hip pain
The hip joint is the second largest joint in the human body after the knee joint. It sits deep between the pelvic bone and the femoral neck, connecting the upper and lower body. As a ball-and-socket joint, it can rotate, extend, and flex, thus providing a very high degree of mobility in this region of the body. The three main movements are anteversion, retroversion, and abduction. Anteversion involves raising the thigh by up to 140 degrees. Retroversion, or extending the thigh backward, is only possible by about 15 degrees. Further backward movement is only possible by tilting the hip forward. Abduction describes the lateral movement of the leg away from the body, which is possible up to about 45 degrees. Internal and external rotation are also possible when the lower leg is turned inward or outward. These functions are made possible by bony and muscular structures, which will be described in more detail below.
Bone
The two bony components that interlock in the hip joint are the acetabulum (hip socket) of the hip bone and the femoral head (caput femoris). The acetabulum, in turn, consists of the ischium (sitting bone), pubis (pubic bone), and ilium (ilium). It borders the pelvis and is surrounded by a layer of cartilage that cushions every movement like a shock absorber. The synovial fluid supplies the cartilage with nutrients and is also responsible for the smooth gliding of the joint. The acetabulum also encloses half of the femoral head, which merges into the femur.
Muscles, tendons and ligaments
Around the hips are 20 muscles, which can be divided into five groups:
the gluteal muscles (for extending and abducting the leg)
the external rotators (for turning or rotating outwards)
the iliac-lumbar muscles (for flexing the hip joint)
the adductors (for pulling the leg towards the center of the body)
the posterior thigh muscles (for extending the hip and bending the knee)
This means a complex interplay of the individual muscle groups, which are used depending on the function or direction of movement.
Together with the tendons of the hip muscles, various ligaments stabilize the joint. The three most important ligaments surround the hip joint capsule and connect the hip bones to the thigh: the iliac ligament (the strongest ligament in the human body), the ischial ligament, and the pubic ligament. When standing upright, the ligaments are taut; when the hip is bent, they relax, thus allowing for greater freedom of movement.
Types of hip pain – Common diagnoses
Bursitis
The bursae in our joints act as cushions, preventing irritation and damage to muscles, tendons, and ligaments. Repetitive, one-sided strain during daily activities or sports can cause them to become inflamed. Bursitis of the hip is one of the most common hip injuries. Most often, the greater trochanter, the bursa on the outer side of the hip, is affected. This bursa is surrounded by numerous hip and gluteal muscles, most notably the gluteus maximus, gluteus medius, and gluteus minimus. Inflammation of the greater trochanter is also known as trochanteric bursitis. This condition is accompanied by visible redness and swelling because the bursa is located close to the skin's surface. Another bursa in the hip that is prone to inflammation is the iliopectineal bursa. This is located on a bony prominence in the groin between the pubic bone and the ilium. Its function is to cushion the iliopsoas muscle (hip flexor) against the hip bone. Unlike trochanteric bursitis, iliopectineal bursitis usually presents with no visible external symptoms. This is because the bursa is located deep in the groin, where the pain becomes noticeable when it is inflamed.
Impingement syndrome
Hip impingement syndrome is also known as a pinched or locked hip. It involves a narrowing of the joint space between the head of the femur and the acetabulum, hence the term femoroacetabular impingement (FAI). This narrowing of the joint space results from a deviation from the normal structure of the femoral head and/or the acetabulum. As a result, the femoral head rubs against the acetabular roof during certain movements, leading to impingement and ultimately damage to the labrum and articular cartilage. The affected person usually experiences this damage as pain in the groin, which can radiate down the thigh. If left untreated, FAI can progress to osteoarthritis of the hip.
Osteoarthritis
Hip osteoarthritis (also known as coxarthrosis) refers to the degenerative wear and tear of the cartilage in the hip joint. It is the most common form of osteoarthritis in the human body, even more so than knee osteoarthritis. Hip osteoarthritis develops gradually over several years. As a result, there are usually no or only minor symptoms at the beginning. Pain and restricted movement only become apparent as the cartilage layer wears down. The pain patterns vary considerably. Some patients experience pain when starting to move in the morning, while others only experience discomfort during activity. Pain at rest is also common. The pain can radiate from the hip or groin area down to the knee.
Treatment depends primarily on the severity of the symptoms, the woman's age, and her desire to have children. Conventional medicine offers the option of medication or surgery. Osteopathy provides a complementary or alternative approach to the treatment of endometriosis. Visceral osteopathy, in particular, focuses on the treatment of endometriosis. At TRIUNE, we employ osteopaths specializing in visceral osteopathy. Furthermore, we are currently the only practice using the Endo Stretcher – a device that allows patients to actively participate in their treatment at home.
