When you present with hip pain your physio will ask many questions and from this make a hypothesis of the cause of your problem. They will then assess any number of joints and muscles that they think could be the driver. In this blog, I won’t go through every assessment that may be chosen.
This blog is about assessing and treating the dynamic hip stability i.e. the muscle system which is responsible for this stability. We call this dynamic hip retraining. There are specific tests we use for this, for all muscle groups that surround the hip. One example is to look at the body position, movement pattern and time how long you can hold your hip in inner range and compare both sides. Please see this example of hip flexion.
Once we determine where the deficits are in your hip, we direct treatment to address it. When managing your hip pain, the first step is to re-educate the deep layer of hip muscle i.e. iliocapsularis and iliacus for hip flexors, gluteus minimus for abduction and the 5 deep external rotators (superior & inferior gemelli, obturator internus & externus and quadratus femoris), and the intermediate layers i.e. gluteus medius, Psoas major, short adductors and piriformis.
The aim of this is to achieve good stability within the pelvis, of the pelvis on the femur in weight bearing and also of femoral head control within the socket when the foot is off the ground (e.g. running, kicking) to minimise shear & translation.
With dynamic hip retraining, the first exercises will be really boring until the pattern of activation is correct, i.e. iliocapsularis before flex hip, glut med before TFL, quadratus femoris before glute med etc and also until the activation of those deep muscles becomes automatic.
Once you have nailed it in lying with no weight on limb, we gradually add weight in bilateral stance, then split stance, then once you are ready, we move to single leg.
Once you can do single leg exercises well, we add more load- weights, more speed, more complex movements eg arm movements, unstable base and functional exercises related to your sport or work. So, you can see it is a clear process of progression to get you back to full pain-free complex function.
The good news is that we need only meet to progress your exercises and then you can do them independently until you are ready for the next instalment. So, work hard, & I’ll be here to guide you along the track to recovery!
Ceridwen Way – Senior Physiotherapist