Hip Pain

The Hip Joint:

• A ball (femoral head) at the top of your thigh bone (femur)
• A rounded socket (acetabulum) in your pelvis 

The ball of the thigh bone fits into the rounded socket in the pelvis. Ligaments -- bands of tissue -- connect the ball to the socket and help keep the ball and socket steady. The surfaces of the ball and socket are covered by a smooth, tough material called articular cartilage which cushions the bones and lets them move easily. The other surfaces of the hip joint are lined with a thin, smooth tissue called the synovial membrane which has a small amount of fluid that is a lubricant so that the bones do not rub against each other.

Treatment Options for Hip Injuries:

Following your evaluation, the ART® specialist will review and discuss your results with you. Based upon his or her diagnosis, your treatment options may include:

• Medication
• ART® treatments
• Physical therapy 
• Hip joint fluid supplements (injections that provide temporary pain relief)
• Total hip joint replacement

If you and your specialist decide that Hip Joint replacement surgery is an option to relieve your pain, your orthopedic specialist will discuss the following with you: the type of artificial joint that is most appropriate for you, what you need to know to prepare for surgery, how the surgery will be performed, and what results you can expect once you are up and moving again.

Ilio-Tibial Band Syndrome:   

Ilio-Tibial Band Syndrome is one of the most common conditions that causes pain on the side of the leg or hip. The IT (Iliotibial) Band is a tough band of fibrous tissue that runs down the outside of the thigh. The upper fibers of the IT- Band start at the hip and the lower fibers insert below the knee on the outside of the tibia (shin bone). 

The IT-Band works with the surrounding muscles to assist pelvic muscle imbalances.  A person with leg length differences may be prone to developing this problem. This is a repetitive stress injury so excessive training or always running on the same side of a curved road is thought to contribute to IT-Band Syndrome. Biomechanical problems in the feet are also a major contributor to the development of this syndrome. 

Pain is usually worse during activity and can lessen during rest. This is because activity tends to promote more tightening of the band and more friction over the bony prominences the band crosses. Pain may be aggravated specifically by excessive pronation or flattening of the arch, walking up stairs, or getting out of a car.

Causes of IT-Band Syndrome:  

• 1. Flattened Archotation
• 2. Pelvis Drops
• 3. Greater Trochanteric Bursitis

Below are anatomical factors that can contribute to the development of this condition:  

• 1. Bowed legs
• 2. Excessive internal rotation of the lower leg, in flexion and stabilization of the knee

IT-Band Syndrome is an irritation of this tissue due to excessive tightening or shortening of the band. It is commonly felt as localized pain on the lower thigh or outside of the knee where the IT-Band inserts. It may also be painful at any point along its length. A tight IT-Band is often the cause of greater trochanteric bursitis (at the prominent knob of the hip bone).  The IT-Band also assists with hip movements out to the side and internal rotation.  Pain can be aggravated by activities such as running and climbing.  Descending arches can also lead to extra stresses on the outside of your thigh.

When the feet flatten, the lower leg is turned inwards (internal rotation). This moves up the chain to rotate your thigh inwards. This creates a bowing of the knee and added strain on the outside of the knee. When you are running or moving on flattened arches, the tightened IT-Band may rub over bones in the hip or knee or just get irritable from the tightness.  These activities can trigger inflammation and pain. 

Exercise helps IT-Band Syndrome. Stretching exercises are directed at lengthening the IT-Band biomechanical shock absorption. This restoration of correct mechanical function takes the abnormal stress off the outside of your knee and allows the IT-Band to heal.  

Total healing depends upon how long you have had the problem (chronicity), how active you are, and how much you modify your activities. By correcting the cause of your problem with a Sole Supports™ foot orthotic, you can expect a fifty to seventy percent (50-70%) relief the first month, seventy to ninety percent (70-90%) relief the second month,  and ninety to one hundred percent (90-100%) relief the third month. The benefit of using an orthotic is that a reduction in training or activity is often not necessary to reduce the stress on your knee; the orthotic reduces the stress  for you. Once your body has adapted to the new corrected position, activity levels can generally be maintained while your body heals.  

Strengthening exercises can be directed at your gluteal region to stabilize the pelvis and try to prevent pulling of the IT-Band at the knee. Remember, the IT-Band is not a muscle; the IT-Band is a thick band of fibrous tissue (think of a tough piece of leather) so it is very resistant to being stretched.

• 1. Active Release Techniques® (ART®) treatments on the IT-Band and other related structures
• 2. Anti-Inflammatory Agents which may include oral anti-inflammatory medications
• 3. Ice can be applied directly to the site of pain to decrease the inflammatory response and provide some temporary relief from the pain of inflammation.  Ice is not helpful in addressing the underlying cause of your condition.
• 4. Rest and/or training modification may be recommended.  Rest is often recommended to reduce inflammation. You may be advised  to decrease your training time or distance. You may also be advised to avoid activities such as running and to try biking or swimming. Altered or reduced training schedules may be suggested in combination with running form advice.
• 5. Shortening your stride and avoiding hills may be part of your strategy. It is important to remember that although rest by itself may decrease your pain temporarily, it does not address the reason why you have developed this problem in the first place.
• 6. Steroid Injections may be recommended.  A local cortisone injection to the site of inflammation can help temporarily reduce the pain of IT-Band Syndrome.
• 7. Custom Foot Orthotics may be prescribed. The proper foot orthotics can go a long way to taking the stress off of your IT-Band. The right custom-made, biomechanical orthotics can address the underlying cause of your knee dysfunction. Abnormal joint positions can be reversed, thereby allowing function to be restored and tissues to heal.

Sciatica Defined:

 The Sciatic Nerve is formed from the lower segments of the spinal cord; it is made up from the lumbar and sacral nerve roots from the spine.  Sciatica refers to a condition in which the Sciatic Nerve is irritated and thus disrupts the normal signals carried by the nerve.  The nerve can be irritated by muscular adhesion (such as piriformis or hamstrings), a herniated or stenosis of the spinal canal, or intervertebral foramen.

• Shooting pains from the buttock, down the leg
• Burning sensation in the thigh
• Tingling, or pins-and-needles sensation in the legs and thighs
• Pain in the gluteal muscles

Treatment of Sciatica:

• Active Release Technique® (ART®) restores the pliability and functional capacity of the tissue by breaking adhesions formed during the inflammatory process.
• Chiropractic Manipulative Therapy restores the biomechanical motion to the joints of the pelvis.
• Ice helps to decrease and control inflammation.
• Stretching combined with instruction on proper stretching can help relieve the tension of the musculature.
• Rehabilitation with Physical Therapy, after the dysfunction in the tissue is addressed, will help to prepare the tissue for load and to avoid future injury.  This would include such things as range of motion exercises, strengthening, and proprioceptive training. 
• Cortisone Injection might be used. This is a powerful anti-inflammatory injection which can be administered when other more conservative approaches fail.  Because the injection only addresses the inflammation and not the change in the tissue fibers, in most cases the pain will reappear when the injection wears off.   

What Is a Pulled/Strained Hamstring:

The hamstring muscle is a group of muscles spanning the back of the thigh that function to extend the hip joint and flex the knee joint.  A strained hamstring is a tearing of the muscle fibers, usually caused by sudden accelerations in sports such as  track and field, soccer, and baseball.