There is nothing cool about hip pain unless you know what you are doing. I have had a special interest in hip pain since realising it was one area that I had little good detailed knowledge in and decided to improve my knowledge base, and make sure I know what I was doing. I also started to develop more hip pain myself following longer spells in front of a computer!

Anterior hip pain seems to be an epidemic as far as my patient referrals go… I have even a few here in Chile with the same issues. Prolonged sitting may be one of the causes, as well as hip flexor tightness, however I believe that most of the issues are triggered by muscle imbalance and the Scharman theory of Femoral head translation, most of these being anterior  femoral head translation. The shortening of irrupted soft tissue around the deeper layers if the capsule, making them become short bad glued down. Due to the fact that the capsular has a very unique rotary arrangement of fibres stretching these tissues in a linear direction will never hit the spot. Most of the patients I have seen have in the past been given standard gluts exercises and have failed miserably.

A good understanding of the capsular pattern and the fibre direction is necessary. Knowing the restriction pattern and mobilising in that direction is vital. Doing mobs or stretches in a linear pattern will have no effect on the capsule of its length. In turn no effect on the pain!

One way to address the issue at the hip, is to position the patient in the prone position with the knee up in flexion and external rotation. .  This external rotation of the femur causes the head of the femur to migrate into external rotation, stretching the iliofemoral ligament, and wind up the anterior capsule.   Then position your hands just inferior to greater trochanter.  Gravity will help those patents who are doing this as a HEP stretch. Then you can hold a stretch in this position or do grade 3+ mobs in this position. Always get the patient to roll to the side to get out of the position.  The patent will feel that they have hit the right spot at the front of the hip that no other stretch or mob has reached. The results are instant- always remembering to retest objective markers following doing these mobs or stretches.

Posterior capsular stretches- Get the patient into a Supine position with hip flexed, adducted and rotated so that the  foot is along the lateral aspect of the opposite knee. Therapist position: Standing on opposite side with hands over the knee. Then provide an oscillatory or static force along the long axis of the femur in a posterior direction. Adjust the flexion, adduction and internal rotation. Pt should feel the stretch “in their back pocket”. Always avoiding anterior hip pinching pain.

These are just two of the manual therapy techniques that can be used, and only cover the anterior and posterior capsule. For further great ideas and in a great explanation of how to do further manila therapy techniques- all of which I use- look at this great article.

cmetracker.net/AURORA/…/ManualTherapyTechniquesfortheHip.pd…