Hip pain has many causes and it is often times the result of a combination of factors. Anterior hip pain can be from strains of the pectineus, adductor, psoas, and/or quadriceps muscles. Lateral hip pain can be from IT and TFL tension or gluteal tendon injury. Posterior hip pain can be from a strained hamstring, gluteal muscle, or external rotator of the hip or SI joint instability and inflammation. In more serious cases, pain in any of these regions or a combination of each of these areas can be due to a labral tear or arthritis.
In any of these cases, instability of the ball and socket joint of the hip can be the primary cause of abnormal biomechanics causing the tendon, labral or cartilage injury. The iliofemoral ligament and the hip capsule help maintain the ball in the socket and when these become lax from over stretching (think yoga or gymnastics) or repetitive stress (think running with weak glutes or heavy weighted squats) then the joint becomes unstable. The glutes and obturator internus are the other main hip stabilizers that help to keep the femoral head from subluxing forward and also help to maintain the socket side of the joint in its proper position. When the Sacroiliac and Iliolumbar ligaments of the low back and gluteal muscles of the hip are injured and no longer functioning then the hip begins to rotate forward causing further impingement of the anterior hip joint. A weak core from lack of training or history of a hernia or C-section can also cause hypermobility at the pubic symphysis, which will cause pelvic rotation.
Often times patients see an orthopedic surgeon specializing in the hip and get an MRI showing a labral tear. In the majority of cases these can be asymptomatic even with a positive finding on an MRI. When the labral tear matches up with the patient’s symptoms and clinical exam then the labral tear can be important to treat, but just shaving down a piece of labrum does not address the larger biomechanical issues that have caused the labrum to tear in the first place. I have successfully treated labral tears using regenerative injections such as Platelet Rich Plasma but in every case I am also treating the associated pathology of ligamentous laxity and tendinosis that is causing the labral tear to develop in the first place.
There is still a place for surgery when there is anatomical impingement or more severe arthritis, but even in cases where there are osteophytes (bony growths) and moderate to severe arthritis patients have become asymptomatic following regenerative injections.
Following regenerative injections it is important to work on hip stability, core strength and train in balance in order to retrain the proper movement patterns. During this process certain aggravating activities need to be avoided such as deep squats or lunges or prolonged sitting.
In some cases, more systemic inflammation in the body is feeding into hip pathology. Evaluating and addressing this type of systemic inflammation requires a functional medicine approach that looks at nutrition, gut health, food allergies, hormone imbalances, and metabolic health.
At the San Francisco Institute for Integrative and Regenerative Medicine we take a deeper look at the biomechanics of the hip and treat the area and patient as a whole to stabilize the joint and optimize the system in which the injury is taking place.