Hip pain, tendonitis and bursitis; Do you need therapy, a better diagnosis or a better overall approach to resolve the problem?
Tendonitis or tendonosis of the hip is a common diagnosis patients are given by their doctors, yet so many people find that the traditional therapy of exercises and massage does not resolve their problem and may even aggravate it. Some people have even had this called bursitis, however, if the reason behind why your hips are painful is not addressed, the therapy is not likely to have any long term effectiveness. It is far more common in females than males, probably due to the fact that females often have wider hips.
Typical symptoms associated with tendonosis of the hips may include hip pain in one or both hips that may be relieved with a pillow between the knees when side sleeping, back pain, calf cramps, knee pain and balance problems. Squatting down is often unstable and painful, with tightness around the knees and many of these patients have wider hips.
Traditionally, most doctors are taught to assess your symptom and find a therapy to treat it. Some offer medications to reduce inflammation which rarely work and usually upset your stomach(1). Pain medications are also often recommended but we are merely trying to get temporary relief, and non steroidal anti inflammatory pain meds will inhibit healing so long term, they are a poor idea.
There are some natural foods such as Turmeric that has curcumin as the active ingredient. This is known to decrease inflammation naturally and is likely safer than most prescription and non prescription medications, however, it can thin the blood so be aware of this when taking blood thinners.
Omega 3 fatty acids taken in the right dosages also reduce pain in higher dosages.
Now that we discussed pain relief, we need to understand that pain relief is what we want, but it is not what we are going to get if we do not figure out why the hip (s) are painful.
The most common reason for hip tendonosis is a chronic problem with how you walk, and the gait system. Technically, tendonitis is an acute injury so if you strain the tendons in a muscle, the term tendonitis is correct. If you developed the problem gradually, there is most likely a mechanical basis for the problem. Since tendonosis is a mechanical problem, it requires a mechanical solution. While medications may offer some relief, they will not fix a mechanical problem, and if exercises continue to strain the dysfunctional area, you are likely to hurt more after doing them if your problem has not been diagnosed correctly.
The most common reasons for a chronic painful hip can include
A. Bowlegged – People who are bowlegged will often load the outside of their legs more than those who are not.
B. High arches – Patients who have high arches, also known as supinators are also likely to load the lateral leg.
C. Women who have wide hips and are built asymmetrically are more likely to suffer from hip pain due to the stress the wider hips place on their overall structure.
The problem has to do with a structure called the fascia lata. Originally, a thick band of tissue along the lateral side of the thigh that extends from the Tensor Fascia Lata, a muscle next to the hip was thought to be the cause but recent study of the fascial system suggest that the fascia lata actually extends all the way down the leg to around the ankle.
Many patients have been told through various sources to stretch the tissue which can sometimes take tension off of the tendon insertion by the hip. The problem is that the relief if any is temporary and it does not address why the tensor fascia lata is always tight.
Foam rolling the Tensor fascia can often be quite painful and may offer temporary relief, requiring multiple painful applications that have limited long term effectiveness.
Is the problem really because we are tight, or is there a mechanism that must be addressed first so we no longer continue to tighten? There are quite a number of treatments that are chasing a problem such as tendinosis, however, most of them cannot possibly work because, just as the anti inflammatory methods, it is not addressing the mechanism of why you hurt.
Exercises for the core are also a popular way of addressing a painful hip with tendonosis however, again, without an understanding of why the hip is painful, the exercises may not get to the source of why you hurt, and help you resolve the mechanism behind the problem.
Good results with treating tendonosis of the hip begins with how we understand the problem. Treating where you hurt (the hip) rather than why you hurt (the mechanism of pain) seems to be a disease that is pervasive in healthcare. We as healthcare practitioners need to look at you, how you walk, how you move, and what your body style is like.
Effective care begins with an effective evaluation. Our active exam begins with looking at you, your hips, how your body is shaped.
Can you do a squat without falling over?
Do you have high arches, flat feet, are you built asymmetrically?
Do you have a history of lower and upper back problems?
Can you get out of a chair easily or do you need to push on your seat to help you get out of the seat. These are all signs that your core is ineffective, which will load the legs and cause them to tighten.
Finding the path that is right for you.
We are not widgets and human beings come in all sorts of shapes and sizes. This is why the approach of throwing therapies at a problem usually fails miserably. Unfortunately, this approach of hit and miss is the norm, not the exception to the rule.
If your gait or your feet are making your pelvis un level, this will strain the fascia lata which will tighten up, and will cause pain at the insertions, which is what your healthcare practitioner is calling bursitis, tendonitis or tendonosis.
Foot orthotics can offer not only relief but marked improvements in the way we walk and move. Foot drill exercises can improve the strength of the intrinsic muscles in the calves and feet, which are important in stabilizing the pelvis and the muscles in the buttock.
The treatment should have a goal of improving the stability of the pelvis and core, which will reduce the strain on the lateral legs which ultimately caused the problem in the first place.
Effective treatments can include
Myofascial Release or Active Release Techniques (r) which is a well accepted style of performing myofascial release treatment.
Instrument Assisted soft tissue treatment such as Graston to the hips, calves and the fascia lata.
Exercises are necessary to reeducate the pelvis and if necessary, improve the gait system and the way it works when you walk.
Manipulation of the extremities and pelvis restores normal movement patterns. Chiropractors are your best source for this type of service.
Foot orthotics help level the pelvis and allow us to change the rules. Some us are born with poor body mechanics that will ultimately cause painful conditions such as hip pain. Here is one of the ways to cheat the system.
Read Cheating Mother Nature, what you need to know to beat chronic pain (2). It will help you understand why you hurt, so you can make better choices on where to and how to get relief.