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Groin Pain – Blog by Kara Giannone

The story of Osteitis Pubis…

Osteitis Pubis (OP) was a very fashionable diagnosis in Australia for a very long time. It seemed every footballer with chronic groin pain was diagnosed with OP. You may be reading this thinking “I had OP, it must exist!”. However in fact, the labelling of OP was far from correct. As many of you will know, the term “itis” refers to inflammation and therefore Osteitis Pubis is suggesting that this is an inflammatory condition of the pubic bone. However, studies involving biopsies of patients diagnosed with OP have in fact revealed no inflammatory markers present. In fact, what we now know is that rather than inflammation, there is a stress response occurring in the pubic bone, similar to that which one may get in a stress reaction or stress fracture.

A funny story came out of the AFL recently, where an Adelaide Crows Footballer was seen reporting to media that he had OP. Meanwhile, coaches were reporting to the media that this player had pubic related groin pain – both parties talking about exactly the same injury, however using different terminology. Quite hilariously, the media went into a frenzy spinning a story that there was conflict within the Adelaide Crows as players and coaches were not in agreement. Maybe the media reporting this story should read this blog hey!

So I’m sure you’re thinking…“I’ve got pain in my groin and if it’s not OP, what is it then?”

Well, turns out pubic joint pain is only one small piece in a large puzzle that can lead to groin pain.

In 2014, the medical experts came together in Doha and decided on universal terminology. They concluded that groin pain should be classified as one or a combination of the following:

  1. Adductor-related groin pain
  2. Pubic-related groin pain
  3. Iliopsoas-related groin pain
  4. Inguinal-related groin pain (which includes abdominal related groin pain)
  5. Hip-related groin pain

 

So, what does this all mean?

The groin is a very complex region of anatomy as shown in the image above. As a result, pain in the groin can be referred from multiple structures. Thanks to the Doha agreement outlined above, we have universal understanding that groin pain can be referred from a wide range of structures including muscles such as the adductors, hip flexors (Iliopsoas) or abdominals and from joints including the hip joint and pubic bone joint.

So what should you do?

If you are suffering from groin pain, it is integral to determine what structure is causing this pain as this will guide treatment. Our physiotherapists are trained in assessment of a wide range of musculoskeletal conditions including groin pain. During this consultation, our physiotherapists will assess:

  • Posture
  • Gait
  • Biomechanics
  • Tenderness via palpation
  • Strength, endurance, power and flexibility – particularly of abdominals, adductors and Iliopsoas
  • Joint integrity – particularly of the hip joint and pubic bone joint

Following this assessment, our physiotherapists will ascertain the cause of your groin pain and treat you accordingly.

What will treatment involve?

It is paramount that any muscle deficits in terms of strength, power, endurance and flexibility are addressed. Therefore, a graduated exercise based rehabilitation program must be at the core of intervention. In addition, treatment of groin pain may include, but is not limited to:

  • Education regarding pain management and load management strategies
  • Soft tissue mobilisation
  • Taping
  • Dry needling
  • Sport (or activity) specific training

So if you’re experiencing groin pain make an appointment below at one of our clinics at Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray

Book an appointment today for your assessment!

 

Snapping Hip Syndrome (Dancer’s Hip) – Blog by Alice Smith

What is it?

Snapping hip syndrome (SHS) is a condition that is defined by a snapping or popping sensation in or around the hip when it is moved in a certain direction. It is most commonly felt when walking, getting up from a chair and swinging your leg around. The sensation occurs when a muscle or tendon moves over a bony protrusion in your hip. There are various causes of SHS and there a thorough examination is required. Some people do not experience pain or dysfunction with the sensation, whereas others report pain and weakness which interferes with their hobbies. In some cases, snapping hip leads to a painful swelling of the fluid- filled sacs that cushion the hip called bursitis.

Snapping hip is believed to affect 5% of the population and is most commonly found in females between the ages of 15 to 40 years old. Sports which involve repetitive hip movement forwards and backwards can lead to this condition. This overuse injury is most commonly seen in dancers, soccer players, runners and gymnasts.

Causes:

The “snap” sensation experienced may be a result of the iliotibial band snapping over a structure on the outside of your hip called the greater trochanter. Some patients describe the sensation of the hip popping in and out of the socket or dislocating. This is however, not what is occurring. The symptoms develop gradually and without a traumatic incident.

Alternatively it can be caused by the iliopsoas tendon snapping over a bony area of the pelvis. This is a muscle located predominantly at the front of pelvis. Patients describe a deep “clunk” or “click” that can be illicit by extending the hip or rotating it out to the side.

Least commonly, it can be the result of a cartlidge tear or loose body in the hip which also leads to the hip “locking up”. This cause of SHS is normally a result of an injury or traumatic event to the hip.

Examination:

During your assessment, your physiotherapist will obtain a detailed history from you about your hip symptoms to rule out any other conditions. You physiotherapist will then perform specific tests on your hip to determine the exact location and cause of the snapping hip sensation. For example, often in dancer’s a deep plie can illicit the hip snap sensation, and therefore they will be asked to perform this movement during the assessment. Ultrasound or MRI can be advised if your physiotherapist is concerned about internal hip pathology.

Management:

The first line of treatment for this condition involves reducing pain with rest, ice, non-steroidal anti-inflammatories if required and physiotherapy. Once your pain has settled, physiotherapy management then aims to address specific impairments such as a tight hip flexor muscle in order to fix imbalances which may have led to this condition. In this cause management will include stretching of the front of your hip to lengthen the muscle combined with strengthening exercises and pelvic stabilisation exercises. You will also be educated to avoid the positions and movements which cause your symptoms and aggravate your pain.

If you are experiencing snapping hip syndrome, please contact us so we can help you out with a comprehensive assessment and treatment plan.

Book an appointment today for your assessment!

Blog by Alice Smith (Physiotherapist)

Femoroacetabular Impingement

What is Femoroacetabular Impingement?

Femoracetabular Impingement (FAI) is a hip condition that occurs when the ball (femoral head) and socket (acetabulum) rub abnormally creating damage to the hip joint. The damage can occur to the articular cartilage (smooth white surface of the ball or socket) or the labral cartilage (soft tissue bumper of the socket) resulting in painful hip movements. Research suggests that there is an association with FAI and development of hip osteoarthritis.

Types of Femoracetabular Impingement

cam lesion

Cam Type

In Cam type FAI the usually spherical femoral head (ball) is abnormally shaped resulting in jamming of the femoral head against the rim of the socket (acetabulum).

This type of FAI is most commonly seen on young athletic men.

Pincer Type

In Pincer type FAI bone spurs formed on the end of the cartilage on the socket of the hip joint (acetabulum) cause painful pinching during activities where the hip is flexed. This occurs in the area of the thigh bone (femur) just below the ball, called the neck of the femur, may bump into the rim of the socket. This type of impingement is more commonly seen in middle aged women.

Mixed Type

In many cases there is a combination of both Cam and Pincer impingement and this is called mixed impingement.

What Causes Femoracetabular Impingement?

FAI occurs when the hip bones do not form normally during childhood. Over time the deformity of a cam bone spur, pincer bone spur, or both, leads to joint damage and pain.

Studies suggest that many people who have no symptoms of hip impingement show findings of FAI on X-Ray. This suggests that the hip needs to be aggravated in some way for symptoms to develop and this explains the tendency for athletes, sporting professionals and active people to be more susceptible to this form of injury.

Sports that may commonly aggravate FAI include: gymnastics, cycling, football, soccer and dancing.

Symptoms

  • Pain is typically felt deep in the groin (at the front of the hip) but may be felt to the side of the hip or in the buttock.
  • Restricted or painful range of hip motion
  • Onset is often insidious, and may be associated with increased activity.
  • Onset can be acute or following injury.
  • Typically pain is provoked by: prolonged sitting, walking, crossing legs, getting in and out of the car and pivoting in sports.

Diagnosis

Assessment of hip pain involves the physiotherapist taking a case history and then performing a thorough physical examination. This will include assessment of functional activities such as walking and sitting as well as range of motion, strength and screening of other joints including the lumbar spine.

In the clinic the most accurate test to diagnose FAI is the hip impingement test. This test involves the physiotherapist moving your hip into hip flexion, adduction and internal rotation. A positive test occurs when pain is reproduced.

Your physiotherapist may also refer you for a radiograph (X-Ray) or MRI of your hip to confirm the diagnosis of a FAI.

Treatment

In most patients it is recommended that a period of conservative (non-operative) management is trialled before considering surgical correction.

Techniques your physiotherapist may use to help treat this injury include:

  • soft tissue massage and joint mobilisation
  • dry needling
  • the use of crutches (if the pain is very severe)
  • ice or heat treatment
  • biomechanical correction (e.g. the use of orthotics)
  • activity modification advice
  • weight loss advice where appropriate
  • education
  • progressive exercises to improve flexibility, balance and strength
  • clinical Pilates, hydrotherapy or gym based rehabilitation
  • a gradual return to running program
  • a gradual return to sport or activity program

Your physiotherapist may also recommend you consult your doctor for advice regarding anti-inflammatory medication and pain killers to help manage your pain, particularly in the early stages.

Hip Surgery for Femoroacetabular Impingement?

If a period of conservative management fails to improve your symptoms then a referral to an orthopaedic surgeon may be indicated. You will need to see your GP for a referral to an orthopaedic surgeon.

Surgical treatment for FAI is most commonly performed arthroscopically, but sometimes involves open debridement. Surgery for FAI aims to correct any bony abnormalities to the ball or socket of the hip joint as well as repairing any associated labral tear.

Following surgical correction of FAI you will need to undergo a supervised rehabilitation program with your physiotherapist.

Your rehabilitation time will depend on the level of activity you wish to return to but most patients resume normal activities after FAI surgery within six weeks. Full recovery and return to sport will be guided by your surgeon and physiotherapist and may take up to six months. Studies show that 80-90% of patients return to athletic activity after surgery.

For more advice about femoroacetabular impingement, book now with one of our Physiotherapists at Total Physiocare!

Post compiled by Claire Devos (Physiotherapist)