Day 3 already! Time to move on to some management tips for hip pain. So far we've talked about the patient interview and the physical assessment on Day 1 and Day 2 of my 12 days of Hip Tips. Both the previous blogs also offered a free clinical resource, so you might like to visit those pages if you haven't already.
Tip #3 Take the time to explain the what, why and how of hip pain and its management
So, you’ve taken that extra time to provide a thorough patient interview and performed a full test battery to improve the likelihood of an accurate diagnosis – well done! You’ve moved into the management side of the session. What’s your first priority? While the answer is going to be different depending on the patient and their presentation, the foundation of a shared-decision-making-model is that the patient understands the situation, the choices and the advice provided. Developing this understanding usually involves answering 3 key questions – What? Why? and How?
What’s wrong? What’s causing my hip pain?
For most of my patients, the number 1 question they would like answered is ‘What’s wrong?’, “What’s causing my hip pain?’ I doubt this is an Australian phenomenon! How you answer that of course depends on the patient presentation. If they are presenting with widespread, persistent pain without clear mechanical origins or behaviour, it may be appropriate to launch straight into some pain education. However, if your patient is describing more localised hip pain with mechanical behaviour, reproducible on mechanical loading in your physical assessment, the chances are high that you have some local source/s of nociception. Now sometimes the structural source is clear, but if the pain is related to prolonged overload of a region, there may be more than one or even multiple sources of nociception. It is not necessary to hang your hat on a single structure, but simply explain the likely possibilities and get onto the next important answer…
Why do I have this hip pain?
Having discussed the possible what’s, now the patient wants to know ‘why?’ Again, there might be quick easy answers around the particular mechanism of an acute event, or more involved answers around multiple contributing factors of gradually developing conditions. While it’s important to acknowledge non-modifiable factors such as age, gender, genetic factors and previous injury, the focus of this part of the discussion should be on factors we can hopefully change to produce a positive impact. The patient with gluteal tendinopathy needs to know why hip flexion/adduction stretches are not advisable for them and those with FAI need to know why their range is restricted and why forcing this range is not such a great idea. The answer to the ‘why’ is essential for patient engagement and compliance with a suggested management plan.
How can you help me with my hip pain? How can I help myself?
Having explained what and why, many patients start having light bulb moments, divulging extra information about other possible contributing factors in their life and even volunteering suggestions for how this might be solved. It’s a beautiful thing when explaining something can lead to shared development of a management plan!
Most will need guidance but the advice is much more likely to be followed if the patient first understands the why. Otherwise, we might have a situation something like this:
Physio: “You have gluteal tendinopathy, stop stretching your ‘ITB’ “
Patient: “But my ‘…fill in the gap…’ told me I need to do it 3 times a day and I feel tight. I’m sure it’s helping.”
Physio: “No’ it’s not going to help, stop doing that.”
Patient: Nods agreement but thinks to themselves: Hmm, my ‘… fill in the gap…’ explained how the problem is all about ITB tightness. I’m not sure if this physio understands that. I’ll keep doing the stretching, just in case it's helping.
This may be one of the main reasons the load management advice provided is not having adequate effect – the patient doesn’t understand, and therefore
- doesn’t follow the advice or
- follows the basic advice but does not understand the underlying principles enough to recognize similar situations in other tasks/parts of their lives.
Never underestimate the importance of taking the time to explain.
If you find you're struggling to identify and understand the 'why' in patients presenting with hip pain, you will gain same invaluable insights in my Anterior Hip & Groin Pain and Lateral Hip and Buttock Pain courses. In these courses, we discuss in depth the pathoaetiological mechanisms for hip conditions and how these impact on our management plan. Or if you want access to all hip resources, you might like to consider joining Hip Academy.
Click on the box above to read Day 2 miniblog
Click on the box above to read Day 4 miniblog