Hip Pain - A real pain in the butt! (Part 2)
Do you have pain around the outside or back of the hip? What a pain in the butt! There are a number of possible causes of hip pain. In our previous blog (Hip pain - a real pain in the butt!) we discussed two common conditions; gluteal tendinopathy and trochanteric bursitis. But what about other causes of hip pain? These include piriformis syndrome, referred pain from the lower back or pain resulting from poor biomechanics and muscular imbalances.
The piriformis muscle is a small muscle that originates from the sacrum and inserts onto the greater trochanter (the bony part that sticks out on the outside of the hip).The sciatic nerve exits the spine and travels through the buttock area either above, below or in some cases directly through the piriformis muscle belly. Piriformis syndrome refers to the dysfunction of the piriformis muscle either due to trauma and inflammation, muscle spasm, or shortening of the muscle due to altered biomechanics. This can cause compression or irritation of the sciatic nerve which can result in radiating buttock pain, numbness, and paraesthesia. These symptoms can be aggravated by activities such as prolonged sitting, walking, squatting, or any activities that increase tension in the piriformis muscle.
Referral from the lower back
The lower back can commonly refer pain to the lateral hip due to irritation or compression of the nerves around where they exit the spine. Although the pain might originate from the lower back, the pain might only be felt in the hip itself. Symptoms can include radiating low back pain, buttock pain, numbness and paraesthesia. These symptoms are usually aggravated by prolonged postures such as sitting for long periods.
Biomechanics / Muscular imbalances
Muscle imbalances and weakness can occur in any of the above conditions and are often a contributing factor in pathologies of the hip and lower back. This refers to certain muscles becoming weaker, tighter or shorter which means that they can’t function as well and fatigue easier. This also means that other surrounding muscles have to work harder to provide support to the area and can become tight and overused creating an imbalance.
How can Physio help?
Good news! A physiotherapist can help to detect the source of your symptoms and help to manage the above conditions. Physiotherapy can assist in settling down the pain and inflammation and in restoring mobility, strength and function. We will take a detailed history of the onset and progression of the pain, assess your range of motion, strength, and observe your movements to determine the underlying cause of your pain. Together we will develop an individualised management plan to get you back to doing what you love.
What will my journey look like?
Initially physiotherapy may include some advice and manual therapy to help loosen tight muscles, relieve inflammation and make you feel a bit more comfortable. We will then develop an individualised exercise program based around your specific needs to help strengthen weak muscles and correct any muscular imbalances that might be contributing to your pain. We will also discuss exercise load and training advice which is often an important factor in recovery. Finding the right balance for you and your body will get you from being in pain, to pain-free to doing what you love sooner without that pesky pain in the butt!
If you are experiencing any of these symptoms book an appointment with one of our physiotherapists today!