Not only are hip problems extremely common, but they can be among the most frustrating conditions to affect the muscles and joints of the body. When hip pain occurs it can prevent you from walking, running, playing golf, exercising, gardening, and even sleeping. To make matters even worse many common hip conditions are slow to respond to traditional types of care, often creating further disappointment and aggravation.
The hip consists of a “ball-and-socket” joint that is formed between the Femoral Head and the Acetabulum, a part of the pelvic bone. As a result of the shape of this joint it is capable of a wide range of motion in all directions – forward and backwards, side-to-side, and rotation inwards and outwards. In addition to this large range of motion it is important to understand that because the hip joint joins the leg to the trunk there is a tremendous amount of force that must pass through this region with daily activities such as walking, bending, crouching, and lifting.
Due to the high amount of force, combined with the large range of motion, the hip must rely on a complex system of muscle to control and protect the area. These muscles include an outer system of muscles – including the Gluteus Maximus, Hamstrings, Quadricep, and Adductor group – as well as a deeper group of smaller muscles that provide an important stabilizing function. This deep group includes the Piriformis, Gluteus Medius, and Obturator group.
The muscle groups around the hip are essentially organized into opposing pairs. This means that the muscles on the front on the hip are paired with muscles on the back of hip and together these muscles control motion in the forward-to-backward direction. Likewise the muscles on the outer side of the hip are paired with the muscles on the inner side and this pair of muscles controls side-to-side movements. Other muscle pairs act to control inward and outward hip rotation as well. These “pairs” of muscles basically surround the hip so that together they can move and control the hip in all directions. When all the muscles are working properly the chance of pain and injury is very small.
Through a variety of causes such as prolonged sitting, repetitive movements, excessive use, previous injury, improper exercise, various athletic activities, or lack of physical activity, one or more of the muscles of the hip region can become tight or weak. When this happens it will result in a “muscle imbalance” in the region, which will not only stress the hip joint itself, but it will place further strain on the other muscle groups as they now must work harder to compensate for the tight or weak muscle. Over time this strain can develop into what is known as micro-trauma. Simply stated, micro-trauma is very small scale damage that occurs in the muscles, tendons, joint capsules, and ligaments in response to small levels of strain. Initially this micro-trauma is not painful, but may be perceived as a mild tightness in the muscles. Although only small, this damage still needs to be repaired. The body responds to micro-trauma in a predictable way by laying down small amounts of scar tissue to repair the injured tissue. Unfortunately, over time this scar tissue will build up and accumulate into what we call adhesions. As these adhesions form they start to affect the normal health and function of the muscles. In fact, they will often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow.
Tissue adhesions accumulate in the muscles, tendons, and ligaments of the hip, it places more and more strain on the muscles as they must now stretch and contract against these adhesions in an attempt to move and stabilize the area. This places even further strain on the hip muscles, which in turn leads to even more micro-trauma. This leads to what is known as “Repetitive Strain Injury Cycle” where continued micro-trauma leads to further adhesion formation, which in turn leads to more stress and further micro-trauma. The health of the tissues and their ability to compensate for the initial imbalance will eventually deteriorate, and eventually this process will lead to noticeable pain and injury, which will occur in one of two ways. Either the Repetitive Injury Cycle will continue and pain will progressively build until it becomes more and more noticeable; or, pain will develop suddenly after some type of seemingly straightforward activity. The latter case tends to be a “straw – that – broke – the – camels – back” phenomenon where the muscles and ligaments have become so affected that minor event can lead to injury.
Another type of hip pain can result from irritation to the nerves in the hip region. This occurs because as the nerves exit the spine and travel down the leg they pass around, under, over, and sometimes through the muscles in the hip region. When there is an accumulation of scar tissue adhesions in and around the hip can also affect the nerves.
Just as the muscles need to be able to glide on each other, the nerves also need to be able to glide freely between the layers of muscles. In many cases the accumulation of scar tissue can cause the nerves to become “stuck” to the surrounding muscles and fascia. Instead of the nerves easily gliding between the muscles they become stretched and irritated and can lead to hip pain. It is quite common for a nerve entrapment at the hip to be misdiagnosed as a simple “bursitis” or “tendonitis”. Obviously an incorrect diagnosis will lead to incorrect treatment, which will not be effective in relieving the condition.
In an attempt to relieve hip pain, a variety of treatment methods are used, either on their own, or in combination with other methods. Some of the more common approaches include anti-inflammatory medications, rest, ice, ultrasound (US), muscle stimulation (E-Stim), stretching and strengthening exercises, and when all else fails, surgery. Unfortunately, most of these traditional techniques generally require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.
The main reason that these approaches are often ineffective is that they fail to address the underlying scar tissue adhesions that develop within the muscles and surrounding soft tissues. It is these adhesions that are binding the tissues together, restricting normal movements, and interfering with the normal flexibility and contraction of the muscles in and around the hip.
Passive approaches such as medications, rest, ice, and ultrasound, all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction. More active approaches such as stretching and exercises are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles, however, they themselves do not treat the underlying adhesions. In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery from hip pain.
A.R.T. stands for Active Release Techniques. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. A.R.T. treatment is highly successful in dealing with hip injuries because it is specifically designed to locate and treat scar tissue adhesions that accumulate in the muscles and surrounding soft tissues. By locating and treating the soft-tissue adhesions with A.R.T. it allows the practitioner to, 1) break-up restrictive adhesions, 2) reinstate normal tissue flexibility and movement, and 3) more completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain.
You can think of an A.R.T. treatment as a type of active massage. The practitioner will first shorten the muscle, tendon, or ligament, and then apply a very specific pressure with their hands as you actively stretch and lengthen the tissue. As the tissue lengthens the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area. In this sense, each treatment is also an assessment of the health of the area as we are able to feel specifically where the problem is occurring.
An additional benefit of A.R.T. is that it allows us to further assess and correct problems not only at the site of pain itself, but also in other areas of the kinetic chain, which are associated with movement compensations and are often contributing factors to the problem. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet all developed pain.
One of the best things about A.R.T. is how fast it can get results. In our experience, the majority of hip injuries respond very well to A.R.T. treatment, especially when combined with the appropriate home stretching and strengthening exercises. Although each case is unique and there are several factors that will determine the length of time required to fully resolve each condition, we usually find a significant improvement can be gained in just 4 – 6 treatments. These results are the main reason that many elite athletes and professional sports teams have A.R.T. practitioners on staff, and why A.R.T. is an integral part of the Ironman triathlon series.