There can be many causes for hip pain. One of the common ones we see here in clinic is gluteal tendinopathy. This usually presents a deep ache in the back/side of the hip that can feel stiff and sore of a morning and can be sharply aggravated by tasks such as increased walking, standing or climbing of stairs.
What is it? Glute muscles are a group of muscles that sit around the hips. They are responsible for the pushing back movement of the upper leg and maintaining stability during standing and walking. Like all muscles they attach to bone at either end with a segment of tendon. At times these tendons can become aggravated when the body cant recover from the work it is being asked to do.
Why? Tendons get aggravated when they are over worked, and the body can’t keep up. This can be a result of increased demands such as a lot of standing and walking, or if body mass has increased. Sometimes there is no change to the amount of activity, but the body’s ability to recover has changed. This can be the case as we age OR when there is a sudden change in hormone levels in the body (particularly during menopause in women)
Other things tendons don’t like is being stretched (sitting with crossed legs or sleeping on the side with the sore leg dropped across the body.) and pressure (sleeping on the affected side)
What can be done? First of all, a scan is not necessary for the diagnosis of this condition. A thorough history and physical assessment is a very effective way of diagnosing this condition (or another hip condition) Once diagnosed the first goal is to bring the pain under control. This means reducing load on the specific tissue that has become aggravated. Initially this may include (if possible) reducing LL exercise/ activity. But also adapting the way you move your body to divert load to other areas of the body. And maybe a few tips and tricks to avoid aggravating it at rest (sleeping position, sitting position etc.)
Sometimes a Corticosteroid injection is suggested. If treated early enough there should be no need for this. And for long term management it is best to be avoided.
The next step is to increase the amount of load the tendons are able to manage. Like with any part of the body, if you don’t use it, you lose it. So it is important to build the tendon and muscle strength up in a controlled way. This will involve some small exercises at first targeted at the gluteal muscles and then moving on to exercise that challenges you at an appropriate level.
What is it? A lateral ankle sprain is a rather common injury where the ankle rolls out. Placing undue stress on the structures on the lateral (outside) of the ankle. When this happens there can be damage to the tissue that supports that side of the ankle. This is commonly called rolling your ankle. What have I injured? There can be a number of structures that are damaged when rolling the ankle, bone, ligaments, muscles and tendons. Physio assessment can be helpful in the first instance to determine if a fracture is possible, as this will require quite a different management initially. The most common tissue damage is the ligaments, tendons and the cartilage of the ankle joint. All those tissues have slightly different properties and different healing times. As the process of rehab goes along the extent to which each has sustained damaged will become more clear.
How do I treat it? Initially we want to protect and calm down inflammation without completely restricting movement. Here are a couple of practical tips for the first 24-48 hours. Compression – this could be a bandage or a tubed bandage. The idea here is to reduce swelling around the ankle. Ice is also sometimes suggested for swelling and may help reduce the pain as well. Protect – depending on the severity it is ok to do a bit of moving around, it is important tho not to damage the already fragile tissue at this time. Sometimes a bit of taping or a supportive brace is necessary for day to day activity. Ice – Ice doesn’t reduce swelling as much as we once believed but it may make a small difference and may also reduce some of the pain sensation. Elevation – keep the foot up and let gravity do its work. After a day or two swelling and pain should start to subside This is the time to start some movement and exercise. Range of motion needs to be addressed early to avoid long term losses. A physio can be helpful for this.
How long will it take to get better? It always depends on the severity, tissues involved and what you are looking to get back to doing. If you wish to return to sport a good set of physical tests can be a good way to measure and plan when you are ready to progress or return to sport. If not rehabbed properly the ankle can become instable or weak. This can lead to pain, recurrent sprain or reduced range of motion or function. A well tracked and progressed rehab program will ensure you get the best out of your body and prevent future ankle sprains.
If you have a new or ongoing ankle injury come in and have a chat to one of our physios to discuss the best way to manage it or progress your performance.