The hip joint is a ball and socket synovial joint, formed by an articulation between the pelvic acetabulum and the head of the femur.
It forms a connection from the lower limb to the pelvic girdle, and thus is designed for stability and weight-bearing – rather than a large range of movement.
What does all that mean?
Unless you have tragically bad arthritis, your hip won’t be a problem if everything stays where it’s supposed to, i.e. Ball in Socket. The relationship between the ball and socket is what causes us pain or functionality and depending on how nicely those two “work” together, determines how our hip feels and moves.
If you don’t have that ball fitting snugly in the socket, you’re going to be predisposed to pain and over stress somewhere.
All too often, I see people who come to my office who are instructed to “stretch things”. They’re told things are tight, “certain muscles are tight so you need to stretch this or stretch that.”
In most cases, hip problems are not a result of needing to stretch something. In most cases, hip problems are because you don’t have the strength and stability to keep that ball in the socket like it’s supposed to be. And I don’t care how much you stretch “this or that”, if you don’t have the proper stability and strength you’re going to experience things like bursitis, tendonitis, labral tears, and premature arthritis.
I want to touch a little on Labral tears because I see them so often.
Labral tears are rampant and they cause a lot of pain. The truth is, probably 75% of people over 45 years old have some kind of labral tear in their hip. There’s also a lot of people living with them who aren’t experiencing pain because they have stability and alignment and the muscular support to help protect them. But there are still a lot of people who have pain in the front of their hip at their labrum. A lot of times there’s “catching”, “snapping”, or you can put your foot on the ground and rotate it and feel a little “clunk”. Those are all signs that labral tears are present. But a frustrating thing is that you can go in to a doctor appointment and hear things like, “stretch it out”, “ice it”, or “surgical repair”.
And your doctor can go in there and put that back in place, but if you don’t do the corrective measures to get things back in order, then you may not experience a terrific amount of relief. From that problem, unfortunately I’ve seen lots of people that come to me after 2 or 3 labral repairs and they’re frustrated because it didn’t work.
You created a labral tear because of an imbalance and an alignment problem and extra stress that caused that ball to not sit in the socket properly. Same thing with hip replacements. I see a lot of people after hip replacements walk very poorly. And although they may not feel pain anymore, they haven’t’ fixed the problem because walking off balance will result in more pain and instability in the near future.
They’re no different, you have a serious misalignment problem that wears out the cartilage in you hip joint and a surgery isn’t going to fix that permanently.
Another thing I harp on when it comes to hip pain is sitting.
I consider sitting like putting gasoline on a fire. It really is dreadful when you have a labral problem and really any of these issues. Sitting is horrible. Sitting in your car, chair, computer desk. I have a dental hygienist patient who has torn labrums in both of her hips because of the sitting and hunching she does every single day. She couldn’t have a worse occupation for her condition. Sitting and leaning over has been terrible for her body.
When you sit your leg is bent up and that ball is smashing into the socket and putting stress on the joint, pushing on the labrum and in some cases, pinching nerves.
All that being said, sitting doesn’t have to be miserable. If you’ve built up the strength around your pelvis to be able to support your body properly, then you’ll be able to sit for some periods of time without doing harm. The problem comes when we start using the chair as a “crutch”. Instead of relying on our own core and pelvis strength to sit us up, we’re hunched against the back of the chair and putting massive amounts of stress on our spine, sacrum, and hip joints.
The last point I want to make has to do with diagnosing you hip problem.
Has anyone ever been to the doctor and the doctor said your MRI or x-ray looked “normal”? I sort of chuckle at that because normal to them means they don’t have anything available to fix it. They can’t find anything surgically to fix and there’s nothing that showed up on the MRI that can be fixed. But you’re left in pain!
Pain is not normal! Our hips should be able to function without pain so even if an MRI comes back clear, it doesn’t mean that you are simply cursed with hip pain forever and there’s nothing we can do. There is a root cause, usually involving the muscles surrounding your hips that needs to be balanced and regularized.
I would just ask that you continue your search for relief and look for alternative forms of treatment. Whether or not Physical Therapy will help you, I don’t know until I learn more about your particular case, but I hope you will keep PT in mind as an option to treat your hip pain.
-Mark Bengtson, MPT
Pinnacle Physical Therapy