Healthy Movement for Life - The Hip

By Jill Trato, DPT

The Hip

A with a hip-hop, the hippie to the hippie

The hip, hip-hop and you don't stop the rockin'

To the bang-bang boogie, say up jump the boogie

To the rhythm of the boogie, the beat

The hip joint is known as the acetabulofemoral joint as it joins the femur with a part of the pelvis called the acetabulum. The word acetabulum means a cup shaped cavity. This cavity is formed by the fusion of the pelvic bones- the ilium, ischium and pubis. The acetabulum forms the “socket” for the ball and socket joint of the hip and it provides a suctioning effect for optimal stability.. The head of the femur bone, the “ball”, is covered in cartilage. It fits snugly into the acetabulum with the assistance of the joint's bony configuration and the acetabular labrum, a ring of cartilage that surrounds the outer rim of the acetabulum. This joint is quite stable and it serves as a conduit of forces acting between the spine and leg. It is versatile and mobile with capabilities to move in multiple planes through large ranges of movement. The musculature about the hip is powerful and dynamic and allows for jumping, running and leaping.

Injury to the hip can occur due to falls, trauma, repetitive movements over time, poor mechanics during activities, degenerative conditions and muscle imbalances. Hip pain can come from cartilage, bone, the acetabular labrum, tendons, muscle, nerve or ligament. Pain can be felt in different locations about the hip depending upon the tissue at fault. For example, the iliopsoas muscle and degenerative changes of the articular cartilage in the hip can send  pain to the front of the hip or groin area. Point tenderness and pain at the side of the hip can be from trochanteric bursitis. Irritation of the piriformis muscle or sciatic nerve are often felt in the buttock. 

From a physical therapy perspective, conservative management is  very helpful. An update of the clinical practice guidelines for nonarthritic hip joint pain (Journal of Orthopaedic and Sports Physical Therapy, Vol. 53 #7, 2023) states the following:

“..........interventions should be based upon clinical examination findings and tailored to meet the specific needs of each patient.

Clinicians should utilize appropriate objective clinical impairment and performance measures to determine response to treatment, guide intervention selection, and exercise dosing. Additionally, clinical and performance measures can also be utilized to provide guidance related to activity resumption and participation recommendations. Interventions may include education, manual therapy, neuromuscular re-education, therapeutic exercise, or training for correction of posture and movement during functional activities. Education may include information about the health condition or activity modification. Manual therapy interventions include techniques to address capsular and periarticular soft tissue restrictions suspected to impair hip mobility. Neuromuscular re-education may include various strategies to address impairments in balance, coordination, and kinesthetic sense. Therapeutic exercises use varied approaches to address impairments in muscle flexibility, muscle strength, muscle power deficits, and deconditioning. Task-specific training may be incorporated to educate a patient in how to optimize their lower extremity movement patterns during symptom-provoking activities.”