercise for the IT band and maybe I'm doing it wrong because I feel a stretch along my side (waist) not in my leg.

  • The focus of the stretch is moving the knee toward the opposite shoulder. Bringing the shoulder to the knee will cause the spine to twist at the waist. All the movement should be at the knee and leg.

  • Interesting

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