Hip and Leg Problems

Hip Pain

Using the Gymnasium Treadmill

Hip pain related to degenerative changes (wear and tear) in the hip joint is typically felt in the groin and possibly down the inner thigh, sometimes as far as the knee.

It can result in a stiff joint that creates problems with walking and changing direction or standing up and moving after sitting or with climbing stairs.

The physiotherapist can direct treatment at stretching the tight tissue, mobilising the joint and give exercises for weak muscles with the addition of electrotherapy or acupuncture for pain relief.

Pain located on the outer part of the thigh could be related to an inflamed bursa called a trochanteric bursitis. This is often associated with a tight Iliotibial band and hip muscle.

This can be treated by stretching the tight structures and using soft tissue techniques, followed by exercises.

Sometimes hip pain is referred from the back and this area may also require treatment.

 

Groin Strain

A groin strain is usually a tear or strain of the groin (adductor) muscle fibres, which run from the pelvis to the inside of the thigh. The injury is graded I-III depending on its severity.

It is very common in sporting activities involving sprinting and stretching the leg out to the side such as football and is often caused by sudden dynamic movements, over stretching or overuse. Often the groin area has not been adequately warmed up prior to playing or the injury can occur when the muscle is fatigued.

Typically the pain is felt in the groin or at the top of the inner thigh. A minor strain may only be symptomatic after exercise, or the next day. More severe injuries will prevent the player from participating at all in their sport. Some players may find they can play for half of the game but it then becomes too painful to continue.

Groin injuries can be particularly stubborn and can take weeks even months to fully heal. Players often go back to sport too soon after the injury thinking the problem has resolved and it then re-occurs.

Physiotherapy is directed at promoting tissue healing using treatment modalities such as massage and ultrasound. Also advising the player on appropriate warm ups and stretches and also ensuring that the player has adequate strength and stability around their hip and pelvis to return safely to their sport.

 

Hamstring strain

The hamstrings are the muscles on the back of the thigh and they are very commonly injured in sporting activities.

Injuries can vary from a minor strain of a few muscle fibres to a complete rupture (tear) of the muscle - although the latter is uncommon.

Acute injuries are best managed for the first few days using the PRICE protocol:
  • Protect
  • Rest
  • Ice
  • Compression
  • Elevation

The physiotherapist can also help accelerate the healing process by using soft tissue techniques, electrotherapy, exercises and stretches. This will help to restore normal length and flexibility in the muscle.

Following the healing phase it is very important to strengthen not only the hamstring muscles but all the leg muscles to prevent further injury.

Sometimes an injury occurs more easily to the hamstrings if they are particularly tight or overactive. What we tend to find is that recurring hamstring injuries can be due to overactive hamstrings and underactive gluteal muscles (buttocks). This muscle imbalance may be related to sedentary work postures.

Although physiotherapy treatment will focus on stretching the muscle it may also be necessary to teach stability exercise around the pelvis to stop the problem recurring.

 

Knee pain

The knee is the body's largest joint and is very commonly injured in sports and other activities.

There are many types of problems that can cause knee pain, ranging from traumatic soft tissue injuries - ligaments, muscles, cartilage - to degenerative arthritic conditions.

But there can also be repetitive/overuse type injuries such as patella tendinopathy which needs a slightly different treatment approach.

Pain can arise from both the patella-femoral (knee cap) joint and the knee joint. The physiotherapist will make a careful assessment of the knee to establish which structures have been injured.

If the problem is degenerative or from overuse then the physiotherapist will not only look at the knee but the overall posture and alignment of the leg, the muscles around the knee and pelvis and if necessary walking and running patterns.

Our team of Physiotherapist will focus on helping to resolve the knee pain quickly by using various soft tissue techniques, electrotherapy and strapping. But most importantly will teach the individual an exercise programme to help improve function and enable a speedy return to normal activities.

If necessary we can refer patients onto local Orthopaedic Consultants who specialise in knee problems.

In addition to treating knee injuries and wear and tear problems in the knees, we receive referrals for post-operative physiotherapy following knee surgery.

 

Shin Splints

Shin splints is a term used to describe pain felt at the front or inside of the shin bones. It is usually caused by overuse of the muscles on the inside of your leg where they attach to the shinbone.

Over time this can lead to micro-trauma and inflammation of the periosteum, which is where the muscles attach to the bone. This is why the bone can sometimes feel 'bumpy' and tender.

Shin splints pain can be felt at the start of an activity and may ease as the muscle warms up. More commonly the pain comes on at a certain point during sport and forces the player to stop. Typically the shins can be stiff and sore the day after exercise.

It is more prevalent in running sports, and can be very persistent once it starts. Many athletes will rest from their sport hoping this will cure it, but find that the pain will return quickly once they recommence their sport. This is often due to the fact that there is often an underlying biomechanical reason for the pain and that needs to be addressed.

Causes may include:
  • Old or inappropriate footwear
  • Over pronation (rolling in) of the foot
  • Training errors
  • Tight calf or hamstring muscles
  • Poor core stability around the pelvis

The Physiotherapist will focus on establishing the cause of the problem and then treat appropriately. This may involve rest, calf and hamstring stretches advice on appropriate footwear and stability exercises to improve landing control and shock absorption.

Sometimes all that is needed is a change of footwear and running on more forgiving surfaces such as track or grass.

Training should be resumed very slowly and should always be kept pain free.

 

Achilles Tendinopathy

Achilles Tendinopathy is a very common problem and can be one that is very slow to settle. It will usually be felt as pain at the back of the ankle when walking, running or going up and down stairs. Very often the tendon will be very tight first thing in the morning and will ease slightly as things get moving.

Many people continue to train with a low level of symptoms but it is far better to get the problem fully assessed and treated promptly.

There are many factors which can contribute to an Achilles Tendinopathy. This can start right up in the body where poor stability around the spine and pelvis affect the way the leg strikes the ground; weakness in certain muscle groups in the leg or lack of flexibility can also increase the stresses going through the tendon and lead to injury.

Individuals who 'overpronate', where the foot rolls inwards, are often more prone to Achilles problems. Or it could be as simple as running in trainers that are inappropriate or just too old!

Treatment will, therefore need to be directed at the cause of the problem. This may include core stability work, strengthening and flexibility exercises, massage and soft tissue manipulation, electrotherapy and advise on training regimes and return to sport.

 

Heel pain - Plantar Fasciitis

Plantar Fasciitis is a common problem characterised by a sharp pain in the heel which is at its worst during the first few steps after getting up from resting and then eases to a continuous, but less severe dull ache on walking. In severe cases the heel pain can be disabling, restricting the ability to walk.

The problem may start after taking up a new activity such as running or from something as simple as wearing inappropriate footwear.

People who are on their feet all day can be more susceptible as can individuals with certain 'foot types'. If your foot has a tendency to roll in (pronate) this can put stress on the fascia. But normally there will be something else that then triggers the problem, i.e. excessive walking in inappropriate shoes.

Plantar fasciitis is most common in the older athletic people, and once it occurs it can be very persistent. Some research suggests plantar fasciitis has a life and will eventually resolve but this can sometimes take up to a year.

Physiotherapy treatment will focus on ways of helping with pain relief. This may include ice, electrotherapy, tissue massage and stretches. But what is also important is advice on appropriate footwear, and looking at ways of unloading the fascia and therefore relieving some of the pain.

This may include strapping, use of insoles or heel pads and supportive footwear. The physiotherapist may also need to look at walking and running patterns and rotation control/shock absorption of the leg.

 
Physiotherapy for hip and leg problems - Leamington Spa, Warwick, Kenilworth, Stratford-upon-Avon, Coventry and Warwickshire