The Missing Link in Hip Rehabilitation – Evidence-Based Treatment for Hip Injuries

The Missing Link in Hip Rehabilitation

All too often, patients who come to physio with pain in the hip are managed from a one-joint or soft tissue injury concept.

Of course, we treat the hip joint itself if there is any primary joint and bone pathology. We assess and reduce neurological referred pain into the patient’s hip. Furthermore, we add the gluteus medius strengthening to ‘the holy trinity’ of a standard hip injury rehabilitation programme. 

Is it enough? In a way, it will reduce the pain and get the patients back to their everyday life and exercise.

Is it the best approach?  No, because a good physio does not just want to get patients back on their feet after injuries, they want to prevent the same injuries from happening over and over.

To do so, we need to think outside the box, look at how the patient’s body functions as a whole and understand the relationship between the lower back, pelvis, hip, and thigh, and their relationship to the functional kinetic chain.

In other words, we need to look above and below the hip for the weak link. Identifying, correcting, and conditioning the weak link is the key to better image treatment, which is not just getting the patients better, but also successfully preventing re-injuries.

So, what are these missing links of hip injuries:

“My knee is not pointing straight when I run/walk”

Yes, we are talking about the alignment from your foot and leg! Often this is associated with a stiff and over-rotated foot and tight calf muscles. Next thing we know, the ankle starts to lock and the leg starts to turn inwards.

This prevents the activation of the gluteus medius muscle and make it weak and prone to inflammation and micro tears. The patient makes compensation in their running/walking pattern until it is too painful to continue. That’s when they come to see their physio.  

“My pelvis is out of alignment”

Pelvis dysfunction is also frequently seen among the hip injuries. You have probably often heard people saying “Oh my pelvic is out of alignment”, which is a common term for the pelvis, in particular, sacroiliac joint (SIJ) dysfunction.

The pelvis serves as a functional link to transfer load from the lower limbs to the spine, and vice versa. Any strains on the ligaments and imbalance/weakness in the muscles (especially Gluteus Maximus and Piriformis) can have negative impact on this link, causing issues on the hip.

“The lazy core and bad posture”

Core stability and strength is often forgotten or overlooked with the hip injury rehabilitation. The core muscle is required to offset the powerful loads that are placed on the spine by the force that is generated by the hip and pelvic muscles. The link between the legs, the core, and upper body allows the power generated by the muscles to transmit through the body to synchronise the motion of our body.

What can we do to eliminate those missing links that prevent you from full recovery and having you coming back for the same hip injuries in a few week/months’ time?

The key is to go beyond the standard hip rehabilitation of the holy trinity”, identify your missing links to a pain free hip, and eliminate those weak links. 

At Gentin Physio, we are committed to a new approach of the 6 steps to success program to help you to identify your missing links, treat any issues related to your hip injuries and guide you through with a personalised rehabilitation program based on your condition.

Step 1

Functional Examination and differential diagnosis.

Step 2

Address the faulty biomechanics elsewhere in the kinetic chain.

Step 3

Functional joint mobilisation and soft tissue release to free up the symptomatic and overloaded structure.

Step 4

Increase the mobility and flexibility throughout the kinetic chain.

Step 5

Functional local muscle activation and strengthening in the hip region to address the imbalance between muscle groups.

Step 6

Core strengthening and globe muscles (above and below the hip) conditioning.