Hip pain is a common condition seen in clinic.
Whether the pain has come about due to an accident such as a fall or if it’s slowly crept up on you for some time, one thing is for sure, hip pain can seriously affect your quality of life. Finding yourself in pain following a short walk to the local shops or simply after sitting at your desk for a couple of hours is no fun for anyone.
Hip pain can be felt in various locations around the hip. Whilst some experience pain to the back of the hip with a referred pain travelling down the leg in a sciatic like pattern, others will describe their pain as being at the front of the hip referring into the groin.
Probably the most common location for hip pain is when pain felt to the side of the hip, with the pain travelling down the outer thigh, occasionally all the way to the knee. Quite often, the client will mention how the pain is tender to touch and has a throbbing tooth ache like quality, which feels worse when they attempt to lie on their side, often resulting in many hours of lost sleep as they try to find a comfortable position sleep in.
A common treatment for this sort of pain is usually for the therapist to apply deep tissue massage to the area in order to ‘release’ the tight, tender tissue on the hip and the side of the thigh. Whilst this type of treatment can initially be quite effective and have a feel good quality to it, the results are usually short lived, with the pain often returning in the coming days and weeks.
Many who attend the gym regularly will probably have witnessed people ‘foam rolling’ their outer thighs in order to release the tight tissues…only to see them doing it again the next week…and the week after…and so it goes on!
Image above: Foam rolling the hip to release muscle tension.
But why is this and why does the pain often return following treatment or self massage.
Well, today I’d like to talk about one potentially cause – fascial restrictions.
Quite often, when fascial restrictions are present throughout the body, they can create a line of pull or tension on another, seemingly unrelated area of the body. This is what I’d like to go into a little more detail on today – hopefully it’s not too difficult to follow?!
First of all, a little bit on what fascia is and how it can affect the body.
Fascia is a tissue within the body which connects all of the muscle, bone, tendons and organs of the body. Fascia is a thin membranous like tissue which acts like a wrapping around the internal structures of the body. Fascia is not a benign tissue, it acts on and reacts to the various changes which occur throughout the body. Fascia is innervated by nerves – in fact it’s the most innervated tissue within the body – and this allows the fascia to absorb what is happening throughout the body and react to these changes.
An example of this is when an area of the body becomes injured; the fascia in the area of the injury will begin to harden – or bind down – in an attempt to protect the area. Due to fascia being continuous (imagine it like one big bed sheet, wrapping itself around the entirety of the body) this hardening or binding down will often create pulls, or lines of tension, throughout the body which can result in pain being felt some distance away from where the pain is actually originating from.
Image above: Fascia is continuous throughout the body, a pull in one area of the body – usually due to injury – can create tension elsewhere.
These lines of tension can often be spotted by how a person holds themselves . For example, does one shoulder sit higher than the other? Does a hip on one side seem to be sitting in a higher position? These types of postural changes can often be clues there may be underlying fascial restrictions present. To explain this point further, i’d like to use one example of a postural change which can potentially be having an affect on persistent hip pain – a side bend of the torso…try to stay with it!
As we looked at earlier, fascia is an interconnected web of tissue which is continuous throughout the body; if one area becomes injured, tight or hardens then this, in turn, can create a pull on another area of the body. This can often be the case with hip pain. Lets look at how this can be relevant in today’s example of a sideways lean of the torso.
Whilst assessing a clients posture, a common observation is when there appears to be a slight lean in the torso to one side. Quite often, the client will be leaning their torso to the opposite side to the hip pain. For example if the left hip is painful, a side bend will often be noticeable to the right.
Image above: Example of a side bend in the torso to the right. Obviously this lady is exercising and a postural side bend will be less extreme but this gives a visual reference. In the example we have used today, the client will usually experience pain in the left hip.
How Does This Affect My Painful Hip?!
When a side bend in the torso is present such as in this example, the opposite hip (the painful side) will be held in an over stretched, lengthened position. The bodies nervous system, through it’s connections with the fascia, will be alerted to this and attempt to correct things by pulling back to try and correct the side bend. The body will try to achieve this by using the muscles of the hip, lower back and outer thigh. As these muscles are continually forced to overwork in order to correct the side bend, they will eventually become tight, tender and painful on the hip and outer thigh.
As we looked at earlier, a common treatment is to try and release the area of pain by massaging the tight hip and thigh muscles in order to reduce the presenting symptoms. Usually this only results in temporary relief with the pain often returning in the coming days and weeks.
How Do We Stop The Pain From Returning?!
What if in this example, instead of continually treating the painful hip we focused our attention on releasing the other side to the pain – where the torso is side bending to one side? Remember when we said the side bend to the opposite side of the pain was continually overstretching the hip and leg on the painful side and forcing the muscles to overwork and place them in a constant state of tension? Well, what if we try to release the tension on the ‘good’ side ( the side bend) to release the tissues (fascial restrictions) around the torso in order to reduce or eliminate the side bend?
If we are able to remove the side bend, can you see how the hip on the painful side will no longer be held in a lengthened state of tension as it fights to try to ‘straighten’ the body?
Continually releasing the tension on the painful side can even make matters worse in many cases. Releasing the tissue on the painful hip will temporarily release and lengthen the tissues but this will simply allow the body to creep further into a side band in the torso. In the weeks following treatment the muscles on the painful hip will then have to work even harder to fight against the pull of the increased side bend and result in more tightness and tension (and pain) in the muscles of the affected side.
Well, I hope that wasn’t too difficult to follow and made some sense?!
It can be difficult to describe pain patterns throughout the body in a short blog but hopefully this has given you some idea with regards to how restrictions in one part of the body can sometimes be responsible for issues elsewhere?
Today we looked at one example of how a fascial restriction within one side of the body (in this case around the torso on the non painful side) can create a pull and tension on the other side. This is just one example but these restrictions can potentially be present throughout the body.
Perhaps there is tension within the rib cage on the same side as the painful hip which is creating the tension and pull? Maybe a restriction within the thigh or the inside of the leg is creating the line of tension to the hip?
The key is to look for these patterns throughout the body to try and find the potential cause of the pain rather than simply treating where the client is experiencing the symptoms – particularly with chronic pain complaints where the pain has continued for some time.
This is often achieved by looking at the clients posture and movement patterns. In today’s example of the opposite hip, then perhaps the hip on the opposite side appears to be held in an elevated position compared to the other side? Perhaps the side bend in the torso is resulting in one shoulder sitting lower than the other side? These postural imbalances can often be clues to restrictions within the body having an impact elsewhere.
It also needs mentioning that there can be other causes of hip pain. Pathological causes such as arthritic changes and lumbar spine issues need to be investigated. Even in these cases, there are usually good reasons to look at restrictions elsewhere in the body to see if positive changes can be made to the clients presenting symptoms.
If the area of pain is being treated and results are not happening then try to observe your posture – does one hip sit higher than the other, does your shoulder sit more forward on one side than the other? Whilst it’s acknowledged that we don’t need to be pictures of perfect posture in order to enjoy a pain free existence, these postural observations can often be clues that maybe part of the issue is not where you are actually feeling the pain but from somewhere else via the fascial system.