Between 200,000 and 300,000 hip replacements are performed each year in the United States according to statistics provided by the American Academy of Orthopaedic Surgeons in 2009. While most patients opting for the surgery are over age 60, up to 10% are in patients 50 or younger. Experts project 600.000 annual operations by the year 2015. Most surgeries are performed as the result of arthritic damage to the joint structure.
What can you do to avoid becoming a candidate for hip surgery?
The ball & socket style hip joint provides us the support and freedom to move from place to place as we choose. It is formed by the round ball on top of the thigh bone (femur) and hip socket in the pelvis (acetabulum). Both parts of the hip joint are lined with hyaline cartilage which allows for smooth gliding between the joint surfaces. The two bones held together by strong ligaments that completely encircle the joint and a round ligament inside the joint (ligamentum fovea capitis) keeping the femur inside the hip socket . The hip joint supports the weight of the pelvis and upper body. The upright, bipedal posture of humans places the weight of the torso directly on top of the head of the femur. We either move the femur and thigh in relation to the pelvis (as in walking) or move the pelvis in relation to the thigh (as in sitting down in a chair). The hip joint is a synovial joint which is buffered by synovial fluid. The long term health of the joint and proper functioning is very much related to the body weight we subject it to. Carrying heavy objects in the course of the workday puts additional strain on the joint to be sure.
Breakdown of the cartilage covering the joint surfaces leading to arthritic pain is hastened by excessive body weight which can grind the joint surfaces together. Hip replacement involves replacing the head of the thigh bone with a steel ball and relining the hip socket in the pelvis with synthetic materials for pain free movement. Advances in materials used in the surgery has extended the life of the artificial hip joint making them an option for people at an earlier age than in the past.
The proper functioning of the hip is in part dependent upon the efficient alignment of the hip, knee and ankle joints of the leg. The ankle should be in line with the knee and the knee should be in line with the hip joint as seen from the front and the side. If the lower joints are misaligned they can cause unnecessary wear and tear on the joint surface of the hip due to the weight imbalance. If the upper body is off center, such as forward shoulders or head, the weight distribution will be affected. The bones forming the hip will rub more frequently on certain points of the joint surface which can cause increased wear and deterioration of the cartilage lining the joint surfaces. Any long term soft tissue work with the body must address the realignment of the head, shoulders, pelvis and legs. Focusing solely on the hip area will bring temporary relief and you may experience a return of the pain over time.
Being such a pivotal player in mobility and so close to our center of gravity, the hip joint is surrounded by muscles that control the movement and stability.
The muscles that move the hip joint attach to the lower lumbar spine (low back), the pelvic bones, and the sacrum. They are among the strongest muscles in the body. When they become tight and glued together they can limit the range of motion of the joint. Excessive tightness in these muscles can lead to trigger point formation causing pain in the hip, abdomen, groin, buttocks, and thigh. Trigger point activity can also cause reduction in blood flow to the area of referral leading to poor nutrition. There are three gluteal muscles that act to move the thigh sideways (abduction) and backward (extension) and rotate the hip. Imbalances in the tension levels or strength of the hamstring and quadricep muscles can cause a rotation of the pelvis which in turn places uneven stress on the hip joints. These imbalances can happen on one side or both and it is frequently the case that one hip joint becomes painful causing more weight to be shifted to the “good” hip. Long term, both hips will suffer.
Pain in the hip area is a frequent area of complaint especially in the more mature crowd, but certainly felt by younger folks who exercise a lot or by women in the later stages of pregnancy. When asked to point out the area of concern there are generally 2 sites reported, rarely the actual hip joint. One area is the iliac crest, a boney ridge near the bottom of the waistline that runs from the sacral area in the back to the anterior superior iliac spine (ASIS), a small boney bump in the front. Pain has been reported at various sites along this boney ridge. The large gluteal muscles attach just below the ridge on the back and sides of the pelvis. The second area pointed to is the greater trochanter of the femur, a pronounced boney bump on the outside of the upper thigh bone where many muscles involved with moving the hip joint attach.
The gluteus maximus is the one that gets all of the press. It is the largest and most superficial of the three. It exerts its most powerful action in resisting gravity as when climbing stairs. It also contracts to lower the body slowly when bending forward from the hip, although it is always advisable to bend the knees when lowering anything to the floor such as a laundry basket or a box. This muscle can cause pain referrals into the hip but most commonly refers pain into the tailbone area and throughout the buttocks. The large gluteus medius is smaller than the maximus and acts to bring the thigh out to the side (abduction) and rotates the hip. It also, along with the minimus, contracts to hold the pelvis level when one leg is off the ground as when walking or running. The medius refers pain mostly along the iliac crest, sacrum area, and to the outer hip area. The gluteus minimus found deeper in the hip area refers pain down the side and back of the thigh. Pain patterns can travel as far as the ankle.
While the pain patterns for the gluteal muscles are felt diversely in the buttocks, thigh and leg the muscles themselves can be painful to the touch when pressed upon or sat upon. These three muscles are found to the back and sides of the actual hip joint as illustrated in the cross section view.
Other muscles that commonly cause pain in the hip region include the piriformis (a deep lateral rotator of the hip), the vastus lateralis (one of the quadriceps group), and the quadratus lumborum (found in the lumbar region between the iliac crest and the 12th rib). In fact, the cascading and overlapping pain patterns from the iliopsoas, quadratus lumborum and gluteal muscles are often involved in hip pain and all need to be addressed to bring relief in the long run.
Read more about secondary and satellite trigger points to get a better understanding of the relationship between these muscles in hip pain patterns. There is a series of post on trigger points on this website.
Emotions and the hip
As with other areas of the body, we have a tendency to stuff emotional stresses various places throughout our body. Authors writing on the subject offer ideas about what chronic or acute hip issues can relate to. One common theme is the inability to move forward in making major decisions and feeling as though one has nothing to look forward to. One author relates hip joint issues with not wanting to accept present experiences, physical or otherwise. As always, you can take a look at your own situation and notice if there are any emotional circumstances you have been dealing with or avoiding that may relate to your physical health. Each of us can store whatever emotional stuff we choose to in any area of our body. When the time is right to revisit them we may find them resurfacing when releasing the physical pain and tensions in these areas.
Massaging the hip
Having an experienced professional massage therapist focus on your hips and other muscles involved in the tension pattern is well worth the investment. If you do not have a therapist you already work with and trust you can read about how to choose one on this website.
Aside from making an appointment for a professional massage, if you have a partner, child or spouse available to lean in to those thick muscles around the hip once in a while you will benefit from the improved circulation and reduced muscle tightness. For those who are active or on your feet a lot, make sure to get more frequent work on those muscles. Areas to focus on are the gluteal muscles which attach along the lower border of the iliac crest and the muscle attachments to the greater trochanter of the femur. Massage work to the hamstrings and quadriceps is also advisable to help keep the pelvis from rotating forward or backward off the center of gravity.
While having someone else leaning into the thick muscles that move the hip is preferred, we don’t always have that luxury. If your health permits it, pressing into the muscles along the iliac crest and around the greater trochanter of the femur on a regular basis will help keep the hips happy. If your hands or fingers can not take the effort needed to press deeply into the muscles, using a tennis ball or golf ball is a great alternative. You simply place the ball on the floor and position your hip muscles on top of the ball. Then roll around on the ball until you encounter a sore spot or tight area. Slowly sink your body down onto the ball pressing it in to the tight spot allowing the pressure to melt the tissue. Rolling your hip around on the ball and moving the hip around while pressing into the ball really helps in loosening up the joint.
Essential Oils for the hip
You can incorporate the use of essential oils for relief of hip tenderness. Adding essential oils to plain vegetable oil for use in massage is effective. Depending upon the quality of the essential oil you can also apply them undiluted onto the hip area. We use oils for relaxing muscles (marjoram, basil, peppermint, Aroma Siez blend, etc); for inflammation (lavender, copaiba, peppermint, etc.); and pain (PanAway blend, Relieve It blend, Deep Relief blend, etc.). You can learn more about essential oils in the video section of the website.
There are areas on the foot that correspond to the hip joint. So, while you are engrossed in a movie or some other television programming you can multitask by grasping your foot and working out the reflex zones for the hip. See the illustration for the area to concentrate on. Remember, it doesn’t have to be sore to be affected or worth working on.
There are times when massage is not appropriate or convenient to do. You can use the simple positioning techniques of Spiral Synergy to place the hip in comfortable positions to alleviate soreness and tenderness. Then, with a gentle compression or traction into or out of the hip joint you allow the body to release tension and restore balance. Many of the positions for the low back and knees work well to help the hip feel better. Read more about Spiral Synergy on this website.