PT-Eval Hip Region

• Hip joint


  • One of the largest and most stable joints in the body
  • If injured or exhibits pathology, the lesion is usually immediately perceptible during walking
• Pain from the hip


  Can be referred to the hip joint itself, SI joints, pelvis or the lumbar spine
• Hip joint


  • Has strong ligaments: iliofemoral, ischiofemoral and pubofemoral ligaments
• Iliofemoral ligament


  • Considered to be the strongest ligament in the body
  • Prevents excessive extension which allows a significant role in stabilizing and maintaining upright position at the hip in whatever position (anterior, posterior)
• Forces exerted on the hip

  • Standing
  • Standing on one limb
  • Walking
  • Walking up stairs
  • Running
• Considering the kinematics of the hip joint we need to know what are the other causes of the hip pathology
• Different conditions occur in different age groups, and ROM decreases with age. There are cases that even just after birth, their ROM decreases.
• Congenital Hip Dysplasia


  • Also known as Congenital hip dislocation
  • More common in girls
  • Can happen during labor or delivery if the baby is pulled out incorrectly, or if the baby is in breech presentation and pulled out incorrectly
• Legg-Calve-Perthes Disease (LCPD)


  • Before the femoral artery, it is the obturator artery that supplies for children
  • If the obturator artery obliterates or diffuses or shrinks, the femoral artery takes place
  • This causes avascular necrosis and an underdeveloped femoral head
  • Can cause pain and problems with walking
  • Occurs in 3-12 year old boys
• Osteoporotic Femoral Neck Fractures

  • Can occur from stress fractures over time, then a traumatic experience leads to a fracture
  • Occurs in 60-80 year old elderly women, often after a fall or slip
  • Caused by low bone density and osteoporosis, especially in menopausal women
• Osteoarthritis of the Hip

  • Occurs in 45-70 year old elderly men
  • Caused by degeneration of the hip joint, often in those with strenuous jobs or occupations requiring prolonged standing or walking
  • Can be diagnosed using the Tonnis Classification based on the appearance of the femoral head
• Mechanisms of injury leading to hip pathology

  • Trauma outside the hip (e.g. trochanteric bursitis)
  • Trauma on the knee (e.g. hip subluxation or acetabular labral tear)
  • Trauma after repetitive loading activity (e.g. femoral stress fracture)
  • Osteoporosis (e.g. insufficiency injury)
• Details of present pain and other symptoms

  • Dull, deep, aching (e.g. arthritic, Paget's disease)
  • Sharp, intense, sudden with weight bearing (e.g. fracture)
  • Tingling that radiates (e.g. radiculopathy, spinal stenosis, meralgia paresthetica)
  • Increased pain while sitting with affected leg crossed (e.g. trochanteric bursitis)
  • Pain at sitting, legs not crossed (e.g. ischiogluteal bursitis)
  • Unremitting, long duration pain (e.g. metastatic carcinoma, severe arthrosis)
  • Lateral hip pain (e.g. trochanteric bursitis, gluteus medius tendon tear)
  • Knee clicking while walking (e.g. labral tear)
• Trochanteric Bursitis


  • Lateral hip pain can indicate problems on the L4 nerve root pain so PT needs to know the possible myotomes affected in the L4 or L1, L2 nerve root
• Ischiogluteal bursitis


  • Affectation in the connection between the gluteal line and to the ischium or ischial tuberosity since its part of the sitting bone. It can manifest and inflamed the bursa
• Unremitting or long duration hip pain

  May indicate metastatic carcinoma. If the pain is constant even at night or while resting, it may indicate a problem with the lymph nodes, cancer, severe arthritis, or paget disease
• Hip pain


  May also be referred to the knees or back and may increase on walking
• Hip pain radiating to the proximal thigh, low back, and perinium area


  May indicate sports hernia or a problem with the groin
• Lateral hip pain


  • May indicate a tear in the gluteus medius tendon and it can manifest as a vertical limp when walking (kumekembot kembot pag naglalakad)
• Snapping Hip Syndrome


  Internal, External, and Intra-articular snapping conditions may be referred to as snapping hip syndrome
• Snapping Hip Syndrome (First Cause)

  1. Most common cause

  2. Caused by slipping of the iliopsoas tendon over the osseous ridge of the lesser trochanter or anterior acetabulum, or the iliofemoral ligament

  3. Iliopsoas tendon slides down and produces a snapping sound that may be due to improper placement or hypertrophy

  4. Due to the iliopsoas tendon or iliofemoral ligament, the snapping often occurs at approximately 45° of flexion when the hip is moving from flexion to extension, especially with the hip abducted and laterally rotated
• Snapping Hip Syndrome (Second Cause)

  1. Caused by a tight iliotibial band or gluteus maximus tendon riding over the greater trochanter of the femur

  2. Snapping or popping, which tends to be felt lateral, occurs during hip flexion and extension, especially if the hip is held in medial rotation, and may be held made worse if the trochanteric bursa is inflamed
• Snapping Hip Syndrome (Third Cause)

  1. Caused by acetabular labral tears or loose bodies, which may be the result of trauma or degeneration

  2. The patient (common between 20 - 40 years old) complains of a sharp pain into the groin and anterior thigh, especially on pivoting movements or rotation of anterior thighs

  3. Passively, clicking may be felt and heard when the extended hip is adducted and laterally rotated
• Classification Criteria for Osteoarthritis of the Hip

  • Clinical (History, Physical Examination, Laboratory)
  • Combined clinical (History, Physical Examination, Laboratory) and Radiographic Classification
• Clinical Criteria for Osteoarthritis of the Hip

  • Hip pain
  • Hip IR < 15° and ESR ≤ 45 mm/hr (if ESR not available, substitute hip flexion ≤ 115°)
  • Hip IR rotation ≥ 15° and Pain on hip IR
  • Morning stiffness of the hip ≥ 60 minutes
  • Age > 50 years
• Combined clinical (History, Physical Examination, Laboratory) and Radiographic Classification Criteria for Osteoarthritis of the Hip

  Hip pain, and at least two of the following three features: ESR < 20 mm/hr, Radiographic femoral or acetabular osteophytes, Radiographic joint space narrowing (superior, axial, and/or medial)
• To determine if the px's condition is improving or worsening or staying the same, we have to consider the classification criteria of osteoarthritis
• History, Physical Examination, Laboratory for Osteoarthritis

  • In the laboratory, blood tests are needed to determine Erythrocyte Sedimentation Rate (ESR)
  • In the history and physical examination, pain during IR/ER and LOM of IR can be observed
• Trochanteric Bursitis


  • Often results from abnormal running mechanics with the feet crossing midline (increased adduction)
  • Wide pelvis and genu valgum, or running on tracks with no banking is also one cause
• Piriformis Syndrome


  • Sciatic nerve may be compressed, the piriformis muscle is tender, and hip abduction and lateral rotation are weak
  • Fat Wallet Syndrome - weakness on the posterior and sometimes lateral side of the hip
• By listening to the patient, the examiner should be able to tell whether repetitive or sustained positions have contributed to the problem
• Guards and salesmen are susceptible for Osteoarthritis due to maintaining a standing position for a long time
• Functional limitations


  Sit to stand, transfers, maintaining prolonged standing position, walking on stairs, walking on ramps
• Assistive device for hip conditions

  • Canes should held opposite to the affected side
  • Decreased load of 40% of the hip
  • When walking, px can give weight to the single tip cane using your hands to act as a substitute to the compensation of the other legs/affected side
• Assistive device for knee conditions

  • Canes may be held in opposite to the affected side
  • Patient may held the cane in the hand of affected side on the following conditions: Osteoarthritis, ACL Tear
• Hip joint


  • One of the largest and most stable joints in the body
  • If injured or exhibits pathology, the lesion is usually immediately perceptible during walking
• Pain from the hip


  Can be referred to the hip joint itself, SI joints, pelvis or the lumbar spine
• Hip joint

  • Has strong ligaments: iliofemoral, ischiofemoral and pubofemoral ligaments
• Iliofemoral ligament

  • Considered to be the strongest ligament in the body
  • Prevents excessive extension which allows a significant role in stabilizing and maintaining upright position at the hip in whatever position (anterior, posterior)
• Forces exerted on the hip

  • Standing
  • Standing on one limb
  • Walking
  • Walking up stairs
  • Running