Still Have Hip Pain? 4 Things Most PTs Overlook

Hip pain can take several forms. This ball-and-socket joint is actually deep in your groin. If it gets irritated, pain usually presents in the groin, but can extend down the front-inner thigh all the way down to the knee, and sometimes even in the buttock. Pain and tenderness can also appear on the outer bone of the hip. Pain and problems have several different causes, and some that are commonly overlooked. If you’re not making progress with a painful hip, here are a couple of things you and your PT may want to re-investigate.

The Thoracic Spine

If you know me, by now you know how important I think the thoracic region of the spine is. Restrictions in this part of the spine cause tightness in the muscles that attach to the pelvis. The result? A twisted pelvis. The earth you walk on isn’t changing at all, so somewhere between your twisted pelvis and the earth, the leg needs to counter-twist to compensate and allow your feet to strike the ground like usual. This compensation can happen at the hip and cause you problems. See our Video example of Hips getting Looser after Thoracic Spine Mobilization.

The Lumbar Spine

What I just said about the thoracic spine is also true of the lumbar spine when it comes to the pelvis: restrictions in this region can put undue stress on the hip joint. But there’s another connection too. If you have pain on the outside of your hip (commonly diagnosed as “bursitis”), odds are extremely high that this stems from a problem in your lumbar spine, even though it appears to be “a hip issue”. A tight lumbar spine compresses nerves going to that area and tightens muscles that are responsible for the pain in the bursa. The lumbar region must be assessed in the case of lateral hip pain. Video: Treatment of the Lumbar Spine.

Pelvis

Our pelvises can get twisted and restricted, causing pain in the hip. As mentioned above, most of these problems resolve once we restore mobility to the vertebral segments in the thoracic and lumbar regions of the spine. Sometimes, there can also be a pain related to a pelvic floor problem, or a unique stressor like a sportsman’s hernia commonly seen in hockey players. Videos: Treatment of an Asymmetrical Pelvis, Treatment of the Sacroiliac Joint]

Foot/ankle

I’ve said before that I think pronation gets a bad rap. This is true when it comes to the hip. Think about this: our feet need to land evenly on the ground with the steps we take. If your foot is not able to do this (by pronating well), are you then going to walk around on the outsides of your feet? I hope not! What you will do to compensate for this restricted ankle is twist your hip differently with your steps. You’ll do what it takes to get your foot-flat contact with the ground, but the hip is straining to do it, and the joint is now susceptible to aggravation. (Videos: How we treat the foot and ankle here and here]