The Hip Joint

Do you have an ache on the outer side of your hip after walking a long time? Do you get a sharp pain in the outer side of your hip when you get out of a car or turn over in bed? Do people ask you why you have a slight limp?

You may have a problem in your hip joint or socket.

The hip is a ball and socket joint. You have a strong ball at the top of your leg bone, the femur, and a bony socket in your pelvis. We have both large and long muscles that control leg and pelvic motion and small and short muscles that are involved in stabilization of this ball and socket joint.  These muscles, and their associated tendons, are subject to wear and tear injuries over time. Common causes of this misuse of muscles have many origins. Improper foot support with a dropping of the arch will cause a torque of the lower leg. This torque causes the muscles, especially the small muscles around the hip socket, to over work, leading to overuse syndromes. The same may be said for individuals with real, anatomical, and muscular, physiological, short legs. Knee injuries, which change the way you walk, get out of a car, bend or even roll over in bed can again lead to excessive use of muscles that are not designed to work the way you need them to.

Hip pains are common in runners and walkers. Other factors, such as the training surface, may be the culprits. Roads and walks are commonly slanted to let the water run off. If you consistently walk or run on one side of the road – you are basically walking with one leg shorter than the other.  Over time, this can lead to changes in your ankle, knee and hip joint. Worn out shoes, inadequate stretching, improper mechanics of walking and running are also causes that have to be investigated and corrected.  Women runners and walkers are more prone to hip problems because of the formation of their hips. Generally, a female pelvis is wider than the male. This means that when the foot strikes the ground, there is more torsion and pronation of the ankle occurring than when a male does the same exercise.  The examination and treatment of general hip joint pain begins with an examination of the mechanics of the lower extremity. Does your ankle support your body weight without excessive twisting? Does you hip excessively rotate, drop, or roll when you walk or run? Does your knee twist or excessively bend when you get up from sitting, walking or running?

These are all signs that something is wrong with the mechanics of the lower leg. Are your leg lengths close to being even? Is there excessive muscle tension in the long large muscles of your pelvis and upper leg?  These are signs of a pelvis problem that causes excessive shifting of weight to one side.

Uncorrected, these imbalances will lead to degeneration in the joint. When this happens, the inner surface and the outer surface of the ball become roughened.  This roughening acts like sandpaper on the cartilage, wearing it down.

Treatment may involve one to possibly all of these areas. Only a skilled examination that pays close attention to the balance and integrated functioning of all of these components will uncover all of the imbalances that must be treated to improve the muscle function and coordination.

The treatment has to be individualized to allow proper balanced muscle action.  Chronically weak muscles need to be treated so that they can function normally.  Some of these will require rehabilitation to increase their strength to the levels needed to support your body weight and anything that you are lifting or carrying. Other muscles will need stretching or procedures designed for all the muscles to fully relax.  Finally, after correcting any problems in the ankle, foot, knee and pelvis, gait training may be needed to normalize the pattern of walking to ensure proper weight transfer as you walk or run.

Degeneration or inflammation in the socket may require specific nutritional modifications aimed at reducing the inflammatory process, stabilizing the cartilage or in rebuilding the muscles.  Each of these is important. If you do not have adequate dietary intake of factors necessary to build muscle, all of the exercise in the world will not build the muscle. Likewise, a diet that promotes inflammation will continue to do so.