Massage Therapy and Hip Pain

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Osteoarthritis of the hip is common in the general population, this may contribute to substantial social and financial burdens. 

Osteoarthritis of the hip is common in the general population, this may contribute to substantial social and financial burdens. 

Non-pharmacological therapeutic interventions are being embraced by the medical community because they are often simple to carry out, economical, and have relatively minor side effects. 

Conservative Care for Mild to Moderate Hip Osteoarthritis

The presentation of hip pain, does not always mean that the joint is the primary contributor to pain. There is research to suggests that in this condition sensitization of nociceptive pathways may result in patients with osteoarthritis perceiving relatively low level stimuli as being overtly painful, which contributes to the complex clinical picture of hip pain.

Structures to be Aware of When Treating Hip Pain

Contemporary multimodal massage therapists are uniquely suited to incorporate a number of rehabilitation strategies for acute and chronic pain based on patient-specific assessment findings including, but not limited to:
• Manual Therapy (neurodynamic mobilization, classic massage, joint mobilizations)
• Education on psychosocial factors (eg. BPS framework of pain, fear avoidance)
• Remedial Loading Programs (eg. static stretching, concentric, eccentric, isometric)

Structures to keep in mind while assessing and treating patients suffering from hip pain may include neurovascular structures and investing fascia of:
• iliopsoas (iliacus and psoas major)
• hip adductors (adductor brevis, adductor longus, adductor magnus, pectineus, gracilis)
• external rotators (piriformis, gemellus superior, externus and internus obturators, gemellus inferior, and quadratus femoris)
• quadriceps (rectus femoris, vastus lateralis, vastus mediali, vastus intermedius)
• gluteal muscles (gluteus maximus, gluteus medius, gluteus minimus, and tensor fasciae latae)

More to Explore

Adhia, D.B., Tumilty, S., Mani, R., Milosavljevic, S., Bussey, M.D. (2016). Can hip abduction and external rotation discriminate sacroiliac joint pain? Man Ther. 
https://www.ncbi.nlm.nih.gov/pubmed/26299325

Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C.L., Bhandari, M., Karlsson, J. (2017). The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28504066

Arendt-Nielsen L. (2017). Pain sensitisation in osteoarthritis. Clin Exp Rheumatol.
https://www.ncbi.nlm.nih.gov/pubmed/28967356

Arendt-Nielsen, L. (2017). Joint pain: more to it than just structural damage? Pain.
https://www.ncbi.nlm.nih.gov/pubmed/28151834

Battaglia, P.J., D'Angelo, K., Kettner, N.W. (2016). Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging. J Chiropr Med. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/27857636

Brennan, K.L., Allen, B.C., Maldonado, Y.M. (2017). Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Non-Inferiority Randomized Clinical Trial. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28257614

Capogna, B.M., Shenoy, K., Youm, T., Stuchin, S.A. (2017). Tendon Disorders After Total Hip Arthroplasty: Evaluation and Management. J Arthroplasty.
https://www.ncbi.nlm.nih.gov/pubmed/28688837/

Cibulka, M.T., Bloom, N.J., Enseki, K.R., Macdonald, C.W., Woehrle, J., McDonough, C.M. (2017). Hip Pain and Mobility Deficits-Hip Osteoarthritis: Revision 2017. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28566053

Cheatham, S. W., Enseki, K. R., & Kolber, M. J. (2015). The clinical presentation of individuals with femoral acetabular impingement and labral tears: A narrative review of the evidence. Journal of Bodywork and Movement Therapies.
https://www.ncbi.nlm.nih.gov/pubmed/27210853

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28438745

Enseki, K., Harris-Hayes, M., White, D.M., Cibulka, M.T., ... Orthopaedic Section of the American Physical Therapy Association. (2014). Nonarthritic hip joint pain. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/24881906 

Ganderton, C., Semciw, A., Cook, J., Pizzari, T. (2017). Demystifying the Clinical Diagnosis of Greater Trochanteric Pain Syndrome in Women. J Womens Health (Larchmt).
https://www.ncbi.nlm.nih.gov/pubmed/28263673

Goode, A., Hegedus, E.J., Sizer, P., Brismee, J.M., Linberg, A., Cook, C.E. (2008). Three-dimensional movements of the sacroiliac joint: a systematic review of the literature and assessment of clinical utility. J Man Manip Ther. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/19119382
* In most clinical cases the sacroiliac joint is stable, and you can not detect it's motion or lack of it by palpation (Goode et al. 2008).

Grimaldi, A., Mellor, R., Hodges, P., ... Vicenzino, B. (2015). Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Med. 
https://www.ncbi.nlm.nih.gov/pubmed/25969366

He, B.H., Christin, M., ... Sharif-Naeini, R. (2017). Mechanosensitive ion channels in articular nociceptors drive mechanical allodynia in osteoarthritis. Osteoarthritis Cartilage.
https://www.ncbi.nlm.nih.gov/pubmed/28882752

Kuhn, A.W., Noonan, B.C., Kelly, B.T., Larson, C.M., Bedi, A. (2016). The Hip in Ice Hockey: A Current Concepts Review. Arthroscopy.
https://www.ncbi.nlm.nih.gov/pubmed/27318779

Loth, F.L., Giesinger, J.M., Giesinger, K., MacDonald, D.J., Simpson, A.H.R.W., Howie, C.R., Hamilton, D.F. (2017). Impact of Comorbidities on Outcome After Total Hip Arthroplasty. J Arthroplasty.
https://www.ncbi.nlm.nih.gov/pubmed/28506675

Neumann, D.A. (2010). Kinesiology of the hip: a focus on muscular actions. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/20118525

Nicolson, P.J.A., Bennell, K.L., Dobson, F.L., Van Ginckel, A., Holden, M.A., Hinman, R.S. (2017). Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis: a systematic review and meta-analysis. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/28087567

O'Sullivan, K., Darlow, B., O'Sullivan, P., Forster, B.B., Reiman, M.P., Weir, A. (2017). Imaging for hip-related groin pain: don't be hip-notised by the findings. Br J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/28935687

Rahman, L.A., Adie, S., Naylor, J.M., Mittal, R., So, S., Harris, I.A. (2013). A systematic review of the diagnostic performance of orthopedic physical examination tests of the hip. BMC Musculoskelet Disord. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/23987589

Redmond, J.M., Chen, A.W., Domb, B.G. (2016). Greater Trochanteric Pain Syndrome. J Am Acad Orthop Surg.
https://www.ncbi.nlm.nih.gov/pubmed/26990713

Reid, D. (2016). The management of greater trochanteric pain syndrome: A systematic literature review. J Orthop. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/26955229

Reiman, M. P., Mather, R. C., & Cook, C. E. (2015). Physical examination tests for hip dysfunction and injury. British Journal of Sports Medicine.
http://www.ncbi.nlm.nih.gov/pubmed/25736298 

Speers, C.J., Bhogal, G.S. (2017). Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. Br J Gen Pract.
https://www.ncbi.nlm.nih.gov/pubmed/28963433/

Torres, A., Fairen, M.F., Fernández, J.S. (2017). Greater trochanteric pain syndrome and gluteus medius and minimus tendinosis: nonsurgical treatment. Pain Manag.
https://www.ncbi.nlm.nih.gov/pubmed/29182042

Tyler, T.F., Fukunaga, T., Gellert, J. (2014). Rehabilitation of soft tissue injuries of the hip and pelvis. Int J Sports Phys Ther. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/25383247