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.

Using Functional Screening to understand YOU!

“You can't put fitness on dysfunction” – Gary Cook

We all want to be able to move, feel and perform at our best, and we don’t want niggling injuries to hold us back, taking us out of doing the things we love, from walking to lifting weights. As human beings we have a tendency to ignore these issues or find the easiest way to avoid pain, causing other compensations on out body. But what if there was a way to help us avoid this set back, a way to have the ultimate success, ease and function in every day life and training.

Well maybe there is? In my opinion, having strong fundamentals are the key to success for any athlete, amateur or elite. What they do is help set a strong foundation to build on. These foundations begin with basic human movement that we use everyday that can become challenged as we progress into more difficult tasks, such as physical activity.

The challenge arises when moving from basic function to the next level, whatever it may be. Its human nature to take the ‘easiest path’ and by doing this we can place extra strain and stress on our bodies, increasing the risk of injury, especially if we don’t have the fundamentals on point.

Why do we train? Fat loss, muscle building, toning, health, performance enhancement. No matter what the reason, our first concern should be injury prevention. WHY? If you are injured then none of these goals matter, because you can’t train.

This is where the Functional Movement Screen (FMS) becomes an important tool in the fitness industry. The Functional movement screen is a concise way to screen individual’s movement before they train. Individuals are assessed on a baseline movement guide. By correcting baseline movements through methodical corrective exercises strategies, injury can be reduced.

So what does this FMS thing do:

  • Screening tool used to identify limitations or asymmetries of seven fundamental movement patterns.
  • The movements combine mobility and stability by placing an individual in extreme positions where weaknesses and imbalances become obvious. The system provides objective, reliable and reproducible outcomes
  • Provides a greater awareness to individual and their trainers on the importance of fundamentals to prevent injury before progressing to the next level.
  • Once dysfunction is reviled and methodical exercise strategy can be applied to correct the problem.

Who is it for?

The FMS is useful for all healthy, active or inactive people who are looking to increase their physical activity.

Take home message:

  1. Find out how, where and why your own body moves or doesn’t move!
  2. Identify potential risk of injury.
  3. Establish an exercise program specific for YOU.
So find out about you, because once you do, maintaining it is so much easier!


Foot Orthotics

In addition to manual therapies, foot orthotics play an important role in a podiatrist’s tool kit for best practice treatment plans and individualised patient care. Every patient has different gait patterns (biomechanics), weight, height, footwear andactivity – therefore results can vary, as do orthotics.

Podiatrist should discuss the full range of benefits that come with orthotics – including fit, comfort and durability. Consumers should also discuss the option of customise versus off the shelf orthotics with their podiatrist, so there is a greater understanding of the individual benefits.

What Are Foot Orthotics?

Also known as orthoses, orthotics are orthopaedic devices designed to support, align or improve the function of the foot or the whole body. There are two types of orthotics – off the shelf or customise. Custom made orthotics are prescribed to treat or correct the patients individual pathologies – much like prescription glasses. Orthotics should not be used in isolation, but as part of an overall treatment plan prescribed by the podiatrist.

What Are The Benefits?

Orthotics can provide pain relief by redistributing the pathological loads away from symptomatic areas. Orthotics also can help to realign the posture to alleviate pain in the feet, ankles hips
and knees.

Who Wears Orthotics?

Orthotics can be used to treat some acute sports injuries of the lower limbs such as;

  • Strains
  • Sprains
  • Tears
  • Acutely inflamed tendons
  • Fractures

They are also used to provide relief from pain caused by chronic conditions such as;

  • Osteoarthritis
  • Rheumatoid Arthritis

Orthotics can also relive pain from foot deformities such as;

  • Bunions
  • Claw Toes
  • Neuromas
  • Bursitis

In addition, Orthotics may be used for paediatric conditions such as;

  • Toe Walking
  • In-Toeing (“Pigeon Toes”)
  • Out-Toeing
  • Flat Feet
  • Severs