Hip pain can develop for various reasons and often occurs when the supporting structures are overworked, joint surfaces are placed under too much load, or are simply not strong enough.

Symptoms

If you have hip pain, then you may also experience discomfort around the groin, thigh, outside or inside of the hip joint or buttocks.  Sometimes pain originating in the back can also refer into the hip region.

Discomfort can be made worse with activity, which can be related to damaged muscles and tendons around the hip, arthritis, or tears in the cartilage lining, which not only results in pain, but sometimes the loss of movement around the hip.

Night pain is also relatively common with hip problems.  It’s often as a result of bursitis, which is irritation of the ‘bursa’ which sit in between the bony surfaces and the muscle’s tendons; or gluteus muscle tendon issues, as well as arthritis related issues.

Causes

The hip joint is lined with cartilage which allows the transfer of weight across the joint surfaces and is designed to take a reasonable amount of load. Whilst it was thought the hip joint was relatively stable it has now been shown that this might not be the case, and that the lining in the socket of the joint can be quite easily torn, causing both pain, loss of movement and function. For the most part these injuries can settle down with the help of physiotherapy, but in some cases a cortisone injection or surgical intervention may be required.

Pain can develop overtime due to instability of the hip structure. The shape of our hip, the position of our femur, and femoral head angle all influence hip stability. In addition, activities that we do throughout our life can cause changes to our joint in the form of a CAM deformity.

Hip dysplasia is the under coverage of the acetabulum (socket part of the joint). For example the hip socket may be too shallow so the joint doesn’t get a good stable area to distribute forces that are placed on it with normal everyday activities.

Femoral neck shaft angle and femoral head angle and position can place unnecessary stress to the joint due to uneven forces placed on the joint, which often leads to microinstability, pain and dysfunction.

Post-menopausal women tend to be more susceptible to gluteus medius and minimus tendonopathies around the hip which causes bursal problems and pain. This can be quite debilitating as well as very uncomfortable during the night.  Physiotherapy can help with these problems by strengthening of the tendons and muscles as well as working on the soft tissues – helping to ease discomfort and pain.

In younger active people, it’s more common to get problems around the bony prominences where tendons attach. Often the growth plates are still present and these can become disrupted causing serious problems.

Changes in joint spaces and joint health affect both men and women.  Narrowing of the joint spaces, spurring and thinning of the cartilage lining the joint can be identified by x-ray.  Often these changes can occur over a period of time, then something like a fall or slip might set off the joint pain. Physiotherapy is important in this situation to help maintain joint mobility as well as helping to strengthen the muscles around the hip region. If degeneration of the joint is significant and a hip replacement is required, then it is beneficial for that person to build up as much strength around the hip, pelvis and thigh region as possible prior to surgery as well as continuing rehabilitation post surgery.

Treatment

Physiotherapy can be very helpful in maintaining or regaining range of movement and helping to strengthen muscles and tendons around the hip and surrounding areas.

If you are suffering pain around the hip or pelvis area, come and see us and we can advise you on the best treatment and rehabilitation plan.

Book your appointment at Ponsonby Physio.

Call: 09 378 6890

Email: info@ponsonbyphysio.co.nz

(Article updated February 2025)

Knee injuries are one of the most common injuries we see at the clinic. They are either the result of an acute traumatic event or an overuse type injury that occurs from repetitive sport or activities.

Acute injuries

In the acute phase of a traumatic injury the body responds with inflammation, swelling, pain and often a loss of movement.

The treatment at this stage is RICE (relative rest, ice, compression and elevation). After 36-48 hours with good management this usually settles, but the underlying damage can still cause on-going problems. If the injury has been particularly traumatic and a fracture is suspected, then this needs to be determined by x-ray and appropriate management started.

On-going pain

There can be many causes for on-going symptoms, such as fractures, ligament injuries, meniscal damage, tendon injuries, patella dislocation or overuse pain such as ITB syndrome and degenerative joint changes (arthritis).

1. Ligament strain

The ligaments go from bone to bone and provide support and stability to the joint. If the ligaments have been strained this can limit joint movement and cause pain. In the knee there are 2 collateral ligaments which run either side of the knee, inside is the medial collateral ligament and the outside one is the lateral collateral ligament.

The cruciate ligaments are inside the joint and are referred to as the intra-articular ligaments and prevent forward and backward movement of knee. The anterior cruciate ligament (ACL) stops the forward movement of the tibia and is frequently injured in sports such as netball and rugby. The ACL is typically injured in a non-contact situation, often with a sudden change in direction or a jumping and landing mechanism causing hyperextension and twisting motion of the knee. Sometimes people hear an audible popping sound as the ligament ruptures.

The posterior cruciate ligament prevents backward movement of the tibia and is not injured as often as the ACL. Injury most often occurs when a force is applied to the front of the tibia when knee is bent, with a hyperextension (forced over straightening), or a twisting motion to the knee.

2. Meniscal damage 

The meniscus act as a cushioning mechanism for the knee and helps aid in the preservation of the joint surfaces. They help in the transfer of forces across the knee joint during movement and help to balance the changes to the joint surfaces that occur with various loads and activities.

The meniscus is most often injured with activities that involve a twisting motion to the knee, more commonly in a bent position and with the foot planted. The degree of damage can vary and cause a variety of symptoms. The most severe being a tear large enough to cause the knee to lock and prevent full movement.  These injuries are always painful. The smaller tears or multiple small splits don’t have quite the same severity of symptoms but are still painful and often prevent people from doing the activities they love.

Surgery is usually required for moderate to larger tears which are restricting joint movement.  Smaller tears are generally managed relatively conservatively to see how they respond. They often take some time to settle, but usually respond well to light exercise – with cycling being the most effective.

3. Tendon injuries

The quadriceps tendon runs across the top of the patella (knee cap) and the patella tendon is at the bottom end and attaches just below the knee at a bony prominence.

Tendons can be acutely injured causing a rupture or suffer from an overuse type injury resulting in tendinopathy. These injuries tend to occur with sports that have a high rate of jumping and landing and fast acceleration-deceleration activities such as basketball, netball and volleyball.

There has been a lot of recent research into the treatment of these structures and specific exercises can be helpful.

The hamstring (muscles at the back of the leg) have tendinous structures that attach to the tibia on either side of the knee and bend the knee. These can also be torn or strained with various sporting activities, football being one of these.

4. Patella pain

The patella (knee cap) can be acutely injured through dislocation where it pops to the outside of the knee causing significant pain and loss of movement. The knee cap can also be fractured through falling with force onto the knee.

Pain around the patella (knee cap) can develop soon after a knee has been traumatised and swelling has occurred. The trauma has a detrimental impact on the muscles around the knee, particularly the inside quadriceps muscle known as the vastus medialis (VMO). The pain, swelling and inflammation cause the muscle signals to ‘switch off’ and for the muscle to become weak, which can cause the patella to track in a less than ideal position, resulting in pain.

Overuse conditions

These conditions are created with repetitive and often weight bearing activity across a variety of sports and can cover a myriad of injuries. Running, walking and cycling are just a few repetitive sports that cause overuse knee pain.

Overuse conditions include retropatella pain or patellofemoral pain, Iliotibial band syndrome (ITB for short), tendinopathies and bursal involvement.

1. Patellofemoral or retropatella pain

Patellofemoral or retropatella pain is often associated with poor tracking of the knee cap causing pain anywhere around the knee cap and even to the back of the knee. It can be further complicated by influencing biomechanics around the pelvis, hip, knee and ankle.  Strengthening and stretching of various muscle groups help unload the knee region.  Technique and training load and progression are major contributors to the development of this problem.

2. ITB syndrome

The Iliotibial band is a wide band of fascia (or ligament) that runs down the side of the upper leg from the outside hip region to the outside of the knee. Imbalance between these two points can cause problems. If some of the muscles around the pelvic/hip region are not doing their job particularly well, then the ITB tends to take up the slack which can cause tension and sub-optimal movement range resulting in knee pain.

This can be particularly noticeable with downhill running control or running on uneven ground. Biomechanics as well as training load and progression also influence this problem and there’s often more than one component that needs addressing.

Stress fractures

Although not overly common at the knee, they can occur with repetitive movement and overloading of the tissue, resulting in severe pain.

Degenerative joint changes (arthritis)

When there has been an injury, often years ago or a gradual build-up of wear on the knee there can be a thinning of the cartilage that lines the joint and a narrowing of the joint space. This causes pain, swelling and sometimes limitation of movement and decreased muscle strength around the knee. An example is the person who years ago had an ACL rupture who then develops a symptomatic knee. Regardless of whether an ACL rupture is repaired or not, it has been shown that the joint will develop arthritis.

This can be distressing but if caught early enough, physiotherapy can improve symptoms and function. If surgery is required then an exercise programme can be helpful to give the best post-operative outcome.

Growing pains

Active young athletes can develop overuse type injuries in the knee affecting the bony compartments of the knee. Osteochondral changes can occur and need to be diagnosed and managed early to prevent major problems to the growing joint. Osgood Schatters disease is another relatively common condition for the young growing athlete, causing pain at the front of the knee at the bony prominence (tibial tubercle) just below the knee cap.

As you can see, knee pain covers a myriad of conditions and injuries. For the most part, injured knees generally respond well to prescribed exercises with some form of stretching and strengthening components. Physiotherapy is a valuable part of the rehabilitation process and with our on-site gym we are able to provide individualised and progressive programmes to help people return to form as soon as possible.

What is it and what causes it?

Tennis elbow is otherwise known as lateral epicondylitis and in most cases it’s due to overload of the common extensor tendon located at the outside of the elbow.  In some instances, the extensor tendon can be acutely injured through lifting or loading, causing a tear in the tendon.

This causes pain in the outside of the elbow which is generally localised to one point. The pain is easily aggravated with activities such as lifting the jug to pour a cup of tea, gripping a door handle or tennis racket or cooking and cutting up food. The pain can be quite debilitating and can impact both work and sporting activities.

Despite its name, it’s not only tennis players that get this injury, but any activity that combines both wrist and elbow movement and gripping under load often in a repetitive manner – for example a builder using a hammer or a tennis player putting excessive spin on the ball or doing a one armed backhand.

The tendon gets loaded beyond its ability to manage which causes changes within the tendon structure resulting in pain and often weakness in the forearm extensors. Tennis elbow injuries can result in a significant difference in grip strength between the affected and unaffected arm.

Due to the overload component, there are often other biomechanical factors involved such as decreased shoulder and shoulder blade strength and imbalances or problems with technique when related to sporting activities.

Consideration of the amount of sport being played, correct technique and frequency and intensity of activity needs to be addressed.

The treatment of tennis elbow

Physiotherapy is very beneficial for the treatment of tennis elbow. It helps with tendon rehabilitation through strengthening and local muscle release through the forearm which can assist with pain alleviation. It is also key to identifying any biomechanical or load issues which caused the injury originally.

Tendons typically are temperamental but generally do well with the right amount of load and strengthening treatment.

Getting treatment for your injury sooner rather than later certainly helps with the overall rehabilitation outcome of a pain-free and strong elbow.

Active children usually between the ages of 7-15 years can be vulnerable to developing what is often called “Growing Pains”. This title is a very broad term for a myriad of symptoms that can develop around the growing body. During this age, children have growth plates (physis) present in their bones and softer boney protrusions where tendons attach. These are called apophyseal sites.

Pain can develop around these apophyseal locations and is caused by a variety of factors:

1. Rapid periods of growth – there is often a difference between the rate of bone growth and the ability of the muscle-tendon complex (or soft tissues) to keep up. This results in the inability of the muscle-tendon complex to stretch sufficiently to the load that is being placed on it, causing an overload tension at the apophyseal site where the tendon attaches.
2. The amount and quality of sporting and activity load; too much training and competition load can place increased stress, resulting in microtrauma of the apophyseal sites which causes pain.
3. Underlying biomechanical factors and general strength and flexibility of the whole body kinetic chain
4. Inadequate warm-up prior to high intensity or impact activity can also be unhelpful

Severs Disease

One of the most common apophyseal injuries in children is Severs disease. Severs disease affects the Achilles tendon insertion into the calcaneal (heel bone) apophyseal growth plate, which through repetitive microtrauma can lead to pain.

Pain is often felt at the heel and into the Achilles itself at times which is made worse by running and jumping activities. It can often occur at the beginning of a season of sport.

There can be an associated tightness or loss of flexibility through the calf area resulting in decreased ankle muscle strength and limitation of joint movement. Tension of the nerve structures can also be apparent.

Boys are 2-3 times more likely to get Severs disease than girls.

Severs disease is a self-limiting condition and the severity of symptoms determines the best course of management.

Treatment

Physiotherapy is very helpful in the management of this condition. Physiotherapists are able to discuss training and activity modification which might range from complete rest to being able to play and train at less frequency and intensity.

Trained physiotherapists are also able to help identify biomechanical factors, areas of tightness and weakness. The analysis of sporting technique can also be helpful in the management of this condition. For example, looking at how an individual jumps and lands can provide many clues as to the management and prevention of further injuries.

Soft tissue mobilisation, nerve and muscle stretches and strengthening exercises all make up the rehabilitation plan.

Podiatry is also helpful in determining appropriate foot wear and the possible addition of formthotics should they be needed. Sometimes it is a case of unloading the areas that are being overloaded.

Self-management includes activity modification, ice, massage, stretching and strengthening where appropriate.

There are multiple apophyseal sites in the growing child and these are the most common cause of pain in active children. If your child is complaining about growing pains or they are very active and have recently had a growth spurt then it’s definitely worth an assessment to identify potentially troublesome areas.  It‘s also good to rule out any other possible conditions that could occur.