Hip Pain: Understanding the Root Cause & Effective Treatment Strategies

Hip pain is a common issue which many face on a day to day basis. The root cause is not often understood, and as a result, we tend to put too much focus on what the structural diagnosis is rather than understanding the movement issues that are the source of the problem.

Structural vs Functional Diagnosis

Structural

When it comes to hip pain there are a lot of structures that can become painful as a result of too much pressure in the area. These include and are not limited to:

• The joint itself: The labrum, capsule, and articular cartilage can all cause problems be a source of pain when someone is experiencing a hip problem.
• Muscles around the hip: The glute, quad, adductor and hamstring muscles all attach to the pelvis and can become restricted and painful when the hip joint becomes problematic.
• Tendons/ligaments: There are many tendon’s and ligaments pulling on the hip and maintaining its stability. The Tensor fascia latae (TFL), and Iliotibial band (ITB) are two large dense bands that can also become symptomatic during hip issues.

Any one or multiple of these structures can be the source of hip pain but one big question remains. What actually starts this chain of events? Why do these structures become problematic in the first place? In order to understand this we have to look at something more fundamental than what structures have become inflamed or painful. The movement or functional diagnosis.

Functional

Traditionally when we think of diagnosis we don’t tend to think in terms of function. Traditional modern medicine likes to put every injury into a neat box with a very exact structural diagnosis that can then be treated with an evidence based protocol. Physiotherapy is no different, but unfortunately this doesn’t always result in a long term solution as the root issue is rarely addressed.

When we approach something with a diagnosis or syndrome already in mind, it can be very easy to try to find information that supports the already established theory. At Functional Patterns the first port of call is to diagnose poor function in terms of posture and the gait cycle. To help understand the difference, below are some issues that we could classify as functional rather than structural.

• In the pelvis: there should be stability during movement but what we tend to see is instability in the form of hip hikes/drops, excessive lateral (side to side) shifting, or asymmetrical rotations.
• The spine: The spine has the capacity to bend and rotate much more to one side than the other during movement. Something that can cause pain and injury over time.
• The ribcage: Can over rotate in one direction and under rotate in the opposite direction. It can also shift back giving a “rounded” appearance or poor posture.

Functional Becomes Structural

Without getting too technical with the language, the above are examples of certain functions in the body being poor or compensated. These issues then become structural over time as the wrong parts of the body become overloaded.

So you can begin to see the picture. It can be futile purely trying to strengthen or loosen parts of the body that have become a problem structurally due to the fact that there is an underlying movement issue that is likely causing it.

Again, traditional therapies make it sound very straightforward. Strengthen the weak muscle, loosen the tight one and all will be ok. Unfortunately if the root movement issues are not properly identified we are simply firefighting. You begin to realize that the exact area that the pain is being felt is less relevant than the movement issue underpinning it.

If someone demonstrates poor pelvic stability, with one hip dropping and laterally shifting every time they strike on one foot, it could manifest a number of pain symptoms. In one person it could be there low back or hip, in another their knee or even their ankle. In order to get a long term solution the movement issue must be addressed.

How Do We Improve Function?

Truly improving functionality in the body starts with a thorough assessment. At Functional Patterns Dublin we assess posture and gait (walking or running) mechanics with every new client that attends us. This way we can find the source of any movement issues that may be leading to pain and injury. From there we build training programs that attack any functional issues that we find.

We do this in a way that allows us to build strength, stability and flexibility all at the same time by following Functional Patterns concepts. A large part of our initial training is spent educating clients on their specific issues and how we can use exercise as a way to combat them.

It’s hugely important that as we embark on our rehab and strength training regime that it actually corrects imbalances we have on the body. Without a proper assessment it’s impossible to know what these are, and it becomes more likely that we are simply compounding existing issues with our training.

Not only is it hugely important that our training can improve our situation, but also that there is evidence of such. That’s why at Functional Patterns Dublin we routinely showcase real client results in terms of posture and improvement.  In order to make sure we are objective and that the methods we use are effective.

Conclusion

We need to be more focused on the imbalances our body holds and the movement issues found in a thorough assessment in order to get to the root cause of hip pain. Focusing too much on the exact structure that is causing pain can have some relevance, but often we get lost in a diagnostic loop. Once we establish a root cause in terms of movement itself, a well structured exercise regime should show evidence of improving stability in the body and correcting imbalance. For more help, reach out to us at Functional Patterns Dublin!