This document discusses hip pain treatment. It describes common hip disorders like osteoarthritis, femoral neck stress fractures, and femoroacetabular impingement. Diagnosis involves clinical exams, imaging like x-rays and MRIs, and gait analysis. Treatment focuses on restoring strength, mobility, and proper biomechanics through physical therapy and techniques like shockwave therapy. The goal is to alleviate pain and improve function for a variety of hip conditions.
Introduction:
Patellofemoral pain (PFP) is one of the most common disorders of the knee. The knee is involved in around 10% of all sporting injuries.
Tria and Alica, described Wiberg classification of patella facet shapes, and there is another classification based on Morphology ratio.
The purpose of this case control study is comparison between the different morphologic types of the patella (Wiberg classification and morphology Ratio) in patients with chondromalacia and normal persons.
Patients & Methods:
In this study we evaluated 30 limbs in 30 patients with chondromalacia (20 females, 10 males ). Medial and lateral facets were calculated on patellar knee view. Also patellar articular length and overall patellar length were calculated in knee joint in 30 flexion. The results were compared to values obtained from 30 limbs in 30 healthy volunteers.
Results:
In Wiberg classification, 57% of normal persons had patella type I while 17% of patients with chondromolacia had this type (p=0.01). Also 43% of normal persons had patella type II while 83% of patients had this type (p= 0.01).
In Morphology ratio classification, 40% of normal persons had patella type II while 13% of patients had this type (p=0.02). Also none of normal persons had patella type III while 13% of patients had this type (p=0.03).
Discussion:
A variety of sports commonly lead to chondromoalacia patella due to unusual compressive forces. Therefore young population specially athletes should pay attention to their patella shapes for selecting the sports types.
Hip and Thigh injuries in sports such as- Perthes Disease, Osteitis Pubis, Avascular Necrosis of The Femoral Head, Hip Pointer, Classic Groin Strain, ‘Pull’ Or Adductor Tendinopathy, Slipped Capital Femoral Epiphysis, Trochanteric Bursitis/Gluteus Medius Tendinopathy, Iliopsoas strain, Quadriceps strain, Irritable Hip etc.
Introduction:
Patellofemoral pain (PFP) is one of the most common disorders of the knee. The knee is involved in around 10% of all sporting injuries.
Tria and Alica, described Wiberg classification of patella facet shapes, and there is another classification based on Morphology ratio.
The purpose of this case control study is comparison between the different morphologic types of the patella (Wiberg classification and morphology Ratio) in patients with chondromalacia and normal persons.
Patients & Methods:
In this study we evaluated 30 limbs in 30 patients with chondromalacia (20 females, 10 males ). Medial and lateral facets were calculated on patellar knee view. Also patellar articular length and overall patellar length were calculated in knee joint in 30 flexion. The results were compared to values obtained from 30 limbs in 30 healthy volunteers.
Results:
In Wiberg classification, 57% of normal persons had patella type I while 17% of patients with chondromolacia had this type (p=0.01). Also 43% of normal persons had patella type II while 83% of patients had this type (p= 0.01).
In Morphology ratio classification, 40% of normal persons had patella type II while 13% of patients had this type (p=0.02). Also none of normal persons had patella type III while 13% of patients had this type (p=0.03).
Discussion:
A variety of sports commonly lead to chondromoalacia patella due to unusual compressive forces. Therefore young population specially athletes should pay attention to their patella shapes for selecting the sports types.
Hip and Thigh injuries in sports such as- Perthes Disease, Osteitis Pubis, Avascular Necrosis of The Femoral Head, Hip Pointer, Classic Groin Strain, ‘Pull’ Or Adductor Tendinopathy, Slipped Capital Femoral Epiphysis, Trochanteric Bursitis/Gluteus Medius Tendinopathy, Iliopsoas strain, Quadriceps strain, Irritable Hip etc.
Recent Advances in Arthroscopic Hip Treatmentcoreinstitute
One of the most exciting and potentially beneficial recent advances in orthopedic surgery has been the use of arthroscopy to repair injuries of the hip joint. View this presentation to learn more about this advance in hip treatment.
what is crouch gait and its Physiotherapy rehabilitation
this type gait mostly seen in spastic diaplegic Cerebral palsy child least common in quadriplegic C P , and hemiplegic C P
HIP PAIN AND INJURY GETTING IN YOUR WAY?
The hip joint is a ball and socket joint where the top of the femur meets the pelvis.
https://evolveny.com/blogposts/2021/21/hip-injury-getting-in-your-way
The neck - or cervical spinal column - is a collaborated network of nerves, bones, joints, as well as muscular tissues guided by the brain and also the spinal cord. It is created for toughness, stability, and nerve communication.
Groin discomfort as well as tenderness establishes from a selection of reasons including athletic and non-athletic injuries in addition to inner physiological elements.
Forgotten in the complexity of attempting to identify. Groin discomfort is tendon laxity. Damaged, torn ligaments that cause instability. Consequently, physicians experienced in ligament reference patterns should be gotten in touch with in cases of groin discomfort.
New York DNS & Physical Therapy center is the first one in the niche to practise Dynamic Neuromuscular Stabilization therapy method in New York. Its professional medicine employees have more than 18 years of experience.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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2 Case Reports of Gastric Ultrasound
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CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
1. Hip Pain Treatment
SYMPTOMS
Most frequently, the pain that arises from the hip joint is felt in the
groin or on the siteof the hip. When the joint is inflamed the pain could
have a very sharp quality. In the chronic condition the pain is dispersed
over larger area and is felt as dull and achy.
CAUSES
Hip pain disorders unless arising from trauma are mostly a
combination of improper development of hip and pelvis bones and
disturbance of walking mechanics.
DIFFERENTIAL DIAGNOSIS
Differential diagnosis is based on clinical examination and radiology
such as x-ray, ultrasound or MRI. Most common hip conditions include:
labral tears, FAI (femoroacetabular impingement), degenerative hip
disease (hip arthritis), degenerative hip tendon disorders and hip bursitis.
Frequently, pain in the joint on the back or side of the hip is referred
from muscles or joints in the spine. Pain arising from spinal nerve
compressions at L2 - L3, L3 – L4 can refer to the hip and groin area.
Spinal joint restrictions from the upper lumbar or lower thoracic areas
can refer to pain in the hip and groin. Occasionally femoral,
illiohypogastrioc and illioinguinal nerves can be impinged.
DIAGNOSIS
At NYDNR we use a thorough clinical exam from both structural and
functional perspective. We use diagnostic ultrasonography to visualize
hip joint, tendons and bursas. We use sophisticated video gait (walking)
2. analysis to define function of hip and its relationship to other joints in
kinetic chain during walking.
TREATMENT ADVANTAGE
at NYDNRehab
Our integrative approach and top notch technology allows us
achieve excellent results with treating variety of hip conditions. We
use extracorporeal shockwave technology to regenerate
degenerated or damaged tendons and overused muscles.
Computer-Assisted Rehabilitation Environment (CAREN) can detect
problems arising from asymmetrical weight-bearing with the
assistance of force-plate and motion-capture analysis, along with a
feedback/feed-forward facilitation retraining that is unique among
newest sports rehabilitation treatments. Last but not least, is our
legendary DNS (Dynamic Neuromuscular Stabilization) therapy,
which has become the hallmark of hip treatment standard in the
industry.
CONDITIONS TREATED
at NYDNRehab
- Hip labrum tears
- FAI ( femoral-acetabular impingement)
- Hip arthritis
- Hip bursitis
- Groin pain
- Hip snapping conditions such as coxa saltans
- Hip pain in runners and various athletes
- Hip tendinitis and tendinoses
- Post-surgical hip rehabilitation
- Myofascial hip conditions
3. HIP SPECIALIST NYC
While injuries of the hip and pelvis are not the most common cause of
pain in the lower extremities, a hip pain can be quite serious and have
significant repercussions for the function and stability of the other parts
of the body. While older adults may suffer from degenerative diseases of
the hip as they age, middle age individuals who used to be very athletic
are especially prone to hip pain due to predisposing factors, excessive
seating and carryover of the prior injuries acquired during teenage
sporting activities. Athletes in general are more susceptible to injuries of
the hip than the average population. Hip injury in runners is 2 to 11
percent higher than in the general population, while the hip is involved in
7 to 14 percent of all ballet injuries. Whatever the source of the problem,
patients need the reassurance that they can receive proper diagnosis
and practical conservative care such as walking and running specific
physical with emphasis on gait and function of lower kinetic chain. The
proper function of the hip is so paramount for pain free low back and
ability of walking and running.
A BRIEF LOOK AT HIP ANATOMY
The hip joint is the largest joint in the body, and also one of the most
stable. It derives much of its stability from being a ball-and-socket joint. A
ball-and-socket joint is a joint in which the rounded end of one bone
inserts into the depression of another. In this case, the “ball” is the head
of the femur (the thigh bone) and the “socket” is the acetabulum, a
sizable concave depression in the lower part of the pelvic girdle. The
acetabulum is lined with a fibrous rim of cartilage known as the
acetabular labrum, which deepens and further stabilizes the hip joint by
4. helping to keep the ball in the socket. If the acetabular rim is injured, a
patient can develop labrum tears, resulting in pain and stiffness.
The major muscles of the hip region can be divided into four groups
according to their various functions: the flexors, the extensors, the
abductors, and the adductors. The iliopsoas and rectus femoris are
largely responsible for flexion. Along with the hamstrings, the gluteal
muscles assist in extension. (The gluteus maximus, which comprises
much of the buttocks, helps to rotate the hip and leg.) The abductor
muscles, which include the gluteus medius and gluteus minimus,
function to pull the legs away from the midline of the body, while the
adductor muscles pull the legs towards the midline of the body.
5. DIAGNOSIS
Diagnosing hip disorders may not be an easy job because hip/groin area
is anatomically dense terrain where different structures are so
functionally and structurally intertwined into a robust lumbo-pelvic
engine, which defines human locomotive machine. The groin hip area is
also very richly innervated by nerves of the lumbar plexus and is known
to be a great mimicker. Although, the use of modern radiology is
extremely helpful clinical experience is the key. The recent advances in
the high resolution ultrasonography as well as gait analysis today allows
the hip the clinician a practical arrival to the right diagnosis on the spot.
HIP DISORDERS
Osteoarthritis is one of the most common causes of hip pain in adults,
affecting over 15 percent of the world’s population—and the numbers
are steadily rising. Typically osteoarthritis develops as a person ages
and the cartilage in the joints begins wearing away. Over time this loss of
cartilage causes the bones to rub against each other, resulting in
considerable hip pain. Osteoarthritis may be exacerbated by obesity or
prior health problems, such as hip dysplasia, in which the hip socket
does not fully encompass the femoral head.
The femoral neck is the area is just below the “ball” part of the
ball-and-socket joint in the hip. If this part of the femur becomes
fractured, it’s called a femoral neck stress fracture. It’s a common injury
in distance runners, and if treatment is delayed it can have serious
6. consequences for the career of the athlete. While this injury often occurs
because of sudden changes in the intensity of a patient’s running or the
rate of acceleration, it can also occur because of overuse, poor footwear,
or training on unlevel surfaces. Symptoms may include pain in the hip,
groin, and thigh, pain at night, and pain when engaging in strenuous
activity or bearing weight.
Femoracetabular impingement ( FAI) is a frequent source of hip pain in
males but also affects females as well. The causes of FAI are a
combination of predisposing structural anatomical variations together
with poor gait mechanics and trauma. Hip dysfunction and weakness is
also most frequently present in people suffering from low back pain,
pelvic pain and foot pain disorders.
Hip flexor strain can occur when a patient is flexing his or her thigh and
something happens that forces the thigh to extend. It can also occur
when the thigh is flexing and is suddenly struck by an external force, as
when an athlete extends her leg to kick a ball and is hit in the leg.
Symptoms may include sharp groin pain and pain that increases with
rotation or extension.
The most common cause of groin pain in athletes is adductor
strain—strain of either the adductor longus, adductor brevis, adductor
magnus, pectineal, or gracilis muscles. These muscles can be strained
when an athlete suddenly changes direction or is forced to rotate the leg
while pulling it towards the body. This injury most commonly strikes
hockey and soccer players. It’s sometimes mistaken for femoral neck
stress fracture or hip bursitis. Immediately following injury, symptoms
may include piercing groin pain, bruising, and swelling. Later, victims
may experience tenderness of the adductor muscles and associated
tendons and pain when stretching.
7. HELP FOR HIP PAIN
Treatment for adductor strain and hip flexor strain typically depends on
the severity of symptoms. Physical therapy is recommended following
rest for the first one to two weeks after injury. A hip pain specialist will
guide the patient in a program of physical therapy to restore motion,
recover strength, motor control restore biomechanics of gait and
functional alignment. Total understanding of all hip disorders is very
important as ignored hip symptoms and functional hip deficit can lead to
hip osteoarthritis. Therefore hip prevention is a duty of every hip
specialist.
When it comes to osteoarthritis, the goals of a hip pain doctor who is not
performing surgery will be to alleviate pain and increase mobility for
patients suffering from this incurable condition. This may include both
medicinal and non-medicinal treatment modalities. Examples of the
former can include NSAIDs, acetaminophen, and right type of hip
physical therapy. Examples of the latter include a general program of
exercise—lack of strength in the lower extremities is sometimes a
contributing factor in osteoarthritis; weight loss; and weight reducing gait
therapy which combines aerobic and strength training. Weight reducing
therapy such as AlterG treadmill can be especially helpful because it
lessens the amount of weight placed on the joints and allows for the
performance of exercises that couldn’t otherwise be managed. The other
type of most useful hip specific physical therapy is retraining
weight-bearing symmetry and gait stability. This type of therapy is highly
skilled and requires modern equipment.
8. HOW WE TREAT HIP PAIN AND THIGH PAIN
Patients struggling with FAI, osteoarthritis, femoral hip pain, anterior and
posterior thigh pain, and other hip pain diseases will find help and most
advanced care at New York Dynamic Rehabilitation Clinic
(NYDNRehab). While there’s no magical hip pain cure for sports injuries,
we do offer advanced rehabilitative treatment that can assist suffering
patients in getting back on their feet.
The success of our method lies in our ability to incorporate advanced
technologies with various manual techniques. Because medical imaging
(such as MRI) is limited in its ability to detect problems during
movement, we employ computerized gait analysis, a system of viewing
and measuring the forces at work when a patient’s body is in motion
during walking or running. This not only allows us to see abnormalities,
but to understand the complex relationships between the tissues of the
body when viewed as part of a moving system. We are the first
outpatient clinic in NYC providing a gait analysis lab. When used in
conjunction with diagnostic ultrasonography and X-ray imaging, we can
obtain a near-complete picture of the mechanics of a person’s gait and
the integrity of the tissues surrounding the hip joint.
If this analysis reveals damage to the integrity of those tissues, our
doctors for hip pain combine standard rehabilitation techniques with
biological treatment. In some cases extracorporeal shockwave therapy
(ESWT) may be employed. ESWT sends low-intensity, high-frequency
sound waves traveling through the skin at the site of injury to regenerate
damaged tissue. In case of myofascial hip syndrome where trigger
points and fascial adhesions are the sole source of problem we combine
defocused shockwaves with ultrasound guided dry needling.Most
importantly, we use Computer Assisted Rehabilitation Environment
9. (CAREN) to resolve problems that have arisen from faulty
weight-bearing. Unique in the annals rehabilitation, CAREN creates a
simulated, virtual-reality environment, similar to a holodeck, in which a
patient is able to perform exercises in an artificial landscape that would
not be possible elsewhere. Our clinic is the first in New York City to
possess CAREN technology.
HIP SPECIALIST NYC
While injuries of the hip and pelvis are not the most common cause of
pain in the lower extremities, a hip pain can be quite serious and have
significant repercussions for the function and stability of the other parts
of the body. While older adults may suffer from degenerative diseases of
the hip as they age, middle age individuals who used to be very athletic
are especially prone to hip pain due to predisposing factors, excessive
seating and carryover of the prior injuries acquired during teenage
sporting activities. Athletes in general are more susceptible to injuries of
the hip than the average population. Hip injury in runners is 2 to 11
percent higher than in the general population, while the hip is involved in
7 to 14 percent of all ballet injuries. Whatever the source of the problem,
patients need the reassurance that they can receive proper diagnosis
and practical conservative care such as walking and running specific
physical with emphasis on gait and function of lower kinetic chain. The
proper function of the hip is so paramount for pain free low back and
ability of walking and running.
A BRIEF LOOK AT HIP ANATOMY
The hip joint is the largest joint in the body, and also one of the most
stable. It derives much of its stability from being a ball-and-socket joint. A
ball-and-socket joint is a joint in which the rounded end of one bone
inserts into the depression of another. In this case, the “ball” is the head
of the femur (the thigh bone) and the “socket” is the acetabulum, a
10. sizable concave depression in the lower part of the pelvic girdle. The
acetabulum is lined with a fibrous rim of cartilage known as the
acetabular labrum, which deepens and further stabilizes the hip joint by
helping to keep the ball in the socket. If the acetabular rim is injured, a
patient can develop labrum tears, resulting in pain and stiffness.
The major muscles of the hip region can be divided into four groups
according to their various functions: the flexors, the extensors, the
abductors, and the adductors. The iliopsoas and rectus femoris are
largely responsible for flexion. Along with the hamstrings, the gluteal
muscles assist in extension. (The gluteus maximus, which comprises
much of the buttocks, helps to rotate the hip and leg.) The abductor
muscles, which include the gluteus medius and gluteus minimus,
function to pull the legs away from the midline of the body, while the
adductor muscles pull the legs towards the midline of the body.
DIAGNOSIS
Diagnosing hip disorders may not be an easy job because hip/groin
area is anatomically dense terrain where different structures are so
functionally and structurally intertwined into a robust lumbo-pelvic
engine, which defines human locomotive machine. The groin hip
area is also very richly innervated by nerves of the lumbar plexus
and is known to be a great mimicker. Although, the use of modern
radiology is extremely helpful clinical experience is the key. The
recent advances in the high resolution ultrasonography as well as
gait analysis today allows the hip the clinician a practical arrival to
the right diagnosis on the spot.
HIP DISORDERS
11. Osteoarthritis is one of the most common causes of hip pain in adults,
affecting over 15 percent of the world’s population—and the numbers
are steadily rising. Typically osteoarthritis develops as a person ages
and the cartilage in the joints begins wearing away. Over time this loss of
cartilage causes the bones to rub against each other, resulting in
considerable hip pain. Osteoarthritis may be exacerbated by obesity or
prior health problems, such as hip dysplasia, in which the hip socket
does not fully encompass the femoral head.
The femoral neck is the area is just below the “ball” part of the
ball-and-socket joint in the hip. If this part of the femur becomes
fractured, it’s called a femoral neck stress fracture. It’s a common injury
in distance runners, and if treatment is delayed it can have serious
consequences for the career of the athlete. While this injury often occurs
because of sudden changes in the intensity of a patient’s running or the
rate of acceleration, it can also occur because of overuse, poor footwear,
or training on unlevel surfaces. Symptoms may include pain in the hip,
groin, and thigh, pain at night, and pain when engaging in strenuous
activity or bearing weight.
Femoracetabular impingement ( FAI) is a frequent source of hip pain in
males but also affects females as well. The causes of FAI are a
combination of predisposing structural anatomical variations together
with poor gait mechanics and trauma. Hip dysfunction and weakness is
also most frequently present in people suffering from low back pain,
pelvic pain and foot pain disorders.
Hip flexor strain can occur when a patient is flexing his or her thigh and
something happens that forces the thigh to extend. It can also occur
when the thigh is flexing and is suddenly struck by an external force, as
when an athlete extends her leg to kick a ball and is hit in the leg.
Symptoms may include sharp groin pain and pain that increases with
rotation or extension.
12. The most common cause of groin pain in athletes is adductor
strain—strain of either the adductor longus, adductor brevis, adductor
magnus, pectineal, or gracilis muscles. These muscles can be strained
when an athlete suddenly changes direction or is forced to rotate the leg
while pulling it towards the body. This injury most commonly strikes
hockey and soccer players. It’s sometimes mistaken for femoral neck
stress fracture or hip bursitis. Immediately following injury, symptoms
may include piercing groin pain, bruising, and swelling. Later, victims
may experience tenderness of the adductor muscles and associated
tendons and pain when stretching.
HELP FOR HIP PAIN
Treatment for adductor strain and hip flexor strain typically depends on
the severity of symptoms. Physical therapy is recommended following
rest for the first one to two weeks after injury. A hip pain specialist will
guide the patient in a program of physical therapy to restore motion,
recover strength, motor control restore biomechanics of gait and
functional alignment. Total understanding of all hip disorders is very
important as ignored hip symptoms and functional hip deficit can lead to
hip osteoarthritis. Therefore hip prevention is a duty of every hip
specialist.
When it comes to osteoarthritis, the goals of a hip pain doctor who is not
performing surgery will be to alleviate pain and increase mobility for
patients suffering from this incurable condition. This may include both
medicinal and non-medicinal treatment modalities. Examples of the
former can include NSAIDs, acetaminophen, and right type of hip
physical therapy. Examples of the latter include a general program of
exercise—lack of strength in the lower extremities is sometimes a
contributing factor in osteoarthritis; weight loss; and weight reducing gait
13. therapy which combines aerobic and strength training. Weight reducing
therapy such as AlterG treadmill can be especially helpful because it
lessens the amount of weight placed on the joints and allows for the
performance of exercises that couldn’t otherwise be managed. The other
type of most useful hip specific physical therapy is retraining
weight-bearing symmetry and gait stability. This type of therapy is highly
skilled and requires modern equipment.
HOW WE TREAT HIP PAIN AND THIGH PAIN
Patients struggling with FAI, osteoarthritis, femoral hip pain, anterior and
posterior thigh pain, and other hip pain diseases will find help and most
advanced care at New York Dynamic Rehabilitation Clinic
(NYDNRehab). While there’s no magical hip pain cure for sports injuries,
we do offer advanced rehabilitative treatment that can assist suffering
patients in getting back on their feet.
The success of our method lies in our ability to incorporate advanced
technologies with various manual techniques. Because medical imaging
(such as MRI) is limited in its ability to detect problems during
movement, we employ computerized gait analysis, a system of viewing
and measuring the forces at work when a patient’s body is in motion
during walking or running. This not only allows us to see abnormalities,
but to understand the complex relationships between the tissues of the
body when viewed as part of a moving system. We are the first
outpatient clinic in NYC providing a gait analysis lab. When used in
conjunction with diagnostic ultrasonography and X-ray imaging, we can
obtain a near-complete picture of the mechanics of a person’s gait and
the integrity of the tissues surrounding the hip joint.
14. If this analysis reveals damage to the integrity of those tissues, our
doctors for hip pain combine standard rehabilitation techniques with
biological treatment. In some cases extracorporeal shockwave therapy
(ESWT) may be employed. ESWT sends low-intensity, high-frequency
sound waves traveling through the skin at the site of injury to regenerate
damaged tissue. In case of myofascial hip syndrome where trigger
points and fascial adhesions are the sole source of problem we combine
defocused shockwaves with ultrasound guided dry needling.Most
importantly, we use Computer Assisted Rehabilitation Environment
(CAREN) to resolve problems that have arisen from faulty
weight-bearing. Unique in the annals rehabilitation, CAREN creates a
simulated, virtual-reality environment, similar to a holodeck, in which a
patient is able to perform exercises in an artificial landscape that would
not be possible elsewhere. Our clinic is the first in New York City to
possess CAREN technology.
Introduction
Pain in the hip may occur because of several different work- and
running-related injuries that afflict the pelvis region. These include
osteoarthritis, hip dysplasia, hip flexor strain, trochanteric bursitis, and
iliopsoas tendinitis, any of which can cause debilitating and excruciating
pain that prevents a person’s body from functioning properly and hinders
the performance of daily activities.
Basic Hip Anatomy
Much of the stability of the hip joint stems from the fact that it’s a
ball-and-socket joint, a joint in which one bone is rounded and can fit
neatly into the depression of another bone. The head of the femur, the
thigh bone, fits completely into the round concavity of the acetabulum, a
vast depression in the pelvis.
The acetabulum is just one of the forces that helps stabilize the hip and
prevent dislocation. Because of its depth and because it surrounds the
femoral head, it diminishes the possibility that the femur will become
15. dislocated. The hip’s stability is further strengthened by the acetabulur
labrum, a rim of cartilage surrounding the acetabulum that makes it even
deeper. This in turn provides a large articular surface that stabilizes the
joint.
There are some important muscles within and connected to the hip that
allow movement. These movements include flexion, extension,
abduction (pulling a structure away from the midline of the body),
adduction (pulling a structure towards the midline of the body), and
rotation. The muscles responsible for flexion are the iliopsoas, rectus
femoris, and sartorius. The hip extends with the assistance of the gluteal
and hamstring muscles. The gluteal muscles also assist in the abduction
of the hips, while the hip adducts with the aid of the adductors muscles,
the pectineus, and the gracilis. Rotation is provided with help from the
gluteal muscles, biceps femoris, and hamstrings.
There are over a dozen nerves that pass through the hip and innervate
muscles, joints, and tissues in the lower half of the body. Of these, the
two most commonly associated with hip injury are the sciatic nerve and
the femoral nerve. The sciatic nerve, the longest and widest nerve in the
body, passes along the back of the leg towards the knee, where it splits
into the tibial and common fibular nerves. The sciatic nerve innervates
the muscles of the posterior thigh and is often the site of injury in
athletes. The femoral nerve is the largest branch of the lumbar plexus,
an important network of nerve fibers located at the side of the first four
lumbar vertebrae situated in the lower back. This nerve provides
cutaneous innervation to the anterior and lateral thigh, as well as the
medial leg and foot.
Over the surface of the femoral head and acetabulum is a layer of
articular cartilage, a white, shiny, rubbery material that cushions the
joints and allows them to rub against each other without causing friction.
They’re assisted in this task by the bursae, small sacs filled with a
special lubricating fluid that moisten the soft tissues around the hip joints
and make articulation easier.
16. Hip Conditions and Treatment of Hip Pain
Hip osteoarthritis, one of the most common causes of hip pain, is a
condition characterized by pain and dysfunction of the joints as a result
of degeneration of the articular cartilage. Physical symptoms of
osteoarthritis include pain in the thigh and groin, pain after prolonged
walking. A patient suffering from this condition may also exhibit improper
gait, decreased range of motion, stiffness, and continual creaking or
popping sounds during movement. Because osteoarthritis is a
progressive condition, patients will initially report intermittent symptoms.
However, if the symptoms are not treated, they will escalate to the point
where he or she may have difficulty sleeping. Osteoarthritis treatment for
the hip includes gentle exercises along with ice and heat therapy to
relieve symptoms. Non-steroidal anti-inflammatory medications may be
prescribed for discomfort and inflammation. In cases where these are
not effective, steroidal injections may provide long-term relief.
Sciatica, or sciatic nerve dysfunction, is a condition involving
compression of a nerve root in the lower back. Typically it begins with a
nerve root leading into the sciatic nerve is compressed, either by a
ruptured disc or a bone spur. The rest of the sciatic nerve becomes
inflamed and pain radiates throughout the hip and leg. Sciatica can
occur either through sudden trauma or the slow degeneration of discs as
a result of aging. In both cases a disc in the spinal column becomes
damaged, or herniated, and the inner, jelly-like tissue of the disc ruptures
out into the vertebral canal.
Although sciatica originates in the lower back, the pain it causes can
create repercussions throughout the lower half of the body. Lateral
femoral cutaneous nerve entrapment is different because it’s a pinched
nerve condition that begins in the femur itself, one of the major bones
that compose the hip joint. Symptoms of lateral femoral cutaneous nerve
entrapment include loss of sensation, tingling, and pain in the area
above the thigh that may necessitate pinched nerve in hip treatment.
17. Hip misalignment, or hip dysplasia, is a normally congenital condition in
which a child is born with or develops a dislocation of the hip joint.
Because the joint has not formed normally, it can easily be dislocated.
However it happens, the patient’s acetabulum is less deep than is
normal, and shaped more like a dish than a cup. The upper part of the
concavity is inclined outward rather than oriented horizontally. As a
consequence, the femoral head does not fit properly into and is not fully
covered by the depression of the acetabulum. In mild cases the head of
the femur simply becomes loose; in others it can be pushed out with
enough pressure. In the most extreme cases, the femoral head is
completely dislocated and hip misalignment treatment becomes
necessary.
Hip flexor strain is a condition characterized by tearing of the muscles
that assist the hip in flexing. The most prominent of these muscles is the
iliopsoas muscle that begins in the lumbar region and inserts into the
femur. The hip flexor muscles assist in sprinting and kicking, and feel
tension during stretching. Too much tension can cause the muscle fibers
of the hip flexors to tear, necessitating treatment for hip flexors. The
severity of the injury can range from minor tears with minimal impairment
to total ruptures involving severe, agonizing pain. Symptoms include
pain on the hip or groin during initial impact, and continual pain when
running, going upstairs, or bending the knee towards the chest. Patients
may also feel pain and stiffness, especially in the mornings, along with
tenderness and bruising. Pulled hip muscle treatment involves rest and
rehabilitation within the limits that pain permits. If the muscle becomes
torn, it may be necessary to refrain from intense physical activity for
between four to six weeks.
Trochanteric bursitis is a form of hip bursitis, a condition in which the
small, lubricating sacs that surround the joints become inflamed. The
greater trochanter is the bony prominence at the side of the body to
which several gluteal muscles are attached. Between these muscles and
the greater trochanter lies the trochanteric bursa. When the gluteals
contract, friction is brought to bear on the trochanteric bursa, and when
this friction becomes excessive, the bursa may become irritated or
18. inflamed, resulting in trochanteric bursitis. This can occur as a result of
prolonged or repetitive engagement in activities like running, jumping,
walking uphill, or lunging. In some cases bursitis develops because of a
direct blow to the tip of the hip. Symptoms may include outer hip pain
and pain along the outer thigh running down to the knee. Patients may
report aching or stiffness, especially when direct force is applied to the
bursa, and a peculiar sensation of weakness in the lower limbs.
Treatment for bursitis of the hip normally begins with alteration of the
patient’s existing exercise and activity schedule to minimize the
conditions that led to overuse. This may be combined with an exercise
program of strengthening and stretching, along with heat and ice
applications and, in certain cases, cortisone treatments to reduce
swelling.
Snapping hip is a clinical condition in which a patient experiences a loud,
painful snapping when flexing or extending the hips. Extra-articular
internal snapping hip is often the result of iliopsoas tendinitis,
inflammation of the hip flexor tendon that drapes over the hip socket.
This tendon can become inflamed with injury or overuse. As the tendon
rubs over the bone of the socket, it can cause painful clicking. Treatment
for hip tendinitis in this instance may involve modification of an existing
schedule to curtail activities, along with anti-inflammatory medication or
cortisone injections. In the most extreme cases snapping may be treated
by removing the inflamed tissue.
Treatment of Hip Pain at the New York DNR
Patients seeking hip strain treatment or hip pain running treatment will
find advanced care at the New York DNR. Because successful hip
treatment depends on diagnostic precision, we employ computerized
gait analysis with advanced technological equipment such as diagnostic
ultrasonography and X-ray imagery to assess and treat movement
dysfunction. In some cases extracorporeal shockwave therapy may be
used to regenerate degenerated or damaged tendons and overused
muscles. Finally, and importantly, Computer-Assisted Rehabilitation
19. Environment (CAREN) can detect problems arising from asymmetrical
weight-bearing with the assistance of force-plate and motion-capture
analysis, along with a feedback/feed-forward facilitation retraining that is
unique among newest sports rehabilitation treatments. Last but not least,
is our legendary DNS ( Dynamic Neuromuscular Stabilization) therapy
which has become the hallmark of hip treatment standard in the industry.
https://nydnrehab.com/what-we-treat/hip-pain/hip-groin-pain/