Getting rid of anterior hip pain can often be tricky.

It can often hang around for a while and because it can be irritated by sim-ple movements and positions, like squatting or lunging…

Or even sedentary activities like siting or driving, it often doesn’t take much to irritate anterior hip symptoms.

Most therapists are missing a simple trick.

Its simple when you know what this is…

And it can be the difference between successful rehab or persistent pain, reduced hip range of movement and poor function with patient presenting with anterior hip pain.

I myself have had some anterior hip pain…

I struggled initially to get on top if it…

I had some right sided anterior hip pain which stemmed from seemed an old left knee issue; previously MCL tear and arthroscope which had happened 9 years previously.

In short, I was loading poorly though my left leg as a result of these previous left knee injuries and as a result I was loading more through my right side…

With my right hip taking the brunt of it.

Initially I hadn’t figured this out and I did all the hip rehab, glute based exer-cises and whilst they did seem to work…

They never worked for long.

I’d jump back in the car to drive to work and I’d start to feel it.

Sometimes I hadn’t felt it for days, but as soon as I tried squatting in the gym it returned straight away.

In this podcast, you will discover what you need to look for for any patient you treat with anterior hip pain.

You will learn how to quickly attain the best way to treat anterior hip pain symptoms, to get your patients back to full health and stop their symptoms quickly returning.

Clicking & Clunking

Anterior hip pain can often be associated with a click or a clunk with certain movements, usually when a patient extends their hip from a flexed position, usually in an open chain movement.

A movement like a dead bug is a common reported exercise patients strug-gle with and one that can produce a click or a clunk.

This noise is caused by contact between the femoral head and the acetabu-lum.

As with any joint, contact between joint surfaces is normal in certain posi-tions.

However, the clicking and clunking associated with anterior hip pain often doesn’t happen at end of range or close packed joint positions where it might be considered normal.

As a general rule this clicking and clunking is something you should not be concerned about, as long as it is not associated with pain.

If your patient does have clicking or clunking and is complaining of anterior hip pain when this happens, the continual contact between the femoral head and acetabulum is likely contributing to this problem.

Every time they hear a click or a clunk, there is contact between the ball and the socket, which is likely causing irritation and an associated inflammatory response, which in turn causes pain.

If this is happening and your patient is getting clicks or clunks and pain, this is something you will need to get fixed up.

Is It A Ball Or A Socket Problem?

Femora-acetabular impingement or FAI is a commonly diagnosed anterior hip problem.

In fact, almost every anterior hip pain presentation is given this diagnosis!

When the hip ‘impinges’ it does so by one of two mechanisms.

1. Femur On The Acetabulum (Ball On The Socket)
2. Acetabulum On The Femur (Socket On The Ball)

You may have heard of CAM & pincer lesions of the hip causing FAI and other hip issues.

A CAM lesion is where there has been a bone laid down on the head of the femur where a pincer lesion occurs where additional bone forms on the edge of the acetabulum.

You can also get a mixed pattern whereby you see both bone being laid down at both the femoral head and the acetabulum – in effect you have both a CAM & pincer lesion.

All these issues cause a reduced amount of space for the ball to move in the socket and as a result cause increased joint contact or impingement and associated problems like loss of ROM, pain and reduced function.

Should I Treat The Ball Or The Socket?

With anterior hip pain rehab you have three options.

1. Treat the ball (femur moving in the acetabulum)
2. Treat the socket (acetabulum moving on the femur)
3. Treat both the ball and the socket

The quickest changes I see is when we focus attention on #2 and treat the socket – change the position of the acetabulum and how it articulates with the femur.

It is important to remember that the socket or acetabulum is housed as part of the pelvis so treating the acetabulum and changing it’s position and artic-ulation with the femur could actually be considered as pelvis rehab.

Whilst I have found that I can change anterior hip pain quickly focusing on the hip, with hands-on treatments and rehab, these results are often unpre-dictable and for many patients short lived.

However, when rehab focuses on the acetabulum (or pelvis) similarly quick changes are seen but these changes stick.

Patients don’t quickly regress and see their hip pain return just as quick as it went away.

If you pick up a issue at the hip like a loss of range of movement in flexion or internal rotation you might need to address this issue first, using ‘hip’ fo-cused treatments and rehab but for long lasting patient improvements…

Make sure you consider the influence of the pelvis, as this houses the ace-tabulum and this structure (the socket) makes up 50% of the hip (ball and socket) joint.

Failure in anterior hip pain rehab often is the result of not considering the role of the pelvis (and the acetabulum) and its influence on the mechanics of the ‘hip’ joint.

Key Points

Clicking & Clunking: This is caused by contact between the ball and the socket (femoral head and the acetabulum). If it’s not associated with pain, don’t worry too much about it.

Is It A Ball Or A Socket Problem? – Bony outgrowths on both the ball (fe-mur > CAM lesion) or the socket (acetabulum > pincer lesion) can both cause anterior hip pain.

Should I Treat The Ball Or The Socket? – For any hip pain patients you need to consider both as it is the mechanics of both the ball and the socket together that control how the hip functions.

Andy

The New Grad Physio Mentor

>>> Do you want to learn more about hip rehab and how to make changes to the pelvis to get quick results with anterior hip pain patients?

If so, let me know.

Email me at andy@newgradphysio.com with the subject ‘Hip’ and I’ll get right back to you and help you out.

The hip can be a complex joint to treat but it doesn’t need to be.

I’d love to share my simple assessment and treatment methods with you so please get in touch!