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Expert 1
Longstanding Hip Pain
May, 2020
A.P, Essex
Question

''I am a 54 year old female who has always been fit and active however for the last few years I have been experiencing recurrent episodes of right hip pain which started gradually. It seems to be worse when I start to walk after a prolonged period of sitting, occasional mornings and when I perform certain movements during my sport such as lunging.

I went to see my local GP who referred me on for an x-ray, which concluded mild to moderate osteoarthitic changes within the right hip and there was some discussion around a hip replacement? 

I do not take any medication apart from supplements, exercise regularly and keep myself well. I have had sports massages targeting the glute muscles before in the past which helped in the short term but nothing that carried over long term. Ice and ibuprofen help when the pain increases.

I was wondering if you had any advice or exercises that may help?

Thanks!''

Expert Answer

Thank you for your message, and sorry to hear that you have been in pain for some time. It seems as though you already lead a very active and healthy lifestyle which is beneficial for overall health.

The fact that your injury was of a progressive onset, that you experience some pain and stiffness after rest and the results of the x-ray show some changes within the hip joint itself does indicate an osteoarthritic picture however I feel as though there is some other factors at play here. 

What we do know from the evidence on osteoarthritis is that exercise, particularly strength based exercises, have the most positive and long term benefits over and above any other form of intervention. You mention that a hip replacement as discussed, however if your hip is not significantly impacting your actives of daily living such as walking, stairs etc then I would sway more towards conservative management first.

What we do know is that joint stability relies on both the passive stabilisers (such as the ligaments) and the active stabilisers (such as the muscles). The muscles around the hip, particularly glute medius and minimus, are responsible for hip stability particularly when standing on the single leg. If these are weak, then the deeper muscles of the hip, such as the lateral rotators, may activate to help with stability when really this is not their job leading to tightness, and maybe why you experience some relief when having a deep tissue / sports massage.

What we want to do is target these hip stabilising muscles through specific and targeted exercises, starting with a low number of sets and repetitions and then gradually build up the amount. Once they start to strengthen we then start to look at multi-joint, functional movements such as lunging that replicates the activity / sport that you enjoy playing.

Start off with the below exercises and start 5-6 repetitions, 2-3 sets with a rest day in between. Gradually increase as able, or you can access my lockdown exercise sheets here

I hope this helps and let me know how you get on

Matt
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