Textbook chapter: Hip Physical Examination. – Benjamin G. Domb Adam Brooks Carlos Guanche
As our understanding and treatment of hip pathology improves, a systematic, consistent, and reproducible means of clinically evaluating the hip is imperative. While a limp, groin pain, and limited internal rotation are often indicators of hip pathology 1 ,the hip is overlooked as the original source of pain or pathology in 60% of primary hip disorders 2 .Hip pain can be ambiguous in its nature and origin, and pathologies of the hip and low back interact with one another and are easily confused. Hip problems can stem from disorders of the paravertebral muscles, which cause soft tissue instability and irregular tension on the hip 3 .Hip pain can also cause back pain by way of muscle con- tractures of the iliopsoas and the hamstrings or through sec- ondary leg length discrepancy 1 .A systematic and reproducible physical examination of the hip is therefore a necessity for cor- rect diagnosis as well as longitudinal follow-up.
The hip is a focal point of initiation for running and walking and can bear forces equal to over fi ve times body weight during running or jumping 4 .Because the hip is almost universally sub- jected to high loads and extremes of motion during sport, hip pain is a common complaint in athletes. In one study, pathol- ogy of the hip accounted for 2.5% of adult athletic injuries and 5% to 9% of high school athletic injuries 5 .Hip pain is especially frequent in sports such as soccer, ballet, hockey, martial arts, rugby, and running 5 .A recent study of injuries in the National Basketball Association over 17 years found a total of 1,340 hip- related injuries causing 4,753 games missed 6 .