Massage Therapy and Hip Pain

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.

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.

Arendt-Nielsen L. (2017). Pain sensitisation in osteoarthritis. Clin Exp Rheumatol.

Arendt-Nielsen, L. (2017). Joint pain: more to it than just structural damage? Pain.

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)

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.

Capogna, B.M., Shenoy, K., Youm, T., Stuchin, S.A. (2017). Tendon Disorders After Total Hip Arthroplasty: Evaluation and Management. J Arthroplasty.

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.

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.

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.

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. 

Ganderton, C., Semciw, A., Cook, J., Pizzari, T. (2017). Demystifying the Clinical Diagnosis of Greater Trochanteric Pain Syndrome in Women. J Womens Health (Larchmt).

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)
* 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.

He, B.H., Christin, M., ... Sharif-Naeini, R. (2017). Mechanosensitive ion channels in articular nociceptors drive mechanical allodynia in osteoarthritis. Osteoarthritis Cartilage.

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.

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.

Neumann, D.A. (2010). Kinesiology of the hip: a focus on muscular actions. J Orthop Sports Phys Ther.

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.

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.

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)

Redmond, J.M., Chen, A.W., Domb, B.G. (2016). Greater Trochanteric Pain Syndrome. J Am Acad Orthop Surg.

Reid, D. (2016). The management of greater trochanteric pain syndrome: A systematic literature review. J Orthop. (OPEN ACCESS)

Reiman, M. P., Mather, R. C., & Cook, C. E. (2015). Physical examination tests for hip dysfunction and injury. British Journal of Sports Medicine. 

Speers, C.J., Bhogal, G.S. (2017). Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. Br J Gen Pract.

Torres, A., Fairen, M.F., Fernández, J.S. (2017). Greater trochanteric pain syndrome and gluteus medius and minimus tendinosis: nonsurgical treatment. Pain Manag.

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)