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The hip and groin area is a complex area to treat. We regularly successfully treat patients who come to us with undiagnosed hip or groin pain that has lasted for months or even years, despite scans, tests and various forms of treatment. A key component of this treatment is the correction of hip biomechanics along with hands on treatment.
Unfortunately hands on treatment can often be sparse or non existent or, on the other end of the spectrum, be carried out without addressing the underlying biomechanical issues using targeted exercises. Hands on treatment is often essential to reduce pain, release tight, stiff or overactive structures and improve sensory feedback to the brain. This enables the muscles to be switched on more effectively, resulting in more sustainable improvements.Hands on treatment is always tailored to the individual patient but our top five most useful hands on techniques for the hip are as follows: 1) Deep soft tissue massage of the lateral hip muscles, hip flexors and hip adductors (extending down the anterolateral aspect of the thigh) 2) Acupuncture to the posterolateral hip musculature 3) Mobilisation with movement into hip flexion (often with a belt) although care must be taken because this can be an aggravating movement 4) Hold relax techniques to the adductors and abductors 5) Thoracic screws
Common conditions that give hip or groin pain include the following – some are local and some are referred from structures elsewhere, which is sometimes why they are missed in diagnosis. Almost always there are a combination of the following things going on and often treatment or surgery has only addressed one or some of the structures involved. We assess and treat all of the contributing factors and it is this thorough approach that gets people better. This means we work closely with leading hip surgeons and consultant physicians who give their input where required to ensure optimal management.
FAI – Femoral acetabular impingement or hip impingement
Tendinopathy (“previously called tendonitis”) – most commonly of the gluteus medius tendon, hip flexor tendon and the hamstring tendon
Lumbar spine injury or pain (e.g. disc, facet problem, arthritis)
Adductor, or hip flexor muscle strain or tearSymphysis pubis dysfunction
Treatment will vary depending on the specific diagnosis, but any biomechanical inefficiencies which may have caused or resulted from the original injury will need to be addressed thoroughly; this is often the aspect of treatment that is neglected. These often include imbalances and weaknesses in the muscles of the hip, pelvis and lower back and incorrect alignment of the leg, particularly when walking or running. It will also include hands on treatment including mobilisation of stiff joints and release of tight or overactive musculature.
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