Hip/Pelvis-Gluteal Pain

Gluteal pain is a common musculoskeletal condition affecting a significant percentage of the sporting and general population.
Presenting pain and discomfort may be felt in various areas of the hip and pelvis.
The pain can be of gradual onset and vary in intensity with daily activities or of sudden onset during or after a sporting event.
Treatment is based on assessment and identification of the specific structures involved, as gluteal pain may arise from various sources these may include the lumbar spine, sacroiliac joint, pelvis and extremities.
To gain an understanding of your particular injury, we need to know a about your past health its onset and exercise regime.
A comprehensive physical examination and functional assessment will be carried out in order to reach a clear diagnosis and a better understanding of your condition.
Based on the examination, an optimal treatment and management plan can be implemented.

Hip and Gluteal Pain Management
Initial management is focused on pain reduction and optimization of movement. Using activity modification, education manual therapy and an individualized exercise program to prevent reoccurrence.

Hip and Gluteal Pain Assessment
• Lower limb alignment and muscles
• The pelvis alignment and sacroiliac joint function
• Lumbar spine
• Hip muscles balance and control
• Abdominal and core strength
• Hamstrings and neural tension
• Palpation of muscles for myofascial pain
• Biomechanics of the hip joint
• Specific functional testing

Some common sources of pain:
Lumbar spine. Due to its proximity and nerve supply to the pelvis, pain may be referred from the lumbar spine to the gluteal region.
Sacroiliac joint. The articulation between the pelvis and sacrum, better known as the sacroiliac joint with ligamentous structures may also be a source. The pain may be local on one side or refer laterally, downwards or anteriorly.
Myofascial pain posteriorly may include strains due to overload in the various soft tissues such as muscle and ligaments.
On the lateral side, the abductor muscles of the hip may be the source due to abductor Tendinopathy, trochanteric bursitis, Iliotibial band syndrome and the lateral cutaneous nerve entrapment.
Hip Joint pain can be due to Labral tears, CAM lesions, stress fractures, hip joint arthritis and other hip joint diseases.
On the posterior inferior border we have hamstring muscles, bursas and the sciatic nerve.
References

P Brukner. 2017. Brukner & Khan’s Clinical Sports Medicine. 5thEdition.593-657.

A Franklyn-Miller, E Falvey, P McCroy. 2009. The gluteal triangle: a clinical patho-anatomical approach to the diagnosis of gluteal pain in athletes. BJSM. 43: 460-466.

A Grimaldi. 2011. Assessing lateral stability of the hip and pelvis. Man Ther. 16(1):26-32.

C Haser, T Stöggl, T Kriner et al. 2017. Effect of Dry Needling on Thigh Muscle Strength and Hip Flexion in Elite Soccer Players. Medicine & Science in Sport & Exercise. 49:2-378-383.

9th Interdisciplinary World Congress on Low Back and Pelvic Girdle Pain. Progress in Evidence Based Diagnosis and Treatment.  Singapore 2016.

D Lee. 2011. The Pelvic Girdle, An Integration of Clinical Expertise and Research. 4thEdition. Churchill Livingstone.

GS Nunes, CJ Barton, FV Serrão. 2018 Hip rate force development and strength are impaired in females with patellofemoral pain without signs of altered gluteus medius and maximus morphology. Journal of Science and Medicine in Sport; 21 (2): 123-128.

MP Reiman, K Thorbog. 2014. Clinical examination and physical assessment of hip joint-related pain in athletes. International Journal of Sports Physical Therapy. 9 (6): 737-755

A Vleeming, V Mooney, R Stoeckart. 2007. Movement Stability & Lumbopelvic Pain. 2NdEdition. Churchill Livingstone.

Hip treatments available with Raymond Smith, Chiropractor, 114 Alexander Street, Crows Nest, NSW 2065


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