Hip | Walker and Hall (formally Ormskirk Physiotherapy Centre)

At Walker and Hall we know through personal experience how hip pain in all its forms can have an enormous effect on every aspect of your life e.g., standing and dressing, walking, sitting, driving and working and sports and leisure activities.

It is an area that people frequently have problems with and the most common types of hip pain we treat are

Trochanteric bursitis
Hip Arthritis
Hip Replacement
Fractured Neck of Femur
Referred Pain

If your condition is not listed above please contact us

We have extensive experience in treating these conditions and managing your recovery.

To see how Walker and Hall can help you please click on the links below:

Trochanteric bursitis
Hip Arthritis
Hip Replacement
Fractured Neck of Femur
Referred Pain

Trochanteric Bursitis

Trochanteric bursitis is a condition characterized by tissue damage and inflammation of the trochanteric bursa (a small fluid filled sac located at the outer aspect of the hip) causing pain in the hip.

At Walker and Hall we know how painful this can be, affecting all aspects of your life from sleeping on your side, to getting in and out of a car to sports and leisure activities.

Fortunately Trochanteric bursitis responds well to the appropriate physiotherapy treatment.

Anatomy

The thigh bone (femur) has a bony process at the top of the bone on the outside of the thigh and is known as the greater trochanter. This bony prominence is the point of attachment for several muscles (the gluteal/buttock muscles) and forms the outer most point of the hip. The gluteal muscles attach to the pelvis and insert into the top of the femur passing over the greater trochanter as they do so. Between the gluteal muscles and the greater trochanter lies a small sac of fluid (bursa) known as the trochanteric bursa. This bursa is designed to reduce the friction between the greater trochanter and the gluteal muscles.

The gluteal muscles are primarily responsible for moving the hip and stabilizing the pelvis during activity and are particularly active during walking, running, jumping, climbing stairs, lunging and squatting. During contraction of the gluteals, friction is placed on the trochanteric bursa. Pressure may also be placed on the trochanteric bursa following a direct impact. When these forces are excessive due to too much repetition or too high a force, irritation and inflammation of the bursa may occur. This condition is known as trochanteric bursitis.

Causes of trochanteric bursitis

Repetitive or prolonged activity – any activity that places a strain on the trochanteric bursa may cause trochanteric bursitis. Repetitive activities such as running and walking (especially up hills or on uneven surfaces) jumping, squatting, lunging, or due to prolonged pressure on the bursa such as excessive side-lying particularly on hard surfaces can all cause pain and inflammation
Trauma – often due to a direct blow to the point of the hip such as a fall onto a hard surface or during a heavy tackle in rugby

Whilst these are the main causes of trochanteric bursitis, other factors may predispose you to developing the condition, viz.

joint stiffness (particularly the hip)
muscle tightness (particularly of the gluteals)
muscle weakness (especially the hamstrings and the gluteals)
poor biomechanics
inappropriate or excessive training
inadequate warm up
inadequate rehabilitation following a previous buttock or hip injury
poor pelvic or core stability
neural tightness
leg length discrepancy

Signs and symptoms of trochanteric bursitis

Pain – usually felt over the outer aspect of the hip it may also radiate down the outer aspect of the thigh as far as the knee. In less severe cases, you may only experience an ache or stiffness in the hip that increases with rest following activities placing strain on the bursa. These activities typically include excessive side lying (especially on hard surfaces), running, jumping, climbing stairs, sitting cross legged, getting in and out of the car or walking excessively – especially up hills or on uneven surfaces. It may also warm up with activity in the initial stages of injury.

As the condition progresses you may experience symptoms that increase during sport or activity and begin to affect performance.

Local tenderness – you will often experience pain on firm pressure over the trochanteric bursa

Lower limb weakness – a feeling of lower limb weakness may also be present particularly when attempting to climb stairs, perform a squat or accelerate whilst running.

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the inflammation of the trochanteric bursa. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a trochanteric bursitis are

R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression bandage and keeping the arm Elevated (providing this is comfortable)
Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
Hip mobilising techniques e.g., gentle stretching and muscle release techniques.
Home exercise programme – a graduated mobilising and strengthening programme to ensure an optimal outcome.
Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Hip Arthritis (also known as Arthritis of the hip, Osteoarthritis, Hip Osteoarthritis, Osteoarthritis of the Hip, Degeneration of the Hip)

Arthritis of the hip is a condition characterized by “wear and tear” of the surfaces of the hip joint associated with inflammation.

At Walker and Hall we know through personal experience how painful and limiting an arthritic hip can be, affecting all aspects of your life, in particular standing, walking and going up and down stairs.

It is a condition that can be extremely frustrating but it does respond well to the appropriate physiotherapy treatment.

Anatomy

The hip joint is a ball and socket joint located where the thigh bone meets the pelvis. The top of the thigh bone (femur) is a round ball that fits into the socket (acetabulum) formed by a cavity in the pelvic bone. Ligaments form a capsule around the joint and hold the ball in the socket. The capsule contains fluid (synovial fluid) that lubricates the joint. The bony joint surfaces are coated with cartilage which provides shock absorption and enables friction-free movement.

When the hip is damaged or overloaded, particularly with excessive weight-bearing or twisting forces, degeneration of the cartilage occurs which reduces the hip’s shock absorption capacity. As the condition progresses there is eventual wearing down of the bone ends so that the surfaces are no longer smooth and may have small bony projections called osteophytes. This condition is known as hip arthritis.

Causes of Hip Arthritis

Arthritis in the hip joint usually occurs after the age of 50 years may be the result of a number of factors:

age (> 50 years)
being overweight
genetics
history of injury or trauma to the hip joint
leg length discrepancy
poor biomechanics
poor core stability
excessive or inappropriate activity

Signs and symptoms of hip arthritis

The symptoms of hip arthritis tend to occur gradually over a period of time.
• Pain – in minor cases little or no symptoms may be present, but as the condition progresses there may be increasing hip pain associated with weight bearing activity and joint stiffness – particularly after rest and first thing in the morning. Severe joint pain, decreased hip flexibility, pain at night and grinding sensations during certain movements may also be experienced. The pain associated with hip arthritis is typically felt in the buttock region and/or front of the hip and groin. Occasionally pain may be referred to the thigh or knee. Symptoms can sometimes fluctuate from month to month with patients reporting an increase in symptoms with colder weather

Joint stiffness – initially felt more as a limitation to walking and movement such as sitting with your legs crossed but as the condition progresses it can begin to affect other activities such as getting in and out of the car etc. As the condition becomes more severe you will find it increasingly difficult to bend your hip, take it out to the side and rotate your foot inward
Muscle wasting – this is associated with severe cases and often presents as wasting of the buttock musculature (the gluteal muscles)
Limp – more associated with severe cases, as the condition progresses weight bearing becomes increasingly painful e.g., walking long distances and prolonged standing

How can Walker and Hall help you?

A thorough musculoskeletal examination is required to determine the extent of the arthritis in the hip. This is essential if the optimum recovery is to be achieved and to reduce the likelihood of recurrence.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for an arthritic hip include:

Advice with regards to remaining as active as possible without aggravating the hip. It can sometimes be difficult to find the right balance between exercise and rest but this is a really important feature of the treatment of hip pain
Advice with regards to the use of crutches and other walking aids
Advice with regards to the use of ice or heat treatment at home
joint mobilization techniques to improve the range of movements
soft tissue massage to reduce pain and muscle spasm
electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce pain and muscle spasm
the use of an appropriate pillow for sleeping
a home exercise programme to improve flexibility and strength
activity modification advice
anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Hip Replacement ( also known as Total Hip Replacement, Total Hip Joint Replacement, Hip Replacement Surgery, Total Hip Arthroplasty)

From our work at Wrightington Hospital, “A Centre of Orthopaedic Excellence”, we know through personal experience how dramatic an improvement a hip replacement can be.

It can improve every aspect of your life and often requires very little post-operative physiotherapy treatment.

What is a hip replacement?

A hip replacement is an invasive surgical procedure that is used to remove a diseased hip joint (most commonly due to osteoarthritis) and replace it with an artificial joint or prosthesis.

Structures within the hip (such as the cartilage or bony joint surfaces) may be damaged due to overuse, trauma or certain conditions (e.g. rheumatoid arthritis, tumours etc.). This may lead to degenerative changes within the hip or osteoarthritis. These injuries may be beyond the body’s healing capacity and if severe enough may warrant hip replacement surgery to treat the condition. This may be particularly indicated in patients with severe hip osteoarthritis who have not responded to appropriate physiotherapy treatment and rehabilitation, and have severe pain and disability due to their hip condition.

Indications for a hip replacement

Hip replacement surgery may be indicated in patients with certain hip conditions, particularly those that do not respond to appropriate physiotherapy treatment and rehabilitation, and have severe pain and disability.

Some of the more common hip conditions treated with a hip replacement include

Severe osteoarthritis
Rheumatoid arthritis
Ligament damage or infection that leads to severe osteoarthritis
Gout
Avascular necrosis (death of bone following loss of blood supply)
Some hip fractures (particularly those with a high likelihood of avascular necrosis).
Bone dysplasia’s (abnormal growth of bone)
Certain tumours

How Walker and Hall can help you

Immediately following a hip replacement you will get out of bed and move about as directed by the Consultant / Surgeon / Specialists “Post-Operative” regime. This will be quite detailed and give you information concerning

how quickly and how far you can walk
how to and how long you can sit down
what positions to sleep in
positions and activities you should not perform
how to go up and down stairs
how to get in and out of a car

Should further physiotherapy treatment be required we will perform a thorough musculoskeletal examination after which we decide what type of treatment you require. This treatment plan will be discussed with you.

The types of physiotherapy treatment used at Walker and Hall following a hip replacement include:

Advice with regards to mobilising and the use of the appropriate walking aids such as walking frames, elbow crutches and walking sticks – this will be done in accordance with the Consultant / Surgeon / Specialists “Post-Operative” treatment regime
Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
Hip mobilising techniques e.g., gentle stretching and muscle release techniques – all performed within the acceptable range for a new hip joint
Home exercise programme – a graduated mobilising and strengthening programme to ensure an optimal outcome.

Fractured Neck of Femur (also known as Femoral Neck Fracture)

A fracture of the neck of the femur (thigh bone) is the most common hip fracture we see at Walker and Hall.

Anatomy

The femur is the name given to the long bone in the thigh and is the largest and strongest bone in the body. The neck of the femur is the part of the bone that connects the round headed ball of the hip joint to the long shaft of the femur.
Following a fall or due to a direct blow to the hip or thigh, stress is placed on the femur. If these forces are excessive and beyond what the femur can stand, a break in the neck of the bone may occur. When this occurs the condition is known as a femoral neck fracture and can vary from a small undisplaced fracture (where the two ends of the bone remain in contact) to a severe displaced fracture (where the two ends of the bone are separated from each other) and/or a comminuted fracture (where the ends of the bones are shattered) with obvious deformity.

Femoral neck fractures are particularly common in elderly patients who have poor balance i.e., are prone to falls, and have reduced bone density due to osteoporosis.

Causes of a fractured neck of femur

Trauma – due to the strength of the femoral bone, a fractured neck of femur usually requires a large amount of force in healthy young adults. This typically occurs due to a fall e.g., usually from a height and often onto a hard surface, or due to a direct blow to the femur such as a motor vehicle accident.

However the most common clinical presentation of a fractured neck of femur is an older patient (over 60) who has weakened bones due to conditions such as osteoporosis or sometimes malignancy. In this case, the injury may occur with minimal force such as a trip, stumble or fall.

Signs and symptoms of a fractured neck of femur

Pain – a sudden onset of sharp, intense pain in the hip, groin, buttock and or thigh at the time of injury.

Unable to weight bear – in severe cases, especially if a displaced fracture of the femur has occurred, weight bearing will be impossible and you will be unable to get up off the floor without help. In less severe cases, you may be able to walk (often with a limp) and may experience symptoms that settle quickly with rest, leaving an ache at the site of injury which may be particularly prominent at night or first thing in the morning on waking. It usually increases with certain movements of the hip or knee, when sitting or when attempting to stand or walk e.g., up hills and on uneven surfaces. Occasionally you may experience symptoms in the low back, knee, lower leg, ankle and foot.

Swelling, bruising and pain on firmly touching the hip region – these symptoms are often associated with a fractured neck of femur

Deformity – often your leg will be in a “turned-out” position and will appear to be shorter compared to the unaffected leg. With a severe fractured neck of femur with bony displacement an obvious deformity will be noticeable

Pins, needles and numbness in the hip, groin, thigh, knee, lower leg, ankle or foot may also be present

How can Walker and Hall help you?

The most common type of fractured neck of femur is the displaced fracture for which the treatment usually involves anatomical reduction (i.e. re-alignment of the fracture by manipulation under anaesthetic – MUA), followed by surgical internal fixation to stabilize the fracture (using rods, plates, pins or screws). This may be followed by a period of rest and the use of walking aids or crutches for a number of weeks. In elderly patients (particularly those with osteoarthritis affecting the hip joint), prosthetic replacement of the hip joint may be indicated. This may be followed by the use of crutches or a walking frame for weeks to months.

Following a thorough musculoskeletal examination we will determine which structures of the hip need treatment and devise a treatment plan accordingly. This plan will be explained to you and you will have every opportunity to express your wishes for treatment.

The types of physiotherapy treatment used at Walker and Hall following a fractured neck of femur include:

Advice with regards to mobilising and the use of the appropriate walking aids such as walking frames, elbow crutches and walking sticks – this will be done in accordance with the Consultant / Surgeon / specialists “Post-Operative” treatment regime
gentle joint mobilization techniques to improve the range of movement
soft tissue massage to reduce pain and muscle spasm
electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce pain and muscle spasm
the use of support for sleeping e.g., positioning of pillows etc. for best comfort
a home exercise programme to improve flexibility and strength
activity modification advice
anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Referred Pain

Not all pain experienced in the hip or leg is necessarily coming from the hip joint. Occasionally pain felt in the hip and leg can be referred or caused by a problem in another area of the body such as the back or spine. This is called referred pain.

What is Referred Pain?

Referred pain occurs when pain is experienced in an area away from the actual injury or problem. This is not uncommon, an example being sciatica, where pain is felt down the leg whilst the problem is in the back, or a heart attack, where the pain is felt in the shoulder, arms and neck.

What structures can refer pain into the hip?

The following structures have the ability to refer pain into the hip and leg

The lumbar and lower thoracic spines (from the 10th thoracic vertebra to the 1st sacral vertebra – T10 to S1). Any problems affecting the intervertebral discs, ligaments, nerves and muscles of this area of the spine can mimic a hip problem.

How can Walker and Hall help you distinguish between a hip problem and referred pain?

At Walker and Hall you will receive a thorough musculoskeletal examination which will examine all the structures that could possibly be responsible for your hip symptoms.

It is only following such an accurate examination and diagnosis that a treatment plan can be devised to address your problems.

You will be involved in all stages of your treatment given every opportunity to ask questions.