The hip joint is a complex ball-and-socket joint that supports the weight of the body and is responsible for the movement of the upper leg. It consists of two main parts including a ball (femoral head) at the top of the thighbone (femur) that fits into a rounded socket, sometimes referred to as the cup, in the pelvis. Bands of tissue, called ligaments, hold the joint together and provide stability. The structure of the hip joint enables the large range of motion needed for daily activities like walking, squatting, and climbing stairs.
A hip fracture occurs when the upper part of the thighbone breaks. The injury usually results from a fall or car accident. Hip fractures are more common in older people because bones weaken and become more brittle with age. Most hip fractures cause severe pain and require surgery immediately. Some patients need a total hip replacement after a hip fracture. Physiotherapy can improve the outlook for people with this type of injury.
In addition, hip fractures can occur in several areas of the upper femur. The most common types of hip fractures include:
- Femoral neck fracture – The neck is the area of bone just below the femoral head (ball).
- Intracapsular fracture – This fracture affects the ball and socket portions of your hip. It can also cause tearing of the blood vessels that feed into the ball.
- Intertrochanteric fracture – The intertrochanteric area is the part of the femur that lies between the femoral neck and the long, straight part of the femur.
Causes & Symptoms
Most hip fractures result from an accident, such as a fall or car crash. Athletes, especially long-distance runners, can also fracture a hip due to repeated use (which is also known as a stress fracture). In older patients, hip fractures can result from a minor fall or from twisting or pivoting suddenly.
Other symptoms linked to a hip fracture include:
- Pain – Normally, hip pain is severe and sharp. However, it can also be mild or achy. Most people feel pain in the thigh, outer hip, pelvis, and groin area. Pain may radiate down your buttock to your leg. You may also feel pain in your knee.
- Limited mobility – Most people with a hip fracture cannot stand nor walk. Sometimes, it may be possible to walk, but it is extremely painful to add weight to the leg.
- Sudden physical changes – You may have a bruise on your hip. One of your legs can appear shorter than the other and the hip might look like it is out of position, twisted, or rotated.
Who Gets a Hip Fracture?
Fractures of the hip are common the world over, across many different types of people – risk factors for a hip fracture include the following:
- Age – Hip fractures are more common in people over the age of 65. With age, bones break down, weaken, and become much more brittle. Older patients are more likely to experience problems with movement and balance, which can then lead to a fall.
- Gender – 75% of hip fractures occur in older women; women tend to lose bone mass after the menopause and weak bones are more likely to break.
- Medications – Some medications increase the risk of falls. Drugs that cause drowsiness or a drop in blood pressure can cause you to lose your balance.
- Lifestyle – People who live a sedentary lifestyle are more likely to fracture a hip. Drinking too much alcohol can also weaken bones and increase your fracture risk.
- Osteoporosis – This disease causes bones to become weak, increasing the risk of a fracture. Women are four times more prone to have osteoporosis rather than men.
- Overall health – People who do not get enough vitamin D, calcium, and other nutrients, have a higher fracture risk. Some health conditions, such as dementia and Parkinson’s disease, increase the risk of a fall.
- Nutritional problems – Lack of calcium and vitamin D in your diet when you’re young lowers your peak bone mass and increases your risk of fracture later in life. Being underweight also increases the risk of bone loss.
- Physical inactivity – Lack of regular weight-bearing exercise, such as walking, can result in weakened bones and muscles, making falls and fractures more likely.
- Nicotine and alcohol use – Both can interfere with the normal processes of bone-building and maintenance, resulting in bone loss.
How Does It Affect You? How Serious Is It?
A hip fracture can help reduce your independence and sometimes shorten your life. About half the people who have hip fractures are not able to regain the ability to live independently. If a hip fracture keeps you immobilized for a long period of time, the complications can include:
- Blood clots
- Further loss of muscle mass, increasing the risk of falls and injuries
Recommended Treatment & Rehabilitation
A healthcare provider will begin by examining the area and ask about any recent accidents or falls. To check for nerve damage, your provider may touch your foot or leg and ask if you feel any sensation.
To diagnose a hip fracture and check for damage to soft tissues, your doctor will likely order imaging studies. These include:
- MRI – This is an imaging test that uses a high-powered magnet to create images of bones and soft tissues.
- X-ray – Which is used to radiate and produce images of your bones.
- CT scan – A test that uses a computer and many X-rays to allow the provider to see detailed images of the affected area.
After a diagnosis, a physiotherapist will design a specific treatment program to help restore function and help you return to activities of daily living. Physiotherapists support your recovery by helping you reduce pain, improve movement in your leg, hip, and back, strengthen your muscles, and improve your standing balance and ability to walk. He / she will also help you return to the level of activity that you enjoyed before the break. This may include a return to sports like tennis, golf, or bike riding for people who were living a physically active lifestyle.
As mentioned earlier, a treatment program will be designed by your physiotherapist and will include specific treatments based on your unique condition and goals which will help you return to your regular activities. These treatment programs include:
- Manual therapy – Your physiotherapist will provide manual therapy to gently help you start to regain motion. They may perform gentle exercises that you cannot perform yourself during the midst of a hip fracture.
- Strengthening exercises – Your physiotherapist will design an exercise program to help you regain movement and strength. You will learn and perform your exercises during your physiotherapy sessions and continue to perform them at home.
The goal of these upcoming exercise examples is to strengthen the hip muscles to better support the hip joint, which can help relieve pain. Here are some exercises for you to try, including:
Lie on the back, extending both legs flat along the floor. Keeping the left leg straight, pull the right knee up towards the chest. Afterwards, place both hands on top of the knee to help pull it in toward the chest. Finally, hold this stretch for 10 seconds, then let go of the knee and gently lower the leg back toward the floor. It is recommended to repeat this exercise 5-10 times on each knee.
External hip rotation
Firstly, sit on the floor with both legs out in front. Secondly, bend the legs at the knees and press the soles of the feet together. Place a hand on top of each knee and gently push them both down onto the floor. Apply pressure to the knees until there is a stretch, but do not push them further than is comfortable. Lastly, hold the stretch for 10 seconds and then relax before repeating the stretch 5-10 times a day.
Stand upright, then extend one arm out to the side and hold on to a sturdy surface, such as a wall or a table for an added support. Slowly raise the right knee to the level of the hip or as far as is comfortable while keeping the left leg straight. Hold this position for a second before placing the left foot back on the floor. Repeat the same procedure with the left knee before repeating 5-10 times a day.
Stand upright with the legs straight and the feet shoulder-width apart. Extend both arms out in front and hold on to a chair or table for support. Whilst keeping the right leg straight, lift the left leg backwards without bending the knee. Lift the leg as far as possible without causing discomfort, then clench the buttock tightly and hold the position for 5 seconds. Finally, repeat this stretch 5-10 times on each leg.
Double hip rotation
Lie flat on your back, then, bend the knees and bring them towards the body until the feet are flat on the floor. Gently rotate the knees to the left, lowering them towards the floor. Rotate the head to face the right whilst keeping the shoulders against the floor. Hold this position for 20-30 seconds. Finally, slowly return both the head and knees to the starting position, then repeat on the opposite side.
Surgery – is usually the best treatment for a broken hip. Three types of surgery can be used, such as the following:
Hip repair – This surgery involves stabilizing broken bones with surgical screws, nails, rods, or plates. This type of surgery is normally for patients who have fractures in which the bones can be properly aligned.
Partial hip replacement surgery – This type of surgery replaces the top of the thigh bone with artificial parts made of ceramic or metal. However, it does not replace the hip socket.
Total hip replacement surgery – This surgery replaces all parts of the joint with artificial parts made of metal, ceramic, or plastic.
Alternative & Homeopathic Treatment
One of the most effective methods of treating hip fractures (or hip pain in general) at home is the RICE method. RICE is a method which anybody can use stands for:
To begin this method, you have to rest. This means you must stop engaging in any activity that causes further pain. This includes a break from performing activities that involve constant walking or running. Secondly, you will apply an ice pack to the affected area where you can feel pain. The ice will help reduce inflammation and will lessen the pain. If you are experiencing severe pain at the hip, then you should ice the area up to five times a day, for 10-15 minutes each time. Make sure to wrap a towel around your ice pack because direct contact with your skin could cause irritation. Additionally, a heat pack can be applied to boost circulation from within the area that is affected. Afterwards, you need to compress the area as well, by applying an elastic bandage around your pelvis and hip. Compression helps reduce swelling, but you must be careful not to wrap the area too tightly as it can cause an additional swelling below your hip. Finally, you need to elevate the affected area as it helps to reduce swelling and relieve pain. Additionally, a cushion or pillow underneath the damaged area can help boost the recovery of the pain.