How to Relieve Hip Pain: Understanding Trigger Points and Myofascial Release Techniques
Hip pain can be a very limiting presentation due to the location and function of the hip joint. Fundamental in walking and pretty much in every movement, experiencing hip pain can restrict the amount of activity that we are able to perform and it is for this reason that it can cause quite a dramatic change is people’s quality of life. It can also affect people’s sleep and therefore their general wellbeing.
According to a survey conducted by Arthritis Research UK, about one in four adults in the UK (25%) report experiencing hip pain. This corresponds to approximately 10.5 million people. Hip pain is more common in women than in men, and its prevalence increases with age.
Causes of hip pain
These last two factors account for a great number of cases and they don’t usually get dealt with or given the credit that they deserve by the medical professionals. They are soft tissue related factors, how could soft tissue cause that much trouble? right? Well it does!
In numerous cases, patients diagnosed with hip arthritis, feel a considerable relieve in pain levels as well as increased functionality of the hip joint when we release the muscles and fascia of the hip joint and neighbouring joints. When the problem is exclusively soft tissue related the benefits of releasing the soft tissue are even more dramatic.
As we’ve mentioned above, Trigger points in the hip muscles can cause hip pain and limit mobility. These trigger points can develop due to overuse, injury, or poor posture.
When these trigger points are present, they can cause pain locally to the hip area or referred pain, meaning pain in other areas of the body such as the lower back, groin, thigh or leg.
Treatment of these trigger points usually alleviates the pain associated with them, improving as well function of the hip joint structures and the whole body as a result.
But what are Trigger Points and how do they case so much trouble?…
A trigger point commonly referred to as a “knot” is a localized, hyperirritable spot in a taut band of muscle fibre that can refer pain and other symptoms locally or to other parts of the body.
Trigger points (TPs) can develop due to diet, stress, overuse, injury, or poor posture, amongst other factors.
TPs can be effective released by applying steady pressure over a period of time. Once Trigger Points are released the symptoms associated with them also release and the muscle returns to a more functional position.
A buildup of Trigger Points around a joint can dramatically restrict the mobility of the joint. This is very common in the hip joint. In this scenario the hip joint is immobilised by soft tissue restrictions which apart from causing pain also increase the speed at which wear and tear happens in the joint, increasing the risk of needing a hip replacement in the future.
Sometimes the problem is not in the hip
We mentioned above that when dealing with hip stiffness and pain we also assess and release the structures involved in the neighbouring joints, both above and below the hip; lower back and knee… but why is this?
This is where the myofascial tissue or fascia comes into play!
The myofascial tissue is a connective tissue in our body that hold organs, muscles and bones in place. This tissue is found in the muscles, bones, it goes down to the cellular level, it creates the base for our brain to sit in… it’s everywhere!
This tissue doesn’t divide, it consists of a single piece of fabric! If we were able to remove everything other than the fascial tissue we would be left with a spider web-like structure so detailed that we would probably be able to recognise the person that it belongs to.
Considering that the body is thought to behave as a tensegrity structure (a design principle that applies when a discontinuous set of compression elements is opposed and balanced by a continuous tensile force, thereby creating an internal prestress that stabilises the entire structure), considering that the fascia is a key element that keeps balance in this system and that the fascia is a single piece of fabric we can say that a restriction anywhere along the fascia will pull on the neighbouring structures and cause an imbalance in the whole system in a domino-like effect.
I case of the hip joint, it’s very important to release the hip muscles and local fascia but it is equally important to recognise that the cause for the hip problem could originate from restrictions somewhere else in the body. We methodically assess the joints immediately above and below the joint that we’re dealing with because being right next to each other they are usually affected as well and need addressing.
At the same time there are a great number of myofascial structures in the hip area that also need to be addressed.
Since we’ve had to end up talking about the myofascial tissue we can also mention here that apart from Trigger Point work, Myofascial Release Work is also a common technique that we use to address hip pain and limited range of motion.
Direct or Indirect Myofascial work
There are several schools of thought when if comes to myofascial techniques, the Rolfing is probably the most known but there are others.
At our clinic we use a combined approach of different techniques to increase the effectiveness of the treatment.
With Myofascial Release Work we release restrictions by applying gentle sustained pressure to the myofascial tissues. This releases the fascia allowing for the joints either to follow or to have more space around them to move better.
Having a good range of motion in the hip is fundamental to prevent issues in the lower back and the knee joints. For this reason a common treatment goal is to increase hip mobility. Apart from Trigger Point Work and Myofascial Release we use advanced stretching techniques like, STR, PNF or AIS. Some of these will not only focus on increasing mobility but also in increasing muscle function and muscle activation.
We’ve talked above about Trigger Point involvement and how these can cause local pain (in this case hip pain) or referred pain somewhere else in the body.
The amazing physicist Dr Janet Travell discovered Tigger Points in the 90’s and realised that they all followed the same pain patterns in all her patients. She went on to document all of them in an incredible 2-volume textbook that is truly a gift to society due to all the people that she’s been able to help out of pain with them. The pictures that I’m about to show you below are an example of some of the most common muscles that cause hip pain and restrictions.
Some of the muscles that can cause hip pain include the hip flexors, gluteus medius and minimus, piriformis, and tensor fasciae latae.
Below you can see the referred pain patterns for each muscle (Source: Travell JG, Simons DG: Myofascial Pain and Dysfunction: The Trigger Point Manual, Williams & Wilkins, Baltimore, 1992)
Psoas pain pattern in hip pain:
Tensor Fasciae Lata: