Hip Pain

Question 1

What are the common causes of hip pain in older people?

Answer 1

• Hip OA
• LBP/SIJ
• GTPS

Question 2

What are the signs & symptoms of hip OA?

Answer 2

• > 50 years old
• Morning stiffness ≤60min
• Reduced ROM
• Groin pain with IR
• Pain location

Question 3

What is the underlying pathology of GTPS?

Answer 3

Gluteal tendinopathy + bursitis (but no evidence of inflammation)

Question 4

How does gait change in GTPS?

Answer 4

Increased hip adduction moment and range

Question 5

What are the intra-articular differential diagnoses around the hip?

Answer 5

• OA/dysplasia
• Chondral surface damage
• Labral tear
• Ligamentum teres injury
• FAI
• Synovitis
• Loose bodies
• Capsular laxity (a/traumatic)
• Capsulitis
• AVN

Question 6

What are the sensitive tests for an intra-articular hip pathology?

Answer 6

• FADIR (Sn 99)
• Limp (x7)
• Groin pain (x7)
• < IR (x14)

Question 7

What are the extra-articular differential diagnoses around the hip?

Answer 7

• Insufficiency or stress #
• Avulsion #
• Lumbar spine/SIJ
• Impingement (trochanteric, pelvic, ischiofemoral)
• Osteitis pubis
• Pubalgia/sports hernia
• Nerve compression
• Snapping tendon
• Tendinopathy/bursitis

Question 8

What snapping tendons can be differential diagnoses around the hip?

Answer 8

• Medial: iliopsoas over iliopectineus eminence, femoral head &/or lesser tuberosity
• Lateral/posterior boarder GT: ITB, Gmed
• Posterior: H/S over ischial tuberosity

Question 9

What are the sensitive tests for an extra-articular hip pathology?

Answer 9

• SLS 30s (Sn 100, Sp 97)
• FABER
• No difficulty with shoes and socks

Question 10

What tendons/bursae may cause extra-articular pain around the hip?

Answer 10

• Medial: Adductors
• Anterior: Rec fem, psoas
• Lateral: Gmed/min
• P/L: Piriforimis
• P/L-distal: Quad fem
• Posterior: ischial tuberosity (H/S)

Question 11

What are the additional physio treatments for hip OA?

Answer 11

• Education
• Weight loss
• SLS use
• Manual therapy
• Postural advice

Question 12

What does treatment for GTPS include?

Answer 12

• Address modifiable risk factors
• Address pain
• Address muscle imbalance
• Address comorbidities (LL OA, back pain, weight, diabetes)

Question 13

What types of exercise therapy should be used for GTPS?

Answer 13

• Isometrics
• Muscle hypertrophy (low speed, high load, avoid adduction)
• Weight bearing (lunges)

Question 14

What does evidence show about isometrics for GTPS?

Answer 14

• Analgesic effect
• Activates segmental & extra segmental descending pain inhibitory pathways
• Lower intensity ideal for strengthening the right muscles

Question 15

What are the most to least effective glut med/min exercises?

Answer 15

• Side lying (with IR)
• Single leg squat
• Lateral band walking
• Single leg dead lift
• Transverse hop
• Forward hop
• Forward lunge c.f. static lunge
• Clam (least effective)