One of the most common areas that we treat as physical therapists is the hip. In fact, patients often complain of back or leg pain which is truly a result of hip dysfunction. It is easy to overlook how many structures cross the hip, how high our hip bones travel, and how intimately related the joint is to our pelvis and lumbar spine.

Hip pain can range from sharp and intense to dull, achy, and omnipresent. These symptoms can arise from a sudden injury or developed over years. Hip pain can even present as low back or groin pain. The .cause and thus symptoms of hip injury differ greatly from person to person, however, the common theme is that hip pain is one huge bummer.

Although each individual’s injury is truly unique, we tend to see some common themes in patients who suffer from hip pain. If these tips help you, GREAT! If they do not fully resolve your symptoms, do yourself a favor and schedule an individualized physical therapy assessment. Keep in mind that hip pain is NOT normal, and you don’t have to live with it!

The five most common causes of hip pain:

1. An unlevel pelvis

an unlevel hip

She’s an incredible endurance athlete, but those hips don’t lie.

Patients often tell me “oh, I have one leg that is longer than the other.” Are you sure? Although it is possible for someone to have one leg with a femur that is actually longer than the other, it is uncommon. More often, muscles are tighter on one side or an individual stands in an asymmetrical posture which makes one leg seem longer. Do you have one leg that you typically like to stand on, and it just feels uncomfortable to lean on the other? Look down and see what that does to your pelvis. One side is up and one leg looks shorter, right?

Over time, muscles on one side can become short and tight and the pelvis can begin to elevate, rotate and/or shift to one side. This puts the hip joint and the associated muscles in a different position compared to the opposite hip. I always like to make the point that there is a reason that one side begins to hurt versus the other…it’s not just a coin flip! Determining that reason and addressing it is an essential component to recovery.

2. A tight psoas, or hip flexor

Not to be dramatic or anything, but I believe that the psoas is the window to the soul. It is an epicenter for so many injuries that I have become somewhat obsessed with it, and it is one of my personal missions to teach others how to properly stretch the psoas.

Why does a tight hip flexor, or psoas, matter? The psoas is able to flex the hip (as in bring your knee closer to your chest) but it is also able to rotate, side bend, and extend the spine because it attaches to the front portion of multiple vertebra. How crazy is that? So a stiff psoas can compress your hip joint, decrease hip range of motion, cause an unlevel pelvis, contribute to back pain, decrease nerve space….the list goes on and on. Who knew one little muscle could cause so much mayhem?

3. Weak or inactive gluteal muscles

The hip is a ball-and-socket joint, meaning that the head of your femur (the ball) sits in a cup-shaped portion of the pelvis called the acetabulum (the socket). This configuration gives the hip a ton of mobility, but also a lot of complexity. If muscles aren’t working properly around the entire joint the ball can sit off-kilter in the socket and problems arise. One example of this would be a tight psoas, pulling the ball forward. Another would be tight, weak, or inactive gluteal muscles, pushing or allowing the ball to move forward inappropriately.

Although strengthening the glutes and learning how to fire them properly is a very generalized approach to treating hip pain, it often works! Check out this video from Garrett Mclaughlin for ideas on a basic hip strengthening program.

4. Tight or inhibited gluteal muscles

All of our muscles have a normal “resting length”, meaning the length the muscle prefers to exist at in order to contract strongly and perform optimally. Try jumping by just using your calf muscles. Keep your knees straight and hop up and down like you are jumping rope. Take note of how high you can bounce. Now try to do the same jumping exercise by starting on your tiptoes, which is a shortened position for the calf. Stay on your tip toes and don’t let your heel come down at all as you try to jump. Now how high can you go? Can you get off the ground at all without cheating?

Tight gluteal muscles will be similarly weak and dysfunctional. You may have proper strength, but if your butt is all knotted up then good luck getting it to properly stabilize your pelvis. (A trip to Cindy Duron, anyone?)

5. Poor movement patterns and habits

running terrible

Here is where I swallow my pride and post pictures of myself running terribly in order to prove a point. I’d love to pretend that because I am a physical therapist I magically move perfectly, never get injured, and have perfect biomechanics. Shockingly…not the case. I’ve had a longstanding left hamstring and hip injury for years. Why the left side and not the right? As I said before, there has to be a reason. Overuse injuries don’t land on one side like the flip of a coin.

both feet on the ground

Take a look at me when both feet are off of the ground. My hips are level left to right, which is the ideal position for running. When hips are level in this plane it minimizes the force that goes through our joints and soft tissues.

left leg stance

When I am in stance phase on my right leg, my hips remain fairly level. Not perfect, but not too bad. This indicates that my right gluteal muscles are strong-ish and function properly.

When I am in stance phase on my left leg however, my left glutes and stabilizers are a hot mess. Yikes, ouch, and yuck. My left glutes just didn’t want to get out of bed today. Can you see how this would stretch the outside of my left hip with every step? The inside of my left knee? Compress the outside of my left knee and stretch my IT band? Make my right leg have to bend further to swing through and not stub a toe? With EVERY. SINGLE. STEP?!? Bleh. Just gross.

Like I said, overuse injuries are never a coin flip; there is a reason and we are here to help you find that reason and treat the problem.

Have you struggled with hip pain, or just tried to live with it? Don’t. Ain’t nobody got time for that. Find out what’s going on and what you can do about it.

Heal Your Body, Strengthen Your Life.
Your friends at Jackson County Physical Therapy

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