What are the common causes of hip fractures. How can hip fractures be prevented. What are the symptoms of hip pain. What treatment options are available for hip fractures and hip pain.

Understanding Hip Fractures: Causes and Risk Factors

Hip fractures are serious injuries that occur in the upper portion of the femur, or thighbone. These fractures can have significant impacts on mobility and quality of life, particularly for older adults. But what exactly causes hip fractures?

Falls are the most common cause of hip fractures, especially side falls. However, other factors can increase the risk of experiencing a hip fracture:

• Age (65 years and older)
• Gender (women are at higher risk)
• Osteoporosis
• Smoking
• Excessive alcohol consumption
• Lack of exercise
• Poor nutrition

Interestingly, certain athletes like distance runners and ballet dancers may develop stress fractures in their hips over time. These small cracks can worsen if left untreated.

Recognizing the Symptoms of Hip Fractures

Identifying a hip fracture quickly is crucial for proper treatment. What are the telltale signs of a hip fracture?

• Severe pain in the hip or groin area
• Inability to walk or bear weight on the affected leg
• Swelling, redness, or bruising around the hip area
• Shortening of the affected leg
• Outward turning of the affected leg

It’s important to note that some individuals with hip fractures may still be able to walk. In these cases, they might experience vague pain in their hips, buttocks, thighs, groin, or back.

Diagnostic Procedures for Hip Fractures

If a hip fracture is suspected, healthcare providers typically follow these steps:

1. Physical examination
2. X-rays
3. MRI or bone scan (if X-ray results are unclear)

For bone scans, a small amount of radioactive dye is injected into a vein, which can reveal fractures as it travels through the bloodstream into the bones.

The Dangers of Untreated Hip Fractures

Are hip fractures dangerous? The answer is yes, they can be if left untreated. Untreated hip fractures can lead to several complications:

• Blood clots in the legs or lungs
• Bedsores from prolonged immobility
• Urinary tract infections
• Pneumonia
• Loss of muscle mass
• Increased risk of future falls

These complications underscore the importance of prompt medical attention and treatment for hip fractures.

Treatment Options for Hip Fractures

How are hip fractures typically treated? The primary treatment for most hip fractures is surgery. The type of surgery depends on several factors:

• The specific location and severity of the fracture
• The patient’s age
• The patient’s overall health condition

Before surgery, patients usually undergo several tests, including:

• Blood tests
• Urine tests
• Chest X-rays
• Electrocardiogram (EKG)

These tests help ensure the patient is healthy enough for surgery and aid in planning the most appropriate surgical approach.

Types of Hip Fracture Surgeries

There are several surgical options for treating hip fractures:

1. Internal fixation: Metal screws, plates, or rods are used to hold the bone together while it heals.
2. Partial hip replacement: The head of the femur is replaced with a prosthesis.
3. Total hip replacement: Both the head of the femur and the socket are replaced with prosthetic parts.

The choice of surgery depends on the location and severity of the fracture, as well as the patient’s overall health and mobility before the injury.

Preventing Hip Fractures: Strategies for Bone Health

Can hip fractures be prevented? While not all hip fractures can be avoided, there are several strategies to reduce the risk:

• Regular exercise, especially weight-bearing and balance exercises
• Adequate calcium and vitamin D intake
• Quitting smoking
• Limiting alcohol consumption
• Fall-proofing your home
• Regular eye check-ups and using vision aids if needed
• Medication review to avoid drugs that may cause dizziness or affect balance

For individuals with osteoporosis, doctors may recommend medications to improve bone density, such as bisphosphonates or selective estrogen receptor modulators.

Hip Protectors: A Preventive Measure

The FDA has approved hip protector garments for older adults with osteoporosis. These specialized garments are designed to absorb the impact of a fall and may help prevent hip fractures. While their effectiveness is still being studied, they offer an additional preventive measure for those at high risk.

Understanding Hip Pain: Beyond Fractures

While hip fractures are a serious concern, hip pain can stem from various other causes. Understanding the location and nature of hip pain can provide valuable clues about its origin.

Types of Hip Pain

Hip pain can be categorized based on its location:

• Inside of the hip or groin: Often indicates problems within the hip joint itself
• Outside of the hip, upper thigh, or outer buttock: Usually related to issues with surrounding muscles, ligaments, tendons, or other soft tissues
• Referred pain: Pain that originates from other areas, such as the lower back, but is felt in the hip

Common Causes of Hip Pain

What are some common causes of hip pain besides fractures? Hip pain can result from various conditions:

• Osteoarthritis
• Rheumatoid arthritis
• Bursitis
• Tendinitis
• Hip labral tear
• Hip impingement syndrome
• Sciatica
• Herniated disc in the lower back

Each of these conditions has unique characteristics and may require different treatment approaches.

Diagnosing Hip Pain

How is the cause of hip pain diagnosed? Healthcare providers typically use a combination of methods:

1. Physical examination
2. Medical history review
3. Imaging tests (X-rays, MRI, CT scan)
4. Blood tests (to check for inflammatory conditions)

The specific diagnostic approach depends on the suspected cause of the pain and its characteristics.

Treatment Options for Hip Pain

The treatment for hip pain varies depending on its cause. Common treatment options include:

• Rest and activity modification
• Physical therapy
• Pain medications (over-the-counter or prescription)
• Anti-inflammatory medications
• Corticosteroid injections
• Surgery (in severe cases or for specific conditions)

Your healthcare provider will recommend a treatment plan based on the specific cause of your hip pain, its severity, and your overall health condition.

Self-Care Measures for Hip Pain

In addition to medical treatments, several self-care measures can help manage hip pain:

• Applying ice or heat to the affected area
• Gentle stretching exercises
• Low-impact exercises like swimming or cycling
• Weight management to reduce stress on the hip joint
• Using assistive devices like a cane or walker if needed

These measures can complement medical treatments and help improve overall hip health and function.

When to Seek Medical Attention for Hip Pain

While some hip pain may resolve with self-care, certain situations warrant immediate medical attention. Seek medical help if you experience:

• Sudden, intense hip pain
• Inability to bear weight on the affected leg
• Visible deformity of the hip
• Signs of infection (fever, redness, warmth around the hip)
• Hip pain that persists for more than a few weeks despite self-care measures

Early intervention can prevent complications and improve outcomes for various hip conditions.

Understanding hip fractures and hip pain is crucial for maintaining mobility and quality of life, especially as we age. By recognizing the symptoms, understanding the causes, and knowing the treatment options, we can better manage these conditions and take steps to prevent them. Remember, maintaining bone health through proper nutrition, regular exercise, and a healthy lifestyle is key to preventing hip fractures and managing hip pain. If you experience persistent hip pain or suspect a hip fracture, don’t hesitate to seek medical attention. Your health and mobility are worth preserving.

Hip Fracture (Broken Hip): Symptoms, Treatment, and Surgery

A hip fracture is a break in the top quarter of the thighbone, which is also called the femur. It can happen for lots of reasons and in many ways. Falls — especially those to the side — are among the most common causes. Some hip fractures are more serious than others, but most are treated with surgery.

Who’s Most at Risk?

Each year about 300,000 Americans — most of them over age 65 — break a hip.

It happens to women more often than men. That’s because women fall more often and are more likely to have osteoporosis, a disease that makes bones weak.

Other things that increase your chances of a hip fracture include:

Also, distance runners and ballet dancers sometimes develop thin cracks called stress fractures in their hips. They can grow bigger over time if they’re not treated.

Hip Fracture Symptoms

You’ll probably have a lot of pain in your hip or groin. You may be unable to walk. Your skin around the injury may also swell, get red or bruise. Some people with hip fractures can still walk. They might just complain of vague pain in their hips, butt, thighs, groin or back.

If your doctor thinks you’ve got a broken hip, they’ll ask questions about any recent injuries or falls. They’ll do a physical exam and take X-rays.

If the X-ray image is unclear, you may also need an MRI or bone scan. To do a bone scan, your doctor injects a very small amount of radioactive dye into a vein in your arm. The ink travels through your blood into your bones, where it can reveal fractures.

Are Hip Fractures Dangerous?

It depends. They can damage surrounding muscles, ligaments, tendons, blood vessels, and nerves. If they’re not treated right away, they could affect your ability to get around for long periods of time. When this happens, you run the risk of a number of complications, like:

What’s the Treatment?

Usually, you’ll need surgery. The type depends on the kind of fracture you have, your age, and your overall health. But first, your doctor will likely order a number of tests, like blood and urine, chest X-rays, and an electrocardiogram (EKG).

How Can I Prevent a Hip Fracture?

The best way is to make sure your bones stay strong and healthy. To that end, your doctor might recommend one or more of the following:

Your doctor may also recommend you take drugs that increase the activity of the hormone estrogen and improve bone density. These are called selective estrogen receptor modulators.

The FDA has approved hip protector garments that can be worn by older people with osteoporosis. It’s thought they may help prevent hip fractures.  

Hip pain – Mayo Clinic

Hip pain is a common complaint that can be caused by a wide variety of problems. The precise location of your hip pain can provide valuable clues about the underlying cause.

Problems within the hip joint itself tend to result in pain on the inside of your hip or your groin. Hip pain on the outside of your hip, upper thigh or outer buttock is usually caused by problems with muscles, ligaments, tendons and other soft tissues that surround your hip joint.

Hip pain can sometimes be caused by diseases and conditions in other areas of your body, such as your lower back. This type of pain is called referred pain.

Get the latest health advice from Mayo Clinic delivered
to your inbox.

Sign up for free, and stay up-to-date on research
advancements, health tips and current health topics,
like COVID-19, plus expert advice on managing your health.

Learn more about our use of data

To provide you with the most relevant and helpful information and to understand which
information
is beneficial, we may combine your e-mail and website usage information with other
information we have about you. If you are a Mayo Clinic Patient,
this could include Protected Health Information (PHI). If we combine this information
with your PHI, we will treat all of that information as PHI,
and will only use or disclose that information as set forth in our notice of privacy
practices. You may opt-out of e-mail communications
at any time by clicking on the Unsubscribe link in the e-mail.

Subscribe!

Thank you for Subscribing

Our Housecall e-newsletter will keep you up-to-date
on the latest health information.

We’re sorry! Our system isn’t working. Please try again.

Something went wrong on our side, please try again.

Please try again

May 20, 2021

Show references

1. Firestein GS, et al. Hip and knee pain. In: Kelley’s Textbook of Rheumatology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed May 6, 2016.
2. DeLee JC, et al. Hip diagnosis and decision making. In: DeLee & Drez’s Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed May 6, 2016.
3. Anderson BC. Evaluation of the adult with hip pain. http://www.uptodate.com/home. Accessed May 6, 2016.
4. Nigrovic PA. Overview of hip pain in childhood. http://www.uptodate.com/home. Accessed May 6, 2016.
5. Anderson BC. Patient information: Hip pain (Beyond the Basics). http://www.uptodate.com/home. Accessed May 6, 2016.
6. Wilkinson JM (expert opinion). Mayo Clinic, Rochester, Minn. May 9, 2016.

Products and Services

1. Book: Mayo Clinic Guide to Pain Relief

.

Hip, Knee & Leg Pain Relief Algonac, MI

Get Rid of Your Hip and Knee Pain With Our Safe and Effective Methods

Your legs (including your hip and knee) are areas in the body where several muscles, tendons, and joints are joined together to help you achieve complex movement. If there is damage (injury, condition, etc.) and pain in these areas, it can be difficult to perform daily activities. There are several specific ways that HealthQuest Physical Therapy can help can help relieve leg, hip and knee pain. 

Common conditions we can help:

The structures in your hips and knees are very similar, therefore they can be subject to many of the same injuries, stress, disorders, deterioration, and diseases. Some of the most common causes of hip and knee pain include:

• Cartilage injuries. Cartilage injuries can affect both the hips or knees. For example, hip pain can be caused by cartilage injuries known as labral tears, while inflammation of the bursa sacs, known as bursitis, is a specific condition that impacts the knee joint.
• Arthritis. Arthritis is a condition that involves the inflammation of tissues that surround the joints. This condition can cause knee and hip pain. A physical therapist can teach you correct posture and proper movement techniques to protect your joints.
• Acute injuries (Sprains/Strains). These are common in both hips and knees, such as sprains, strains, and dislocations.
• Overuse injuries. Several overuse injuries, including muscle strains and tendonitis, are common in both hips and knees. This is because the joints both experience constant use.
• Gait or stance imbalances. These can cause abnormal stress and premature wear-and-tear on your hips and knees, which can result in painful symptoms or arthritis.
• Weak or tight muscles. If you have a weak gluteus medius muscles and tight hip flexor muscles, this can cause the hip to rotate inward without you realizing it. Because of this, abnormal stress can be put on the knees, resulting in painful conditions, such as patellofemoral stress syndrome or iliotibial band friction syndrome.
• Referred pain. Pain may also develop as a result of referred pain from a pinched sciatic nerve since the nerve travels through both areas.

Why do I have hip or knee pain?

The hips and knees are two very different types of joints: the hips are ball-and-socket joints that act as a support for your upper body weight, while the knees are hinge joints that allow for the forward-and-backward motions within the joint. Believe it or not, the knees actually support more of your weight than the hips do, as they allow you to stand, walk, run, dance, etc. Your hips and knees rely on numerous muscles and tissues to maintain their proper function and mobility, and when things aren’t working correctly, you may experience hip or knee pain.

People can experience hip and knee pain together or separately. The hip and knee joints work together to provide the optimum function for the lower extremities; however, sometimes a condition resulting in pain with these joints can cause their function to go awry.

Sometimes hip or knee pain originates within the respective joint; however, it is also possible that the pain you feel in your hip or knee may be rooted in a different part of the body. For example, a problem with the hip joint may transmit a pain signal to the knees, and vice versa. Since the hips and knees are both parts of the same kinetic chain, they make up a combination of weight-bearing joints that must function together in harmony in order for your body and posture to function properly. If one part of the kinetic chain is out of balance, stress may be placed on another joint.

How physical therapy can help

No matter what condition you have, a physical therapy program can help relieve your pain. Your physical therapist will evaluate your condition and create an individualized program to meet your specific needs. Range of motion and strength measurements may be taken during the physical therapy evaluation. The following are several treatment methods a physical therapist may use to help limit or relieve both knee and hip pain.

• Manual Physical Therapy –  Your physical therapist might use several hands-on techniques to reduce pain in your hips and knees. This could include stretching exercises or a variety of massage techniques.
• Heat & Ice Physical Therapy – Heat is often used during physical therapy treatment to help increase mobility and lessen pain. A physical therapist may also use ice to reduce swelling and inflammation.
• Ultrasound Therapy – Your physical therapist may use ultrasound to provide deep healing in the tissues.
• Home Exercises – Your physical therapist can teach you exercises to do at home to alleviate your leg, hip, and knee pain. Physical therapy techniques can be incorporated into a home exercise program that can become part of your daily routine and anytime symptoms try to return.
• Additional “modalities” – Your therapist is trained in many tools and techniques to help you get back to doing what you love. He/she will utilize all/any of them! Some include dry needling, blood flow restriction, cupping and many more! Your therapist will include all or some of whatever tools that will help you in your treatment plan!

Contact HealthQuest Physical Therapy today!

If you have one of the conditions listed above or a different condition that is causing your leg, hip, or knee pain, contact a HealthQuest Physical Therapy location today. One of our dedicated Southeast Michigan physical therapists will help you!

FAQs

What causes knee pain?

Your knees are hinge joints that allow for the forward-and-backward motions within the joint. The knee is one of the largest joints in your body, made up of a complex system of bones, tendons, and ligaments. Because of this, the knee can be easily injured due to overexertion or repetitive motions. Additionally, knee pain can be caused due to an underlying ailment. Some of the most common causes of knee pain are sprains, strains, fractures, tears, dislocation, tendinitis, bursitis, and arthritis.

How long should knee pain last?

Some knee pain can ease on its own. However, if you notice persistent pain, you should contact a physical therapist. Many people try to push through the pain that they feel; however, this can actually cause an issue to worsen and become more problematic. Sharp or dull pain in the knee should be paid attention to and not pushed through. If pain persists, especially for three months or longer, it is in your best interest to contact a physical therapist, as that can be an indication of a chronic condition.

Is walking good for knee pain?

Knee pain can be debilitating, making it difficult to walk, run, and move. While exercise can certainly help heal the root cause of your knee pain, it is important to make sure to only do so under the discretion of your physical therapist. Your treatment plan will largely consist of targeted exercises and manual treatments; however, additional pain relief modalities may also be added as your physical therapist deems fit. This will help you improve any problem areas and prevent further injury from occurring.

What is the best therapy for knee pain?

Our licensed physical therapists will examine your knee for signs of misalignment or structural damage, in addition to examining your stance, posture, gait, and range of motion. After your physical exam is complete, your physical therapist will prescribe a physical therapy plan for you, aimed at relieving unnatural stresses and strains, and normalizing your joint function. Treatment plans for knee pain typically include activity modification, manual therapy, strength and capacity training, range of motion restoration, graded exposure to previously painful activities, and patient education regarding activity modification.

Hip Pain | Advocare Broomall Pediatric Associates

Is this your symptom?

Causes

There are many possible causes of hip pain. Some common minor causes are:

• Muscle overuse
• Muscle strain
• Muscle aches that occur with the common cold, the flu, and other viral illnesses.

Sometimes hip pain can be from arthritis. Arthritis means joint (“arthr”) inflammation (“itis”). Pain is worse with walking or moving the inflamed joint. There are different types of arthritis. The most common type of hip arthritis is osteoarthritis:

• This is also called “wear and tear” arthritis.
• As people get older the cartilage in the joints wears down.
• This type of arthritis often affects both sides of the body equally. The joints hurt and feel stiff.
• Osteoarthritis is seen more often after age 50. Nearly everyone will get some wear and tear arthritis as they get older.

Other causes of hip pain are:

• Bursitis
• Cellulitis (skin infection)
• Herpes zoster (shingles)
• Sciatica (buttock and leg pain from a pinched sciatic nerve)

When Should You Seek Medical Help Right Away?

Here are some signs that the hip pain might be serious. You should seek medical help right away if:

• Signs of infection occur (such as spreading redness, red streak, warmth)

Pain Scale

• None: No pain. Pain score is 0 on a scale of 0 to 10.
• Mild: The pain does not keep you from work, school, or other normal activities. Pain score is 1-3 on a scale of 0 to 10.
• Moderate: The pain keeps you from working or going to school. It wakes you up from sleep. Pain score is 4-7 on a scale of 0 to 10.
• Severe: The pain is very bad. It may be worse than any pain you have had before. It keeps you from doing any normal activities. Pain score is 8-10 on a scale of 0 to 10.

When to Call for Hip Pain

Care Advice

Mild Hip Pain

1. What You Should Know:
   • Hip pain can be caused by many things. Muscle aches can occur with the common cold, the flu, and other viral illnesses. Muscle strain and overuse can cause hip pain. Hip pain can also be caused by arthritis, bursitis, or a pinched nerve in the back (sciatica).
   • The best way to treat hip pain will depend on the exact cause.
   • Here is some care advice that should help.
2. What to Expect:
   • Muscle aches from the common cold, the flu, and other viral illness most often last just 2 to 3 days.
   • Minor muscle strain and overuse should start to get better in a couple days. The pain should go away within one week.
   • Pain and stiffness from osteoarthritis (wear and tear arthritis) can be chronic. That is, it can last weeks, months or years. Sometimes the pain can flare up and then get better after a couple days.
   • What to expect in other cases will depend on the cause of pain.
3. Call Your Doctor If:
   • Severe pain
   • Pain keeps you from doing normal activities (such as school, work)
   • Pain lasts more than 7 days
   • Signs of infection occur (such as spreading redness, red streak, warmth)
   • You think you need to be seen
   • You get worse

Muscle Strain or Overuse

1. What You Should Know – Muscle Strain:
   • A muscle strain occurs from over-stretching or tearing a muscle. People often call this a “pulled muscle.” This muscle injury can occur while playing a sport or lifting something. Sometimes it can also occur while doing normal activities.
   • People often describe a sharp pain or popping when the muscle strain occurs. The muscle pain worsens when moving the hip or leg.
   • Here is some care advice that should help.
2. What You Should Know – Overuse:
   • Sore muscles are common following vigorous activity (such as running, sports, weight lifting, and moving furniture). This can happen when your body is not used to this amount of activity.
   • Strained muscles often feel achy and sore all over.
   • Here is some care advice that should help.
3. Apply a Cold Pack:
   • Apply a cold pack or an ice bag (wrapped in a moist towel) to the area for 20 minutes. Repeat this in 1 hour and then every 4 hours while awake.
   • Do this for the first 48 hours after an injury.
   • This will help decrease pain and swelling.
4. Apply Heat to the Area:
   • Beginning 48 hours after an injury, apply a warm washcloth or heating pad for 10 minutes 3 times a day.
   • This will help increase blood flow and improve healing.
   • Caution: avoid burns. Make sure it is warm, not hot. Never sleep on, or with, a heating pad.
5. Hot Shower:
   • If stiffness lasts over 48 hours, relax in a hot shower twice a day.
   • Gently move the leg under the falling water.
6. Rest vs. Movement:
   • Rest the hip and leg as much as possible for the first day or two.
   • Staying active helps muscle healing more than resting does.
   • Continue normal activities as much as your pain permits.
   • Avoid heavy lifting and active sports for 1 to 2 weeks or until the pain and swelling are gone.
7. What to Expect:
   • Minor muscle strain and overuse should start to get better in a couple days.
   • The pain should go away within one week.
8. Call Your Doctor If:
   • Severe pain
   • Pain keeps you from doing normal activities (such as school, work)
   • Pain lasts more than 7 days
   • You think you need to be seen
   • You get worse

Over-the-Counter Pain Medicines

1. Pain Medicine:
   • You can take one of the following drugs if you have pain: acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve).
   • They are over-the-counter (OTC) pain drugs. You can buy them at the drugstore.
   • Use the lowest amount of a drug that makes your pain feel better.
   • Acetaminophen is safer than ibuprofen or naproxen in people over 65 years old.
   • Read the instructions and warnings on the package insert for all medicines you take.
2. Call Your Doctor If:
   • You have more questions
   • You think you need to be seen
   • You get worse

And remember, contact your doctor if you develop any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Hip Arthritis and Leg Pain | Treatment

Arthritis in the hips causes pain and stiffness that limits the range of motion of your hips. However, hip arthritis isn’t limited to causing pain in your hips. It can cause pain to shoot down your entire leg.

Limited range of motion in your hips has a domino effect on the surrounding muscles, ligaments and tendons in your legs. Stiffness and weakness can develop in these muscles and soft tissue due to inactivity caused by the pain in your hip that limits your mobility. However, exercising helps reduce and prevent this kind of pain.

Treat your hip arthritis with physical therapy

Exercising is difficult when you have hip pain, so you feel like you’re stuck in a loop if you need exercise to help reduce pain but cannot exercise because of the pain. This is where physical therapists come in.

Physical therapists are licensed health care professionals who specialize in treatments that help reduce pain and improve your range of motion. They frequently work with conditions that cause pain and stiffness in the joints like arthritis.

Physical therapists customize treatments to the needs of each individual patient. If you visit a physical therapist for help with hip arthritis and leg pain, they’ll examine your condition to determine which exercises and other treatments are right for you.

The exercises that physical therapists guide you through are designed specifically with people like you in mind. These exercises are gentle on the hips but challenging enough to engage the muscles and help improve their strength and flexibility. The goal of increasing strength and flexibility in these muscles is to help improve your range of motion and reduce pressure off the hip joint that contributes to arthritis pain.

Visit Peak Performance Sports and Physical Therapy for hip arthritis treatment

Is your hip arthritis causing pain to shoot down your entire leg? It’s time you talked to a physical therapist about your treatment options to help reduce your pain. Contact our team today for more information about hip arthritis or to schedule an initial appointment. 

Current knowledge and future prospective

Abstract

Chronic hip pain is distressing to the patient as it not only impairs the daily activities of life but also affects the quality of life. Chronic hip pain is difficult to diagnose as patients often present with associated chronic lumbar spine and/or knee joint pain. Moreover, nonorthopaedic causes may also present as chronic hip pain. The accurate diagnosis of chronic hip pain starts with a detailed history of the patient and thorough knowledge of anatomy of the hip joint. Various physical tests are performed to look for the causes of hip pain and investigations to confirm the diagnosis. Management of chronic hip pain should be mechanistic-based multimodal therapy targeting the pain pathway. This narrative review will describe relevant anatomy, causes, assessment, investigation, and management of chronic hip pain. The focus will be on current evidence-based management of hip osteoarthritis, greater trochanteric pain syndrome, meralgia paresthetica, and piriformis syndrome. Recently, there is emphasis on the role of ultrasound in interventional pain procedures. The use of fluoroscopic-guided radiofrequency in periarticular branches of hip joint has reported to provide pain relief of up to 36 months. However, the current evidence for use of platelet-rich plasma in chronic hip osteoarthritis pain is inconclusive. Further research is required in the management of chronic hip pain regarding comparison of fluoroscopic- and ultrasound-guided procedures, role of platelet-rich plasma, and radiofrequency procedures with long-term follow-up of patients.

Keywords: Chronic pain, greater trochanteric pain syndrome, hip joint, meralgia paresthetica, osteoarthritis, piriformis syndrome, radiofrequency ablation

Introduction

The prevalence of hip pain in the general population is 10%, and it increases with age.[1] In a published study, 14.3% of adults reported significant hip pain on most days over the previous 6 weeks.[2] Hip pain is associated with impairment of simple movements such as sitting and standing which can precipitate chronic pain resulting in impaired functional outcomes and poorer quality of life. The diagnosis of hip pain can be challenging at times due to referred pain from spine or knee, trauma, tumor, abdomen, hernial sites, joint arthropathies, muscular, and neuropathies.[3]

A search of the existing published literature revealed extensive narrative reviews on knee joint osteoarthritis (OA) but not on comprehensive chronic hip pain management.[4] In this narrative review, we searched review articles, randomized controlled trial, and case series from 2000 to 2019 using keywords “hip joint; chronic pain; radiofrequency ablation; osteoarthritis; meralgia paresthetica; piriformis syndrome; greater trochanteric pain syndrome” in PubMed and EMBASE, and relevant articles were included. This narrative review focuses on the pathophysiology, assessment, investigations, and published current evidence-based management of individual conditions causing chronic hip pain, relevant to anesthesiologist and pain physicians.

Relevant anatomy of hip joint

The hip joint is a ball-and-socket synovial joint which transfers the weight between the upper and lower parts of the body and allows movement in the multiaxial plane. This shallow joint is provided depth and stability by the labrum which is a fibrocartilage covering the acetabular rim.[3] The hyaline cartilage covers the articular surfaces and dissipates the shear and compressive forces during hip motion. Hip joint is supported anteriorly by illiofemoral and pubofemoral ligaments and posteriorly by ischiofemoral ligament.[5] The hip joint is surrounded by a large number of muscle groups which help in a wide range of motion [].[5] The trochanteric, iliopsoas, gluteus medius, and ischiogluteal bursa act as cushion between the bone and the tendons around the hip joint. Articular branches of nerve to quadratus femoris, obturator, femoral, sciatic, nerves supplying the adjacent muscles, and superior and inferior gluteal supply the hip joint.[5,6] Due to multiple nerves innervating the hip, it is difficult to distinguish between the primary hip and radicular lumbar pain.[3]

Different movements of the hip joint and the involved muscles

Causes of hip pain

Hip pain can be broadly differentiated into either orthopaedic (intraarticular and extraarticular) and nonorthopaedic causes as mentioned in .[7,8,9,10] History related to duration, site, severity, characteristic of pain, history of trauma, steroid use, and any referred pain should be asked.[7,8] In prepubescent and adolescent patients, congenital malformations of the femoroacetabular joint, avulsion fractures, and apophyseal or epiphyseal injuries are common.[3] In young skeletally mature patients, hip pain occurs due to musculotendinous strain, ligamentous sprain, contusion, or bursitis. In older adults, degenerative OA and fractures should be considered first.[3] Hip pain can be assessed using different tools such as numeric rating scale, visual analog scale, McGill pain questionnaire, pain quality assessment scale, and Massachusetts general hospital pain center’s pain assessment form.[8,9] Red flag signs should always be ruled out which includes sudden onset of severe pain due to hip fracture, infectious arthritis, osteomyelitis, history of malignancy, avascular necrosis, and unexplained chronic pain. Furthermore, a multidisciplinary team approach should be adopted with surgical, physician, pain specialist, psychologist, nursing, and caregivers as major stakeholders.

Table 1

Causes of hip pain[7,8,9,10]

Examination of hip joint

The examination of hip pain is guided by look, feel, range of hip movement, neurovascular evaluation, and physical examination test.[3,8,10] Look for any Trendelenburg gait in which there is excessive drop of the contralateral side of pelvis while walking due to weakness of gluteus medius and minimus muscles.[10] Patients with hip OA and slipped capital femoral epiphysis have demonstrated this type of gait dysfunction.[11] Waddling gait occurs due to congenital hip disorders, spinal muscle dystrophy, or myopathy. Antalgic gait is an adopted limp to avoid pain due to injury in the legs. In spastic gait, a patient walks in a crisscross manner, seen in intoxication, brain injury, stroke, and polyneuropathy. In steppage gait, foot hangs with the toes pointing down and scraping the ground while walking, which is seen in patients suffering from multiple sclerosis, peripheral neuropathy, and spinal cord injury.[12] Patients with an intraarticular source of pain can often show this using the C-sign, deep pointer sign, or coordinate fingers [].[8,10]

Patient finger pointing indicative of hip joint pain. (a) Trochanteric C sign, (b) triangular sign, and (c) deep pointer sign

The normal range of hip movement is 100° flexion, 30° extension, 40° abduction, and 20°adduction. With hip in flexed position, the internal and external rotation of hip joint is 45°. The range of movement is also restricted in various pathologies of hip joint.

Physical examination of hip can be assessed systematically as starting from leg length difference, contracture of musculature, and intra- and extraarticular hip pathologies as enumerated in .[13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29]

Table 2

Differential diagnosis of hip pain according to site of pain[7,8,9,10]

• (a) Leg length difference: Galeazzi test and leg length difference test are commonly performed for leg length difference.[13,14] On measuring the distance from anterior superior iliac spine medial malleolus on each side, if the measured difference is more than 1.5 cm, it is considered abnormal[15]

• (b) Contracture of musculature: Noble test and Ober test are done for iliotibial tract. Different tests are done to identify hamstring tightness and adductor contracture test[17,18,19,20] as mentioned in

  Table 3

  Physical examination tests for hip pain[13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29]

  Test	Performance	Assessment
  Leg length difference test
  Galeazzi test[13,14]	Patient is supine with knees flexed at 90° and the sole of feet lie flat on the examination table. Normally both knees are at the same level.	When one knee is higher than the other, either tibia of the same side is longer or contralateral tibia is shorter. When one knee projects farther forward than the other, either that femur is longer or the contralateral femur is shorter.
  Actual or functional leg length difference test[13,15]	Patient is standing with shims of varying thickness (0.5, 1, and 2 cm) placed in/under shortened leg until pelvic obliquity is fully compensated.	This will give the estimate of leg length difference. In cases where shims cannot compensate for pelvic obliquity, patient is having a fixed deformity of one or more joints leading to functional leg length difference. This can be a result of flexion or adduction contracture in hip. The pelvic dips towards normal side; the normal leg appears lengthened and effected leg shortened.
  Contracture of musculature
  Noble compression test[18,19,20]	Patient lies on a flat table with knee at 90° and hips at 50°. The examiner moves the knee back and forth several times from 0° to 90° while palpating the lateral epicondyle of femur on the effected site.	Palpable snapping, rubbing, crepitus or localized pain along the distal iliotibial tract (ITB) suggests a iliotibial tract frictional tendinitis. Pain in the posterior aspect of thigh indicates hamstring contracture.
  Ober test[13]	Patient is in lateral position, the leg to be examined is up, slightly adducted, and hip is slightly hyperextended. The examiner places hand on distal iliotibial tract and allows leg to move from abduction to adduction.	If the leg fails to touch the floor then Iliotibial band shortening is present.
  Fingertip test[14]	Patient is asked to sit on a flat table with one leg flexed at hip and knee and the other extended at hip and knee. Patient is asked to touch the toe of the extended leg with hand.	Inability to touch the toes of feet and hand in the general area of foot and complains of “pulling” pain in posterior thigh indicates hamstring contracture.
  Test for hip osteoarthritis
  Trendelenburg’s sign[15]	Patient in standing position is instructed to lift one leg up by flexing their hip and knee, standing on only one leg.	Positive test is 2 cm drop of the contralateral side of pelvis once the leg is lifted. Sensitivity (SN) 55%, specificity (SP) 70%
  Test for Impingement/labral tear
  Impingement FADIR test[25,26,27]	Supine, bilateral legs extended. Clinician passively moves the patient’s one leg to 90° hip and knee flexion. The leg is then passively adducted and internally rotated with overpressure to both motions at end range	Positive test is reproduction of concordant pain, locking, clicking and catching pain.
  Thomas test[27]	Patients hold nontested leg toward their chest with bilateral arms as the clinician passively lowers the tested leg into extension. Holding the other knee to chest allows flatten lumbar lordosis and stabilizes pelvis.	If iliopsoas contracture is present then, the extended leg will not reach a full extension position on the table.
  Log Roll (Freiberg) test[13,14]	Patient is in supine position with hip in a neutral position, and the leg is passively rolled into full internal and external rotation.	A click reproduced during the test is suggestive of labral tear, while increased external rotation range of movement may indicate iliofemoral ligament laxicity.
  FABER test (Patrick test)[13,15]	Patient is in supine position, and one leg is extended straight on table. The other leg is flexed, adducted, and externally rotated at the hip joint. The flexed leg is pressed at knee joint.	Pain produced in groin indicates hip pain and if produced in gluteal region indicates sacroiliac pathology.
  Lumbar spine radiculopathy
  SLR test[11,15]	Patient is in supine, and the examiner passively elevates the leg by holding it at ankle. The hip is flexed to 70°-90° with knee extended.	Positive test is reproduction of pain in from hip to ankle in lumbosacral radiculopathy. Both SLR and cross SLR put strain on lumbosacral nerve roots. Pain restricted to posterior aspect of thigh indicates tension on hamstrings.
  Miscellaneous
  Piriformis test (FAIR test)[28,29]	Patient lies in lateral position with test leg uppermost.[28] The patient flexes upper hip at 60° with flexed knee. The examiner stabilizes the hip and applies downward pressure on the upper knee with internal rotation.	If sciatic nerve is pinched in pyriformis muscle than patient experiences sciatica type pain in hip and leg.[29]

• (c) For intraarticular hip pain, a patient is made lie flat on the table. One limb is elevated with knee in extension and hip in flexion. A downward resistance is applied at the level of thigh at 30°–45° (Stinchfield test). If there is any intraarticular cause of hip pain, then the patient will complain of pain in the hip[22]

• (d) For iliopsoas bursitis, bilateral isometric resisted hip adduction produces groin pain. In trochanteric bursitis, positive resisted abduction release produces pain at the same site. In iliopsoas bursitis pain, a snapping hip manoeuvre produces pain. The patient is made to lie supine with the hip to be examined flexed, then abducted, and externally rotated. The examiner’s hand is kept at the inguinal crease. Then the hip is returned to neutral position. A palpable snap during the last phase of the maneuvre is indicative of iliopsoas bursitis. The other tests for hip examination are summarized in [24,25,26,27]

• (e) In piriformis test (FAIR test),[28] The maneuvre elicits pain in hip if pyriformis muscle is tight. If sciatic nerve is pinched in pyriformis muscle, then the patient experiences sciatica-type pain in the hip and leg[29]

• (f) The test for hip dislocation is Drehmann sign.[30] The Anvil test is done to differentiate hip pain from spine disorders[31]

• (g) Sensory, motor, reflexes, and neurovascular examination should be done of the lower leg. Details will be beyond the scope of this article.

Investigations

Blood investigations such as complete blood counts and erythrocyte sedimentation rate can differentiate infective versus inflammatory cause of hip pain. X-ray of the hip joint should be performed if there is any suspicion of acute fracture, dislocation, or stress fracture. Ultrasonography is a useful technique for evaluating individual tendons, identifying joint effusions, confirming suspected bursitis, and functional causes of hip pain. Conventional magnetic resonance imaging (MRI) of the hip can detect many soft tissue abnormalities and is the preferred imaging modality. Conventional MRI has a sensitivity of 30% and an accuracy of 36% for diagnosing hip labral tears, whereas magnetic resonance arthrography provides added sensitivity of 90% and accuracy of 91% for the detection of labral tears.[32]

Management of chronic hip pain

Chronic pain involves nociceptive or/and neuropathic pain. Nociceptive pain originates from the bone, synovium, and other tissues. In nociceptive pain, initially there is only peripheral sensitization and pain can be controlled with systemic or topical drugs as they decrease the release of peripheral inflammatory mediators.[33] Neuropathic pain is due to injury in the path of somatosensory nervous system. For example, in piriformis syndrome, there is stretching of nerves or due to lumbar disc prolapse there is radiculopathy. In chronic conditions such as OA or RA, neural sensitization will not be confined only to the periphery. Due to persistent tissue inflammation around the nerve, pain mediators are released which increase the excitability of pain pathways, and hence lead to neuroplasticity pain.[33] Referred pain and pain away from the original site can be neuroplasticity in origin. The increased excitability of spinal neurons in this condition leads to enhanced pain perception at the site of injury. In chronic pain conditions, the presence and severity of pain is also determined by psychological and social factors. These external factors modulate nociceptive processing at a supra spinal or cortical level enhancing the pain perception, reporting, and behavioral change.[33]

Management of individual chronic hip pain conditions

1. OA hip

   OA of the hip is the second most common joint after knee affecting women twice as common as men. The common risk factors are genetic, dysplasia of hip, hip joint laxity, increased body mass index, and manual labour. These factors cause increase in wear and tear, instability, malalignment, microtrauma, and structural damage of hip joint[34]

   Patients with hip OA present with groin pain, which is initially intermittent, worse at the end of the day, and activity-related. The most popular score for OA is Kellgren–Lawrence system based on the assessment of the presence of osteophytes, joint space narrowing, subchondral sclerosis, and deformity of femoral head and acetabulum. Computed tomography (CT)-based scoring is accurate and involves assignment of score to osteophytes, subchondral cyst, and joint space narrowing for determining severity of OA. MRI helps in diagnosing cartilage and labrum pathology[35]

   In evidence-based medicine, Level A evidence means a strong recommendation and should be followed. Level B evidence is a recommendation, but the clinician should be alert to new information and sensitive to patient preferences. Level C evidence signifies an option and the clinician should be flexible in their decision-making. Level D evidence lacks a sufficient data and its significance is very less[36]

   Evidence-based clinical practice guidelines for the management of OA hip are formulated by the American Academy of Orthopedic Surgeons,[37] American College of Rheumatology,[38] National Institute for Health and Care Excellence (NICE),[39] and Royal Australian College of General Practitioners (RACGP).[40]

   • (i) Strong evidence (Level A) supports the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to improve the short-term pain, function, or both in patients with symptomatic OA hip[37,38]

   • (ii) Moderate strength evidence (Level B) does not support the use of glucosamine sulfate because it did not show any added benefits than placebo for improving function, reducing stiffness, and decreasing pain for patients with symptomatic OA hip[37]

   • (iii) Strong evidence (Level A) supports the use of intraarticular corticosteroids to improve function and reduce pain in the short-term for patients with symptomatic OA hip.[37] Indications of intraarticular hip joint corticosteroid injection are 1) to determine whether hip pain is secondary to hip versus spine pathology, 2) to determine intraarticular versus extraarticular pathology, 3) likelihood of achieving pain relief with hip arthroplasty, 4) whether surgery is contraindicated, and 5) in young patients in whom there is concern for the longevity of implant. One should be cautious while giving intraarticular steroid injections as rapid destructive OA is one of its complications[41]

   • (iv) Ultrasound-guided hip joint injection: The patient lies in supine position with linear transducer placed in longitudinal oblique plane along the axis of the femoral neck to examine the anterior recess. The femoral head is identified and the probe is positioned to obtain an axial view through the head. Then slide the probe distally toward the junction of the femoral neck and head. The needle is inserted from the lateral side along the long axis of the probe []. When the needle as bone contact, it will lie within the joint on the anterolateral aspect of head–neck junction. Under strict asepsis, 4–5 mL of mixture of steroid and local anesthetic is injected at the anterior recess in the axial plane[42]

     Ultrasound image showing hip joint injection. Longitudinal view high-frequency ultrasound linear probe. 1 acetabulum, 2 hyperechoic labrum, 3 femoral head, 4 iliofemoral ligament, 5 anterior recess, 6 iliopsoas, 7, sartorius. The white line represents the trajectory of the needle for placement in hip joint

   • (v) Strong evidence (Level A) does not support the use of intraarticular hyaluronic acid because it does not perform better than placebo for function, stiffness, and pain in patients with symptomatic OA hip[37]

   • (vi) Strong evidence (Level A) supports the use of physical therapy as a treatment to improve function and reduce pain for patients with OA of the hip with mild to moderate symptoms.[37,38] It is strongly recommended to perform aerobic and stretching exercises, lose weight if obese, and to receive psychosocial interventions[37,38]

   • (vii) Duloxetine could be considered for some people with knee and/or hip OA when other forms of pain relief are inadequate.[40] There is a strong recommendation against the use of the oral and transdermal opioids, viscosupplementation injection for hip OA, doxycycline, strontium ranelate, interleukin-1 inhibitors, and stem-cell therapy. Due to a lack of high-quality evidence, no recommendation can be made for the injections of platelet-rich plasma (PRP), NSAIDs cream applied locally, capsaicin, collagen, and methylsulfonylmethane[40]

   • (viii) A moderate quality evidence was reported favoring tramadol alone or in combination with acetaminophen versus placebo but had no important benefit on mean pain or function in people with OA, although slightly more people in the tramadol group report an important improvement (defined as 20% or more)[43]

   • (ix) Patients with advanced symptoms and pathology not responding to conventional treatment should be referred for arthroplasty. But total hip arthroplasty is also associated with concerning failure rate (5%–15%),[41,44] significant cost, and persistent postsurgical pain (7%–28%).[45,46] Nerves supplying the hip joint like articular branches of the obturator nerve, articular branches of the femoral nerve, articular branches of the sciatic, and superior gluteal nerve can be ablated with radiofrequency. Ablation of sensory nerves by preserving motor branches can improve the success rate and decrease the complications[7]

   • (x) Fluoroscopic-guided ablation of articular branches of hip joint: Initially, a diagnostic block of 0.5–3 mL of local anesthetic is administered under fluoroscopic guidance. For articular branches of the obturator nerve, the target is the point immediately inferior to the “teardrop” silhouette, formed by the junction of the pubic and ischial bones. For articular branches of the femoral nerve, the target point is immediately inferior and medial to the anterior inferior iliac spine []. In narrative review, 14 publications reported high success rate in relieving chronic hip pain at 8 days to 36 months after the procedures, but none of the publications was randomized controlled trials.[7]

     Suggested site of needle placement for radiofrequency ablation of articular nerves under fluoroscopic guidance. (a) Site for articular branches of FN – femoral nerve, OV – obturator nerve on anterior surface of hip joint. (b) Site for articular branches of SGN – superior gluteal nerve, NQF – nerve to quadratus femoris on posterior surface of hip joint

2. Greater trochanteric pain syndrome

   The term “greater trochanteric pain syndrome” encompasses gluteal medius and minimus tendinopathy/tears, trochanteric bursitis, and external coxa saltans. Bursitis occurs in 4%–46% and gluteal tendinopathy in 18%–50% patients.[47] The trochanteric bursa is located deep to the iliotibial band and superficial to the hip abductors and is a frequent cause of lateral hip pain. A localized tenderness may be elicited on deep palpation of the lateral aspect of greater trochanter. Pain is elicited with resisted hip abduction and hip extension more during gluteal tendinopathy when compared with trochanteric bursitis. Ultrasound will show increased fluid signal with trochanteric bursa[47]

   Gluteal tendinopathy presents as chronic activity-related pain and impaired performance of a tendon. X-ray of the hip shows normal study.[48] Patients are advised to avoid cross leg standing and lying on either side as it increases friction of tendon and pain[48]

   Conservative treatment is gold standard for 90% success rate. The initial treatment of trochanteric bursitis is conservative with rest, physical therapy, and NSAIDs.[47] In gluteal tendinopathy, therapy is directed toward quadriceps strengthening and ilio tibial band stretching. Hip abduction exercises directed toward strengthening and stretching of gluteus medius and minimus should be initiated. For persistent cases, a corticosteroid injection should be given and repeated in 6 weeks if pain persists.[48] Concern regarding corticosteroid injection is the risk of weakening the tendon structure in long-term. Recently, use of PRP has reported improvement in patients at 3- and 12-month follow up, but lacked high-quality evidence.[49] Surgery may be considered if these measures do not relieve symptoms and pain lasts longer than 1 year[47]

   Ultrasound-guided injection of greater trochanteric bursa is best approached with patient in lateral position with effected side up. Under strict asepsis, a linear probe in placed in the longitudinal plane to greater trochanter. Trochanteric bursae lies adjacent to the bone cortex, and a combination of steroid and local anesthetic is injected after aspiration[42]

   For iliopsoas tendinopathy, the patient is positioned supine and a linear probe is placed along iliopsoas tendon lateral to the neurovascular bundle. The needle is advanced from the lateral side of the thigh, in plane, and a mixture of steroid and local anaesthetic is injected in the peritendon area.[42]

3. Meralgia paresthetica

   Meralgia paresthetica (MP) refers to the entrapment of the lateral femoral cutaneous nerve at the level of the inguinal ligament. The cause is usually idiopathic but can be due to trauma, overuse, leg/trunk discrepancy, prolonged standing, external compression by belts, weight gain, and tight clothing. The symptoms include paresthesia, numbness, burning sensation, dysesthesia, and pain over the lateral aspect of the thigh. Treatment includes removal of source of compression, physical therapy, NSAIDs, tricyclic antidepressants, and anticonvulsants. For patients irresponsive to initial treatment, local anesthetic and/or corticosteroid injection under ultrasound guidance may be therapeutic.[42] Pulsed radiofrequency of the lateral femoral cutaneous nerve (LFCN) provides an effective, low-risk treatment in patients refractory to conservative medical management.[50] In a recently published review article, insufficient data were found to compare the recommendation of neurolysis or neurectomy as the modality of treatment for MP.[51]

4) Piriformis syndrome

Treatment of piriformis syndrome is mainly conservative methods, such as stretching exercises, injections, NSAIDs, muscle relaxants, ice, and activity modifications.[52] Corticosteroid injections may provide temporary analgesia to allow patients to participate in physical therapy, but it does not correct the underlying pathophysiology and may need to be repeated. Injections with neurotoxins such as botulinum toxin are also being investigated.[53,54] Surgical decompression can be considered as the last option to reduce any tension in the piriformis muscle by releasing fibrous bands or constrictions compressing the sciatic nerve.[52]

Clinical points for management of chronic hip pain

1. Correct diagnosis is most important in management of chronic hip pain. Taking detailed history, clinical examination, investigations, and clinical judgement allow one to reach the cause of pain

2. Mechanistic-based management of chronic pain relies on the type of pain, somatic, neuropathic, or mixed type of chronic pain

3. Strong evidence in support for use of NSAIDS and use of physical therapy as a treatment to improve function and reduce pain for patients with OA hip with mild to moderate symptoms

4. For OA hip, intra-articular hip joint once very popular is not being slowly replaced with extra-articular ablation of articular branches of hip joint

5. Treatment of trochanteric bursitis is conservative and NSAIDS. Local anesthetic with steroid may be injected in refractory cases

6. Gluteal tendinopathy therapy is directed toward quadriceps strengthening and iliotibial band stretching. Recently, use of PRP has reported improvement in patients at 3- and 12-month follow up, but lacked high-quality evidence

7. For MP and pyriformis syndrome, removal of source of compression, physical therapy, NSAIDs, tricyclic antidepressants, and anticonvulsants. Pulsed radiofrequency of the LFCN provides an effective, low-risk treatment in patients refractory to MP. For pyriformis syndrome, corticosteroid injections may provide temporary analgesia and may need to be repeated.

Hip Pain | Aurora, CO

90,000 Pain in the Legs, Knees, or Hips: 6 Exercises to Help You Heal

Knee Pain is the second largest cause of chronic pain in the United States, and millions of people suffer from pain in the hips and legs every day.

The hips and knees are the largest joints in the body, responsible for the way we walk and stand. Pain in these areas, as well as in the lower back, neck, and shoulders, can come from the legs.

Physiotherapy is the most effective way to relieve these pains and it can improve the quality of your daily life.

Here are six of the best exercises to soothe hip, knee, and leg pain:

Walking on tiptoe
All you have to do is stand on tiptoe and walk at an accelerated pace for 5-15 minutes.

Walking on a tennis ball
Sitting on a chair, roll a tennis ball with your foot on the floor and massage your foot from toes to heels.

Circles
Sitting or standing, lift one leg and slowly rotate it in a circular motion, 10 times clockwise, 10 more times counterclockwise, and then repeat the same with the other leg.

Resistance
Wrap the tape around a chair or bed, sit on the floor and place one leg under the other. Bend your knees slightly and try to grab the tape with your upper leg. Bend your leg back towards your head while stretching the tape and relax. Do 10 reps with both legs.

Heel Raises
Hold the back of the chair and stand behind it. Use it to maintain balance by bending one leg behind you at the knee. Then slowly lift the heel of the other foot so that you are on your toes, hold and lower your body back onto your heels.Do 10 reps with both legs.

Toes
Bend your toes and try to lift the towel off the floor. Repeat 10 times with both legs.

Research has shown that a good pair of shoes will be of great help in treating knee and hip pain and:
“Never wear high heels. They increase the risk of knee degeneration. ”

However, not all flat shoes are good for your feet. Shoes that don’t provide support can lead to back and knee pain.

Choose the right footwear
Tight shoes can cause limp from pain in your feet.

The sneaker provides cushioning and helps control overvoltage. Change your shoes if necessary.

If your knee or hip pain is caused by the function of your foot, the right shoes, along with orthopedic insoles, can be a very effective way to relieve symptoms. Invest in quality footwear.

A healthy man contracted the coronavirus and lost his leg: People: From life: Lenta.Common crawl en

A resident of the English city of Bournemouth, Dorset, suffered a leg amputation after he developed a blood clot as a result of infection with the coronavirus. This is reported by the Daily Mail.

At the end of October, 56-year-old Lee Mabbatt fell ill with COVID-19. He could no longer distinguish between tastes, and his whole body ached. After ten days of isolation at home, Mabbett’s health improved. The man decided that he had recovered from his illness, but later realized that he could not feel his right leg.

Related materials

00:01 – December 21, 2020

00:01 – July 22, 2020

The Englishman called the specialists of the National Health Service, who advised him to take pain medications. After a few days, the pain in his leg worsened, and this time he was advised to go to the emergency room. Computed tomography revealed a 15 cm thrombus in the patient’s upper thigh.

Surgeons immediately performed surgery to remove the blood clot to restore blood supply to Mabbet’s leg.But a few days later, the toes and the arch of the patient’s right foot began to turn black. After the operation, Mabbett remained in the hospital for 13 days. The blood supply did not resume, and his leg slowly began to die off.

Doctors decided to amputate the patient’s leg in January, and the man was temporarily discharged from the hospital. However, on December 15, he was taken back to the medical facility and urgently amputated a limb, as it turned black.

“In three months I will be able to walk with a prosthesis again.I just want to walk with my dogs and have a normal life, but now things are different. I am very lucky with the lifestyle: I live in a bungalow and can work from home while sitting in a wheelchair. The loss of a limb will not affect me the way it affects other people, ”he said.

Mabbett stressed that he was completely healthy before the coronavirus. He urged others to maintain social distance to avoid contracting the coronavirus.

Earlier it was reported that a resident of the English city of Whitstable, Kent, who had recovered from COVID-19, complained of a distorted sense of smell and taste, because of which she thinks that any food smells like rot.The Englishwoman compares the taste of meat to floral soap or perfume, toothpaste to gasoline, and coffee to the smell of car exhaust or tobacco smoke.

Stories without censorship and prohibitions – in the “Tape of the Bottom” in Telegram

90,000 Everything hurts after the first ride. What to do?

In most cases, it is completely normal for body parts to ache after the first ride. This just means that you are going through the process of being initiated into cyclists;) But in some cases, you should pay attention to unpleasant sensations, especially if the body aches and hurts after 4-5 rides.

In this article we will tell you how to facilitate the rolling-in process, as well as what unpleasant sensations you should pay special attention to and how you can get rid of or prevent them.

Problem: after the first trips, the butt hurts 🙁

An aching backside after the first rides is absolutely normal and everyone, even experienced cyclists, encounters it after a long break. Your body adjusts to new loads, it needs to be given a little time and everything will pass! However, if the discomfort does not subside after the first 4-5 rides, then you should think about changing the saddle – most likely it was chosen incorrectly.

Solution:

Everything is pretty simple here. Very soon your body will get used to it and the discomfort will pass, and so that the muscles and soft tissues at the initial stage are better adapted to the load, they can be warmed up with regular squats. Do 25-30 deep squats before riding – that should be enough.

Special cycling shorts with a diaper will facilitate the process of getting used to and add comfort while riding. They are used by both experienced cyclists and long-distance riders.But if the discomfort does not go away, and the cycling shorts did not save you from pain and discomfort, then you need to think about changing the saddle. Most likely it does not suit you in size, shape, or it is too soft.

Problem: wrists hurt after riding

Often, beginners complain of pain and sagging in their hands during and after skiing. There may be several reasons at once and, therefore, ways to solve them.

Solution:

Firstly, the hands can hurt due to excessive pressure on them as a result of improper seating.Make sure your saddle is level, flat and nose-down, causing you to roll off the saddle like a slide, pushing against the handlebars. Also pay attention to the position of the handlebar, it may be set too low, as a result of which a high load is placed on the hands. Fit also directly affects wrist comfort. Make sure the size of the bike is correct.

Secondly, discomfort in the hands can be caused by a lack of shock absorption and shock loads in the hands.This can be corrected with softer grips, straps, cycling gloves with special softening pads.

Problem: after riding the muscles of the legs or knees hurt

Pain in the muscles of the legs after the first trips in popularity comes immediately after the aching priests;) It is easy to cope with it with exercises BEFORE and AFTER riding. But aching knee joints should immediately alert …

Solution:

Aching quads and partly calf muscles after the first rides are normal.They can be prevented with a couple of simple exercises before riding.

Classic: Our favorite 25-30 pre-set squats will warm up your legs and improve blood flow. 15-20 forward bends of the trunk with straight legs will do the same with the muscles of the back of the thigh and lower leg. Pulling up the ankle with your hand to the buttock 10-15 times will also help well. This exercise can be done even while parked or resting. Begin riding in low gear and high cadence to warm up your muscles and joints.After skiing, stretch or massage the muscles of the legs – this will help them recover faster and partially remove the discomfort after.

All of the above exercises are also suitable for warming up the knee joints. To avoid knee pain, remember to drink water or isotonic drinks while riding, especially in hot weather. Also, do not ignore gear shifting, it helps to regulate the load, apply effort rationally and not overload the knee joints.You need to constantly operate the switches and try to maintain optimal high cadence. Keep your knees warm in cold weather.

Conclusion

Do not be afraid of unpleasant sensations after the first trips – this is normal and they pass quickly. Use our tips and it will greatly facilitate your process of adapting to the bike!

90,000 Pain in hips, joints, lower back and bones in cancer patients

Highlights

Pain in the hip, joints, lower back or bones is a very common sign / symptom / side effect associated with many different diseases, including cancers such as primary and secondary bone cancers, advanced bone metastatic cancers, chondrosarcoma, and leukemia.Various laboratory studies and several human trials show that omega-3 fatty acids, curcumin, vitamin D3, and glucosamine with chondroitin are promising supplements that may have the potential to reduce pain in the musculoskeletal system, including pain in joints, hips, bones and the lower back in cancer patients, especially the chest. cancer. Cancer patients should discuss with their healthcare providers before accidentally taking these nutritional supplements for bone pain to avoid unwanted interactions with ongoing treatment.

Is bone, hip, joint and lower back pain a sign of cancer?

Musculoskeletal pain, including pain in the hips, joints, lower back and bones, is a very common health problem around the world. According to the World Health Organization, lifetime prevalence of non-specific low back pain ranges from 60% to 70%.

Pain in the hips, joints, lower back, and bones can be associated with many different conditions, including arthritis, injury, pinched nerves, and cancer.

Musculoskeletal pain, including pain in the hips, bones and lower back, is a very common sign / symptom of cancers such as:

• Bone cancer: Pain in bone cancer is one of the most common signs of bone cancer (primary and secondary cancer).

• Leukemia or myelodysplastic syndromes (MDS): In cancers such as leukemia and MDS, the bone marrow becomes overcrowded due to uncontrolled production of certain types of white blood cells, resulting in bone pain that begins first in the arms and legs, and then in the thigh.

• Metastatic or advanced cancer: In advanced cancers or cancers with metastases (such as metastatic cancer of the prostate or breast), cancer often spreads to the bones of the spine, ribs, hip, or pelvis, causing hip pain.

• Chondrosarcoma: This is a rare type of cancer that usually begins in the bones or soft tissue near bones. Chondrosarcoma tumors mainly affect the pelvic, hip, and shoulder areas, so pain in these areas is a common symptom of this cancer.However, in some cases, the base of the skull is also affected.

• Lung cancer: If the tumor occurs in the back of the lung, the pain can spread to the lower back.

Link between hip pain and prostate, breast and lung cancer

More than 60% of patients with advanced prostate cancer develop bone metastases followed by bone and hip pain.

In a population-based study of United Kingdom primary care patients conducted by researchers from Keele University in the United Kingdom, they highlighted that new back, hip and neck problems were associated with later diagnosis of prostate, breast and other conditions.lung cancer, especially one year after consultation for back, hip and neck problems. They found that after a year, the risk of prostate cancer was five times higher among those men who consulted for back pain. (Calvin P. Jordan et al., Int J Cancer., 2013)

Association between hip / back pain and metastatic breast cancer

Bone is the most common site for breast cancer metastasis or spread. In 70% of all patients with metastatic breast cancer, bone is a frequent site of cancer spread / metastasis, which can lead to bone or back pain.

Breast cancer metastases often involve the spine, ribs, skull, pelvis, and upper bones of the arms and legs. In 13.6% of patients with breast cancer diagnosed in stages I-III, after 15 years of follow-up, bone metastases (cancer spread) will develop. (Caroline Goupil et al., Nutrients., 2020)

Foods to Eat After Cancer Diagnosis!

No two cancers are the same. Go beyond general dietary guidelines for everyone and make individual decisions about food and supplements with confidence.

Possible dietary interventions for hip and bone pain in cancer

The following are examples of several promising products / supplements that may reduce joint, hip and bone pain in cancer patients.

Omega-3 fatty acids may help reduce bone metastases in breast cancer patients

A study published by researchers at the Tours Regional Hospital University in France showed that low levels of long-chain omega-3 polyunsaturated fatty acids may be associated with bone metastases in premenopausal women with breast cancer.(Caroline Goupil et al., Nutrients., 2020)

Research shows that omega-3 fatty acid supplementation may be a promising dietary intervention for reducing bone metastases (and possibly secondary bone cancer), ultimately reducing bone and hip pain in cancer patients, especially breast cancer patients …

In addition, the use of omega-3 fatty acids reduces inflammatory joint pain in rheumatoid arthritis, chronic spinal pain in autoimmune diseases, and neuropathic pain.

Food sources rich in omega-3: Fatty fish such as salmon and plant foods such as walnuts, vegetable oils and seeds such as chia seeds and flax seeds.

Vitamin D3 may help reduce musculoskeletal pain in breast cancer patients

In a study by researchers at the University of Nebraska Medical Center at Lincoln in the United States, breast cancer patients with low vitamin D3 levels reported joint pain and stiffness, bone and muscle pain in the neck and back / hip areas.pain increases significantly with a decrease in serum vitamin D3 levels. (Nancy L. Waltman et al., Cancer Nurs., March-April 2009)

Research shows that vitamin D3 supplementation may be a potential nutritional intervention to reduce joint pain and stiffness, bone pain, and muscle pain in the neck and back in cancer patients, especially breast cancer patients.

Food sources rich in vitamin D: Fatty fish such as salmon, tuna and mackerel, meat, eggs, dairy products, mushrooms.

Curcumin may suppress bone cancer and reduce joint pain in cancer patients.

Curcumin is the key active ingredient in the turmeric spice.

An experimental study by researchers at the Chinese Medical University Hospital, Taichung, Taiwan, showed that curcumin can induce apoptosis (cell death) in human chondrosarcoma cell lines (cancer that starts in the bones). (Xiang-Ping Li et al., Int Immunopharmacol., 2012)

Due to the anti-inflammatory and anti-cancer potential of curcumin, City of Hope Medical Center is conducting clinical trials to study how well curcumin reduces joint pain in breast cancer survivors and joint diseases caused by treatment with aromatase inhibitors.(NCT03865992)

Curcumin may be a promising supplement with the potential to suppress primary and secondary bone cancers and reduce joint pain in cancer patients.

Is curcumin good for breast cancer? | Get Personalized Nutrition for Breast Cancer

Watch this video on YouTube

Glucosamine, together with chondroitin, may reduce aromatase inhibitor joint pain in breast cancer patients

A phase II study from Columbia University in the United States assessed the effect of 24 weeks of glucosamine sulfate and chondroitin sulfate use on joint pain / stiffness in postmenopausal women with early breast cancer who developed moderate to severe joint pain …after you start taking aromatase inhibitors. A study found that glucosamine / chondroitin supplementation resulted in a moderate reduction in joint pain and stiffness caused by aromatase inhibitors, with minimal side effects in breast cancer patients. (Heather Greenlee et al., Support Care Cancer., 2013)

Conclusion

Pain in the hip, joint, lower back or bone is a very common sign / symptom / side effect in various types of cancer. Food and supplements, including omega-3 fatty acids, curcumin, vitamin D3, and glucosamine with chondroitin, may have the potential to reduce musculoskeletal pain, including joint, hip, bone, and lower back pain in cancer patients, especially breast cancer.Larger clinical trials are needed to confirm these results. Avoid accidentally taking these supplements without consulting your healthcare professional to avoid unwanted interactions with ongoing cancer treatments.

What food you eat and what supplements you take is your decision. Your decision should include consideration of cancer gene mutations, type of cancer, ongoing treatments and supplements, any allergies, lifestyle information, weight, height, and habits.

Cancer nutritional planning from the add-on is not based on Internet searches. It automates the molecular science decision making process implemented by our scientists and software developers. Whether you want to understand the underlying biochemical molecular pathways or not, this understanding is essential for cancer nutrition planning.

Get started NOW with meal planning by answering questions about cancer name, genetic mutations, current treatments and supplements, any allergies, habits, lifestyle, age group and gender.

Foods to Eat After Cancer Diagnosis!

No two cancers are the same. Go beyond general dietary guidelines for everyone and make individual decisions about food and supplements with confidence.

Cancer patients often have to deal with various side effects of chemotherapy that affect their quality of life and seek alternative cancer treatments.