Image is from Shutterstock, credit to "Litvinov".

by Eric Winder, DC  

Hip pain can be debilitating. The hip joint is close to our center of gravity and becomes involved in almost any body movement we make. Moreover, a painful hip often becomes tight and restricted which can lead to arthritis. This means that successful treatment of hip pain is crucial, not just for immediate pain relief, but for long-term health and integrity of the joint. The reasons behind hip pain can be complex, so I will take you through the evaluation and treatment of a real patient to offer insight into my process of helping to heal this difficult problem.  

A patient, whom I will refer to as Mary, came to my office complaining of difficult pain in her left hip that caused a limp and limited her ability to perform daily activities. Over the previous six months, she had difficulty lifting her leg, and was also not sleeping well. Pain in the hip often woke her anytime she shifted on her side in bed. She had fallen on that hip two years prior after slipping on a wet floor, but had only experienced pain for about two weeks. She had not thought about it again until I asked her about injuries to the area.  

A thorough examination was next. In addition to the typical examination of range-of-motion, muscle tone and strength and tenderness, there are three specific issues I look for when evaluating hip problems. These include fascia restrictions affecting the hip muscles, fascia restrictions of the hip joint and nearby joints, and degenerative changes in the hip that can be found through x-ray or MRI. All of these played a role in identifying the causes of Mary’s pain, as well as successfully treating it.   

Fascia Restrictions  

The hip joint’s mobility is made possible by several different muscles, both large and small. These muscles obtain their structural toughness from a fibrous connective tissue called fascia which can become restricted from injury or repetitive stress. In this case, Mary’s fall had caused stiffening of fascia in specific muscles.    

On examination, two of her large hip muscles (gluteus maximus and psoas) and one smaller muscle (pectineus) showed restriction of the fascia. As a result, her gluteal muscle was weak, and the psoas and pectineus muscles were abnormally tight. This muscle imbalance, in turn, created instability in the hip, causing repetitive stress to the joint tissues.  

I mentioned earlier that nearby joints can be a problem, and in Mary’s case, there was also restriction of the fascia at the front of her left sacroiliac joint which limited motion in that joint. This most likely happened at the time of her fall. When a joint is restricted, other nearby joints often are also affected, and in her case, the restriction created a slight twist of her pelvic posture that resulted in further misalignment of the hip joint.    

Arthritis  

Arthritis and degenerative change are always possibilities when significant hip pain presents. Mary’s pain had persisted for several months, and she had consulted with an orthopedist who ordered an MRI. The images showed a small bone spur and mild loss of joint cartilage in the left hip joint. The orthopedist had prescribed physical therapy which is often a helpful alleviation for hip pain. However, in her case, because of the fascia restrictions, physical therapy had only further aggravated the problem.   

Overall, there were numerous factors contributing to Mary’s pain. At the top of this list of concerns was the bone spur because this is a relatively permanent change. The question in a situation like this is whether it’s the bone spur causing pain, or if it is something else entirely.  To find the answer, I performed a simple test.  

As a part of her examination, I took Mary’s hip through its range-of-motion to see which directions of movement were painful. Her most intense pain occurred with a combined flexion and rotation outward (lifting her thigh forward and outward). I then retested this same motion while holding pressure at points of fascia restriction. This pressure makes the restricted fascia temporarily relax. Her range-of-motion and comfort increased which suggested that her pain was at least in part due to the restrictions, not just the spur.  

In the end, Mary’s main hip issues were driven by restrictions in her fascia. After a series of treatments to release the tight connective tissue, her left sacroiliac joint returned to normal motion. Her hip muscles regained normal tone and strength, and her hip could move freely again with just mild discomfort at the far end of its range-of-motion.  

This mild discomfort was probably due to the bone spur, but it was not prohibitive for her daily life. I find it is typical that arthritic changes such as spurs and joint narrowing can cause mild discomfort or stiffness, but these are not usually the main sources of pain.   

Scar Tissue  

Mary’s case is typical of hip pain. An additional type of hip problem that I also treat involves pain after hip surgery. This was not a consideration with Mary, but I see it often in my office. Sometimes the scar tissue from incisions made during surgery can distort and restrict fascia, resulting in painful motion and weight-bearing in the affected hip.    

Fortunately, this type of problem is easily treated with gentle fascia release in the area of the scar tissue. In general, I find that treating fascia restrictions is incredibly helpful to resolve all kinds of hip pain issues. Even in the occasional case of severe arthritis that requires surgery, treating fascia problems can restore function to improve rehabilitation after surgery.   

Making sure all joints and muscles in the area are functioning correctly allows for a smoother recovery. Mary did not require surgery and returned to all her normal activities, including a two-mile daily walk without pain. This type of success is common, and I recommend fascia therapy as a conservative treatment of first choice for hip pain.  

Dr. Eric Winder has been practicing chiropractic for 25 years. His practice emphasizes relieving pain and restoring alignment and motion with gentle fascia release therapies. For more information, call 941-957-8390 or visit Gentlebay.com.