Hip and Pelvic Pain

Our hips and pelvis carry the most weight with everything we do. Tightness and compressive pain is common.

Like any joint, the hip joint can deteriorate and wear out causing you to suffer from hip pain. The degree of deterioration can vary of course and it goes in stages. First the cartilage thins out and the joint space decreases slightly. At that stage treatment can have a significant impact and decrease hip pain levels. If you then continue to stretch and exercise appropriately it may halt the course of the degeneration. The next stage is when the cartilage wears out and bone begins to rub on bone. At this stage it gets significantly harder to make an impact on the hip pain, but we can still have a reasonable degree of improvement so long as you are willing to get involved in the treatment process and do regular stretching and exercising.

The final stage is when the bone integrity is compromised and cysts form under the surface of it. At this stage the best we can do it control the symptoms to an extent with a view towards getting a hip replacement organised for you if the condition is limiting your daily activities sufficiently. At that final stage we have to ask the hard question: is the lack of mobility and hip pain which a badly arthritic joint causes going to begin to affect other areas such as your knees and lower back. We will discuss such factors with you in detail and help you find the solution you are most happy with. If there is any uncertainty as to what stage you are at we would order imaging such as X-rays, MRI's or ultrasound to rule out muscle tears or labral issues.

The sacroiliac joints are very large units and bear a lot of weight. They help us convert the up and down motion which our legs are able to produce into rotational motion which our spine is good at dissipating so it doesn't get damaged. When they get jammed up the lower back suffers a lot. Most of the time our patients will come in complaining of lower back pain when in fact it's the sacroiliac joints which aren't working right. There are many very thick and large ligaments over the sacroiliac area which may also need to be addressed, otherwise once you put weight back onto the pelvis, they would just pull it back into a dysfunctional position.

Other than mechanical issues, the pelvic organs can affect them too. The left sacroiliac joint is at risk of inflammation from the descending colon as the colon is literally right in front of the joint. In these cases your pain usually feels reasonably better after passing a bowel movement. In such cases we need to address the visceral problems as well as the mechanical dysfunction. Other common issues which causes sacroiliac pain are ovarian and bladder problems. We would need to figure out which of these factors are causing dysfunction in your particular case and then if we cannot address it just with osteopathy we would help you find the appropriate additional course of action.

The hip joint carries a lot of weight so the body aims to try and create as much stability as possible. The hip labrum is a lip made of cartilage which runs along the edge of the joint and in a way 'grips' the head of your thigh bone as it inserts into the joint. With extreme movements the hip labrum can get pinched, torn and partially avulsed. This usually produces a deep seated pain around the hip area all around - from the outer side, in a circle around into the groin and back. There is always a particular range of movement which aggravates the condition greatly, whereas other ranges of movement can be quite free. It is also common to develop minor muscle tears in the area over time, and we need to dignose those accurately too.

Small labral tears, irritations and avulsions are treated conservatively and by avoidance of aggravating activities. In general we prefer to get an accurate diagnosis via imaging if your response to osteopathic treatment is not what we would expect. Once it is accurately diagnosed and we know that osteopathic treatment is appropriate, we can confidently persevere with the correct steps to get you the best possible result. If the damage to the hip labrum is significant enough, there may be a need for a small arthroscopic surgery. Generally you would be recovered back to normal walking / moving within about 3-4 weeks and then you can gradually get back into your usual activities as you had done before. Whilst we always look for all conservative treatment options to help you avoid surgery, if the other option is that the labral tear leads to gradual hip joint arthritis and then you end up needing a total hip replacement - it's worth considering.

The muscles around the hips and pelvis are very large and strong. So if they tighten they will decrease the available movement to the underlying joints. They also decrease the blood flow to themselves and can develop muscle tears as time goes on. The other function which muscles have in this area is to absorb force and shock in order to take decrease the load on the underlying joints. Under a fair few of these muscles there are small fluid sacs called bursae which decrease the friction over the underlying bone.

A bursa will create a very local pain which is made worse when you put direct pressure over the affected area. Either a direct fall onto the bursa or gradual irritation can take place. The muscles which run across a bursa can tighten and rub over the bursa which creates inflammation and swelling and leading to bursitis. A lot of the time this can be addressed through osteopathic treatment. However, if you are not responding the way we would expect you to, we would recommend a ultrasound to get a precise diagnosis on what is going on. With more severe cases of hip bursitis it may be necessary to send for a cortisone injection in order to initiate the healing process. We would still need to address the muscle tightness in order to prevent the hip bursitis from coming back - and you would need ot keep stretching.

The main muscles in the pelvic and hip area which tend to be most often problematic are the gluteal, piriformis, iliopsoas and hamstring muscles. All of these can become inflamed as well as their tendons. All of them will hurt locally where the inflammation is taking place, but they can also send some pain down the leg. This can often be mistaken for a pinched nerve in the lower back when in fact it is just a muscle problem. The piriformis is the only muscle which can create a significant neurological problem in some individuals because it has a large nerve bundle called the sciatic tract which passes near it. If this tract becomes irritated it can create a serious degree of pain in the leg and buttock area. All of these muscular issues can be address through osteopathy. If we do not get the desired treatment response then we would advise you on which further investigations would be needed.

Pain referral into the hip and pelvis can be very varied. The knee joint can refer up to the hip, the lower back muscles and joints can send pain into the hip and pelvis and the sacroiliac joints can send pain into the hip area too. Structural osteopathy can help address all of these easily. Organs which are in the lower abdomen and pelvis can also send pain into the wider area and appear to be pain coming from the mechanical structures. The difference is that organ related pain is not affected by mechanical movement. For example if your pain gets worse after a big, long walk then it is far more likely mechanical pain. If the pain is worst after having a large meal it is more likely related to your lower digestive system.

The most common organs which will affect the area are the gynaecological organs, bladder, ureters and the lower digestive system. In all of these cases it may be a simple restriction or organ movement which we can ease through visceral osteopathic treatment. It may, however, be a more serious visceral condition in which case we would need to either organise further investigations or further treatment. We would of course discuss all options together with you in order to choose the approach you are most comfortable with.

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