Hip
Early intervention has always been advocated by musculoskeletal physiotherapists for the management of mechanical neuro-musculo-skeletal (nerve-muscle-skeleton) conditions. Since most soft tissue injuries require 3 to 6 weeks to recover, specific treatment and appropriate advice within the first 3 weeks are paramount to prevent further aggravations, to minimize unwanted scar tissue formation and to ensure best possible recovery of mobility and stability while the injuries are healing.
It is however difficult to identify the source of symptoms until all possible medical/surgical conditions are excluded. We are therefore very happy if patients may be referred to us within a few months' of the onset of their injuries. One of the many cases of happy ending involved a 33-years-old lady complained of a 5 months gradual insidious onset of left groin pain. She was referred to a Gynaecologist and all medical conditions were excluded. Her pain gradually spread to her left buttock and began radiating down her thigh posteriorly (back of the thigh). Her left hip began stiffening up and she was unable to bend her knee to her chest and cross her left leg. Fortunately, her doctor noticed such movement restrictions and she was referred for manipulative physiotherapy. On examinations, left hip joint external rotation (roll outward) at 90 degree flexion (forward bend) and flexion/adduction (forward/inward bend) were very much restricted to 1/2 range and reproduced her buttock and groin pain respectively. Her clinical presentation suggested mechanical hip joint pathology with tight posterior joint capsules (ligament of the back of the hip joint). It is not uncommon for such hip pain and stiffness develops after a minor trauma to the hip joint. Not noticing the significance of the injury, the patient continues normal sporting and daily activities. The injury gradually recovers but not without leaving significant amount of scar tissues both intra- and extra-articularly (within and surrounding the joint). Extra-articular soft tissues such as the capsular ligaments gradually tighten up and restrict movements. If severe or left untreated, hip joint space is reduced and intra-articular damage results. By the time when x-ray shows joint space reduction and articular surface degeneration, full recovery could be difficult! Thanks to her doctor's early referral, this patient responded to hip joint traction with specific belt techniques and other mobilizations, stretches and mobility exercises very well. Full movements were restored and she was symptom free after a course of 10 treatments in 3 weeks. She was discharged with a full rehabilitation mobility, stretching and strengthening exercise program and was encouraged to continue her exercises to prevent recurrence of her condition.
Unfortunately, not all patients are so lucky! I am seeing a 45-years-old hip patient once a fortnight merely aiming at maintaining his partially improved movements and to keep his symptoms abated. He understands that his condition has been left untreated for too long (2 years for him) and he is happy to have restored 3/4 of his movements, enough to perform his daily activities well without pain. For him, the aim of treatment is to maintain minimal discomfort and to prevent worsening of his condition and hope he may never deteriorate to a stage that he needs a hip replacement operation.
Luck LI
Musculoskeletal Physiotherapist
It is however difficult to identify the source of symptoms until all possible medical/surgical conditions are excluded. We are therefore very happy if patients may be referred to us within a few months' of the onset of their injuries. One of the many cases of happy ending involved a 33-years-old lady complained of a 5 months gradual insidious onset of left groin pain. She was referred to a Gynaecologist and all medical conditions were excluded. Her pain gradually spread to her left buttock and began radiating down her thigh posteriorly (back of the thigh). Her left hip began stiffening up and she was unable to bend her knee to her chest and cross her left leg. Fortunately, her doctor noticed such movement restrictions and she was referred for manipulative physiotherapy. On examinations, left hip joint external rotation (roll outward) at 90 degree flexion (forward bend) and flexion/adduction (forward/inward bend) were very much restricted to 1/2 range and reproduced her buttock and groin pain respectively. Her clinical presentation suggested mechanical hip joint pathology with tight posterior joint capsules (ligament of the back of the hip joint). It is not uncommon for such hip pain and stiffness develops after a minor trauma to the hip joint. Not noticing the significance of the injury, the patient continues normal sporting and daily activities. The injury gradually recovers but not without leaving significant amount of scar tissues both intra- and extra-articularly (within and surrounding the joint). Extra-articular soft tissues such as the capsular ligaments gradually tighten up and restrict movements. If severe or left untreated, hip joint space is reduced and intra-articular damage results. By the time when x-ray shows joint space reduction and articular surface degeneration, full recovery could be difficult! Thanks to her doctor's early referral, this patient responded to hip joint traction with specific belt techniques and other mobilizations, stretches and mobility exercises very well. Full movements were restored and she was symptom free after a course of 10 treatments in 3 weeks. She was discharged with a full rehabilitation mobility, stretching and strengthening exercise program and was encouraged to continue her exercises to prevent recurrence of her condition.
Unfortunately, not all patients are so lucky! I am seeing a 45-years-old hip patient once a fortnight merely aiming at maintaining his partially improved movements and to keep his symptoms abated. He understands that his condition has been left untreated for too long (2 years for him) and he is happy to have restored 3/4 of his movements, enough to perform his daily activities well without pain. For him, the aim of treatment is to maintain minimal discomfort and to prevent worsening of his condition and hope he may never deteriorate to a stage that he needs a hip replacement operation.
Luck LI
Musculoskeletal Physiotherapist