Differentiate True Hip Pain from its Misconceptions

The human hip is a complex and intricate series of muscles, tendons and ligaments. This enables the everyday person to accomplish everyday tasks. With the dancer however, the demands of the hip are significantly greater. Not only does it have to maintain extreme flexibility, it also needs to have excellent balance, strength and coordination, which bring us to the dancer's hip. Maintaining well-balanced hips will give you a long healthy dance career.

Dance injury evaluation and treatment are unique as the dancers demands on the body go well beyond the day-to-day athlete!

Hip pain misconceptions

I would like to clear up some common misconceptions regarding hip pain.

The dancer's hip usually involves one or more of the muscle tendons ligaments or bursa that attach to or surround the hip. As you know, movements associated with dance involve multiple movements, which requires great degrees of strength and flexibility. True hip joint conditions would involve the bony hip socket. Most of the conditions that I treat involve the soft tissue structures that surround the hip. These common conditions present themselves as popping, clicking, snapping with or without pain. With dancers, the repetitive use and demands in the hip region are usually the cause of these symptoms unless there is an injury. With my experience, these are common causes related to the dancer's hip:

• Muscle imbalances - Related to strength or flexibility. You must maintain a balance of equal strength and flexibility in the entire body.
• De-conditioning - Not keeping up with training, which will lead to weak muscles, tendons, and ligaments.
• Faulty technique - Or bad habits.
• New activity/movements

Maintaining well-balanced hips will give you a long healthy dance career.

The soft tissue structures in the hip, groin, gluteal and thigh are the surrounding structures of the hip that are commonly misread as hip joint pain include the following:

• Snapping hip syndrome
  • Will affect one or more muscles in the front of the hip/groin area.
  • Common movements where a dancer would experience this would be arabesques, passés, forcing your turn out (watch your technique!) dégagés, tendus, battements.
• Hamstring strain
  • A muscle that is located in the back of the thigh. You would experience pain located in the top middle or bottom of your hamstring.
  • Common movements: battements, kicks, lunges, splits, jetés, etc.
• Hip flexor/Psoas strain
  • A muscle that is located in the upper groin region. You would have pain located deep in the groin area, where the thighbone meets the pelvis.
  • Common movements: improper contractions, battements, attitudes, etc.
• Hip pointer strain
  • A muscle that is in the top portion of your pelvis a.k.a iliac. You would have tenderness or constant pain located in the top crest of your iliac.
  • Common movements: parallel work, quick, short movements or prolonged running.
• Piriformis syndrome
  • A muscle located deep in the buttock. You would experience pain and or deep burning sensation deep in the buttock.
  • Common movements: any outward hip rotation, squats, back attitudes, etc.
• Quadriceps contusion/thigh bruise
  • A muscle located on the front of your leg. There may be bruising or discoloration.
  • Common movements: squats, lunges, leaping and landing.
• Bursitis
  • A fluid filled sac that acts as a cushion between tendons, bones, and skin. You would experience discomfort on the outer area of your thigh or hip. Falling onto your hip can cause traumatic bursitis. For example: the muscle injured in a hip pointer strain or syndrome continues down the outside of your thigh, which becomes the IT Band. An extremely tight IT band will basically rub or cause friction on the bursa, remember the bursa is located between the IT band and the bony hip.

The conditions as described above can also applied to similar movements that are non-dance related, such as soccer, cross training, running. These conditions respond favorably to self-care as well as conservative treatment. If a hip condition does not respond to self care such as RICE: Rest, Ice, Compression and Elevation within 2-3 days, then it would be wise to seek the help of a knowledgeable practitioner who is experienced with the evaluation and treatment of dance injuries. Dance injury evaluation and treatment are unique as the dancers demands on the body go well beyond the day-to-day athlete!

True hip joint pain

True hip joint pain could include the following:

• Rheumatoid Arthritis
• Osseo-Arthritis - Associated with long-term repetitive movement(s).
• Dislocation - Seek Medical Attention
• Hip fracture - Seek Medical Attention

These are extreme conditions and in my experience typically do not involve the dancer's hip. HOWEVER if you feel that you have sustained a serious injury you should contact your physician immediately. As always, take care of your body and your body will return the favor.

This article is information based only and is not intended to diagnose or treat any conditions discussed. Please consult your physician should you have injuries of any kind.

To Your Health Sincerely,
Tim Manchin D.C., IDE Dance Doctor