Injury Prevention Series
Maintaining a Health Hip
Kevin F Lockette PT
The hip is a classic example of a ball and socket joint. Similar to the shoulder, the hip is a highly mobile joint. Unlike the shoulder, the hip is pretty sturdy, which it needs to be to withstand the tremendous forces put on it from weight bearing.
The total arc of motion for the hip is approximately 110 degrees compared to 180 degrees in the shoulder. With movement restrictions or weakness in your hip, you would have difficulty with climbing stairs, getting into and out of a car or with stepping into a bathtub. So let's take a look at a couple of hip injuries that are common in older adults as well as look at what you can do to "maintain a health hip" and to stay out of trouble.
What Can Go Wrong
Hip Osteoarthritis (OA) is the most common disease process affecting the hip. Osteoarthritis is basically wear and tear of the joint surface. Similar to the treads on your tires, your joint cartilage can wear down as you put more miles on them. It is worse when you bear weight on the affected limb. Range of motion is often limited especially internal rotation and hip flexion. Typical complaints of OA of the hip include morning stiffness and stiffness when arising from sitting with pain by the days end. This can progress to a constant ache at night and a loss of functional abilities such as tying one's shoes and climbing stairs.
Recent studies have demonstrated that joint mobilization and stretching can result in significant pain relief. In severe deterioration of the joint, total hip replacement surgery may be required.
A bursa is a fluid-filled sack that decreases shear forces between tissues of the body. Trochanteric bursitis (inflammation of a bursa) is caused by excessive stress on the bursa between the IT Band and the greater trochanter. Signs and symptoms include pain over the outer aspect of the hipbone, which often is exacerbated when lying on the affected side, standing on the affected leg, or excessive walking. Treatment often includes rest, ice, and compression, physical therapy including stretching and progressive strengthening, and steroid injection may be helpful.
Weakness, Gait and Balance Problems
Weakness in the different muscles that surround the hip can cause multiple gait deviations that can lead to painful syndromes or even loss of balance. Weakness in the muscles on the lateral aspect of the hip can lead to decrease stabilization of the hip causing an increased "side-to-side" movement with walking (Trendelenberg gait). These gait deviations can lead to the above injuries due to "multiple micro-traumas" or even lead to falls.