Make no mistake, the hip joint is the Don.
The mob boss, the crimelord.
Why?
1. Because, as far as joints go, it is a big player.
Arguably, it is the most important joint in the body. It connects the entire locomotive and weight-bearing limb to the rest of the body. You can walk (with great difficulty) without a knee and an ankle but you can’t walk at all without a hip.
2. Because it is so elusive to capture.
Just like Capone and Escobar, it’s very hard to pin a crime on the hip joint. Unlike the knee and ankle that cause localised pain and visible, palpable swelling, the hip is buried deep in the underworld. It’s hard to get to. It surrounds itself with layers of smaller players that it can divert blame to.
<3>3.Because it has a fall guy.
The hip’s favourite fall guy is its neighbour: the iliopsoas tendon and bursa. The poor iliopsoas rarely causes trouble. Rarely are primary strains seen in iliopsoas on MRI the way we commonly see them in calves, hamstrings and quads. Yet when the hip is angry, it gets inflamed and the inflammation spills over into the iliopsoas bursa and irritates the tendon. Poor old iliopsoas can’t keep his cool when irritated and interrogated. Stretch him across an inflamed hip joint and he’ll squeal. Test him against resistance and he’ll crack. But what you can’t see is his boss: the hip joint sticking the knife in from behind.
Hip pain is most commonly felt in the anterior inguinal area (at the front in that crease where the leg joins the body – and deep to it). It can however radiate laterally and commonly down the lateral thigh (sometimes as far as the knee). It can send pain into the buttock and occasionally into the groin.
Commonly the hip flexors look and feel irritated but they are rarely the primary problem
How do you uncover the kingpin?
To find the clues you need to know his tricks. These are his most common signs.
1. Pain in either of its top two favourite spots (pictured below)
2. Pain with FADIR: combined passive flexion, adduction and internal rotation
3. Pain or restriction with a hip flexor stretch
4. Pain or restriction with passive internal rotation (see below)
