Hip

Several of the supporting structures and key aspects of the hip joint are listed below. Each of these structures has the potential to be injured and can lead to a pathology that may require treatment.

1. Articular cartilage is a very specialized tissue that lines the ends of the bones that form the joint and creates a smooth gliding surface. The cartilage is normally a few millimeters thick on each end of the bone. The cartilage can be damaged in a localized area or more diffusely. When the cartilage is damaged more diffusely, it is called arthritis.
2. The labrum is a thin piece of cartilage that attaches circumferentially around the acetabulum (socket). It deepens the socket and also creates a seal around the ball trapping fluid in the joint, which is critical for the health of the articular cartilage.
   • The labrum can be torn in different places, but the most common location of labral tears is toward the top. If the socket were a clock, most tears occur from 10:00-2:00.
3. The capsule is a thin connective tissue that surrounds the joint. Within the capsule are several strong ligaments that provide stability to the joint. It is normal for the capsule to be redundant or loose so that it can be stretched when the hip is moved into the extremes of motion.
   • Sometimes the capsule can become inflamed and tight like a drum, causing restricted range of motion and severe pain when the capsule is stretched. This is called adhesive capsulitis.
4. A synovial membrane lines the inner surface of the capsule and produces synovial fluid to lubricate the joint. It also provides nutrition to the cartilage. The synovium often becomes inflamed in cases of adhesive capsulitis.
5. There are three groups of muscles that provide strength to the hip: the hip flexors, hip extensors, and hip abductors and adductors. Each group of muscles act in concert to allow mobility and the body to function.
   • Injuries can occur to these muscles or tendons. Inflammation of the tendons (tendonitis) can cause hip pain. Also, the muscles or tendons have the potential to sustain a partial or complete tear.
6. In the space between the hip abductor muscles and the IT band is a thin sac called the trochanteric bursa. This sac provides lubrication, allowing the muscles to glide over the bony prominence on the outside of the hip (called the greater trochanter) every time the leg is raised out to the side.
   • Inflammation can occur in this sac, causing it to swell. This is called bursitis, and it typically manifests as pain on the outside of the hip.

Initial Goals:

• Pain reduction
• Reduce inflammation through Manual Therapy and Home Exercises
• Improve range of motion
• Restore functional mobility such as home mobility and sleeping through the night
• Post-surgical: avoid loading directly affected tissue to protect against bursitis risk

Secondary/Progressed Goals (4-8 weeks):

• Restore full range of motion
• Normalize community distance walking
• Return to work duty function

Tertiary Goals (Injury dependent as educated by your surgeon and physical therapist):

• Return to Sport/Work out as indicated
• Restore full strength in effected hip
• Jogging/running assessment

Long Term Goals:

• Return to impact/sport drills
• Jogging/running assessment
• Plyometric training