HIP
Femoral acetabular impingement
What Is It?
From an osteopathic perspective, femoroacetabular impingement (FAI) is a condition in which abnormal bony growths, or spurs, develop on the bones that form the hip joint. This disrupts the normal congruency between the ball (head of the femur) and socket (acetabulum), leading to friction, irritation, and discomfort during various movements. The hip joint, a crucial weight-bearing structure, relies on smooth articulation between its components for optimal function. When FAI occurs, this smoothness is compromised, resulting in restricted range of motion and pain, particularly during activities that involve deep hip flexion or rotation.
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Osteopathic principles highlight the importance of joint alignment and fluidity of movement. FAI disrupts the body’s natural mechanics, causing not just localized pain but also affecting the biomechanics of surrounding structures, leading to compensatory patterns in posture and gait.
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How Does It Present?
FAI commonly presents with discomfort or sharp pain at the end of certain ranges of motion, particularly during hip extension (moving the leg backward) and medial (internal) rotation. These movements may cause a pinching or catching sensation in the hip, particularly after prolonged periods of sitting, walking, or during sports activities that require deep hip flexion, such as squatting or running. The severity and specific symptoms often depend on the type of impingement—whether it's the "cam" type, affecting the femoral head, or the "pincer" type, which involves the acetabular socket. Pain may also radiate to the groin, thigh, or buttocks, and stiffness or reduced mobility in the hip joint is common.
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Why Has It Happened?
FAI results from abnormal bone growth over time, which can occur due to various factors such as repetitive stress, overuse, genetic predispositions, or improper healing after a hip injury. There are two main types of FAI:
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Cam impingement occurs when there is an irregular shape or excess bone growth on the head of the femur (the ball of the hip joint). This creates friction between the femur and the acetabulum during movement.
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Pincer impingement happens when the acetabulum (the socket) has excessive bone growth, leading to compression of the femoral head.
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In some cases, both types of impingement may be present simultaneously, leading to a more pronounced limitation of movement. These bony growths can develop over time and may be exacerbated by high-impact activities, poor posture, or inadequate joint alignment.
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How Can We Help?
Osteopathic treatment for FAI focuses on restoring balance and mobility to the hip and surrounding structures. A key aspect is identifying and addressing compensatory patterns that have developed due to the body’s attempt to accommodate the impingement. Osteopaths may use a combination of gentle manipulative techniques, soft tissue massage, and stretching to relieve tension and improve range of motion.
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Strengthening the muscles that support the hip joint, particularly the deep stabilizers such as the gluteal and core muscles, is crucial in maintaining joint integrity and alleviating symptoms. Tailored exercises aim to improve flexibility, reduce stiffness, and enhance stability, allowing for better joint function without aggravating the condition.
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Additionally, osteopathic practitioners will provide lifestyle and ergonomic advice to minimize strain on the hip joint during everyday activities. Homecare exercises will be prescribed to support the healing process and help prevent future exacerbations. In cases where conservative management is not enough, surgery to remove the bony outgrowth might be considered, but osteopathic care can often play a supportive role in post-surgical rehabilitation by aiding in the restoration of movement and strength.
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Holistically, osteopathy aims to not only treat the symptoms of FAI but also to enhance overall mobility and wellbeing, helping patients regain pain-free function and maintain it in the long term.
Trochanteric bursitis
What Is It?
From an osteopathic perspective, the femur, or thigh bone, has two key bony landmarks at its upper, or proximal, end known as the greater and lesser trochanters. These prominences serve as important attachment points for various tendons and ligaments that support and stabilise the hip joint. The greater trochanter, in particular, is associated with a bursa, a small sac filled with synovial fluid, which helps to cushion and reduce friction between the muscles and tendons as they move over the bone. Bursae are present in many joints throughout the body, and when they become irritated or inflamed, the condition is known as bursitis.
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How Does It Present?
Greater trochanteric pain syndrome, often linked with trochanteric bursitis, typically manifests as pain on the outside of the hip, especially over the greater trochanter. Sitting with your legs crossed can trigger discomfort due to increased pressure on the trochanter. You may also experience pain when rising from a seated position or while lying on the affected side, as both positions put stress on the inflamed area. The pain can radiate down the outer thigh and may worsen with physical activities like walking, running, or climbing stairs.
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Why Has It Happened?
This condition is commonly seen in runners and athletes, particularly those who run on flat, unbanked surfaces or exhibit improper running mechanics, such as excessive inward rotation of the foot, causing the toes to cross the midline with each stride. This repetitive movement places added strain on the hip's soft tissues and the greater trochanter. Individuals with genu valgum (where the knees naturally angle inward when standing) are also predisposed to increased pressure on the greater trochanter. However, bursitis can develop in sedentary individuals as well, particularly from prolonged pressure or irritation, direct impact to the hip, or friction caused by poor posture or awkward movements.
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How Can We Help?
As osteopaths, we take a holistic approach to addressing hip pain by examining the interconnectedness of the hip, knee, ankle, and foot mechanics. It's essential to understand how these areas function together as part of the body's overall movement system. We would assess your posture, gait, and any muscle imbalances to identify the underlying causes of your discomfort. Once imbalances are recognised, we can work to correct them using manual therapy techniques, such as soft tissue manipulation, joint mobilisation, and specific exercises aimed at restoring balance and proper function. This approach not only helps relieve pain but also addresses the root of the problem, reducing the risk of recurrence.
Osteoarthritis
What Is It?
As we age, it is common for degenerative changes to occur in our joints, particularly in weight-bearing areas such as the hips. This process, known as osteoarthritis, involves the gradual thinning of the cartilage that cushions the joint surfaces. When the cartilage wears away, it can lead to inflammation, stiffness, and pain, though the severity of symptoms can vary greatly between individuals. Some people may experience little to no discomfort, while others may find their mobility and overall quality of life significantly affected. Osteopathically, this condition is seen as part of the body’s natural ageing process, but one that can be managed and supported with appropriate care.
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How Does It Present?
Osteoarthritis of the hip often presents with stiffness, discomfort, or pain, particularly during certain movements such as walking, bending, or standing after long periods of rest. The symptoms can be worse in colder weather, as cartilage has a limited blood supply, and warmth encourages better circulation and healing. You may also notice a reduction in your range of motion or a feeling of tightness around the hip. Pain may radiate to the groin, thigh, or even the knee, reflecting the interconnected nature of the body’s musculoskeletal system, which osteopaths take into account during treatment.
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Why Has It Happened?
Joint degeneration is a natural part of ageing, though the degree to which it affects each individual can vary depending on factors such as lifestyle, posture, and activity levels. Poor movement patterns, long-term postural strain, and previous injuries can accelerate the wear and tear on the hip joint. From an osteopathic perspective, this degeneration is not an isolated problem but often part of a larger biomechanical picture, where surrounding muscles and joints may also contribute to the condition. Addressing these contributing factors early can help slow down the progression and manage symptoms effectively.
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How Can We Help?
Osteopathic treatment can play a vital role in managing hip osteoarthritis. By focusing on improving the mobility of the hip and surrounding structures, osteopaths can help reduce stiffness and relieve pain. Hands-on techniques such as joint articulation, soft tissue manipulation, and muscle release can enhance circulation and flexibility, promoting better function in the joint. Strengthening the muscles around the hip, particularly the glutes and core, is essential to provide better support and reduce the load on the joint.
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We also offer lifestyle advice tailored to your needs, including recommendations for improving posture, modifying daily activities, and staying active in a way that promotes joint health without aggravating symptoms. In addition, osteopathic treatment can address compensatory patterns in other areas of the body—such as the lower back or knees—that may be putting extra pressure on the hip joint. By taking a holistic view of the body, we aim to reduce strain and improve overall movement, helping you maintain a more comfortable and active lifestyle despite the presence of osteoarthritis.
Adductor Strain
What Is It?
From an osteopathic perspective, an adductor strain—commonly known as "groin strain"—is a frequent injury, particularly among athletes. This condition involves a strain or tear in the muscles along the inner thigh, which extend from the inside of the knee up into the pelvis and groin area. These muscles, known as the adductors, play a key role in bringing the thighs together (adduction) and stabilising the pelvis during movement. If not properly treated, an adductor strain can become chronic, leading to ongoing discomfort and frustration.
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How Does It Present?
The hallmark symptom of an adductor strain is pain in the groin, especially when engaging in physical activity. This pain can range from mild discomfort to more severe cases, where swelling or bruising may be present. While the strain typically occurs higher up in the groin, it can also happen near the knee, although this is less common. Pain may worsen with specific movements, such as bringing the legs together or pushing off to change direction.
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Why Has It Happened?
An adductor strain is often the result of trauma, such as overstretching the leg into abduction (away from the body) or hip extension. Rapid or forceful movements in sports, especially those involving quick changes in direction or kicking, can place excessive stress on these muscles. In some cases, the strain may keep recurring if the muscles are not properly rehabilitated or rested. Additionally, muscle imbalances can play a role—tight adductors often compensate for weak abdominal muscles, placing added strain on the groin area as they work harder to stabilise the pelvis.
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How Can We Help?
As osteopaths, we take a holistic approach to understanding the root cause of recurring adductor strains. A thorough orthopaedic assessment can help identify underlying issues, such as tightness or dysfunction in other areas of the body that may be contributing to the strain.
Treatment may involve a combination of manual therapies to release tight muscles and restore proper function, including soft tissue massage, manipulation, and techniques like medical acupuncture. Additionally, we focus on improving overall biomechanics by addressing postural imbalances and prescribing targeted rehabilitation exercises to strengthen the adductors and supporting muscle groups. This approach helps promote healing, prevent future injury, and enhance overall pelvic stability.