ANATOMY
The hip is a complex, ball-and-socket joint representing the pelvis and femur articulation. The hip connects the axial skeleton with the lower extremities. Its primary function is to provide dynamic support for the body weight while also facilitating load and force transmission from the axial skeleton to the lower extremities. In that way, the hip joint is responsible for allowing mobility. As such, it is a highly important joint supported by several muscles[1]Bennett R. Myofascial pain syndromes and their evaluation. Best practice & research Clinical rheumatology. 2007 Jun 1;21(3):427-45..
However, hip pain is a common concern for many people, which can occur due to several pathological entities. Problems with soft tissues, including muscles, tendons, and ligaments, as well as problems with the lower back and spine and bones of the hip, can all be the cause of, sometimes, unbearable pain.
CAUSES
Hip pain may be felt in the groin, outer hip, and upper thigh, and the exact location and type of pain are important cues in determining the underlying cause.
More often than expected, hip pain is caused by the trigger hip points in the muscles surrounding and supporting the hip joint. Hip trigger points, also known as muscle knots, are hypersensitive and hyperirritable spots in the ¸hip muscles, causing pain due to decreased blood circulation, spasms, and the build-up of waste products. This leads to increased sensitivity of nerve endings, which presents with different pain patterns and ranges.
Hip trigger points usually develop due to muscle overuse, prolonged contraction, poor posture, stress, trauma, lack of stretching, improper stretching, overburdening of the muscle, prolonged sitting, and especially sitting without firm back support or armrests. Also, hip trigger spots can develop if one leg is shorter than another. Furthermore, if a person has prolonged improper sleeping positions or walks with a cane for long periods of time, it is very likely that their hip trigger points will get activated and become painful.
If left untreated, hip trigger points will develop reduced circulation. They may eventually cause muscle shortening and lead to restricted movement, which further worsens the pain. As time passes, this turn into a vicious cycle of worsening pain and further decreased mobility, leading to chronic hip pain. The hip flexors become tight, and the patient suffers until the trigger points are addressed and treated properly.
SYMPTOMS
The symptoms of the hip trigger points may be a dull pain with the local and/or referred pain pattern, muscle stiffness, muscle tenderness, muscle weakness or fatigue, reduced range of motion, muscle twitches – involuntary muscle contractions.
Furthermore, the affected area may feel warm to the touch. In some cases, burning or tingling sensations can be felt. However, the symptoms are not limited to the abovementioned ones.
HIP TRIGGER POINTS
Hip trigger points are the following:
- an iliopsoas trigger point (iliacus and psoas trigger points),
- gluteus minimus trigger points,
- piriformis trigger points,
- tensor fasciae latae trigger points, and
- quadratus lumborum trigger points.
ILIOPSOAS TRIGGER POINTS
Iliopsoas muscle is actually made up of three muscles. This muscle is known as the primary mover of the hip joint. Iliopsoas trigger points cause pain which refers to the pain in the anterior part of the hip, thigh, and groin. Differential diagnoses are quadriceps tightness and pain, arthritis, or problems with the hip labrum.
Iliopsoas Trigger Points can cause a variety of symptoms, including:
- Pain in the hip, abdomen, or lower back
- Pain that radiates down the front or back of the thigh
- Pain that is worse when sitting, bending, or twisting the hip
- Difficulty standing up from a seated position
- Weakness in the hip muscles
- A feeling of tightness or tenderness in the hip
- Pain with climbing stairs or hills
GLUTEUS MINIMUS TRIGGER POINTS
Gluteus minimus muscle is located near the rotators of the hip. Gluteus minimus trigger points pain is referred to deep gluteal and outer hip area. The pain may spread down the leg. Gluteus minimus trigger points pain can be misdiagnosed as hip bursitis, iliotibial (IT) band syndrome and even sciatica.
PIRIFORMIS TRIGGER POINTS
Piriformis muscle is one of the lateral rotator muscle groups of the hip. Piriformis trigger points pain spreads in the gluteal region and down the posterior thigh. This can easily be mistaken for sciatica pain. If the piriformis syndrome is present, the sciatic nerve could be compressed, and symptoms may include numbness, sexual dysfunction and leg swelling.
QUADRATUS LUMBORUM TRIGGER POINTS
Quadratus lumborum muscle trigger points cause pain in the sacroiliac (SI) joint and the gluteal region. Differential diagnoses are the issues with sacroiliac joint.
TENSOR FASCIAE LATAE TRIGGER POINTS
Tensor fasciae latae trigger points cause pain, usually located in the region of the anterolateral thigh and over the greater trochanter of the femoral bone. However, the pain can also spread down the thigh and the knee. It is often mistaken for trochanteric bursitis.
Unfortunately, many times the hip pain is misdiagnosed, and medicine has not yet completely recognized the role of trigger points in hip pain syndromes.
TREATMENT
Hip trigger points pain can be treated effectively by trigger point release and myofascial massage. Applying pressure to these spots can also be used for hip muscle and lower back relaxation. The self-myofascial release using a ball is also a good way of releasing tight hip flexors[2]Nicolakis P, Erdogmus B, Kopf A, Nicolakis M, Piehslinger E, Fialka‐Moser V. Effectiveness of exercise therapy in patients with myofascial pain dysfunction syndrome. Journal of oral rehabilitation. … Continue reading.
Hip pain should always be thoroughly evaluated, and trigger points and the hip trigger points are a cause of hip pain more often than it is diagnosed. Therefore, the hip trigger points should be inspected as part of the physical examination and treated properly.
Physical therapy for hip pain
Physiotherapy is one of the most effective treatment options for hip pain. Physiotherapy can help to reduce inflammation, improve mobility, and strengthen the muscles around the hip[3]Galasso A, Urits I, An D, Nguyen D, Borchart M, Yazdi C, Manchikanti L, Kaye RJ, Kaye AD, Mancuso KF, Viswanath O. A comprehensive review of the treatment and management of myofascial pain syndrome. … Continue reading.
Physiotherapy treatment for hip pain may include: –
- Stretching and Strengthening Exercises: A physiotherapist can identify weak or tight muscles in the hip and prescribe specific exercises to improve strength, flexibility, and range of motion.
- Manual Therapy: Manual therapy techniques such as soft tissue massage, joint mobilization, and trigger point release can help to reduce pain and improve mobility.
- Ultrasound Therapy: Ultrasound therapy uses sound waves to reduce inflammation and improve circulation in the hip area.
- Electrical Stimulation: Electrical stimulation can be used to reduce pain and promote healing in the hip area.
- Heat and Cold Therapy: Heat and cold therapies can be used to reduce pain and inflammation in the hip area.
Extracorporeal shockwave therapy for hip pain
Shockwave therapy is a non-invasive treatment that uses high-energy sound waves to reduce pain and promote healing in the hip area. It is used to treat a variety of musculoskeletal conditions, including hip pain[4]Ramon S, Gleitz M, Hernandez L, Romero LD. Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia. International journal of surgery. 2015 Dec … Continue reading.
Shockwave therapy can help to reduce inflammation and pain in the hip area by increasing blood flow and stimulating the healing process. It can also help to break up scar tissue and adhesions that can form around the hip joint.
The treatment typically consists of several sessions, which are usually performed on an outpatient basis. The sound waves are directed at the area of pain, and the patient may experience a brief, mild discomfort during the treatment.
The results of shockwave therapy may not be immediate, and it may take several weeks to months to see the full benefits. However, many people with hip pain report a decrease in pain and improved function after treatment.
When to look for a doctor?
It is important to speak to a doctor if you are experiencing hip pain that does not improve with rest and home remedies, or if the pain is severe or persistent.
Additionally, if you experience any of the following symptoms, you should seek medical advice:
- Swelling, redness, or warmth in the hip area -Inability to move the hip or leg
- Numbness or tingling in the hip or leg
- Fever or chills
- Unexplained weight loss
- Unable to bear weight on the affected hip
Your doctor can perform a physical examination, order imaging tests, and make a diagnosis.
They can then recommend the best course of treatment, which may include medication, physical therapy, or surgery.
MD. Physiatrist at University of São Paulo
References
| ↑1 | Bennett R. Myofascial pain syndromes and their evaluation. Best practice & research Clinical rheumatology. 2007 Jun 1;21(3):427-45. |
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| ↑2 | Nicolakis P, Erdogmus B, Kopf A, Nicolakis M, Piehslinger E, Fialka‐Moser V. Effectiveness of exercise therapy in patients with myofascial pain dysfunction syndrome. Journal of oral rehabilitation. 2002 Apr;29(4):362-8. |
| ↑3 | Galasso A, Urits I, An D, Nguyen D, Borchart M, Yazdi C, Manchikanti L, Kaye RJ, Kaye AD, Mancuso KF, Viswanath O. A comprehensive review of the treatment and management of myofascial pain syndrome. Current pain and headache reports. 2020 Aug;24(8):1-1. |
| ↑4 | Ramon S, Gleitz M, Hernandez L, Romero LD. Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia. International journal of surgery. 2015 Dec 1;24:201-6. |