Hip problems are not only extremely common, but they are among the most frustrating conditions to affect the muscles and joints of the body. When hip pain occurs it can prevent you from walking, running, playing golf, exercising, gardening, and even sleeping. To make matters even worse many common hip conditions are slow to respond to traditional types of care, often creating further disappointment and aggravation.

Now for the good news: a new treatment technique known as Active Release Techniques® (ART®) is proving to be a very effective method to treat many common hip problems and is helping hip-pain sufferers get back to doing their favorite activities. Before we talk about why ART® works so effectively, you need to understand how the hip becomes injured.

The hip is a ball-and-socket joint formed between the femoral head and the acetabulum, a part of the pelvic bone. Because of the shape of this joint, it is capable of a wide range of motion in all directions: forward and backward, side to side, and inward and outward rotation. A tremendous amount of force must pass through this region regularly, with activities such as walking, bending, crouching, and lifting.

Due to the high amount of force, combined with the large range of motion, the hip must rely on a complex system of muscles to control and protect the area. These muscles include an outer system of muscles, including the gluteus maximus, hamstring, quadricep, and adductor, as well as a deeper group of smaller muscles that provide an important stabilizing function. This deep group includes the piriformis, gluteus medius, and obturator.

The muscle groups around the hip are organized into opposing pairs. This means that the muscles on the front of the hip are paired with muscles on the back of the hip and together these muscles control motion in the forward-to-backward direction. Likewise, the muscles on the outer side of the hip are paired with muscles on the inner side and act to control the inward and outward hip rotation. These pairs of muscles surround the hip so that together they can move and control the hip in all directions. When all the muscles are working properly, the chance of pain and injury is minimal.

Through a variety of causes such as prolonged sitting, repetitive movements, excessive use, previous injury, improper exercise, various athletic activities, or lack of physical activity, one or more of the muscles of the hip region can become tight or weak. When this happens a muscle imbalance results, which not only stresses the hip joint itself, but places further strain on the other muscle groups, as they must work harder to compensate for the tight or weak muscle. Over time this strain can develop into what is known as micro-trauma. Micro-trauma is very small-scale muscle damage that occurs in the muscles and ligaments in response to small levels of strain. Initially, this micro-trauma is not painful, but may be perceived as a mild ache or tightness in the muscles. Although small, this damage needs to be repaired. The body responds to micro-trauma by laying down small amounts of scar tissue to repair the injured area. Over time this scar tissue builds up and accumulates into adhesions. As these adhesions form, they start to affect the normal health and function of the muscles. In fact, they will often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow.

As scar-tissue adhesions accumulate in the muscles, tendons, and ligaments of the hip, more and more strain is placed on the muscles, because they must stretch and contract against the adhesions in an attempt to move and stabilize the area. This places even further strain on the hip muscles, which in turn leads to even more micro-trauma. This causes Repetitive Strain Injury Cycle, when continued micro-trauma leads to further adhesion formation, which in turn leads to more stress and further micro-trauma. The health of the tissues and there ability to compensate for the initial imbalance eventually deteriorates, and this process leads to noticeable pain and injury, which occurs in one of two ways. Either the repetitive injury cycle continues and pain progressively builds until it becomes more and more noticeable, or pain develops suddenly after some type of seemingly straightforward activity. This second scenario happens when the muscles and ligaments have become so affected that a minor event can lead to injury.

Active Release Technique® (ART®) can help resolve many common hip conditions, including:

• trochanteric bursitis
• gluteus medius tendonitis
• arthritis
• sciatic nerve entrapment
• hamstring strain
• ischial-gluteal bursitis
• iliopsoas tendonitis
• upper quadricep strain
• femoral nerve entrapment
• meralgia peristhetica
• groin/adductor strain
• piriformis syndrome
• iliopsoas bursitis
• upper hamstring tendonitis
• and many more

Another type of hip pain can result from irritation to the nerves in the hip region. This occurs because as the nerves exit the spine and travel down the leg, they pass around, under, over, and sometimes through the muscles in the hip region. An accumulation of scar-tissue adhesions in and around the hip can affect these nerves.

Just as the muscles need to be able to glide on each other, the nerves also need to be able to glide freely between the layers of muscles. In many cases the accumulation of scar tissue can cause the nerves to become stuck to the surrounding muscles and fascia and instead of easily gliding between the muscles, they become stretched and irritated and can cause hip pain. It is quite common for a nerve entrapment at the hip to be misdiagnosed as bursitis or tendonitis. An incorrect diagnosis leads to incorrect treatment, which will not be effective in relieving the condition.

In an attempt to relieve hip pain, a variety of treatment methods are used, either alone or in combination with other methods. Some of the more common approaches include anti-inflammatory medication, rest, ice, ultrasound (US), muscle stimulation (E-Stim), stretching and strengthening exercises, and when all else fails, surgery. Most of these traditional techniques generally require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem. The main reason these approaches are often ineffective is that they fail to address the underlying scar-tissue adhesions that develop within the muscles and surrounding soft tissue. It is these adhesions that are binding the tissues together, restricting normal movement, and interfering with the normal flexibility and contraction of the muscles in and around the hip.

Passive approaches such as medication, rest, ice, and ultrasound focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction. More active approaches such as stretching and exercise are often needed for full correction of the condition and to restore full strength and function of the muscles, but do not treat the underlying adhesions. In fact, without first addressing the scar-tissue adhesions, stretches and exercise are often less effective and much slower to produce pain relief or recovery from hip pain.

ART® stands for Active Release Techniques®. It is a new and highly successful hands-on treatment method to address problems in the soft tissue of the body, including the muscles, ligaments, fascia, and nerves. ART® treatment is highly successful in dealing with hip injuries because it is specifically designed to locate and treat scar-tissue adhesions that accumulate in the muscles and surrounding soft tissue. Locating and treating the soft-tissue adhesions with ART® allows the practitioner to:

break up restrictive adhesions
reinstate normal tissue flexibility and movement
more completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain.
You can think of an ART® treatment as a type of active massage. The practitioner first shortens the muscle, tendon, or ligament, and then applies a very specific pressure with the hands as you actively stretch and lengthen the tissue. As the tissue lengthens the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar-tissue adhesions are felt, the amount and direction of tension can be modified to treat the problem area. In this sense, each treatment is also an assessment of the health of the area, as we are able to feel specifically where the problem is occurring.

An additional benefit of ART® is it allows us to further assess and correct problems not only at the site of pain itself, but also in other areas of the kinetic chain, which are associated with movement compensations, and are often contributing factors to the problem. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet all developed pain.

One of the best things about ART® is how quickly results are obtained. In our experience, the majority of hip injuries respond very well to ART® treatment, especially when combined with the appropriate home stretching and strengthening exercises. Although each case is unique and there are several factors that determine the length of time required to fully resolve each condition, we usually find that significant improvement can be gained in four to six treatments. These results are the main reason many elite athletes and professional sports teams have ART® practitioners on staff, and why ART® is an integral part of the Ironman triathlon series.

To book an appointment to see if ART® can help with your hip pain, call our office at (248) 477- 2100.