The hip can give problems and deteriorate into a severely painful joint very quickly after a traumatic event such as a fall, strain or jar. However, this is less common on average as hip problems usually come on slowly over a long period. A small event can set off a painful process which starts with some muscle spasm and a reduction in the extension range typically used in walking. The hip joint is at its tightest and most pressured when it is put into extension, and when we have a painful joint we avoid this kind of joint position in order to avoid pain.
A typical reaction to a painful hip is the development of a limp, a common finding in hip and knee pain problems. Whilst possible to eradicate a limp, once practiced for a while, is very difficult. A limp changes the mechanical stresses through the hip radically, alters the muscle function to different angles and allows the joint to restrict its ranges of motion. This can encourage the hip capsule to tighten up further and perpetuate the cycle. This is why physiotherapists encourage people with hip problems to perform as normal a gait as possible.
The major weight bearing joints of the knee and hip are mostly affected by osteoarthritic changes, osteoarthritis being the most common degenerative joint condition in the world. Many factors contribute to the incidence and severity of arthritis, with a family history being important to some degree. Osteoarthritis becomes much more prevalent with increasing age and is almost universal in some joints in older people. As the arthritis worsens the joint can gradually lose movement as the capsule tightens, with a slow healing due to the lack of good blood supply.
The steady loss of the articular surface of the hip goes on with an increased limp and consequent spasm of the hip muscles. There can be a rapid deterioration of an arthritic joint without much of a mechanical insult and it is not understood exactly why, but elevated levels of muscle spasm and pain may contribute. Pain from a hip joint refers to the anterior thigh region, the groin, the side of the hip or the lower buttock. Patients may attend a medical consultation with what they expect is a leg or knee condition and are surprised with a diagnosis of an arthritic hip.
Little useful information may come from x-rays of the hip in the early stages of osteoarthritis and the patients disability or pain is not easily connected with x-ray findings overall. A worsening joint will show clear x-ray changes such as narrowing of the joint space caused by loss of thickness of the articular cartilage. Abnormal shaping of the femoral head and the formation of marginal joint bone outgrowths called osteophytes will occur in severe cases. On bearing weight or movement a severely osteoarthritic joint will shudder and grate audibly.
The hip loses its ranges of joint movement typically in a predictable order with the first loss being of extension, the second of abduction (moving the legs apart out to the side) and the last internal joint rotation. On physiotherapy examination an osteoarthritic hip will be positioned forwards and be unable to extend, be laterally rotated so the foot points out and will be kept in close the middle as the outward movement has been lost. The leg shortening and inability to extend the hip during walking can mean that every step involves trunk twisting and the need to go up on tiptoe to some degree to allow for leg shortening.
Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in bradford visit his website.
