This week’s blog is focused on a commonly treated problem at Life’s Work Physical Therapy: hip pain. When clients describe front of hip pain, pain radiating down the front of the leg, pain in front of the hip joint and pain along the underwear line on the front of the hip joint, physical therapists consider this a primary hip problem. In the cases where pain radiates down the front of the leg, we do a thorough exam to rule out pain generated from the back. Pain in the front of the hip joint is very painful with walking, flexing the hip and getting up from a seated position. It may be accompanied by a click or shifting sensation. It’s important to get it evaluated by a physical therapist sooner rather than later. For tips on finding a good PT in your area, read our recent blog post on How to Find a Good PT.
So, why do hips hurt on the front of the hip joint or as clients often describe along the underwear line? In this blog, I will discuss the most common musculoskeletal causes of pain in the front of the hip. Bear in mind that sometimes these symptoms are caused by hip osteoarthritis that is quite advanced. If you believe this is you, see your primary care doctor to get imaging, referral to PT and to an orthopedic surgeon when appropriate. (This blog will not discuss front of hip pain caused by hip osteoarthritis.)
The diagram on the right shows a cross section of the hip. As you can see, the top of the femur is shaped like a ball and the concave cavity of the pelvis is shaped like a socket. Appropriately named, the hip is a ball and socket joint. The round head of the femur spins and moves inside the deep socket of the pelvis. In an ideal world, all the muscles, ligaments and other soft tissue provide symmetric support on all sides of the hip joint so that the ball stays centered in the socket with motion.
When clients come to physical therapy with complaints of pain in the front of the hip, or pain along the underwear line on the front of the hip, we often find imbalance in the muscles, ligaments and other soft tissues that support the hip. In these cases, the femur cannot “park” in the center of the socket and often slips slightly forward. When the hip sits slightly forward, it irritates the front edge of the hip joint and can cause front of hip pain especially with walking, flexing the hip and getting up from a seated position. In physical therapy, we call this Anterior Hip Impingement.
Common Causes of Pain in the Front of the Hip or “Anterior Hip Impingement”
1. THE HYPERACTIVE PSOAS
In the diagram on the left, you are looking at a pelvis, the top of two femurs, the lower back and the bottom ribs. This is a belly side or front view of the body. The large rope-like muscles running adjacent to the lower back and attaching to the inside of the femurs are psoas muscles (pronounced “so-as”). The psoas muscles help lift the leg, as in climbing stairs, and also help you bend forward bringing your trunk toward your knees. Psoas muscles should relax when done working. When it’s hyperactive, it pulls the top of the femur forward making it hard for the femur to stay centered in the socket. With walking and other movements, the femur migrates forward, impinges upon the tissues and creates front of hip pain, or as physical therapists call Anterior Hip Impingement. So, often the number one cause of pain in the front of hip joint are hyperactive psoas muscles. This is treatable in physical therapy.
2. WEAK GLUTES
Gluteal muscles are located on our back sides. There are three main gluteal muscles, the gluteus maximus, the gluteus medius and the gluteus minimus. Collectively, we often refer to them as “the glutes.” As a group, they move the thigh behind the body as in kicking backwards. They also help move the leg to the side and turn the leg inward. Clients with pain at the front of the hip have very strong front of thigh muscles and very weak glutes. Weakness in the glutes leads to altered walking and movement patterns, poor flexibility into hip extension and a more forward position of the head of the femur in the socket. This is highly treatable with a prescribed physical therapy program.
3. POOR POSTURE
In prior blogs, I’ve discussed the importance of posture to prevent spine pain, headaches and ergonomic injuries. Believe it or not, poor posture can lead to front of hip pain as well. Most of us have the tendency to slump forward rounding our back as above on the left. When we stand, walk and even sit in poor posture, it puts unnecessary strain and stress through the muscles and other soft tissues that support the hips. Poor posture is often accompanied by weak gluteals and core and hyperactive psoas. With treatment in physical therapy, we correct the weakness and the hyperactive psoas AND our clients must improve their poor posture for the best long term results.
Front of the hip pain is a very painful and common complaint. If you are suffering from front of the hip pain, get help. If you live in the Portland area, contact us or call 503-295-2585, or visit us at lifesworkpt.com. For those of you living outside the Portland, Oregon area, go to apta.org and click on the “Find a PT” link.
Most clients who have pain on the front of the hip joint get better with physical therapy. If symptoms fail to resolve in physical therapy, other interventions are available through an orthopedic surgeon who specializes in hip injuries.