The Hip Joint
The hip joint is a deep ball and socket joint comprised of the convex femoral head and the concave acetabulum of the pelvis. Similar to the glenohumeral joint, the acetabulum has a glenoidal lip or labrum around its edges for extra stability.
It is estimated that around 10% of the general population suffers from some sort of hip complaint (Birrel et al. 2005). In the athletic population (mainly club football) hip/groin injuries accounted for 4-19% of all injuries (Weir et al. 2015). The most common conditions, which we will cover in more detail in this course are osteoarthritis, labral tears due to femoroacetabular impingement (FAI), and greater trochanteric pain syndrome (GTPS) also known as gluteal tendinopathy.
According to the Dutch study by Picavet et al. (2003), around 28% of people with hip or knee pain have continuous mild pain and mild pain is recurrent in 46% of people with either a hip or knee complaint.
Lievense et al. (2007) followed 224 patients age ≥50 with hip pain over a period of six years and assessed disease progression and incidence of total hip replacement at three and six years. After three years, 15% of patients showed disease progression and 12% underwent hip replacement surgery. Disease progression almost doubled at the second follow-up (28%) and 22% had received a hip replacement.
The individual prognosis for the specific pathologies is discussed in the next units.
According to a review by Artus et al. (2017) the following factors are related, but not limited to, the course of hip pain:
- widespread pain
- high functional disability
- high pain intensity
- presence of previous pain episodes
Next to the general red flags that should be asked in any case, specific red flags in the hip joint can be:
1) Region-specific red flags:
- Again fractures. This is especially important in the elderly population where hip fractures accounted for up to 14% of all fractures (Burge et al. 2007, Ensrud et al. 2013)
- Avascular femoral head necrosis, which manifests as intermittent groin pain that increases with activity. Usually the case in prolonged use of corticosteroids (Barille et al. 2014)
2) Tract anamnesis:
- Gastrointestinal tract: this visceral pain is mostly deep aching, gnawing, vague, or deep grinding. Conditions include GI bleeding, epigastric pain, constipation, obturator or psoas abscess, appendicitis.
Furthermore, you should not forget to rule out SI Joint or lumbar spine involvement in case of a hip complaint. This is because the hip receives innervation from spinal segments L2-S2. Therefore it is a common site for referred pain from these structures. Check the “further reading” section and the bottom for literature on the topic.
LEVEL UP YOUR DIFFERENTIAL DIAGNOSIS IN RUNNING RELATED HIP PAIN - FOR FREE!
Depending on the outcome, your basic assessment can give you the following info:
1) Limitations in range of motion and their end-feel can guide structural assessment (e.g. bone to bone=osteoarthritis, empty=tendinopathy due to pain)
It’s best to start with Active Range of Motion Assessment:
Standard values for the range of motion in different directions are as follows:
AROM assessment is then typically followed by Passive Range of Motion Assessment (PROM). PROM assessment in the hip joint is also used as part of the diagnostic criteria for hip osteoarthritis, where a marked decrease increases the likelihood of OA.
During PROM assessment, it’s important to compare the range of motion as well as the end-feel of the affected hip with the unaffected side.
Muscle strains or sprains are common in the hip and groin region, especially in athletic populations. In the following two videos, you will see how you can stress the muscles around the hip joint to possibly identify them as a source of nociception as well as a video on the differentiation of groin pain in athletes.
Specific Pathologies in the Hip
There are several pathologies that are commonly seen in the hip area. For more information, click on the respective pathology (content will be added in the near future):
- Muscle Contractures
- Leg Length Difference
- Hip Microinstability
- Femoroacetabular Impingement (FAI) / Labrum Tears
- Deep Gluteal Syndrome
- Ischiofemoral Impingement
- Osteoarthritis of the Hip
Artus, Majid et al. “Generic Prognostic Factors for Musculoskeletal Pain in Primary Care: A Systematic Review.” BMJ Open 7.1 (2017): e012901. PMC. Web. 6 Sept. 2018.
Birrell F, Croft P, Cooper C, Hosie G, Macfarlane GJ & Silman A. (2000) Radiographic change is common in new presenters in primary care with hip pain. Rheumatology. 2000;39:772–5.
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A & Tosteson A. (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007;22:465–475.
Ensrud KE. (2013) Epidemiology of fracture risk with advanced age. Gerontol A Biol Sci Med Sci 2013;68(10):1236–1242
Lievense, Annet M., et al. “Prognosis of hip pain in general practice: a prospective followup study.” Arthritis Care & Research 57.8 (2007): 1368-1374.
Picavet, H. S. J., and J. S. A. G. Schouten. “Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC3-study.” Pain 102.1-2 (2003): 167-178.
Weir, Adam, et al. “Doha agreement meeting on terminology and definitions in groin pain in athletes.” Br J Sports Med 49.12 (2015): 768-774.
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What customers have to say about this online course
- Lucinda de Vries20/02/23Orthopedic Physiotherapy of the Upper and Lower Extremities ORTHOPEDIC PHYSIOTHERAPY OF THE UPPER AND LOWER EXTREMITIES
Super interessante en leuke cursus. Ook zeker voor afgestudeerde fysiotherapeuten om hun kennis weer op te halen/bij te spijkeren. Ondanks dat ik al 5 jaar werkzaam ben als fysiotherapeut was deze cursus zeker een uitdaging en op veel punten echt heel moeilijk en leerzaam.
Het enige vervelende (waar weinig aan gedaan kan worden). de vertalingen eng-nl zijn soms heel onduidelijk.
Al met al zeer genoten tijdens het volgen van deze cursus en er zullen er zeker meerdere volgen.Aurelio Basile09/12/22Orthopedic Physiotherapy of the Spine ORTHOPEDIC PHYSIOTERAPY OF THE SPINE
Fantastic course! simple to follow and extremely helpful in assessing and treating spinal related issues. Furthermore, it is possible to immediately apply the knowledge acquired in the clinic. A must for us physiotherapists.Aurelio Basile09/12/22Orthopedic Physiotherapy of the Upper and Lower Extremities ORTHOPEDIC PHYSIOTERAPY OF THE UPPER AND LOWER EXTREMITIES
Great course! It allows you to make objective assessments with order and clarity. As a result, it is possible to set up effective and efficient treatments.
I also found the sections on the epidemiology and course of the diseases very useful, in order to educate patients and obtain greater compliance with the treatment. Super recommended!!
- DUNCAN10/01/21Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE
Great course, lots of information, the instruction videos are really helpful.DOUWE WILLAERT28/12/20Orthopedic Physiotherapy of the Upper and Lower Extremities i would recommend this course to everyone.
if i may give one suggestion that is maybe hard to implement. but i sometimes struggle with explaining things in patient language. so maybe add some frequent asked questions / mechanisms from patients and how to explain it simple or with a metaphore ?
Thanks again for all your work putted in to this course <3JEROEN VAN ZANTEN20/10/20Orthopedic Physiotherapy of the Upper and Lower Extremities I LOVE IT
This course really helps the starting physio. It gives you more convidence. The first year out of school i was really not convident and after this ( relative cheap) course, it got better! Thanks a lot physiotutors! I also got motivation to start studying manual therapy, as i know now, that there is way more to learn.
- WOUTER13/09/20Orthopedic Physiotherapy of the Upper and Lower Extremities FUN AND EASY TO IMPLEMENT IN THE CLINICAL PRACTISE
Took my time to learn and enjoy form this course!
Would definitely recommend this to other physiotherapist who work in the first-line care.ANTONIUS SMOOK22/08/20Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE
They go, from the basic assessment to the lower and upper limb, step by step with scientific reasoning. It’s a very usefull course to improve your clinical reasoning in practice.JASMIN KONJIC07/07/20Orthopedic Physiotherapy of the Upper and Lower Extremities REALLY REALLY GREAT!
Everything is extremely well-researched and carefully structured! My only complaint, or actually just a hope for their future courses is that more things should to be structured as bullet points. It can sometimes hard to remember facts from a big block of text. Other than that, amazing. Thanks for your great work guys, it’s been a big help!
- AVIV27/05/20Orthopedic Physiotherapy of the Upper and Lower Extremities Great course, very nice and clean, full attention to details, great job boys!
AvivThomas20/03/20Orthopedic Physiotherapy of the Upper and Lower Extremities STARKES KONZEPT!
Starkes Konzept wissenschaftlich untermauert für die Haupt-Diagnosen der Extremitäten. Sehr übersichtliches Design. Gute Möglichkeit das Lernen einzuteilen. Fortbildung der Zukunft. Nur zu empfehlen. Freue mich auf die nächsten Kurse!Marc07/01/20Orthopedic Physiotherapy of the Upper and Lower Extremities LEERZAAM
Goede opbouw en uitleg per onderdeel.
- JUDITH06/01/20Orthopedic Physiotherapy of the Upper and Lower Extremities My compliments for this online course! I’m feeling all up to date now! I can see why it is highly accredited with the KNGF. Other than expected I quite enjoyed taking the course! Good structure ,good balance between text en videos and content en quiz. For me the assessment assignments worked great to lock the knowledge in! Quizzes are sufficiantly challenging and force/ motivate to really study the contents, think about it and listen to the questions carefully!
Great video footage of tests and exercises! Great links to articles! All very useful for dailey practice (even in osteopathy ;)) and immediately applicable! Should contribute to communication with other health care specialists e.g. when it comes to clinical reasoning for requesting further medical examination e.g. immaging. I already recommended the course to several colleagues!
One point of attention: I got the feeling that the short quizzes at the end of each unit didn’t always mach the unit’s content or plainly state differently (e.g. Type of SLAP lesions).AARON03/01/20Orthopedic Physiotherapy of the Upper and Lower Extremities PERFECT INFORMATION
Much of it was fresh rehearsal including some new insights! Would recommend.DIMITRY22/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities THE FUTURE OF PHYSIOTHERAPY
I think this course should be done by all physiotherapists! The evidence based principle should be adopted by every physiotherapist, this course is a great way to learn how to apply tests, but also background information, advice for patients and some rehabilitation. I believe this kind of course is the future of physiotherapy and is very suitable for everyone.
- Marijke13/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities BEDANKT!
Uitstekende manier van leren.LIEKE11/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities PERFECT
The course was very interesting Learned a lot!JORN08/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities ZEER LEERZAAM!
Zeer leerzame cursus, welke zeker de moeite en tijd waard is!
Gaat goed stapsgewijs dieper in op de stof.
Zorg er wel voor dat je engels up-to-date is.
- MATAN03/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE
Super cursus!! Overzichtelijk en up to date.Willem01/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities EXCELLENT COURSE!
A course of the highest quality. It adresses a plethora of conditions both theoreticaly and practically. Everything is well laid out and substatiated with current research. Its fun to take and challenging. If you spend the nescessary time on this course youre sure to learn a lot.
Theres allways room for some pointers so
Andreas you should stop staring so aggresivly during the examinations, its scaring me. Just lay off the steroids for a while and youll mellow out soon enough, theyre other ways to get swole bro.
Kai youve been blasting me with research citations during the whole course. my head is about to explode. Youve been luring me to the dark side of science but i know this knowledge has been paid for in missed sleep and coffee. The bags under your eyes attest to this.
Just joking, you guys are heroes to everyone enrolled in the physiotherapy eduction and therapists alike. ill be buying all of your courses as will the rest of my team.HYEOK17/11/19Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE FOR NOT ONLY FIRST YEAR PHYSIOS BUT ALSO EXPERIENCED PHYSIOS.
I’ve been working in this field for 10 years and still learn from many resources such as books, youtube channels, essays and so on. And this course is awesome because it’s time efficacy and broad perspective of information in each chapter from basic anatomy, pathophysiology, to treatment. After taking this course for 5 months, I able to give more clear, updated information about each patient’s conditions and course of the current problem.
I hope you guys make another course for the spine . I wil take it!
- Rik24/10/19Orthopedic Physiotherapy of the Upper and Lower Extremities This course showed me some new insights that I can use in my own practice.
The course is easy to follow in your own time.
I really enjoyed it!
Thanks guys!M.J. Post08/09/19Orthopedic Physiotherapy of the Upper and Lower Extremities As I said, great course. When you take this course, you’re being pushed into improving your assessment skillset.Vadym Grytsenko29/07/19GREAT ILLUSTRATION OF WHAT ONLINE EDUCATION SHOULD BE! The great course with absolutely new approache to study information online!
Content is extremely useful in daily physiotherapy routine and all the material is based upon scientific researches. I did rehearse the screening and assessment process.
Great illustration of what online education should be!
- Jerry06/06/19GREAT! It was an excellent course! Took me 33 hours and 26 minutes to complete. I liked the cases a lot and the statistics gave me a totally new point of view to assess different tests. This course will make me a better physiotherapist. Thank you!Francisco Javier31/05/19THE UNIVERSITY OF THE FUTURE Awesome Course!!!, honestly it´s the University of future, you will learn all the commmon pathologies of the body with just 1 click: epidemiology, prognostic factors, course, asessment and treatment, everything from a scientific point of view. Well structured, easy to read, fast navegation, high quality videos. You will be able to answer your patient how long the complaints will last base on the last evidence with proper numbers, giving a fair prognosis which will help you to keep them motivate to the therapy and be patients and constant. There is no a day when I dont use it in the practice to consult a specific test or the sensibility of this one. Even you get you acreditation points, a bunch of them actually in comparison with other courses that you will never use in your daily routine. 100% advisable!!!
Curso Magnifico!!!, honestamente, es la universidad del futuro, aprenderá todas las patologías comunes del cuerpo con un solo clic: epidemiología, factores pronósticos, curso, evaluación y tratamiento, todo desde un punto de vista científico. Bien estructurado, fácil de leer, navegación rápida, videos de alta calidad. Podrás responder a tu paciente cuánto tiempo durarán sus molestias basado en la última evidencia con los números adecuados, lo que les dará un pronóstico justo que los ayudará a mantenerlos motivados para la terapia y ser pacientes y constantes. No hay un día en el que no lo use en la práctica para consultar una test específico o la sensibilidad de este. Incluso se obtienen puntos de acreditación, un monton ellos en comparación con otros cursos que luego nunca usas en su rutina diaria. 100% recomendable!!Nathan28/05/19Orthopedic Physiotherapy of the Upper and Lower Extremities A great course for new grads! I have found this course to be very well put together. Firstly the formatting is very user friendly – it’s easy to work through but also very to easy to navigate to specific sections to use as a reference resource. As always with these guys the videos are very high quality. The attention to detail with academic references is also spot on. You can be assured that the info is evidence based. Overall, highly recommended.
- Stijn14/02/19GREAT COURSE I thinks this course is great, I find the framework it teaches you very useful in assessing my patients. I like how the different pathologies are very clearly explained from epidemiology to pathophysiology to diagnostics to treatment, all evidence based. The Physiotutors-style videos used to explain the subject matter are really useful for studying too. Finally, the assingments at the end of the chapters are a great way to test and practice your knowledge on the subject you just studied.Remy29/05/22Orthopedic Physiotherapy of the Upper and Lower Extremities Great course; gives you a good foundation to build upon. As for potential improvements; maybe include a bit more articles that are freely available for people that don’t have access to the scientific database.Rick10/01/22Orthopedic Physiotherapy of the Upper and Lower Extremities USEFUL AND CLEAR
The course consists of easily understandable bite sized lessons. This way it was easy to spend a little time every day to work on this course. All information is easily to find and it is not too much information to remember. It really helped me as a starting physio to get more structure and confidence in my intakes and testing procedures.
Sometimes there are some grammatical or spelling mistakes, but those don’t bother me. Sometimes it would have been nice to maybe have had a bit more information on treatments though.
All-in-all a great course that I would recommend, especially for starting physio’s!