Hip pain can be a result of several things including arthritis, injury from overdoing various activities, or problems in the muscles in the legs, gluteal muscles, abdomen and low back. While massage will not eliminate pain from arthritis directly, it can often reduce it by releasing tight muscles affecting the area, eliminating them as a source of pain. The gluteal muscles are the largest in the body, and hamstring and quadriceps (front and back of thigh) are also large muscle groups. Trigger points or spasms in these muscles, therefore, can cause significant pain in the muscles themselves as well as referred pain in the hips and low back.
When pain is a result from spasms or trigger points in the muscles affecting the hips, massage has been proven to offer significant relief, even allowing distorted gait and movement patterns to return to normal. Massage can reduce tightness and tension, and increase circulation which reduces trigger points and allows for improved muscle recovery after exertion. It also reduces scar tissue from tears and injuries, allowing for normal, smooth movement of muscle fibers. Read more about “Six Massage Techniques to Remove Scar Tissue.”
Muscles in the legs can often cause hip pain because they can impact the way we move, walk and even sit. For example, flat feet (especially common in women) can result in the foot over-pronating (rolling in). This force is then transferred to the knee, and finally the hip, as the muscles attached at each joint are either pulled or shortened depending on the angle and location of attachments.
Massage can help release overtight muscles that result from this problem, especially the gastrocnemius muscles. With the client prone, use the heels of your hands to grab the muscle and compress, lifting it up from the bone. The compression provides a flushing of the muscle tissue while the stretch lengthens fibers.
Tight Hamstrings and Quadriceps
Another common hip problem that originates in the leg is the result of overly tight hamstrings or quadriceps. If the hamstrings are overly tight, they pull the pelvic bone down from the attachment on the ischial tuberosity (sit bones). When the quadriceps are overly tight, they pull the pelvic bones forward and down, anteriorly tilting the hips.
As large muscle groups, both the hamstrings and the quadriceps respond wonderfully to massage therapy. Both the hamstrings and quadriceps may benefit from slow, deep gliding strokes to lengthen muscle fibers and release restrictions. Friction, especially a few inches inferior of the ischial tuberosity attachment of the hamstrings (a common location for muscle tearing), is great for freeing up tight, restricted muscles. Read “How Bodyworkers Can Identify a Pulled Hamstring.”
As mentioned, the gluteal muscles are the largest in the body, so when they are tight, in spasm or contain active trigger points, they can cause a tremendous amount of pain! Find out if “Your Client’s Low Back Pain Is Caused By Weak Glutes.” Tears and injuries also create significant pain in these muscles, and in the hip. Elbow work is an excellent way to release these large muscles. By controlling the angle of pressure and the degree of flexion of the elbow, you can control how much pressure you apply, as well as how fine a ‘point’ you are applying pressure with. The elbow can be used to apply static pressure or to friction deep muscle fibers, freeing up the hips.
Lesser known are the six deep lateral rotators, which run from the sacrum to the upper femur. These muscles, including piriformis, rotate the leg laterally (toes out). The sciatic nerve runs between them (at the piriformis), so when they are tight or there is inflammation, there can be significant impact on the sciatic nerve, causing various levels of sciatic pain in the hip and down the leg. Using your elbows is a great way to apply pressure and release tightness in the rotators, especially piriformis. A great way to enhance this is to use a pin and stretch technique; with the client prone, pin the hip just medial of the greater trochanter and bend the knee so the leg is at 90 degrees. Then with the hip pinned, move foot medially and ‘pin’ with your elbow the piriformis. Then, move foot laterally, applying a stretch of the piriformis against the pressure of your elbow. This gives the rotators a great stretch. For more information, read “False Sciatica: Detecting and Easing Piriformis Syndrome.”
The abdominal muscles can impact the hips by pulling the hips forward and up when they are tightened and shortened. If they are unbalanced or uneven in strength due to postural habits, they can pull the hips off balance as well. Stripping, friction and trigger point work will release the abdominal muscles, but ‘pulling’ the muscle works well, too. It is important to move slowly as abdominal muscles are sensitive when tight.
Located in the abdomen, the hip flexors are what enable you to lift your legs. Spending a lot of time seated with hips flexed can result in shortened hip flexors, which may result in hip pain. Massage therapy techniques to stretch and lengthen these muscles may reduce the problem, and regular stretching may help eliminate hip flexor pain altogether. For a great stretch of the hip flexors, begin with the client prone and pin the hip to support the low back. Then bend the knee to 90 degrees and lift the leg by grabbing the knee, extending the hip. Be sure to support the low back while doing this stretch.
Another muscle in the abdomen is the psoas, or iliopsoas. This muscle runs from the transverse processes of the lumbar vertebrae and inserts deep in the groin on the lesser trochanter of the femur. This is one of the deepest muscles in the body and stabilizes, joining upper and lower body and flexes the hip. While it is possible to access part of the psoas on the medial side of the pelvic muscles, this is an extremely sensitive area. Any work on the psoas must be done slowly and with steady pressure, giving the client time to react and respond. The psoas is a muscle that ‘holds’ a lot of our fears in life, and clients may become very agitated if we work on it too aggressively. Learn more about “The Mind/Body Connection.”
Improper lifting or posture can result in uneven development or tightening of the postural muscles of the back. The deep erector muscles which run between ribs and vertebrae account for our ability to move and remain upright. Large muscles over them such as trapezius and latissimus dorsi allow us to move, lift and pull ourselves up. When they are unbalanced or uneven in strength, they begin to affect our posture and movement. They also begin to pull on the pelvic bones and this tension often results in pain in the hip.
Swedish and deep tissue massage techniques can reduce muscle tension, balancing the muscles of the back releasing the hips to return to balance. By using a combination of effleurage, friction and compression we can release the back – a major objective in almost every massage.
Massage therapy can have enormous impact on many postural and muscle imbalances due to uneven workload, habit or injuries. A comprehensive plan of massage therapy, stretching and appropriate strengthening can go a long way to eliminating hip pain.