Welcome to Hip Physio

Do you have hip pain?

Hip pain is disabling problem that affects a large proportion of the population. It can occur in any age group – children with hip pain should be seen by a doctor immediately. It occurs in people of both sedentary and active life styles, and it affects both women and men. Hip pain has been shown to slow people down; getting around normally becomes painful and difficult. It can generally make life less enjoyable (1, 2). People who complain of hip pain often talk about having pain around their side, lower back and sometimes their groin (Figure 1). Some people have widespread, overlapping and multiple areas of pain. The back and hip are integrally linked and these problems may occur simultaneously (2-6). People with problems in their hip joint may feel pain in the front of the thigh, the knee and sometimes right down the leg (the red shaded areas), even without having “hip pain” (6).

Contact Hip Physio

Image showing that problems with the hip joint may present as pain in the leg, side, lower back, or groin
When addressing hip pain it is important to seek help from someone who can tease out all the likely causes, so they can provide effective treatment.

Why should you come and see Angie Fearon?

Angie is an international expert in the field of hip pain. In addition to her 29 years of clinical experience she has a number of publications in international peer reviewed journals and has presented at international and national conferences (7-18). Angie has committed the last 14 years of her life to the study of hip pain related problems – so as to improve the lives of those who suffer from it. In the mid 2000s she and Professor Paul Smith recognised the many people were being misdiagnosed in relation to the cause of their hip pain. Angie undertook to positively affect this situation, undertaking a series of research projects that lead to a PhD which examined the difference between hip osteoarthritis and bursitis/Greater trochanteric pain syndrome.

Prior to completing her PhD in 2011 (Medical science, ANU) Angie completed a Master’s degree in 1999 (Physiotherapy, UNISA), and a Bachelor’s degree in 1985 (Physiotherapy, Lincoln Institute of Health Science). Angie established Hip Physio in 2013 after returning in late 2012 after being a Post- doctoral Fellow at the Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada. She currently holds an appointment as Professor Paul Smith’s Clinical Assistant, is an Adjunct A/Prof the University of Canberra (Physiotherapy School) and is a visiting physio at the Australian Institute of Sport.

She has previously worked at TM Physio in Deakin, Corinna Physiotherapy Centre in Woden, Margaret O’Donovan’s City Physiotherapy, Di Keddie’s Physiotherapy practice in Dickson, and the Monash Medical Centre in Victoria. Angie is a member of the Australian Physiotherapy Association and contributes to this by being the ACT representative on the National Orthopaedic Network committee.

Angie is also a very nice person. She enjoys her family, dancing, bike riding, XC-skiing and trying to keep fit.

What to expect at your first appointment with Angie

Your first appointment will last one hour. During this time you will get Angie’s complete and undivided attention. Angie will want to ask you a lot of questions, so as to understand your story. She will then want to undertake thorough physical examination – for example looking at how you walk, use steps and move from sitting standing. She will also want to examine your range of movement and strength. This assessment will also include a review of any imaging (x-ray/ultrasound/MRI), integrating these findings to the clinical picture.

Angie will then discuss with you what she thinks is going on, ensuring (as best she can) that you understand the cause of the problem and the current status. You and Angie will then discuss a tailored rehabilitation program for you. This program may include appropriate and acceptable exercise therapy, hands-on treatment, guidance regarding lifestyle modifications and load modification training (16-18). Importantly, if Angie considers that physiotherapy will not benefit your situation she will tell you this and offer you and your doctor (if appropriate) advice about the way forward.

During the first appointment the initial stages of that rehabilitation program will be implemented as is appropriate.

If you need further appointments (some people do, and some don’t) the timing and duration of these will be discussed.

Please bring with you some shorts and any x-rays, ultrasounds, MRI, or other imaging that you have had taken.

Fees

$200 for a 60 minute consultation

$175 for a 45 minute consultation

$120 for a 30 minute consultation

Correct money, cheque or direct debit at the appointment or on the same day is appreciated and attracts a 10% discount.

If you have private health insurance some of your fees may be refunded by your fund. Please note that Angie does not process HICAPS or Medicare payments. Angie does not have any credit or debit card facilities.

Want more information about hip pain?

How common is hip pain?

Pain arising from bones, ligaments, joints, tendons and muscles (musculoskeletal pain) is a major public health issue, In the four years 2004-2006 it cost Australians $4 billion (19) and affected 30% of the population (about one in three people) (1) Hip pain, regardless of the cause, makes up a substantial portion of this group and the cost. It is a problem found in all age groups and in people of both athletic and sedentary lifestyles. Hip pain does occur more commonly in older age groups and in women. Close to 40% of women over the age of 70 (20) and up to 23% of women over the age of 40 have reported hip pain (21). Hip pain is also a problem for men.

Hip pain in children can be serious: a child with hip pain should be seen by a doctor immediately.

How does hip pain impact on people?

People with hip pain have more trouble leading active lives than those without hip pain, tend not to participate in physical leisure activities and are likely to find normal activity harder and less pleasurable (22). This will often adversely affect a person’s ability to control their blood pressure, maintain a healthy weight (1) and maintain a sense of good well-being.

What causes hip pain?

Hip pain can result from problems in or around the hip joint and can arise from referred pain from the lower back or pelvic joints (for example the sacro-illiac joint or the pubic symphysis) (23-26).

Conditions that involve the hip joint include

  • Hip arthritis
  • Hip labral tears
  • Ligamentum teres tears
  • Damage to the surface of the hip joint (chrondral surface deficits)
  • Loose bodies within the hip

Conditions that involve the tissues around the hip joint include

  • Bursitis and tendon problems
  • Greater trochanteric pain syndrome
  • Bursitis
  • Tendons that are commonly involved include but are not limited to; Gluteus medius and minimus, Quadratus Femoris, and the tendons of Psoas and Piriformis.
  • Strain of the anterior pelvic structures, e.g. osteitis pubis
  • Post-natal “weakness” or “instability”
  • Problems with appropriate muscle activation
  • Iilo tibial Band syndrome/tightness
  • Problems with the bones about the hips e.g. stress fractures (27).

Conditions that refer to the hip area, that is, it feels like “hip pain” but is actually from somewhere else (23-26)

  • Low back pain
  • Sacroiliac joint pain
  • Pubic symphysis issues
  • The back and hip are integrally linked, it is possible to have several of these problems occurring simultaneously (2, 28)

What helps with hip pain?

Getting the right diagnosis

Why is diagnosis difficult at times?
  1. In addition to the hip joint, reported pain can be a symptom of a number of different problems - for example problems in the back and/or pelvis
  2. Xrays, Ultra sound and MRI scans don’t always help. It can be difficult to distinguish the actual cause of the problem when there are changes due to normal (mostly pain free) aging, leading to misdiagnosis
  3. There are a lot of joints, muscles, tendons, ligaments and bursa located in this area - therefore many components that need to be evaluated

Effective treatment

Effective treatment relies on three things:
  1. Identifying the most likely affected tissue (e.g. bone, ligament, tendon, muscle, cartilage)
  2. Addressing and correcting (if possible) the most likely cause or causes of the problem
  3. Identifying and modifying (if applicable) any lifestyle activities/behaviours that may be making the situation worse

Physiotherapy

  1. Physiotherapists are trained to undertake a thorough assessment - including a comprehensive history and examination of the person’s ability to move and the function of their hip and back - to evaluate the contributing factors.
  2. Physiotherapists are trained to review of any imaging (x-ray, ultrasound, MRI), and the reports so as to put these into the context of the person’s history and thus interpret and integrate all the findings
  3. This will lead to a tailored rehabilitation program that may include: appropriate exercise therapy, hands on treatment, and guidance and education regarding any necessary lifestyle modifications (29-31)

Lifestyle changes

  1. Modifying activities where necessary e.g. including some non-weight bearing exercises into a fitness program, and possibly reducing any high impact exercise
  2. Using a walking stick or walking poles
  3. Changing sitting, sleeping and exercise arrangements
  4. If appropriate, losing just 5kg of weight may help significantly with the pain (32)

Surgery:

Total hip replacement is the preferred treatment for severe hip osteoarthritis (33). Fortunately not everyone needs this level of intervention. Occasionally people who suffer from hip pain are given the wrong diagnosis or the whole picture is not clear, in these cases, proper diagnosis and/or simple lifestyle changes can often make a big difference.

Surgery is also an option for severe and non-responsive bursitis and gluteal tendon tears. However this should be a last resort option once a tailored physiotherapy program has been shown to be ineffective (34).

Hip arthroscopy is sometimes recommended for labral tears and for femoral acetabular impingement. As with bursitis and gluteal tendon tears, this generally should be a last resort once a tailored physiotherapy program has been shown to be ineffective.

Injection therapy for tendons (tendinopathy) and bursitis:

While some injection drugs provide good short term relief there is limited evidence that they provide long term relief. In some people injections stop being effective altogether and may even result in a worse outcome for the person Cortisone injections treat the symptoms, they do not address the underlying biomechanical, training, activity related problems that have led to the tendinopathy or bursitis in the first place. The most effective long term treatment for tendinopathy is tailored exercise therapy (35-37).

How quickly does hip pain resolve?

Hip pain as a result of tendon, bursa or labral tear problems can take a number of weeks and even months improve. This is because there are lots of components to address and because tendons and the labrum don’t have a good blood supply. There are some effective treatments that can help in the short term, but long term results take…a long time. It is likely the person has had the problem for some time – so the muscles and tendons needs time to regain strength and flexibility. Even with the correct treatment a tendon/bursa problem may take 3 to 12 months to get better.

A problem related to the joint may resolve quickly or slowly.

References
  1. A.I.H.W. Australia's health 2008. In: Welfare. AIoHa, editor. Canberra: Australian Institute of Health and Welfare.; 2008.
  2. Fearon A, Cook J, Scarvell J, Neeman T, Cormick W, Smith P. Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. Journal of Arthroplasty. 2014 Feb 2014;29(2):383- 6. Epub 5 Nov 2013.
  3. Sakamoto J, Morimoto Y, Ishii S, Nakano J, Manabe Y, Okita M, et al. Investigation and Macroscopic Anatomical Study of Referred Pain in Patients with Hip Disease. Journal of Physical Therapy Science. 2014 02/28 07/08/received 08/28/accepted;26(2):203-8. PubMed PMID: PMC3944289.
  4. Arnold DR, Keene JS, Blankenbaker DG, Desmet AA. Hip pain referral patterns in patients with labral tears: analysis based on intra-articular anesthetic injections, hip arthroscopy, and a new pain "circle" diagram. The Physician and sportsmedicine. 2011 Feb;39(1):29-35. PubMed PMID: 21378484. Epub 2011/03/08. eng.
  5. Hsieh PH, Chang Y, Chen DW, Lee MS, Shih HN, Ueng SW. Pain distribution and response to total hip arthroplasty: a prospective observational study in 113 patients with end-stage hip disease. J Orthop Sci. 2012 May;17(3):213-8. PubMed PMID: 22427017. Epub 2012/03/20. eng.
  6. Lesher JM, Dreyfuss P, Hager N, Kaplan M, Furman M. Hip joint pain referral patterns: A descriptive study. Pain Medicine. 2008 Jan-Feb;9(1):22-5. PubMed PMID: WOS:000252814100004.
  7. Fearon A. Differentiating greater trochanteric pain syndrome from hip osteoarthritis. Canberra: Australian National University; 2011.
  8. Fearon A, Dahlstrom JE, Twin J, Cook J, Scott A. The Bonar score revisited: Region of evaluation significantly influences the standardized assessment of tendon degeneration. J Sci Med Sport 2013 Aug 8. PubMed PMID: 23932935.
  9. Fearon A, Scarvell J, Neeman T, Cook J, Cormick W, Smith P. Greater trochanteric pain syndrome: defining the clinical syndrome. Br J Sports Med. 2012;47(10):649-53. Epub 14/09/2012.
  10. Fearon A, Stephens S, Cook J, Smith P, Neeman T, Cormick W, et al. The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. A case control morphology and anthropometric study. British journal of sports medicine. 2012 Sep;46(12):888-92. PubMed PMID: 22547561. Pubmed Central PMCID: 3597182.
  11. Fearon AM, Cook JL, Scarvell JM, Neeman T, Cormick W, Smith PN. Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. J Arthroplasty. 2014 Feb;29(2):383-6. PubMed PMID: 24210307. Epub 2013 Nov 5.
  12. Fearon AM, Scarvell JM, Cook JL, Smith PN. Does ultrasound correlate with surgical or histologic findings in greater trochanteric pain syndrome? A pilot study. Clinical Orthopaedics and Related Research. 2010 Jul;468(7):1838-44. PubMed PMID: 19941093. Pubmed Central PMCID: 2882020. Epub 2009/11/27. eng.
  13. Fearon AM, Scarvell JM, Neeman T, Cook JL, Cormick W, Smith PN. Greater trochanteric pain syndrome: defining the clinical syndrome. British journal of sports medicine. 2013 Jul;47(10):649-53. PubMed PMID: 22983121.
  14. Dirks RC, Galley MR, Childress PJ, Fearon AM, Scott A, Koch LG, et al. Uphill running does not exacerbate collagenase-induced pathological changes in the Achilles tendon of rats selectively bred for high-capacity running. Connect Tissue Res. 2013;54(6):386-93. PubMed PMID: 24060053.
  15. Dirks RC, Richard JS, Fearon AM, Scott A, Koch LG, Britton SL, et al. Uphill treadmill running does not induce histopathological changes in the rat Achilles tendon. BMC Musculoskelet Disord. 2013. PubMed PMID: 23496843. Pubmed Central PMCID: 3599857. Epub 2013 Mar 11;14:90.
  16. Fearon A, Smith PN, Dear K, Scarvell. MINIMUM ONE YEAR OUTCOMES AND SATISFACTION FOLLOWING GLUTEAL TENDON RECONSTRUCTION. J Bone Joint Surg Br Proceedings. 2010;92-B(188):HP31.
  17. Lundgreen K, Lian OB, Scott A, Nassab P, Fearon A, Engebretsen L. Rotator Cuff Tear Degeneration and Cell Apoptosis in Smokers Versus Nonsmokers. Arthroscopy. 2014 May 23. PubMed PMID: 24863404.
  18. Scott A, Docking S, Vicenzino B, Alfredson H, Murphy RJ, Carr AJ, et al. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012. Br J Sports Med. 2013 Jun;47(9):536-44. PubMed PMID: 23584762. Pubmed Central PMCID: 3664390.
  19. Access, Economics. The painful realities: The economic impact of arthritis in Australia in 2007. ARTHRITIS AUSTRALIA, 2007.
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  21. Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Archives of Physical Medicine and Rehabilitation. 2007 Aug;88(8):988-92. PubMed PMID: 17678660. Pubmed Central PMCID: 2907104. Epub 2007/08/07. eng.
  22. Christmas C, Crespo CJ, Franckowiak SC, Bathon JM, Bartlett SJ, Andersen RE. How common is hip pain among older adults? Results from the Third National Health and Nutrition Examination Survey. Journal of Family Practice. 2002 Apr;51(4):345-8. PubMed PMID: 11978258. Epub 2002/04/30. eng.
  23. Slipman CW, Jackson HB, Lipetz JS, Chan KT, Lenrow D, Vresilovic EJ. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil. 2000 Mar;81(3):334-8. PubMed PMID: 10724079.
  24. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine (Phila Pa 1976). 1994 May 15;19(10):1132-7. PubMed PMID: 8059268.
  25. Tortolani P, Carbone J, Quartararo L. Greater trochanteric pain syndrome in patients referred to orthopedic spine specialists. The Spine Journal. 2002 Jul-Aug;2(4):251-4. PubMed PMID: 14589475.
  26. Abrahams P, SC M, R H. Human Anatomy. 5th ed2003.
  27. Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. 2008 Dec;24(12):1407-21. PubMed PMID: 19038713. Epub 2008/11/29. eng.
  28. Ben-Galim PMD, Ben-Galim TMD, Rand NMD, Haim AMD, Hipp JP, Dekel SMDP, et al. Hip-Spine Syndrome: The Effect of Total Hip Replacement Surgery on Low Back Pain in Severe Osteoarthritis of the Hip. Spine. 2007;32:2099-102. PubMed PMID: 00007632-200709010-00011.
  29. Khan K, Scott A. Mechanotherapy: how physical therapists' prescription of exercise promotes tissue repair. Br J Sports Med. 2009 APR 2009;43(4):247-51. PubMed PMID: WOS:000265181800004. English.
  30. Kjaer M, Heinemeier KM. Eccentric exercise: acute and chronic effects on healthy and diseased tendons. Journal of applied physiology (Bethesda, Md : 1985). 2014 Jun 1;116(11):1435-8. PubMed PMID: 24436295. Epub 2014/01/18. eng.
  31. Rees J, Maffulli N, Cook J. Management of Tendinopathy. The American Journal of Sports Medicine. 2009 February 2, 2009:-.
  32. Wickelgren I. Obesity: how big a problem? Science. 1998 May 29;280(5368):1364-7. PubMed PMID: 9634413. Epub 1998/06/20. eng.
  33. George LK, Ruiz D, Sloan FA. The Effects of Total Hip Arthroplasty on Physical Functioning in the Older Population. Journal of the American Geriatrics Society. 2008;56(6):1057-62.
  34. Walsh MJ, Walton JR, Walsh NA. Surgical repair of the gluteal tendons: a report of 72 cases. Journal of Arthroplasty. 2011 Dec;26(8):1514-9. PubMed PMID: 21798694. Epub 2011/07/30. eng.
  35. Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008 Jul;466(7):1539-54. PubMed PMID: 18446422. eng.
  36. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010 Oct 21. PubMed PMID: 20970844. Epub 2010/10/26. Eng.
  37. Malliaras P, Maffulli N, Garau G. Eccentric training programmes in the management of lateral elbow tendinopathy. Disability and Rehabilitation. 2008 2008;30(20-22):1590-6. PubMed PMID: WOS:000260851000012.

Contact Us

Angie Fearon sees all patients through rooms at the Australian Institute of Sport. For an appointment please contact:
phone: (02) 6214 1728
email: angie@angiefearon.com

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