Groin Pain

Groin pain can be most commonly caused by hip arthritis or from a internal hip injury like a labral tear or hip impingment.  Hip osteoarthritis is inflammation of the hip joint. It can develop at any age, although it is more commonly diagnosed in older adults. Hip osteoarthritis can make everyday activities such as walking or climbing stairs difficult.

The Centers for Disease Control and Prevention reports that 25% of all people may develop painful hip osteoarthritis by age 85. There is no known specific cause of the condition; everyone is at equal risk of developing it. Recent research found no difference in the rate of occurrence of hip osteoarthritis in the general public based on race, gender, weight, or educational level.

More severe cases may require hip joint replacement surgery. Whether or not patients have surgery, however, physical therapists design specific exercise and treatment programs to get people with hip osteoarthritis moving again.

Other Arthritis Resources:

  • Community-Based Physical Activity Programs for Arthritis
  • Osteoarthritis
  • Rheumatoid Arthritis

What is Osteoarthritis of the Hip?

Hip osteoarthritis is inflammation of the hip joint, a condition that is more likely to develop as people age. Osteoarthritis results when injury or inflammation in a joint causes the soft, shock-absorbing cartilage that lines and cushions the joint surfaces to break down. When the cartilage is damaged, the joint can become painful and swollen. Over time, this condition can cause stiffness and more pain.

How Does Hip Arthritis Feel?

Hip osteoarthritis may cause:

  • Sharp, shooting pain or dull, achy pain in the hip, groin, thigh, knee, or buttocks
  • Stiffness in the hip joint, which is worse after sleeping or sitting
  • A “crunching”; sound when the hip joint is moved, caused by bone rubbing on bone
  • Difficulty and pain when getting out of bed, standing up from a sitting position, walking, or climbing stairs
  • Difficulty performing normal daily activities, such as putting on socks and shoes

How Is Hip Arthritis Diagnosed?

If you see your physical therapist first, the therapist will conduct a full evaluation that includes your medical history, and will ask you questions such as:

  • When and how frequently do you feel pain and/or stiffness?
  • What activities in your life are made difficult by this pain and stiffness?

He or she will perform special tests to help determine whether you have hip osteoarthritis, such as:

  • Gently moving your leg in all directions (range of motion test)
  • Asking you to resist against her hand as she tries to gently push your leg and hip in different directions (muscle strength test)
  • Watching you walk to check for limping
  • Asking you to balance while standing (balance test)

Your physical therapist may use additional tests to look for problems in other parts of your body, such as your lower back. He or she may recommend that you consult with an orthopedist, who can order diagnostic testing such as an x-ray or MRI, to confirm the diagnosis.

How Can a Physical Therapist Help Treat Arthritis in the Hip?

Your physical therapist will explain what hip osteoarthritis is, how it is treated, the benefits of exercise, the importance of increasing overall daily physical activity, and how to protect the hip joint while walking, sitting, stair climbing, standing, load carrying, and lying in bed.Testing will reveal any specific physical problems you have that are related to hip osteoarthritis, such as loss of motion, muscle weakness, or balance problems.The pain of hip osteoarthritis can be reduced through simple, safe, and effective physical activities such as walking, riding a bike, or swimming.Although physical activity can delay the onset of disability from osteoarthritis, people may avoid being physically active because of their pain and stiffness, confusion about how much and what to do, and not knowing when they will see benefits. Your physical therapist will be able to guide you in learning a personal exercise program that will help reduce your pain and stiffness.

Your physical therapist will work with you to:

  • Reduce your pain
  • Improve your leg, hip, and back motion
  • Improve your strength, standing balance, and walking ability
  • Speed healing and your return to activity and sport

 
Reduce Pain
Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electrical stimulation, taping, exercises, and hands-on (manual) therapy techniques, such as massage.
Improve Motion
Your physical therapist will choose specific activities and treatments to help restore normal movement in the leg and hip. These might begin with “passive” motions that the therapist performs for you to gently move your leg and hip joint, and progress to active exercises and stretches that you perform yourself. The physical therapist may use sustained stretches and manual therapy techniques that gently move the joint and stretch the muscles around the joint.
Improve Strength
Certain exercises will benefit healing at each stage of recovery; your physical therapist will choose and teach you the appropriate exercises to steadily restore your strength and agility. These may include using cuff weights, stretchy resistance bands, weight-lifting equipment, and cardio exercise equipment such as treadmills or stationary bicycles.
Speed Recovery Time
Your physical therapist will design a specific treatment program to speed your recovery. He or she is trained and experienced in choosing the right treatments and exercises to help you heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.
Return to Activities
Your physical therapist will design your treatment program to help you return to work or sport in the safest, fastest, and most effective way possible. You may engage in work re-training activities, or learn sport-specific techniques and drills to help you achieve your goals.
If Surgery Is Necessary
In severe cases of hip osteoarthritis, the hip joint degenerates until bone is rubbing on bone. This condition can require hip joint replacement surgery. Physical therapy is an essential part of postsurgical recovery, which can take several months.

If you undergo hip joint replacement surgery, your physical therapist will visit you in your hospital room to help you get out of bed and walk, and will explain any movements that you must avoid to protect the healing hip area.

He or she will work with you daily in the hospital and then in the clinic once you are discharged. He or she will be an integral part of your treatment and recoveries – helping you minimize pain, restore motion and strength, and return to normal activities in the speediest yet safest manner possible after surgery.

Can Hip Arthritis be Prevented?

Hip osteoarthritis may be prevented or limited by keeping the hip and leg muscles strong and flexible, maintaining a healthy body weight, and using proper balance skills. Research shows that strengthening and stretching exercises for the hip, core and leg can minimize and reduce osteoarthritis pain and stiffness, so it is reasonable to conclude that keeping those muscles strong and limber will help prevent painful osteoarthritis symptoms and problems.When you seek help once hip osteoarthritis develops, your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your hip, upper leg, and abdomen to help prevent future hip pain and problems. These may include strength and flexibility exercises.References:http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=3ebaeb44-7d44-4520-b3af-d53a34ce480c#.VZmXM_lViko

 

Hip impingement involves a change in the shape of the surface of the hip joint that predisposes it to damage, resulting in stiffness and pain. Hip impingement is a process that may precede hip osteoarthritis. It most often occurs in young, active people. A recent study found that 87% of teens and adults with hip pain showed evidence of hip impingement on diagnostic images taken of their hip joints. To treat hip impingement, physical therapists prescribe stretches and strengthening exercises to better balance the muscles around the hip to protect it, and use manual therapies to help restore range of motion and increase comfort.

What is Hip Impingement?

There are 2 types of hip impingement; they may occur alone or together.
Pincer-Type Impingement

  • In pincer-type impingement, the hip socket (acetabulum), which is usually angled forward, may be angled toward the back, or protruding bone may be present on the pelvis side of the hip joint making the socket a deeper recess that covers more of the ball or head of the femur bone.
  • The overgrown bone or incorrect angle of the socket causes the labrum, a rim of connective tissue around the edge of the hip socket, to be pinched. Over time, this extra pressure to the labrum when flexing (moving the leg forward) leads to wear and tear that can cause inflammation and could result in a tear. If this condition persists, eventually the cartilage that lines the hip joint can become worn and form holes.
  • This condition affects men and women equally; symptoms often begin early, appearing at any time between 15 to 50 years of age.

Cam-Type Impingement

  • In cam-type impingement, the shape of the bone around the head of the femur—the ball at the top of the bone in the thigh—is misshapen. It can vary from the normal round ball shape, or have overgrown bone formed at the top and front. The nickname “pistol grip” deformity is given to the appearance of the bony overgrowth on x-rays.
  • The overgrown or misshapen bone contacts the cartilage that lines the hip socket, and can cause it to peel away from the bone in the socket. The labrum can become worn, frayed, or torn as well.
  • This condition affects men to women at a ratio of 3 to 1; symptoms often manifest during the teen years and 20s.

Signs and Symptoms of Hip Impingement

Hip impingement may cause you to experience:

  • Stiffness or deep aching pain in the front or side of the hip or front of the upper thigh while resting.
  • Sharp, stabbing pain when standing up from a chair, squatting, rising from a squat, running, “cutting,” jumping, twisting, pivoting, or making lateral motions.
  • Hip pain described in a specific location by making a “C” with the thumb and hand and placing it on the fold at the front and side of the hip, known as the “C-sign.”
  • Pain that most often starts gradually, but can also remain after another injury resolves.
  • Pain that increases with prolonged sitting or forward leaning.
  • Feeling less flexible at the hips, including a decreased ability to turn your thigh inward on the painful side.

How Is Hip Impingement Diagnosed?

Your physical therapist will evaluate the range of motion (movement) of the hip and surrounding joints, and test the strength of the muscles in that area. Your therapist will feel the hip joint and surrounding muscles to evaluate their condition. The examination will include observing how you move, standing from a sitting position, walking, running, or squatting, as appropriate. Your physical therapist may perform special tests to help determine whether the hip is the source of your symptoms. For instance, the therapist may gently roll your leg in and out (the “log roll” test), or bend your hip up and in while turning the lower leg out to the side (the “FADDIR” test) to assess your condition.If further diagnosis is needed, your doctor may order diagnostic tests to help identify any joint changes, including x-rays, magnetic resonance imaging (MRI), or diagnostic injections. Hip impingement can occur at the same time as low back, buttock, or pelvic pain, or from conditions such as bursitis or groin strain. The final diagnosis of hip impingement may take some time, especially when other conditions are present.

How Can a Physical Therapist Help Treat Hip Impingment?

Without Surgery

When an active person develops hip pain, but does not have severe symptoms or joint damage, the recommended treatment is physical therapy. The following interventions can help decrease pain, improve movement, and avoid the progression of hip impingement and the need for surgery:

  • Improving the strength of your hips and trunk. Strengthening of the hips and trunk can reduce abnormal forces on the already injured joint and help with strategies to compensate.
  • Improving hip muscle flexibility and joint mobility. Stretching tight muscles can reduce abnormal forces that cause pain with motion. Joint mobilization may help ease pain from the hip joint; however, these treatments do not always help range of motion, especially if the shape of the bone at the hip joint has changed.
  • Improving tolerance of daily activities. Your physical therapist can consider your job and recreational activities and offer advice regarding maintaining postures that are healthier for your hip and activity modification. Often this involves limiting the amount of bending at the hip to avoid further hip damage.

Following Surgery
Surgery for hip impingement is performed with arthroscopy. This is a minimally invasive type of surgery, where the surgeon makes small incisions in the skin and inserts pencil-sized instruments into the joint to repair damage. The surgeon may perform 1 or several techniques during your procedure as needed. The surgeon may remove or reshape the bone on the pelvis or femur side of the joint, and repair or remove the damaged labrum or cartilage of the hip joint.

Postsurgical physical therapy varies based on the procedure performed. It may include:

  • Ensuring your safety as you heal. Your physical therapist may recommend that you limit the amount of weight you put on the operated leg if there was a repair of the labrum. You may wear a brace to help limit the amount of bending at the hip. You might also use crutches to avoid overloading the leg if the bone on the femur was reshaped.
  • Improving your range of motion, strength, and balance. Your physical therapist will guide you through safe range-of-motion, strengthening, and balance activities to improve your movement as quickly as possible while allowing the surgical site to heal properly.
  • Instructions on returning to an active lifestyle. Most people return to normal daily activities about 3 months after surgery, and to high-level activities and sports 4 to 6 months after surgery. Your physical therapist will recommend a gradual return to activity based on your condition—research shows that 60% to 90% of athletes return to their previous playing ability depending on the surgical procedure performed and the sport.

Can Hip Impingement be Prevented?

Currently there are no recommendations to prevent hip impingement. Despite a major increase in research to learn more about hip impingement, there is a great deal that is unknown. For instance, many active young people whose x-rays show hips as being abnormal do not have pain despite continuing to live active lives and participate in sports.However, there is evidence that physical therapy interventions along with anti-inflammatory drugs can decrease pain, slow joint damage, and improve function. This is particularly important in those with mild hip impingement, those who are attempting to avoid surgery, and those who are not candidates for surgery.
Reference:
http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=ded8ddca-4386-4d42-bf62-78129e04bd12#.VW84n8_BzGd