The Hip Joint

The Hip

The hip joint is made up of the femur (thigh bone) and pelvis forming a ball and socket synovial joint.

Figure 1 – Hip ligaments

Stability of the hip is gained by ligaments that attach from the femur to the pelvis and help to keep the ball in the socket as well as resist specific movements. The ligaments that help with the stability of the joint include the iliofemoral, ischiofemoral and pubofemoral ligaments (figure 1).

How the hip moves…

The motions we can achieve at the hip joint includes;

  • Flexion – bringing knee to chest
  • Extension – bringing the knee behind the body
  • Medial rotation – turning the thigh bone inwards
  • Lateral rotation – turning the thigh bone outwards
  • Abduction – taking the leg out to the side
  • Adduction – bringing the leg across the body

Movement of the hip joint occurs by the contraction of muscles. These muscles attach around the hip joint and help us to so movements such as; stand, walk, get up from a chair and run.

Common Pathologies

Hip Impingement

Known medically as femoroacetabular impingement (FAI) this can be a very painful issue. The hip joint can become impinged or ‘pinched’ for two reasons:

         

  • ‘Pincer’ lesions occur when the socket (acetabulum) over covers the femoral head (ball). This causes the femoral head to touch the socket when moving the hip joint.
  • ‘Cam’ lesions occur when the femoral head (ball) becomes misshapen – it loses it spherical shape and the neck becomes thickened with bony deposits.

The majority of patients present with both ‘pincer’ and ‘cam’ lesions.

So how do we fix this?

  • Relative rest from the aggravating activities
  • Pain medication as advised by your GP
  • Exercise to improve biomechanics or muscle imbalances
  • Surgery is often required to return the shape of the ball and socket back to their original shape and stop the impingement. This would only be considered if conservative management had failed.

Labral Tears

The labrum lines the outside of the socket providing stability by suctioning the femoral head and increasing depth of the socket. It has a high water content which aids nutrition of the hip joint. The labrum can become impinged as well as torn or degenerated.

The synovial fluid which lubricates the joint has a high neural content meaning there are a lot of nerve endings present. This means that pain can often be high in the hip joint.

Presentation

  • Groin pain
  • Limited functional / sporting activites
  • High irritability
  • Limping
  • Painful clicking or catching
  • Night pain

To XRAY or scan?

XRAY is a brilliant tool at looking at the bone anatomy of the hip and is usually the first tool when we are imaging the hip. MRI scans, CT scans and occasionally ultrasound scans are used depending what structures are being investigated.

Strengthening

The hip muscles can be strengthened in a number of ways. We have a playlist of exercises that are aimed at improving strength around the hip and core muscles. Please ask your Physiotherapist for advice before performing theses exercises.

Mobility

Hip mobility exercises are great at improving hip range of motion. The following playlist has exercises that your Physiotherapist will guide you through to improve hip range of motion.

Need some advice?

Give Complete Physiotherapy a call to book an assessment with one of our expert Physiotherapists on 01189462299.