Dry Needling for Hip Impingement
A person with hip pain
For a comprehensive understanding of hip impingement, its causes, symptoms, and the traditional medical approach to its treatment, our previous blog post "What is Hip Impingement?" offers valuable insights. Building upon that knowledge, this article explores the role of dry needling in managing hip impingement, providing an alternative and complementary approach to traditional methods.
Dry Needling Can Help Manage Hip Impingement Pain
Dry needling stands out as a key modality in the multidisciplinary approach to treating hip impingement. Its effectiveness lies in its ability to directly target and alleviate the issues contributing to hip pain and dysfunction.
Dry Needling Before Hip Surgery
Pre-Surgical Benefits:
Pain Reduction: Dry needling can significantly reduce pain levels in the hip area, making the days leading up to surgery more comfortable for the patient.
Muscle Relaxation: By releasing trigger points, particularly in tight and overactive muscles like the iliopsoas and gluteus medius, dry needling helps in relaxing the muscles around the hip. This relaxation is crucial for improving surgical outcomes.
Enhancing Mobility: Improved joint mobility through dry needling can be beneficial in pre-operative physical therapy, ensuring the hip is in the best possible condition before surgery.
Reducing Inflammation: Dry needling can help in managing local inflammation, potentially reducing the need for anti-inflammatory medications before surgery.
Preparation for Surgery: Implementing dry needling in the pre-surgical phase can prepare the hip joint for the surgical procedure, potentially aiding in a smoother surgical process and recovery.
Dry Needling After Hip Surgery
Post-Surgical Rehabilitation:
Aiding in Recovery: Post-surgery, dry needling can be an effective tool in the rehabilitation process. It helps in alleviating pain and facilitating muscle recovery.
Restoring Muscle Function: After hip surgery, certain muscles may become weak or dysfunctional. Dry needling can help reactivate these muscles, aiding in restoring strength and function.
Improving Flexibility: As the patient recovers, dry needling can aid in improving flexibility and range of motion, which are often limited post-surgery.
Reducing Scar Tissue: Dry needling may also play a role in managing and reducing scar tissue formation around the surgical site, thereby enhancing mobility and reducing discomfort.
Complement to Physical Therapy: When combined with physical therapy, dry needling after hip surgery can accelerate the healing process, helping patients return to their normal activities sooner.
When should I start post-operative dry needling?
Orthopedic surgeons typically recommend starting dry needling as part of post-operative care once the initial healing phase has progressed sufficiently — usually several weeks after surgery. The exact timing can vary based on factors such as:
The Nature of the Surgery: More invasive procedures may require a longer healing period before dry needling can begin.
Individual Healing Rates: Patients heal at different rates, and the readiness for dry needling will depend on individual progress.
Post-Operative Complications: If there are any complications or increased sensitivity around the surgical site, the introduction of dry needling might be delayed.
Surgeon’s and Physical Therapist’s Assessment: The decision is often made collaboratively between the surgeon, the physical therapist, and sometimes the acupuncturist, based on a thorough assessment of the patient's recovery status.
Patient’s Pain and Mobility Levels: Once the patient has reached a certain level of pain reduction and regained some mobility, dry needling can be more effectively and safely administered.
State of Wound Healing: It’s crucial that the surgical wounds have sufficiently healed to avoid the risk of infection.
In general, dry needling is considered safe and beneficial in the later stages of post-operative rehabilitation, helping to address muscle tightness, improve mobility, and facilitate a quicker return to normal activities. However, it's important for patients to follow the specific guidance of their healthcare team regarding the timing of this treatment.
Muscle Tightness and Trigger Points: Biomechanical Impact
Hip impingement can be significantly influenced by the condition of the surrounding muscles. Muscle tightness and the presence of trigger points play a crucial role in altering hip biomechanics, often exacerbating the symptoms of hip impingement.
Having hip impingement does not mean you will have pain, as there are many people with hip morphology but no symptoms. Addressing and ruling out muscle pain is important as that is a common cause of hip pain.
Altering Hip Biomechanics
Impact of Muscle Tightness: Tight muscles in the hip region can disrupt the normal movement and alignment of the hip joint. This misalignment increases stress on the joint, contributing to the impingement.
Muscles Commonly Involved:
Hip Flexors (Psoas and Iliacus): Tight hip flexors can tilt the pelvis forward, altering the angle of the hip joint and increasing the risk of impingement.
Adductor Muscles: These muscles, when tight, can pull the femur inward, affecting the joint's mechanics.
Piriformis: A tight piriformis, located in the buttock region, can affect the rotation of the femur, contributing to impingement.
Gluteal Muscles: These muscles, especially the gluteus medius and gluteus minimus, play a role in stabilizing the hip. Tightness here can impact gait and hip movement.
Hamstring Group: Including the biceps femoris, semimembranosus, and semitendinosus, tight hamstrings can affect the positioning of the pelvis and thus the hip joint.
Quadriceps: Particularly the rectus femoris, which also acts as a hip flexor, can contribute to altered hip mechanics if tight.
Trigger Points and Pain
Direct Pain from Trigger Points: Trigger points in the hip muscles can cause localized pain in the hip region, often mistaken for joint pain.
Referred Pain: These trigger points can also refer pain to other areas, such as the lower back, groin, or down the leg, which can complicate the diagnosis and management of hip impingement.
Muscles Prone to Trigger Points:
Iliopsoas: Often referred to as the primary hip flexor, trigger points here can mimic hip impingement pain.
Tensor Fasciae Latae (TFL): This muscle, part of the IT band, can develop trigger points that exacerbate hip discomfort.
Gluteus Maximus and Medius: Trigger points in these muscles can refer pain to the hip joint area.
Quadratus Lumborum: Although not a hip muscle per se, trigger points in the QL can impact hip mechanics and contribute to pain.
The biomechanical impact of muscle tightness and trigger points is an important aspect to consider in the treatment of hip impingement. By addressing these muscular issues through targeted therapies like dry needling and acupuncture, we can reduce the mechanical stress on the hip joint, alleviate pain, and improve mobility. This approach is vital for a holistic treatment plan, especially for those seeking non-surgical management of hip impingement.
Hip pain has many causes, and it is essential to differentiate these from a range of other potential sources. These include conditions such as osteonecrosis (also known as avascular necrosis) of the femoral head, anomalies in hip development like hip dysplasia, inflammation of the iliopsoas tendon commonly referred to as iliopsoas tendinitis, bursitis affecting the greater trochanter, tendinopathy of the gluteal muscles, various types of arthritis, issues related to the iliotibial band such as iliotibial band syndrome, the occurrence of snapping hip syndrome, and nerve compression issues like lumbar radiculopathy. Identifying the precise cause is crucial for effective treatment planning and management.
Overall Benefits of Dry Needling in Hip Impingement
Dry needling offers a non-pharmacological option for managing pain and muscle dysfunction both before and after hip surgery. Its role in enhancing joint mobility, reducing muscle tension, and aiding in the overall rehabilitation process makes it a valuable component of comprehensive hip impingement treatment plans. By integrating dry needling with other conservative treatments and post-surgical rehabilitation protocols, patients with hip impingement can achieve better outcomes and improved quality of life.
Over to you
If you liked this article, please share with friends and family who may be suffering with hip impingement or hip pain.
Sources:
Travell, J. G., Simons, D. G. (1993). Myofascial pain and dysfunction: The trigger point manual. London: Lippincott Williams & Wilkins.
Biel, A., & Dorn, R. (2010). Trail guide to the body: A hands-on guide to locating muscles, bones and more. Boulder, CO: Books of Dicovery.
O'Rourke RJ, El Bitar Y. Femoroacetabular Impingement. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547699/
Fortier, L. M., Popovsky, D., Durci, M. M., Norwood, H., Sherman, W. F., & Kaye, A. D. (2022). An Updated Review of Femoroacetabular Impingement Syndrome. Orthopedic reviews, 14(3), 37513. https://doi.org/10.52965/001c.37513
Ceballos-Laita, L., Jiménez-Del-Barrio, S., Marín-Zurdo, J., Moreno-Calvo, A., Marín-Boné, J., Albarova-Corral, M. I., & Estébanez-de-Miguel, E. (2019). Effects of dry needling in hip muscles in patients with hip osteoarthritis: A randomized controlled trial. Musculoskeletal science & practice, 43, 76–82. https://doi.org/10.1016/j.msksp.2019.07.006
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