Bursitis of the hip is the most common cause of hip pain. A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees and when bursa become inflamed, the condition is known as "bursitis." Most common bursitis is caused by inflammation resulting from local soft tissue trauma or strain injury.
There are two major bursae of the hip. Inflammation of these bursae can both be associated with stiffness and pain around the hip joint. The trochanteric bursa is located on the side of the hip. Trochanteric bursitis frequently causes tenderness of the outer hip, causing increased pain when lying on the involved side. It also causes a dull, burning pain on the outer hip that is often worsens with excessive walking or stair climbing. The ischial bursa is located in the upper buttock area which can cause dull pain in this area that is most noticeable when climbing uphill. The pain sometimes occurs after prolonged sitting on hard surfaces, hence the names "weaver's bottom" and "tailor's bottom."
Treatment includes modalities for inflammation and healing such as ultrasound, ice, heat, electrical stimulation, or iontophoresis, along with exercises for stretching and strengthening when appropriate.
Total Hip Replacement (THR)
A total hip replacement is a surgical procedure where the diseased cartilage and bone of the hip joint is surgically replaced with an artificial joint. The normal hip joint is a ball and socket joint. Total hip joint replacement involves surgical replacement of the diseased ball and socket and with a metal ball and stem inserted into the femur bone and an artificial plastic cup in the socket. The metallic artificial ball and stem are referred to as the "prosthesis." The artificial joint is fixed with a bony cement called methylmethacrylate. Alternatively, there is a "cementless" prosthesis also of which has microscopic pores that allow bony ingrowth from the normal femur into the prosthesis stem. This "cementless" hip is felt to have a longer duration and is frequently used in younger patients.
Rehabilitation for THR patients focuses on exercises to improve strength of the lower limb, education on precautions for restrictions with motion for 3 months post-operatively, and activities to promote return to normal ADLs after surgery.
Anterior Cruciate Ligament Repair
The anterior cruciate ligament, or ACL, is one of four major knee ligament and is critical to knee stability. People who injure their ACL often complain of symptoms of their knee giving-out from under them. Once the ACL is torn, the decision has to be made whether to repair or not. Repairs are chosen predominantly for people expecting to return to high-level athletic activities in sports such as soccer or basketball, individuals who experience recurrent episodes of knee instability due to ACL deficiency, and patients who do not want to attempt conservative therapy.
Although people (including doctors and therapists) often refer to the surgery as an "ACL repair," it is better classified as an "ACL reconstruction." Once the ACL is completely torn, it cannot be repaired only reconstructed.
Rehabilitation for ACL repair is acutely 3 months, but rehabilitation can last up to a year for athletes returning to full activity. Many times the strengthening exercise is coupled with NMES (neuromuscular electrical stimulation) promote and accelerate the strengthening of weakened musculature. Cryotherapy and elevation are also helpful in reduction of pain and swelling post-operatively.
The knee is a joint where the bone of the thigh (femur) meets the shinbone of the leg (tibia). The meniscus is the cartilage within the joint that provides cushioning to protect the bones from the regular trauma of walking, running, and climbing. The medial and lateral meniscuses are two thick wedge-shaped pads of cartilage attached to the leg bone (tibia). If the meniscus is damaged, irritation occurs with each flexion (bending) or extension (straightening) of the knee. Damage to the meniscus may occur due to a twisting or over-flexing injury. Meniscal cartilage can also deteriorate or wear out because of age and overuse.
If a meniscal tear is small and located on the outer edge of the meniscus, it is possible that rehabilitation without surgery may be all that is needed for recovery. Also, with other meniscal injuries, if the knee is stable and if the symptoms do not persist and do not limit lifestyle, nonsurgical treatments may still remain an option. However, the decision to defer surgery depends upon pain rate, loss of function, and whether the knee joint remains functional.
Rehabilitation is available for both non-operative and operative meniscal situations. Exercise for range of motion and strengthening are vital in both cases. Post-operative patients may also benefit from electrical stimulation and cryotherapy to reduce pain, inflammation, and swelling.
Total Knee Replacement
A total knee replacement is a surgical procedure where the diseased knee joint bone and tissue is replaced with artificial material. The knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic "button" may also be added under the kneecap surface.
Rehabilitation after a replacement typically lasts about 3 months. It consists of exercises, gait training, balance, and proprioceptive activities.
Patellar Maltracking/Chondromalacia Patella
Chondromalacia patella is abnormal softening of the cartilage of the under the kneecap (patella) and the most common cause of chronic knee pain. Chondromalacia patella results from degeneration of cartilage due to poor alignment of the kneecap as it slides over the lower end of the thigh bone (femur). Patients with chondromalacia patella frequently have abnormal patellar "tracking" toward the lateral or outside of the femur. This slightly 'off-kilter" pathway causes the undersurface of the patella to grate along the femur causing chronic inflammation and pain. This incorrect tracking of the kneecap (patella) is referred to as 'patellar maltracking'. This process is, therefore, sometimes referred to as patellofemoral syndrome (PFS) due to the combination of patellar dysfunction and its resulting chondromalacia.
The symptoms of chondromalacia patella or patellafemoral syndrome (PFS) are generally a vague discomfort of the inner knee area. PFS is aggravated by activities including running, jumping, climbing or descending stairs or by prolonged sitting with knees in a moderately bent position (the so called "theater sign" of pain upon arising from a desk or theater seat). This is sometimes accompanied with a vague sense of "tightness" or "fullness" in the knee area. Treatment for PFS includes taping of the patella to promote correct patellar alignment, stretching exercises to the lateral or outside of the leg, and strengthening exercises to the medial or inside of the leg. Primary focus is on the VMO muscle on the inner quadriceps as it is typically weak and partially responsible for the muscle imbalance causing the maltracking.