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The hip area is the conduit between the upper and lower extremity and therefore receives messages from multiple body parts and systems. The hip joint is also connected to the pelvis and can contribute to female gynecological conditions such as sexual pain, deep vaginal pain, pain with walking/sitting and pain with prolonged standing. The hip area is highly responsive to what is happening in the lumbar pelvic region and it can respond by creating more pain and contributing to pelvic pain in general.
The hip joint itself houses 14-plus muscles. Pain results when the hip muscles “guard.” Muscle guarding is a protective response to pain when there is an abnormal stimuli in the muscles, joints or ligaments. Muscle guarding leads to muscle spasms, myofascial restrictions and/or trigger points. Many of the hip muscles are influenced by the bones and their alignment, so hip and pelvic pain can result from hip malalignment, joint hypomobility or joint hypermobility. Hip pain also contributes to the pelvic pain puzzle and if you want to resolve your pelvic pain you must address the hip region and its associated muscles. The hip region also responds to what is going on in the pelvic floor muscles often contributing to sexual pain. One of the hip muscles that is a big contributor to pelvic pain is the obturator internus. The obturator internus, a hip external rotator, can be accessed both intra-vaginally and externally on the hip bone itself. You will learn how to reduce pain in the obturator internus using the Hip Ball Clock Trigger Point Release that I have shared with you in this blog.
Regardless of the causes of hip and pelvic pain, this area must be normalized and treated. The hip area responds well to self-care techniques that involve a ball. I use a small ball to massage the hip, to release myofascial hip tension and to get rid of hip trigger points. My patients swear by their tennis, handballs and other types of therapeutic balls for pain relief in the hip area. Hip pain can be difficult to self-treat, but I have made it easy with my Hip Pain Releasing (HPR) Ball exercises that I am sharing with you in this blog.
The posterior aspect of the hip bone houses up to 14 muscles—meaning several major muscles including the piriformis and obturator internus insert into this bone. This bone is called the greater trochanter. When these hip muscles are tight, have spasms or trigger points in them, the pain can be excruciating. I made this short video that explains the location of the greater trochanter “house” so you can get the visual about where to use the ball to find and eliminate these trigger points.
WHAT TO DO:
1.Imagine that the greater trochanter is a clock and the top of the bone is 12 o’clock and the bottom of the bone is 6 o’clock. Your focus is on the 6, 7, 8, 9, 10, 11, 12 positions.
2.Place the ball on the tender clock position and ask yourself: “What is my pain level on a scale of 0 to 10 (0 is no pain, 10 is the worst pain imaginable)?” Press into the pain but do not elicit a pain higher than level 5.
3.With this exercise you will target all the hip muscles that insert into the hip bone (greater trochanter) including the obturator internus.
4.Stay on that spot for 60-90 seconds, or until your pain reduces by at least 50 percent. Repeat several times until tender spots are relieved. Do this once a day for pain relief.
WHAT TO WATCH OUT FOR:
1. Avoid pressing too hard into the muscle, which can cause it to spasm more. Try to keep your pain level less than 5 on the 0 to 10 pain scale.
2. Avoid sitting on the tennis ball on the inside of your sit bones close to the anus. This spot can be very sensitive and a tennis ball should not be used to release this muscle.
3. If you feel numbness or nerve pain you are on an artery or nerve and you should immediately get off that point and move the ball to another area that has a trigger point.
Trigger points are knot-like spots – the most well-known example being the ones we sometimes get in our necks and trapezius muscle that create a burning and stabbing pain. Trigger points in the hip and gluteal region are quite similar to these. On a more anatomical and physiological level, trigger points are taut muscular bands that are the result of an injury to the motor end plate of the muscle cells. Trigger points in the hip muscles can be activated by stress, pelvic and hip malalignment, chronic pelvic floor muscle holding, hormonal imbalances, prolonged sitting or pressure on the pelvic muscles. Trigger points in the hip are common and can refer pain to the pelvic and vaginal area.
WHAT TO DO:
1. This exercise may be done standing next to a wall or supine.
2. If standing, place the tennis ball between the wall and your gluteal muscles. If you are lying down, you will place the tennis ball underneath your gluteal muscles and sit on top of the ball.
3. Roll the ball around the gluteal muscles until you find a tender spot. The muscles you are targeting here include the piriformis muscle, gluteus maximus, gluteus and medius muscles.
4. Stop on the tender spot and ask yourself: “What is my pain level on a scale of 0 to 10 (0 is no pain, 10 is the worst pain imaginable)?” Press into the pain but do not elicit a pain higher than level 5.
5. Stay on that spot for 60-90 seconds, or until your pain reduces by at least 50 percent. Repeat several times until tender spots are relieved. Do this 1-3 times a day for pain relief. This type of pressure to a tender spot is called trigger point therapy.
WHAT TO WATCH OUT FOR:
1. Avoid pressing too hard into the muscle, which can cause it to spasm more. Try to keep your pain level below 5 on the 0 to 10 pain scale.
2. Avoid sitting on the tennis ball on the inside of your sit bones close to the anus. This spot can be very sensitive and a tennis ball should not be used to release this muscle.
3. Ensure you are holding each tender spot long enough for your pain to reduce by 50 percent. The trigger point you are targeting will not be shut down if you fail to do this. If you encounter a stubborn spot, you may need to do this trigger point release multiple times before it lets go.
4. If you feel numbness or nerve pain, you are on an artery or nerve and you should immediately get off that point and move the ball to another area that has a trigger point.
BENEFITS:
1. Reduces muscle spasm in the gluteal muscles, which can help decompress the sciatic nerve as it travels through the posterior gluteal region.
2. Helps facilitate and maintain proper sacroiliac joint alignment by reducing muscle tension, improving flexibility, and allowing pelvic bones to sustain alignment corrections longer.
3. Improves blood flow to the hip and pelvic muscles enhancing vitality and sexual function.
4. Reduces pain by decreasing trigger points that originate from tight posterior gluteal muscles.
WHAT TO DO:
1. For general hip pain relief I recommend that you place a small ball on the painful hip area and that you roll it back and forth until the pain starts to dissipate. At first the pain can be excruciating but the longer you do it the better you will feel.
WHAT TO WATCH OUT FOR:
1. Avoid pressing too hard into the muscle, which can cause it to spasm more. Try to keep your pain level less than 5 on the 0 to 10 pain scale.
2. Avoid sitting on the tennis ball on the inside of your sit bones close to the anus. This spot can be very sensitive and a tennis ball should not be used to release this muscle.
3. If you feel numbness or nerve pain, you are on an artery or nerve and you should immediately get off that point and move the ball to another area that has a trigger point.
Conclusion
It is very important to address hip painbecasue it is a big driver for pelvic pain. Take the time to get to know this area of your body and you will be amazed at how you can decrease pain not only in your hips, but also in the other area where these type of trigger points can refer pain.
Medical Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Check with your Doctor before attempting any of the recommendations on this website. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEB SITE. Renew Physical Therapy IS NOT RESPONSIBLE NOR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR PRODUCTS THAT YOU OBTAIN THROUGH THIS WEB SITE. If you are in acute pain and would like to have a physical therapy program developed for you for your condition please give us a call at 212-213-4660.
Isa Herrera, MSPT, CSCS is a New York City-based holistic women's pelvic floor specialist, author of 5 books on pelvic health, including the international best seller Female Pelvic Alchemy, and the ground-breaking self-help book, Ending Female Pain, A Woman's Manual. She has dedicated her career to advancing awareness of pelvic floor conditions so that more people can find relief from this silent epidemic that affects over 30 million people in the US alone. Ms. Herrera holds a BA in Psychology and Biology from Fordham University and also a Masters in Physical Therapy from Hunter College.
