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Hip Microinstability

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Physiotherapy being done for hip microinstability
Hip instability is present when there is a laxity or looseness causing unstable movement in the hip. Hip microinstability is a fairly new diagnosis and can be a cause of pain and disability in people, not only athletes who put a lot of stress on this joint.

Hip microinstability can be related to one or more of the following things¹ ²:

  • Laxity (looseness) of the capsule or ligaments around the hip joint;
  • Cartilage changes;
  • Muscular weakness of the hip and pelvic girdle;
  • Bone abnormalities or changes;
  • Repetitive joint loading, especially into extreme ranges.

 

Diagram of ligaments related to Hip microinstability
Diagram single hip ligaments relevant for hip microinstability

The main symptoms of hip microinstability

The main symptoms of this condition include the following, but patients do not necessarily experience all of the symptoms:

  1. Pain in the groin, front of the hip, thigh or buttocks³;
  2. A feeling of instability³; and
  3. Clicking or locking in the hip joint⁴.

Diagnosis of is based on many factors and multiple factors need to be present for the diagnosis to be made. There is no single test that can confirm the diagnosis.

How can physiotherapy help?

Physiotherapy is the proposed treatment to manage this condition and, in most cases, can resolve the symptoms. The most important part of physiotherapy is to strengthen specific muscles around the hip and in the trunk (core strength). If needed, physiotherapy can be combined with anti-inflammatory medication⁵.

Your physiotherapist may also suggest that you avoid activities or positions that involve deep hip flexion, e.g. sitting in a low chair, low squats and exercises that require pulling your knee to your chest and movements where your hip moves backwards while rotating to the outside⁷. In certain cases, depending on what is actually causing the problem, and if six months of conservative management has not helped⁶, surgery may be indicated.

If you have been experiencing any sort of instability in the hip area, contact one of our physiotherapists who will gladly assist with an assessment to diagnose and treat your condition.

References
  1. Hoppe DJ, Truntzer JN, Shapiro LM, Abrams GD, Safran MR. Diagnostic accuracy of 3 physical examination tests in the assessment of hip microinstability. Orthopaedic Journal of Sports Medicine. 2017 Nov 23;5(11):2325967117740121.
  2. Dangin A, Tardy N, Wettstein M, May O, Bonin N. Microinstability of the hip: a review. Orthopaedics & Traumatology: Surgery & Research. 2016 Dec 1;102(8):S301-9.
  3. Matthewson G, Williams A, Macciacchera M, Shahabinezhad A, Duong A, Ayeni OR. Effective Management Options for Treatment of Microinstability of the Hip: a Scoping Review. Current Reviews in Musculoskeletal Medicine. 2023 Jan;16(1):9-18.
  4. ISHA 2023 Cape Town presentation by Dr Almeida: Current concepts on hip microinstability.
  5. Khanduja V, Darby N, O’Donnell J, Bonin N, Safran MR. Diagnosing Hip Microinstability: an international consensus study using the Delphi methodology. Knee Surgery, Sports Traumatology, Arthroscopy. 2023 Jan;31(1):40-9.
  6. Matthewson G, Williams A, Macciacchera M, Shahabinezhad A, Duong A, Ayeni OR. Effective Management Options for Treatment of Microinstability of the Hip: a Scoping Review. Current Reviews in Musculoskeletal Medicine. 2023 Jan;16(1):9-18.
  7. Ejnisman L, Elisman K, Safran MR. Effectiveness of nonoperative management of hip microinstability. The American Journal of Sports Medicine. 2022 Mar;50(4):1013-9.