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Chronic Hip Pain: A Commentary and Case Study

Updated: May 10, 2022

"September 29, 2021

I started PT at The Green Room in early June. I had constant pain in my right hip that had progressively had gotten worse over the last couple of years. I was sure I needed a hip replacement. My Orthopedist’s evaluation concluded it was all soft tissue/muscular and there wasn’t a quick fix for the pain.

I read Dr. Ashley’s blog about Myofascial release therapy and inquired if it might help me. I immediately started that therapy with Debbie once or twice a week. Amazingly, after a few weeks I would say I was 85% better. Then we added Pelvic Floor Therapy and Laser therapy to the mix. The combination of these three therapies helped me tremendously. Soon I was relatively pain-free. The three therapies working together was the “perfect recipe” for relief of my hip pain.

I know I may need to pursue this same issue in the future, but at least now I know there is help, a plan, and a treatment for the pain. Thank you, Dr. Ashley Bertorelli, Debbie McCormick and The Green Room staff!

Eileen O’Donnell”

In Physical Therapy, we see patients with a variety of diagnoses. One of the more common diagnoses we evaluate and treat is hip pain. When it comes to chronic hip pain, things can become more complicated. There are many reasons someone’s hip may hurt for a long period of time. Sometimes it’s actually a stiff ankle that needs to be mobilized and exercised in order to improve that person’s gait in order to alleviate the hip pressure. Sometimes it’s hip osteoarthritis, and mobility and strengthening exercises do the trick much of the time. But sometimes, the pain can be referred from the muscles or the pelvic floor. And in that case, you can strengthen, mobilize, and exercise the hip joint all you like, but without addressing the pelvic floor dysfunctions, you will have a hard time getting the pain to completely subside.

Why does the pelvic floor refer pain to the hip sometimes? The pelvic floor refers to a group of muscles that spans the bottom of the core, extending from the pubic bone in the front to the tailbone or coccyx in the back. It helps support your bladder, bowel, and reproductive organs. Your pelvic floor needs to be able to contract on demand, and to relax on demand, in order to function properly. If muscles in this area are too weak or too tight, it can cause dysfunction. Pain, dysfunction, and compensations can occur to create stability when muscle imbalances are present. Also, the obturator internus is an important hip muscle that attaches inside of the pelvic floor. This muscle can develop tightness and spasm that can be difficult to relieve with traditional hip stretches. Here are just some of the pelvic floor muscles pictured below:

The patient above received myofascial therapy to alleviate spasm and pain in the external hip rotators, followed by strengthening exercises to help stabilize the back and pelvis. Once this alleviated most of her pain, Pelvic floor PT and laser therapy to isolated spots of remaining pain helped to complete the treatment plan.

Not everyone’s case is this complex or requires such a varied mix of interventions, but in this case, it was the “perfect recipe” according to the patient.

How might you know that your chronic hip or back pain may be referred from the Pelvic Floor? You may have some of these symptoms or medical history:

  • Urinary frequency, urgency

  • Urinary incontinence

  • Chronic constipation

  • History of childbirth

  • Hard fall onto bottom

  • Abdominal or pelvic surgery

  • Diastasis recti

This in non an all-inclusive list. The best thing you can do if you suspect a pelvic floor condition causing your hip pain is to schedule a free phone or in-person consultation with one of our Doctors. You may easily do so here

The purpose of this blog is not to convince everyone that their pelvic floor is dysfunctional, or that they need laser therapy or myofascial release. In most cases of hip pain, strengthening and mobility exercise it the answer! And exercise therapy and manual mobilizations are evidence-based and highly researched interventions for hip and back pain. BUT if you've completed rounds of targeted exercise training and PT with a skilled and knowledgeable therapist and your pain is not gone, it is worth considering the role that the pelvic floor may be playing in your remaining symptoms, especially if you check any of the boxes above. And don't be embarrassed to talk to your Physical Therapist or MD about your Pelvic Floor, it is an important part of the body and often gets overlooked!

In good health,

Dr. Ashley Bertorelli, PT and Founder of The Green Room Physical Therapy

Ph: 518-326-3771

Clifton Park & Troy

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