Conservative management of Non-Arthritic Hip Pain
The hip joint is created by the junction between the femur (thigh bone) and the pelvis. The round femoral head articulates with the lower part of the pelvis, called the acetabulum (socket). The hip joint has a complex muscle anatomy which allows it to undergo significant stress in everyday activities, but also more importantly in extremes of motion. Stability of the hip joint is increased by the labrum (a cartilaginous ring around the socket), responsible for the suction seal effect in this ball and socket joint.
Research has greatly progressed over the past decades and surgeons now better understand nonarthritic hip pain. While there can be multiple causes for hip pain in the absence of arthritis, one reason could be abnormal contact between the femur and the acetabulum, also called femoroacetabular impingement (FAI). FAI is usually characterized by pain in specific positions and/or extremes of movements.
For the management of FAI, research strongly supports attempting a thorough hip-focused rehabilitation protocol. A substantial proportion of patients find this very helpful in preventing surgical management. Even if surgery is undertaken, rehabilitation prior to it can better prepare the patient for postoperative rehabilitation. It is therefore essential to attempt a conservative management with a well-trained rehabilitation specialist, before considering any surgical management.
Furthermore, the scientific data has also allowed us to highlight that a high percentage of radiologic abnormalities are found in asymptomatic patients, which emphasizes the importance of a thorough assessment and a comprehensive trial of conservative management strategies. Hip related pain can be associated with a wide variety of muscle and/or kinematic abnormalities that can originate anywhere from the lower back to the knee. Recent literature supports that supervised rehabilitation protocols with focus on active strengthening and core strengthening are the most effective for better outcomes of conservative management of hip related pathologies.
Recent literature supports that a supervised rehabilitation plan with a focus on lower extremity and core strengthening leads to better outcomes and return to sport rates.
For detailed physiotherapy suggestions, please download the Non-operative rehabilitation protocol.