Tuesday, November 25, 2008

My Hips Don't Lie

Today's blog post is about hips.

I know... you think you know 'the hips'. Often curvy, located between the thigh bone and the back bone. (Oh, those bones, those bones, those crazy skeleton bones.)

But when patients come in complaining of hip pain, it often becomes obvious that one of us didn't pass Anatomy 101. "My hip hurts", you say, pointing to your waist or lower back. "Fix my hip" you insist.

The picture to the left was found by Googling 'hip pain', though I'd refer to that area as the low back, the upper glutes, or even the 'iliac crest' if I thought you'd be impressed by that sort of thing. True hip joint pain will present in the front near the groin, as demonstrated by the picture to the right. Note that these are my favourite patients, the ones who present with their bones visible through their clothes and the problem highlighted in bright red. Makes for an easy diagnosis.

Just so we are clear: the hip joint proper refers to the connection between the femur (leg bone) inserting into the pelvis. So in fact, the thigh bone connects to the pelvic bone, and I don't really know what the hip bone is. It is a fascinating joint, the hip (to me anyway... though my favourite joint is the shoulder. Fun!), influenced by a host of muscles like the iliopsoas and the gluteals. It is a stable ball and socket joint, which sacrifices mobility for stability. This means that it is strong enough to hold up your hefty 'hips', Beyonce, but just mobile enough to let you walk, and rarely mobile enough to do the splits or the cancan.

I've had some of my own hip pain lately, thanks to a certain fetus who shall remain nameless (Especially if it is a girl, seriously, we can't agree on a name. Suggestions welcome...). This is a common pregnancy complaint, hip pain, due to pressure from the growing baby directly on the pelvic joints as well as muscular compensation around the area. In my case, the baby was positioned diagonally, the head pushing against the inside of one side of my pelvis.

Funny thing, it felt just like someone was pushing my pelvis apart from the inside.

My relief came in the form of massage, pelvic adjustments, and the baby committing to a more head down position. A complete cure for my particular condition apparently involves becoming a parent. Fortunately, most hip pain problems are much simpler to treat. Hip pain from arthritis is often managed with a combination of massage and modalities such as ultrasound, as well as nutritional supplements like glucosamine. Hip pain in runners is commonly due to iliotibial tightness and can be relieved by releasing that muscle. Hip pain may also be due to bursitis, a local inflammation that responds to ice and rest.

Tragically, hip pain is often misdiagnosed due to simple anatomical confusion. (Tragically Hip pain is entirely different, often due to pain in little bones, but can be fully completely treated.*) The important thing is to really understand the origin of your 'hip' pain, and treat it accordingly.

So, Shakira, your hips may not lie, but they sure are misleading. Work that into a catchy tune.

*I'm so sorry for this... so very sorry.

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