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The Human Hip – Part Three

The effect on the function of the hip joint of a difference in the length of the legs has been mentioned previously in an article in this series. The longer of the two legs will attempt to keep the head level by flexing slightly at the hip and knee, leading to a lack of movement into extension of the hip as we walk. Rotation of the hip and pelvis is required to achieve a more normal gait pattern if extension is not fully achievable. This may be a small change in joint movement, but on repetition thousands of times per day this can set up difficulties in joint movement and over time a painful joint condition.

The hip can give problems and deteriorate into a severely painful joint very quickly after a traumatic event such as a fall, strain or jar. However, this is less common on average as hip problems usually come on slowly over a long period. A small event can set off a painful process which starts with some muscle spasm and a reduction in the extension range typically used in walking. The hip joint is at its tightest and most pressured when it is put into extension, and when we have a painful joint we avoid this kind of joint position in order to avoid pain.

A painful hip or other lower limb joint such as a knee is often accompanied by the development of a limp, which is difficult to correct or get rid of when it has been entrenched over some period. The mechanical forces which are transmitted through the hip are significantly altered by a limp, and it changes the actions of the muscles and allows movement restrictions to develop. A steady tightening of the joint capsule can develop and cause loss of hip range of movement. On assessment and treatment of a hip problem a physiotherapist will always correct gait.

The most common degenerative condition in the world’s population is osteoarthritis, which commonly affects the knees and hips. There are many reasons for the onset and progression of osteoarthritis but a history in the family is known to be of some importance. As people get older the occurrence of osteoarthritis rises until in old age virtually everyone has one of more arthritic joints. As the osteoarthritis worsens the joint capsule can tighten up steadily and the healing process in this area is slow due to a low blood supply.

Gradual destruction of the cartilaginous joint lining continues, with some muscle spasm and increasing limp. At some point some arthritic joints deteriorate quickly, perhaps after a trivial traumatic event, and the exact reason for this is not clear, but increased pain and consequent increased muscle spasm may be responsible. Typically hip pain is felt in the lower buttock, the side of the hip, the groin and the front of the thigh. Some patients go to the doctor thinking that they have a thigh or knee problem and end up being diagnosed with hip arthritis.

Little useful information may come from x-rays of the hip in the early stages of osteoarthritis and the patients disability or pain is not easily connected with x-ray findings overall. A worsening joint will show clear x-ray changes such as narrowing of the joint space caused by loss of thickness of the articular cartilage. Abnormal shaping of the femoral head and the formation of marginal joint bone outgrowths called osteophytes will occur in severe cases. On bearing weight or movement a severely osteoarthritic joint will shudder and grate audibly.

The losses of joint movement in the hip occur in a characteristic order, with extension being lost first, followed by abduction, the ability to move the hip out to the side and finally of internal rotation of the joint. On examination of a hip with an osteoarthritic joint the hip will be held forwards and lack extension, the leg will be rotated outwards and can be held close to the other leg as it cannot easily be moved away. The lack of extension and shortening of the leg due to the arthritis can force the trunk to twist in gait and the person to go up on their toes slightly to compensate for the shortening.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, Physiotherapists in Coventry, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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