Decompression gets hip: It isn’t just for spines

Hip problems and their various decompression therapy options

TODAY’S LIFESTYLES CONSIST OF prolonged standing, sitting, walking and trips to the gym — all of which can increase pressure on the hip joints.  

The human body is an incredible moving machine requiring constant joint motion to maintain health and function at full capacity. Our everyday movements and even the occasional awkward or unusual position should be performed without pain, but over time, aging and wear and tear from repetitive use takes its toll. Other typical factors  affect the body, causing unwanted symptoms in the most heavily used joints and tissues. This leads to painful joints and limited motion that, if untreated, worsens.¹ 

Decompression for more relief options 

Most people think of chiropractors as “back doctors,” but if you have a decompression table that allows for the setup and treatment of extremities, you can offer relief for those with hip pain by decompressing or “tractioning” their hips.  

Hip decompression helps neutralize joint pressure and can decrease muscle tension, accelerate recovery and increase joint mobility while reducing pain via the activation of mechanoreceptors. I see results in my office quickly with this treatment due to applying treatment technique by first performing the proper provocative exams. This allows me to know with certainty that each patient is a great candidate for hip decompression treatment.  

The Agency for Healthcare Research and Quality has stated that more than 285,000 total hip replacements are performed each year in the United States, and as many as 60% of patients who undergo hip replacement surgery end up with deep vein clots that pose a serious risk of death or disability.² This is where providing hip decompression as a more conservative option with minimal risk is a great option for your hip pain patients. 

Hip decompression therapy can be used with patients suffering from arthritis, sciatic pain across the hip, overuse from running or work, bursitis-related inflammation, tendinitis, and hip strain from sports or a fall. 

How decompression impacts the hip

The hip joint is a ball-and-socket joint, much like the shoulder. The ball portion is made up of the femoral head, and the socket is formed by a cupped area of the pelvis called the acetabulum.   

Within the joint is the labrum, a ring of cartilage surrounding the acetabulum that provides a smooth surface and seals the lubricating fluid inside the joint for proper joint motion. The surrounding muscles, ligaments and tendons stabilize the joint, providing pain-free function.³ 

After a 10-minute decompression treatment to the hip, additional techniques, ranging from electrotherapy and manual adjustments to massage therapy and ultrasound, can be utilized to treat mild hip pain. When hip pain is moderate to severe and is more chronic, adding more recent modalities like pulse wave or shockwave can provide relief in a few treatments even when nothing else has helped.⁴ 

Treating the hip

In my practice, I usually begin a hip treatment with extremity and spinal manipulation, also known as a chiropractic adjustment. These adjustments can improve joint mobility by applying a controlled force to the hip joints that have become restricted.  

Even if the patient is in a great deal of pain, the hip joint can usually be adjusted with a painless drop table technique that uses gravity to help correct issues within the joint. This will open the joint up, improve motion and provide some pain relief. I will then put the patient on my decompression table to distract the hip joint with intermittent traction pulls and finish treatment using stretches and exercises designed to strengthen weak muscles and improve hip flexibility.  

The piriformis muscle is often overlooked as a contributor to a patient’s hip complaint. An early symptom suggesting piriformis involvement is pain in and around the outer hip bone. When tight, the piriformis muscle causes increased tension between its tendon attachments at the anterior of the sacrum and the trochanter. This can cause joint bursitis resulting in discomfort and pain.⁵ 

I utilize these three piriformis stretches in most of my hip pain cases and instruct the patient on doing them at home:⁶ 

1. The Cross-Legged Seat Stretch. Sit cross-legged on the floor for several minutes a day. Doing this for even a few minutes a day can slowly open the hips and stretch out the glutes and piriformis muscle.
2. The Piriformis Chair Stretch. This one is perfect for anyone who sits for long periods each day. Simply cross one leg over the other with their ankle resting on the knee of the opposite leg. Then they gently press down on the inside of the knee and slowly lean forward until they feel a mild stretch in the hips. 
3. The Lying Piriformis Stretch. This intense stretch can be performed while lying on their back on the floor. Have them cross the right leg over the left, with the right ankle resting on the left knee. Then they will slowly lift their left foot off the floor and toward them while applying gentle pressure to the inside of their right knee. Hold 20-30 seconds; repeat on the other side.

Expand your practice and pain relief

Hopefully, you have a table that will allow for unilateral or bilateral knee and hip decompression so you can begin offering this pain-relieving and many times life-changing option for your hip pain patients. If not, there are decompression tables on the market that quickly and comfortably distract your patient’s hip joints.  

Understanding and adding this therapeutic approach to your practice will expand your practice and the usefulness of your decompression table.

DAVID BOHN, DC, graduated from National University of Health Sciences (formerly National College of Chiropractic) in 1988 and has since been in continuous practice. Since 2004 he has pursued development of both documentation and X-ray analysis software. He has extensive experience with developing, marketing and maintaining a successful practice, and is an instructor for KDT Decompression Therapy Seminars. For more information, go to kdttechnique.com/upcoming-seminars. 

REFERENCES  

1.     J Anaesthesiol Clin Pharmacol. Chronic hip pain in adults: Current knowledge and future prospective. 2020 Oct-Dec; 36(4): 450–457. Published online 2020 Sep 26. doi: 10.4103/joacp.JOACP_170_19
2.     April 2018. Agency for Healthcare Research and Quality, Rockville, MD.
3.     Ramage JL, Varacallo M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 29, 2022. Anatomy, Bony Pelvis and Lower Limb, Medial Thigh Muscles. 
4.     Extracorporeal shockwave therapy shows regeneration in hip necrosis  C.-J. Wang, F.-S. Wang, J.-Y. Ko, H.-Y. Huang, C.-J. Chen, Y.-C. Sun, Y.-J. Yang. Rheumatology, Volume 47, Issue 4, April 2008, Pages 542–546
5.     The Bone & Joint Journal Vol. 102-B, No. 5 Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain. Jung Wee Park, Young-Kyun Lee, Yun Jong Lee, Seunghwan Shin, Yusuhn Kan, Kyung-Hoi Koo. Apr 30 2020
6.     Piriformis Syndrome, Roy, Brad A. Ph.D., FACSM, FACHE. ACSM’s Health & Fitness Journal 18(4):p 3-4, July/August 2014.