Hip

Snapping hip syndrome presents as a noticeable and audible snapping in the hip area during movement. In most cases, a snapping hip is harmless and is typically not accompanied by pain. We usually hear tight movements of the tendons or fibres of the iliotibial band over bony prominences and bony processes. The snapping sensation is annoying and uncomfortable, often occurring after prolonged forced postures and disappearing when the soft tissues warm up during movement. Snapping in the hip, which is a result of friction of soft structures, is more typical of the active population and is reduced with physical therapy, correcting muscle asymmetries, and relaxing shortened muscles.

Snapping hip is most often caused by a tight passage of the iliotibial band over the greater trochanter of the femur (femur). When you stand upright with your leg extended, the line of the iliotibial band runs behind the greater trochanter of the femur. When you bend the hip and knee joints, the iliotibial band slides over the greater trochanter of the femur into its anterior region. Snapping is also often caused by the tendon of the iliopsoas muscle, which runs across the hip joint, or the tendon of the rectus femoris muscle, which flexes the hip joint and slides over the greater trochanter of the femur during hip extension.

In rare cases, a snapping hip can also be the result of cartilage injury or loose cartilage fragments that move within the joint space and disrupt its natural mechanics. In this case, the snapping is often accompanied by pain and catching in the joint. A snapping hip can also be the result of bone damage injury and loose bone fragments moving within the joint space and disrupting its natural mechanics. A snapping hip can also be caused by acetabular labrum injury, which is accompanied by pain, swelling, limited mobility of the hip joint, and catching of the hip joint.

If pain and catching of the hip joint occur during snapping, we recommend a diagnostic magnetic resonance imaging (MRI) scan and avoiding activities that aggravate the symptoms. Physical therapy and kinesiology training should be the first solutions in the management of snapping hip syndrome, even in cases of mild pain. The treatment of injuries that cause greater limitations in the hip joint in the case of a snapping hip is described below under other injuries.

It is important for the hip joint to be normally developed. The acetabulum (joint socket) must be deep enough and correctly positioned so that pressures in the hip are minimal during loads. A too deep acetabulum and a non-round shape of the femoral head can mechanically impede intra-articular movement in the hip. Anomalies in the development of the head and neck of the femur or acetabulum (joint socket) pose a risk of injury and early wear and tear of the hip. Developmental dysplasia of the hip (DDH) is one of the most common abnormalities in the development of the locomotor system.

Hip dysplasia encompasses various abnormalities in the anatomical relationship between the head and neck of the femur and the acetabulum, ranging from joint instability, incomplete dislocation (subluxation) and dislocation (luxation) to delays in ossification or an irregularly shaped acetabulum (acetabular dysplasia).

The incidence of congenital unstable hips is 2.5%, with 8 out of 10 cases developing to a normal state without treatment. Hip dysplasia is three times more common in women than in men and is the most common cause of hip arthritis in women under the age of 40. Developmental hip dysplasia is the cause of 10% of total hip endoprostheses. Congenital hip dysplasia has a hereditary effect of a tendency towards improper development of the hip socket or laxity of the joint capsule. Half of patients with hip dysplasia also have a poorly developed other hip joint. Patients with untreated hip dysplasia have a significantly higher risk of developing early wear and tear of the joint.

An early symptom of hip dysplasia is a feeling of fatigue after exertion, such as after long walks. At first, the problems are occasional and mild, with increasingly severe groin pain and subsequent limping occurring later. Pain at rest can be a sign of joint wear.

Early symptoms are characterised by specific pain that only occurs at certain angles, with the entire repertoire of movement patterns of the hip joint later becoming symptomatic. A dysplastic hip is characterised by abnormal or increased mobility compared to a healthy hip, usually in external rotation, with associated reduced mobility in flexion and internal rotation. In some patients, the femoral head may slip out of the joint during movement.

Dysplasia of the hip joint is more common on the left side, usually the leg is slightly longer on the affected side, which can also cause abnormal walking and running patterns.

Early recognition and starting treatment of developmental hip dysplasia as early as possible are essential for a good prognosis for rehabilitation.

When deciding on the method of treatment, clinical, anatomical, and biomechanical conditions in the hip joint are considered; for assessing the latter, the Wiberg angle of lateral coverage of the femoral head has become an important parameter in clinical practice. Based on the Wiberg angle, a method is proposed for assessing hip dysplasia parameters from standard anteroposterior X-ray scans.

Early recognition and starting treatment of developmental hip dysplasia as early as possible are essential for a good prognosis for rehabilitation. ​

​Conservative training is necessary to strengthen the hip joint stabiliser muscle and to strengthen the key muscle in all directions of hip joint movement.

​In the late stages of hip dysplasia, physical therapy with kinesiology training plays a key role in preventing muscle atrophy and accelerating recovery after surgical treatment.

Hip bursitis is an inflammation of a bursa, small sacs located between a tendon and a bone. Bursae reduce friction between tendons, muscles, and other joint structures and improve joint mechanics, resulting in smoother movement.

Hip bursitis is also called trochanteric bursitis. The hip bursa is located on the outside of the hip joint, between the greater trochanter and the iliotibial tract.

​Hip bursitis is more common with age and, due to the larger angle between the femur and the vertical line, it more often affects the female population. The cause of hip bursitis is unknown, but risk factors include chronic physical overload, such as running, and traumatic injuries to the hip joint.

The acute form of hip bursitis usually occurs after high exertion or specific loads. The hip bursa can also become inflamed due to muscle imbalances, stiff muscle groups and/or ligaments, incorrect biomechanics of walking, and/or poor pelvic and trunk stability. Chronic hip bursitis that lasts for several months is usually related to previous, repeated traumatic injuries to the hip.

Inflammation of the hip bursa causes severe pain that seemingly comes out of nowhere, initially only occurring while running, walking up stairs, or during activities that involve intense movement in the hip. The pain can spread from the hip joint down the leg to the level of the knee. Pain symptoms usually appear gradually and can become chronic. As symptoms progress, hip mobility decreases, and pain becomes present even when walking on flat ground, sitting for long periods of time, and chronically at rest.

A reliable diagnosis is made through clinical and palpation tests performed by an orthopaedist and/or physiotherapist. An X-ray scan is used to rule out bone fractures, while magnetic resonance imaging (MRI) is not necessary in cases of suspected hip bursitis, except in cases of atypical symptoms and uncertainty about the diagnosis.

Treatment includes therapy with nonsteroidal anti-inflammatory drugs and systematic individualised physical therapy. Activities that place excessive strain on the hip (running and rapid changes of direction), impacts and pressure on the outside of the hip should be avoided.

Conservative treatment is recommended, which includes specialised exercises to correct asymmetrical hip muscles, exercises to strengthen the hip stabiliser muscles, and therapeutic techniques such as friction massage, laser therapy, and magnetic therapy.

In rare cases, steroid injections and surgical treatment are also used to treat advanced forms of hip bursitis. If hip bursitis is not treated, it can lead to calcium deposits in the soft tissues in the long term, and thus permanent impairment of the joint. With appropriate conservative physical therapy, most patients’ symptoms improve within 6 to 12 weeks.

The acetabular labrum is a ring of cartilage that surrounds the socket of the hip joint, thereby increasing the articular surface of the socket (acetabulum) and improving the stability of the entire joint. The cartilaginous labrum in the hip acts as a rubber seal, holding the head of the femur firmly in the acetabulum of the hip and providing negative pressure, thereby reducing forces between the head and the socket of the hip joint, which slows down the wear of the cartilage.

Hip labrum injuries are rarely isolated, in most cases they are an associated consequence of another hip pathology, such as hip impingement syndrome (FAI), developmental dysplasia of the hip or degenerative disease, which are predominantly the result of congenital anatomical anomalies of the articular surfaces of the acetabulum and femoral head.

The cause of hip labrum injury can also be trauma, such as a fall or collision to the hip, chronic overload of the hip with large quantities of external rotation and hip hyperextension, as is common in certain sports (ballet, football), and psoas tendon impingement. There is a high correlation between hip labrum injury and early onset of hip arthrosis. Injuries to the anterior, lateral anterior, superior or lateral superior and anterior medial regions of the labrum are the most common compared to injuries to other surfaces of the labrum.

Many injuries to the hip labrum remain present without distinct symptoms and can primarily cause gradual degenerative changes to the cartilage surfaces at the site of labrum injury, which become symptomatic over a longer period of time.

Acute symptoms of a hip labrum injury include pain in the groin area, in the anterior of the hip, and deep in the joint, which becomes more intense after prolonged walking and generally after static sitting and standing postures. As many as 55% of individuals with groin and anterior hip pain suffer from a hip labrum injury. Acute signs of hip labrum disorders also include catching of the joint and clicking sounds when performing hip movements, instability of the joint, occasionally a feeling as if “something is caught” in the joint, characteristically reduced mobility and stiffness of the joint, and movement restrictions occurring with larger tears.

n injured hip labrum does not have the capacity to self-regenerate, so correction of the cartilage tissue can only be done through surgical treatment. Most minor hip labrum injuries without intense symptoms are treated conservatively with physical therapy and specialised training for hip stabiliser muscles, maintaining muscle symmetry and local endurance of the hip muscles.

With minor injuries to the hip labrum, it is possible to completely avoid surgery or extend the time until surgery with appropriate lifestyle management and conservative treatment. In addition to those already listed, weight loss and improving movement patterns play an important role in conservative treatment.

Surgical treatment of hip labrum injury is performed with minimally invasive arthroscopy of the joint when conservative treatments do not improve acute symptoms or when there is major damage to the hip labrum surfaces. Arthroscopic surgery removes damaged parts of the labrum from the joint and grinds away potential osteophytes or bone outgrowths that limit movement in the joint; in case of a larger tear, the damaged area is re-fixed to its original position with anchors.

When the damage to the hip labrum is extensive, total removal is recommended. Before surgery of a labrum injury with hip arthroscopy, a three-month preoperative specialised training programme is recommended to strengthen neuromuscular connections, improve the regeneration capacity of the hip muscles, and build a “store” of muscle mass that will accelerate postoperative rehabilitation. Full recovery after arthroscopic hip surgery depends on the associated injuries and the functional condition of the hip muscle groups, and is usually completed by the sixth postoperative month if physical therapy and training were performed progressively and systematically.

With minor injuries to the hip labrum, it is possible to completely avoid surgery or extend the time until surgery with appropriate lifestyle management and conservative treatment.

Arthroscopic surgery removes damaged parts of the labrum from the joint and grinds away potential osteophytes or bone outgrowths that limit movement in the joint; in case of a larger tear, the damaged area is re-fixed to its original position with anchors. When the damage to the hip labrum is extensive, total removal is recommended.

​Before surgery of a labrum injury with hip arthroscopy, a three-month preoperative specialised training programme is recommended to strengthen neuromuscular connections, improve the regeneration capacity of the hip muscles, and build a “store” of muscle mass that will accelerate postoperative rehabilitation.

Hip wear is defined as wear of the cartilage that is located inside the joint and surrounds/protects the bones. It is a medical condition that most often occurs due to degenerative changes that occur in the body due to age.

It also occurs as a result of traumatic injury (such as a fracture) that involves damage to cartilage, genetic predisposition, and being overweight (increased load on the joint).

When wear advances, it is felt as sharp pain, reduced range of motion, reduced mobility, decreased muscle strength, and a feeling of stiffness in the joint.

The hip joint is one of the largest joints in the body, connecting the pelvis to the thigh bone. The joint is anatomically structured to allow a large range of motion while simultaneously ensuring stability during movement and load transfer.

Static stability in the hip joint is additionally provided by the ligaments that surround it, while dynamic stability is provided by the muscles that perform the movement.

Did you know that articular cartilage does not have a blood supply? This means that it does not regenerate in the same way as other tissues, but regenerates with the help of synovial fluid.

Synovial fluid supplies the cartilage with nutrients, enables easier joint movement, and reduces the friction that occurs within it.

Treatment begins with a diagnostic examination, where the physiotherapist diagnostician gathers information about the medical history, duration of the problem, and degree of hip wear.

First, we conduct an initial interview (in-depth medical history), where we enquire about the history of your problems, the duration of the pain, any genetic predisposition, and the presence of other diseases.

This is followed by a clinical examination, where a physiotherapist diagnostician performs inspection and palpation (temperature, colour, skin perspiration, potential swelling, inflammation, or loss of muscle mass).

Passive mobility measurements are performed, where the movement is performed by the diagnostician, as well as active mobility measurements, where the movement is performed by the patient.

We perform muscle strength tests, which provide information about muscle strength and endurance, as well as ratio in muscle function.

Comprehensive treatment at MEDICOFIT physiotherapy clinic, Ljubljana, consists of different phases that are closely connected to each other – it begins with a diagnostic examination, acute physiotherapy, and continues with post-acute kinesiology and a post-kinesiology programme.

We perform active physiotherapy, where each patient is actively involved in their comprehensive treatment process, which is continuously adjusted according to the patient’s progress.