PT for Hip Pain

The hip is a common area for pain as a result of its multidirectional movement and from the force placed on the joint.  This joint is unique since it assists with movement of the lower extremities as well as its effects on the upper body through movement of the pelvis.  This joint is made up of the socket on the hip bone or pelvis and ball shape bone on top of the thigh bone or femur.  This ball and socket arrangement gives the hip its wide range of motion and function.  The hip joint socket is shallow and a cartilage ring around this socket called the labrum deepens the socket adding more stability to the joint.

The nerve that supplies the hip with sensation also supplies the knee.  This can result in knee pain which is actually a result of a hip injury.  Doctor’s call this referred pain and it requires further testing to determine the exact location of the injury.

Actions Of the Hip

The motions of the hip joint are moving the leg forward (flexion), moving the leg backward (extension), moving the leg out to the side (abduction), moving the leg back toward the midline (adduction), rotating the leg inward (medial rotation) and rotating the leg outward (lateral rotation).

Some of the common muscles which act on the hip are the glutes (gluteus minimus, medius and maximus), the piriformis (which connects your tailbone to your hip) and the hip flexors which allow you to lift your leg up onto a step.

Causes Of Hip Pain

• Arthritis
  • The hip joint allows our leg to move in many different directions.  To allow for smooth movement, the socket and head of the femur are covered with cartilage.  As a result of repetitive movement, the cartilage can wear away causing one bone to rub on the other.  This is referred to as arthritis.  When this cartilage wears away, most people experience pain located in the groin as well as muscle weakness.
• Bursitis
  • A bursa is a fluid filled sac that provides a cushion.  The bursa at the hip joint can become inflamed from repetitive movement which can cause pain.  This bursa can be extremely painful if inflamed and even lying on the affected side can be intolerable.
• Fracture
  • A fall can result in a hip fracture.  This term is misleading since the hip refers to the joint itself.  The majority of fractures occur on the thigh bone or femur.  The elderly have to be very cautious since they have frail bones and poor balance.  This makes for a dangerous combination especially in unsafe environments or icy weather.  As a result of the blood vessels which surround the femur, further injury from a hip fracture can result including bone death as a result of a destruction of the blood supply to the area.

• Lack of blood flow
  • A less common cause of hip pain is from lack of blood flow to the joint also called osteonecrosis.  This fancy term breaks down to “osteo” meaning bone and “necrosis” meaning death.
• Referral Pain From The Back
  • Occasionally, hip pain can be caused by a back injury.  Injury to the muscles and nerves of the low back can refer pain to the hip area.

What Can I do?

Rest

The best initial treatment for hip pain is to rest and assess your activity over the previous week.  Many people experience aches and pains after increasing their activity levels.  Before beginning any home rehab of your injury consult your physician for appropriate medical evaluation.

Ice

If an injury to your hip occurred in the past 24-48 hours, ice can be applied for 10-15 minutes every 2-3 hours and after activity.  Ice will help to reduce your pain and inflammation.  Crushed ice in a plastic bag or a frozen back of vegetables is a useful ice pack for the hip.

Stretching

If rest and ice help to reduce your pain levels you can begin gentle stretching of the area.  Stretching should be comfortable.  If you experience any increase in pain levels stop immediately.

Hamstring Stretch

The hamstrings are muscles along the back of your thigh.  These muscles attach near the hip and assist with movement at this joint.

• Lie on your back.
• Wrap a towel, bed sheet, belt or even a dog leash around the bottom of your foot.
• Keeping the knee straight, slowly lift the leg until a gentle stretch is felt in back of your leg.
• The opposite knee can be kept straight or bent.
• Hold this stretch for 30 seconds and repeat three times.
• The second stretch is in the same position but pull the leg across your body to stretch the outside of your leg.
  • This stretch is for a muscle called the iliotibial band or ITB.  This muscle runs along the outside of your leg.

Quadriceps Stretch

The quadriceps muscle runs along the front of your thigh.

• Lie on your back in bed.
• Wrap the strap or bed sheet around your leg near the ankle.
• Let the leg drop off the side of the bed.
• Slowly pull the strap, keeping the leg relaxed.
• The strap will bend your knee and you will feel a stretch in the front of your thigh.
• Hold this stretch for 30 seconds and repeat three times.

How Does PT Address This Issue?

A physical therapist will first determine the cause of your hip pain.  This is determined by an evaluation which includes special tests and clinical questions allowing the physical therapist to arrive at a musculoskeletal cause of your pain.

Once your hip pain has been determined your physical therapist will address the pain and inflammation associated with your particular injury.

Your physical therapist will then instruct you in various stretches and strengthening exercises specific for your injury and activity level.

Reasons to Visit Your Doctor

Hip pain can be caused by many factors so proper diagnosis by your doctor is important especially if conservative measures do not decrease your pain.

• Hip feels unstable
• No decrease in pain after a few days
• Pain at night or when not moving
• Swelling that does not decrease with rest and ice
• Unable to place full weight on leg
• Warmth and redness

Sources:

Bennell KL, Egerton T, Pua YH, Abbott JH, et al.  “Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol.” BMC Musculoskeletal Disorders 14 Oct 2010 11:238.

Jonas Franklin, Martin Englund, Torvaldur Ingvarsson, and Stefan Lohmander.  “The Association between hip fracture and hip osteoarthritis: A case-control study.” BMC Musculoskeletal Disorders 26 Nov 2010 11:274.

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What Is the Achilles Tendon?

The achilles tendon is located at the base of the lower leg just above the ankle and “-itis” indicates inflammation.  The large calf muscle which is made up of two muscles, the gastrocnemius and the soleus, travel down the lower leg and form this tendon.  These muscles allow you to push up onto your toes which is an important motion during walking, running and climbing stairs.  The tendon also works to lower the heel to the ground after landing from jumping and elongates during hill walking or running..

The exact location of the tendonitis can occur either at the tendon’s attachment to the heel bone (calcaneus) or in the middle of the tendon.  Chronic achilles pain is actually a result of degeneration of the tendon fibers rather than an acute inflammatory process.  This area takes a long time to heal as a result of its poor blood supply and the blood supply decreases with age.   Irritation of the achilles tendon presents as warmth, redness, pain or even a visible bump.

Causes

• Repetitive motion

o   Activities such as walking, running or going up stairs and hills can cause repetitive contraction of the calf muscle.  This can lead to irritation and inflammation of the achilles tendon.

• Tight calf muscles

o   If the muscles at the back of the lower leg are tight they will place increased stress on the achilles tendon leading to inflammation.

• Improper footwear

o   Runner’s should pay particular attention to the footwear used for training.  A very soft heel or soft heel insert can increase the stress placed on the achilles tendon.  As the heel strikes the ground during a normal stride, a soft heel will cause the foot to continue downward which stretches the achilles tendon.

• Flat feet or high arch

o   A person with flat feet simply means a decreased arch on the bottom of the foot.  A low arch or high arch can both place stress on the achilles tendon.  People with these issues benefit from shoe inserts to correct their foot alignment.

What Can I Do?

Rest

The best initial treatment for pain at the back of the lower leg is to rest the area.  Avoid repetitive movements such as walking and running.  Athletes should decrease their training frequency and avoid hills when walking or running.

Ice

Ice to the area will help reduce any inflammation or irritation.  Crushed ice in a plastic bag, a bag of frozen vegetables or an ice pack can be applied to the area for 10-15 minutes every 2-3 hours or after activity.

The achilles tendon is an irregular shape and can be a difficult area to ice.  A second option is to fill a paper cup with water and freeze.  Remove this cup from the freezer and tear away part of the cup so some of the ice is exposed.  Gently massage the achilles tendon with this ice cup for approximately 10 minutes.

Stretching

It is important to remember that stretching should be gentle.  Many individuals with achilles tendonitis actually have micro tears of the tendon.  Aggressive stretching of the area will only worsen the injury.  Stretching should be slow and gentle to keep the tendon mobile and prevent further injury to the area.

Runner’s Stretch

• Stand with your palms against a wall.
• Place the affected leg in back with knee straight, heel on the floor and toes pointed forward.
• Front leg should be bent at the knee with toes pointed forward.
• Slowly lean onto the front foot until gentle stretch is felt in the back leg.
• Hold for 30 seconds and perform 3 times.
• Repeat with opposite leg.

Seated Heel and Foot Stretch

• Sit in chair with shoe off.
• Grasp ball of foot with one hand and heel of foot with opposite hand.
• Pull up on the ball of the foot and push down on the heel as if you were removing a shoe.
• Hold for 30 seconds and perform 3 times.
• Repeat with opposite foot.

Massage

When a tendon becomes inflamed and irritated scar tissue can form.  Scar tissue is nothing more than the body’s attempt to heal the area.  This scar tissue can restrict movement of the tendon. Performing massage to the area can help break up this scar tissue and maintain the mobility of the achilles tendon. The massage should be performed left to right or what’s called a cross friction massage.

Massage is also a beneficial way to increase the blood flow to the area which increases the healing rate.

How Does PT Address This Issue?

A physical therapist will first address the pain and inflammation of your injury.  Since the poor blood supply of the area slows healing, your physical therapist may use ultrasound.  Ultrasound heats deep into the tissues and increases blood flow to the area which provides essential healing nutrients.

A physical therapist will perform a postural assessment to determine what is causing the tendon injury and to prevent further damage to the tendon.

Stretches and strengthening exercises will be incorporated into the PT plan of care to ensure adequate range of motion and proper muscle recruitment during activity.

Reasons to Consult Your Physician

• A popping sound at the back of the lower leg during walking, running or other activity.
• Inability to bear weight on the leg.
• No decrease in symptoms after several days of rest and ice.
• Swelling, redness and warmth of the lower leg.

Do Not Wait to Treat This Issue

Pain of the achilles tendon is a warning sign from the body.  This area is active during movement and if not addressed properly, it can lead to further injury.  A common occurrence at the achilles tendon is a tear or rupture.  This causes the tendon to rip away from the bone.  It can happen without warning and involves surgery.  Rest, ice and stretching of the area upon symptoms of pain are important.

Sources:

Lisa Chinn, and Jay Hertel.  “Rehabilitation of Ankle and Foot Injuries in Athletes.” Clinics in Sports Medicine 29 Jan 2010 29(1):157-167.

Michael R. Simpson, and Thomas M. Howard.  “Tendinopathies of the Foot and Ankle.” American Family Physician 15 Nov 2009 80(10):1107-1114.

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What should my heart rate be to lose weight?

If you workout on any modern aerobic machine, odds are that the machine will have hand grips that measure your heart rate or pulse.  But what number is good and how do you check your pulse if this fancy addition to exercise equipment is not available.

When exercising it is important to monitor how hard your heart is working.  To determine your heart rate you have to find your pulse.  There are several areas on the body to measure your pulse.  The two most common areas are on your neck (below your jaw line)called the carotid pulse and on your wrist called the radial pulse.  There are also areas on your thigh, behind your knee and on your foot but you may look a little strange at the gym  checking these areas.

To check your pulse it is important use your fingers and never your thumb since your thumb has a pulse of it’s own and can mess up your readings.

I learned this lesson the hard way.

During a practical exam I was asked to take the pedal pulse on one of my patients.  I took a deep breath to calm myself down and then got very excited because I thought “That’s so easy, it’s on the top of the foot between the first and second toes.”  What I failed to realize was I was using my thumb which is a huge no no.  Needless to say, I got that section wrong.

So, now that you know how and where to find your pulse, what numbers should you aim for?

Here is a helpful chart.



To determine your maximum heart rate you simply use this calculation:
220-your age = max. heart rate

Then you can use this guide.

50%-60% is great for people just starting a fitness program or as a good warmup zone.

60%-70% is a great fat burning zone.

70%-80% is great for endurance and improving your cardiovascular and respiratory systems.

80%-90% improves your VO2 max. Vo2 max is the most amount of oxygen you are able to consume while exercising.

90%-100% This zone can be very dangerous and only elite athletes should train in this zone.

I try to keep my heart rate anywhere from 60-80%.  This is a great cardiovascular and fat burning zone.

Many factors affect your heart rate and the zone you should exercise in.  Medication, age, weight and many other factors are all reasons to consult with your physician about the proper heart rate zone for you.

Now you can share your knowledge with your fellow gym buddies as they grip the handles on the treadmill and see the heart rate number pop up on the screen.

Does your back pain require surgery?

Are there other ways to prevent back pain?

In a report on NBC Nightly news, we learn that not all back pain is a candidate for surgery.