HIP PAIN
Ross Hauser, M.D.
 

The hip joint joins the leg to the pelvis. Unfortunately, for most people, both legs are not exactly the same. They may look the same, but from a bio-mechanical standpoint, they are not the same. One leg may be rotated either in or out, or one leg may be shorter than the other. The latter is especially common if one leg was broken during childhood. Because the hip joint connects the leg to the pelvis, the hip joint will sustain the brunt of any bio-mechanical abnormality that may occur. If one leg is shorter than the other, the hip joints will be stressed because the leg length discrepancy causes an abnormal gait (manner of walking).

With leg length discrepancy either hip joint can cause pain and usually both hip joints hurt to some degree. 'To propel the leg forward, the hip joint must be raised which strains the gluteus medius muscle and the posterior hip ligaments. Leg length problems are also associated with recurrent lower back problems because they cause the pelvis to be asymmetric. Prolotherapy to the sacroiliac and hip joints will correct the asymmetries in the majority of cases. The leg length discrepancy disappears from the leveling of the pelvis. If asymmetry remains after treatment, a shoe insert or heel lift will generally correct the problem.

A problem in the hip may commonly manifest itself as groin or inguinal pain. Pain from the hip joint may also be felt locally, directly above the hip joint in the back. When the hip joint becomes lax, the muscles over the joint compensate for the laxity by tensing. As is the case with any joint of the body, lax ligaments initiate muscle tension in an attempt to stabilize the joint. This compensatory mechanism to stabilize the hip joint eventually causes the area's  muscles to tighten because of chronic contraction in an attempt to compensate for a loose hip joint. The contracted muscles can eventually irritate the trochanteric bursa causing a trochanteric bursitis. A bursa is a fluid-filled sac which helps muscles glide over bony prominences. Patients with chronic hip problems often have had cortisone injected into this bursa, which generally brings temporary relief. But this treatment does not provide permanent relief because the underlying laxity is not being corrected. Prolotherapy injections to strengthen the hip ligaments will provide definitive relief in such a case.

It is interesting to note that trochanteric bursitis, Pyriformi Syndrome (pain and weakness in the Pyriformi muscle of the hip), and weakness in the iliotibial band (muscles near the knee) also cause "sciatica". The sciatic nerve runs between the two heads of the pyriformi muscle. When the pyriformi muscle is spastic, the sciatic nerve may be pinched. Lumbosacral and hip joint weakness are two main causes of pyriforrni muscle spasm. Pyriformi muscle stretches and physical therapy directed at the pyriformi muscle to reduce spasm help temporarily, but do not alleviate the real problem. Prolotherapy of the hip and lower back strengthens those joints, thus eliminating the pyriformi muscle spasms.

HIP REPLACEMENT SURGERY
In 1994, the National Institute of Health gathered 27 experts in hip replacement and component parts to evaluate hip replacement. In their report, they noted that 120,000 artificial hip joints are implanted annually in the United States. They further stated, "Candidates for elective total hip replacement should have radiographic evidence of joint damage and moderate to severe persistent pain or disability or both that is not substantially relieved by an extended course of nonsurgical management." The National Institute of health is clearly recommending conservative treatment modalities prior to surgical intervention.

A concern with hip and knee replacements is that the replacement part becomes loose and requires replacement. A loose hip replacement can be treated successfully with Prolotherapy.

SNAPPING HIP SYNDROME