Hip fractures is a dreaded topic of conversation, because the thought of breaking a bone in your hip is a painful one. Usually, it happens when you fall onto your hip or with a traumatic type of injury like a car accident. You will experience severe pain in your hip that shoots through the roof when you try to step on your leg. Walking will be impossible to do, so much so that your leg simply buckles beneath you. A broken hip will leave you completely disabled and even if you get the necessary surgery to fixate your hip, it won’t be a quick fix. Getting the right treatment when you’ve had a hip fracture is so important. It influences your whole recovery process.

Maybe you had a hip fracture years ago, but never recovered completely. Or maybe you recently injured your hip and you are not sure if you’ve fractured it. The hip joint is supposed to be a very mobile joint, but now you walk with a painful and uncomfortable limp and your hip has become stiff. A painful hip will hold you back and prevent you to do the most basic things like walking, climb stairs or even exercise.

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The structure of your hip

The hip is the joint between the upper end of your thigh-bone (femur) and your hip-bone (pelvis). It is a ball and socket joint, the same as your shoulder. The top part of your femur (called head of the femur) forms the ball and this fits into the socket (acetabulum) in your pelvis.

Let’s look at the structure of the femur and the pelvis separately.

The femur (thigh-bone)

The femur is the largest and longest bone in your body. It stretches all the way from your hip down to your knee, giving structure to your upper leg (thigh). If you use the term ‘hip fracture’, it refers to a fracture of the top part of your femur, also called the head and neck of the femur. The top end of the femur can be divided into four major parts namely: the femoral head, the femoral neck, the greater trochanter and the lesser trochanter.

  • Head of the femur: This is the round top end of the femur that fits into the acetabulum of your pelvis. It is covered with a thick layer of cartilage.
  • Neck of the femur: This connects the head of the femur to the main shaft of the bone (the same way your neck connects your head to your body). From the main shaft of the bone, the femur neck angles inward toward the pelvis. This unfortunately forms a weak spot in the bone that is most prone to fracture with impact.
  • Greater and lesser trochanter: These are bony protrusions just below the neck of the femur that provides a point of attachment for muscles of the hip. If you press on the side of your hip, you can usually feel the bony point of your greater trochanter sticking out.

The pelvis (hip-bone)

Your pelvis forms the other half of your hip joint. It forms a round cavity or socket called the acetabulum, into which the head of the femur fits. The acetabulum is not big enough to cover the whole round head of the femur. However, this is where the acetabuler labrum does its job. The layer of cartilage that covers the acetabulum extends into a ring-shaped lip called the labrum. It forms a seal that helps to keep the femur inside the socket.

Putting the femur and pelvis together to form the hip joint

The femur and pelvis is connected by a layer of tissue called the capsule. It keeps the two bones together, and it keeps fluid and nutrients safely inside the joint. The hip joint is structured in such a way that there is several millimeters of space between the femur and the acetabulum and this prevents any friction or compression of the bones. The loose fibrous capsule of the hip joint permits the hip joint to have the second largest range of movement (second only to the shoulder) and yet it is strong enough to keep the joint stable enough to support the weight of the upper body.

There are several important arteries, veins and nerves either inside the hip joint or travelling alongside it to lower parts of the leg. This is important to take note of, because with a hip fracture these arteries, veins and nerves can be damaged leading to serious complications.

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Stability and mobility

The hip joint has fantastic mobility, enough to allow gymnasts and ballerinas to split in any direction. So, how can it still be strong enough to support you when you put lot of impact and load through it when you jump or run or walk? Actually, the hip joint is very sturdy and strong due to very strong ligaments and muscles providing extra stability.

Ligaments reinforce your hip joint by preventing excessive range of movement. They provide static stability. Muscles, on the other hand, provide dynamic stability. The muscles around your hip gives you the ability to lift your leg in any direction, whilst providing stability to the joint.

Hip muscles

Muscles around your hip can be divided into groups according to the movement that they do. Some muscles are ‘moving muscles’ and others are ‘stabilising muscles’. ‘Moving muscles’ (mobilisers) are big strong muscles responsible for moving your hip. ‘Stabilising muscles’ (stabilisers) are located in the deep layers, close to the hip joint. They contract constantly, even before you start moving, to keep your hip joint stable.

  • Extensors muscles are located at the back of your thigh and buttock. They are called: gluteus maximus and hamstrings.
  • Flexors muscles are located at the front of your hip and groin. They are called: iliopsoas and quadriceps.
  • Abductor muscles are located at the side of your hip and towards your buttock. They are called: gluteus medius, gluteus minimus and tensor fascia lata.
  • Adductor muscles are located around your inner thigh and groin. They are called adductor magnus, adductor brevis and pectineus.
  • Internal rotator muscles are located at the back of your hip and buttock. They are called: gluteus medius and gluteus minmus.
  • External rotator muscles are located at the back of your hip and buttock. They are called: gluteus maximus, piriformis, obturator internus, obturator externus, gemellus inferior and gemellus superior.

What is the function of your hip joint?

Your hip joint is the place where your leg connects onto your body. From your hip, you can do movements like lifting your leg up to climb up a step or lifting your leg sideways to climb in and out of the car. It also provides a stable base for your leg to be able to carry the weight of your body when you walk, stand or run.

Extreme opposites

On one hand the hip joint is mobile enough to allow gymnasts and acrobats to split and cartwheel. It gives a ballerina the ability to balance on one leg whilst turning around and around. But on the other hand it is stable and strong enough to withstand impact, pressure and load when this same gymnast runs and jumps with great speed.

The secret is in the stability of the hip joint. It is able to stabilise your leg where it connects to your body whether you are in a static position (like standing) or whether you are moving or even doing the splits. So, if this stable foundation gets weak or wobbly, it becomes unreliable and you become scared of doing the most simple tasks. When you climb up a step you wonder if your leg will be able to handle the weight. When you squat down to play with your kids you wonder if your leg will buckle beneath you.

Unfortunately, the trauma of a hip fracture changes your hip’s stability and mobility. This should be enough reason for you to get your hip checked out and get the right treatment after a hip fracture.

Muscle movement and stability

Muscles in your hip allow you to lift and bend your hip in practically any direction and even though the different muscles do different movements, they never work in isolation. Flexors, extensors, rotators, abductors and adductors provide the best stability when they work together. A good example of this is when you stand. You probably thought that your muscles wouldn’t have to work hard when you stand still. But, even though you are not moving, all these muscles around your hip are actively contracting to keep your hip stable and to help you balance.

Actions of each seperate muscle group:

  • Flexors: Hip flexor muscles bend your hip and lift your leg up. An example of this: lifting your leg up to climb up a step.
  • Extensors: Hip extensor muscles pulls leg backwards allowing you to straighten your hip and leg when you stand up.
  • Rotators: Hip rotator muscles allow you to turn your whole leg either inside or our. Turning around when you walk or doing a twirl when you dance are examples of this.
  • Abducctors: Hip abductor muscles are the main muscle group that is responsible for keeping your hip joint in position. They also allow you to lift your leg sideways when you need to climb out of your car.
  • Adductors: Hip adductor muscles pulls your leg in, allowing you to squeeze your legs together or cross your legs.
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I think I have a hip fracture. How did it happen?

A force that is stronger than your femur bone itself is needed to break it. Keeping in mind that the femur is the strongest and biggest bone in your body, you will need an immense force to cause a hip fracture. That is why hip fractures are mostly caused by incidents like motor vehicle accidents or falls.

It starts with an injury

Let’s say you had a serious fall at home when you slipped on your wet tile floor. You took the brunt of the impact directly onto your hip and now you are in extreme pain. You can barely get up from the floor and your pain shoots through the roof the moment you try to walk. What to do? You end up thinking that you’ve broken your hip.

The x-rays show that you have a hip fracture

You saw a doctor, got x-rays taken and it shows a clear fracture in the top part of your femur, close to your hip. Your body will respond with an immediate and severe inflammatory reaction. All in the hopes of trying to heal the injured area. Inflammation will lead to swelling of the tissue around the broken bone and this will add to your pain. Walking or stepping on the injured leg will cause you severe pain, because it compresses the fractured bone pieces together.

It’s a serious injury

To have a broken hip is a serious medical emergency. It needs to be managed by an orthopaedic surgeon as soon as possible. Unfortunately the only way that your femur can heal again is if it is fixated and kept in the right position to allow bone healing to take place. Your body can heal and your bone will grow back together again, but it will take time. And if you were to continue moving or walking, there would be too much movement between the pieces of bone. Not ideal.

Hip fractures can lead to serious complications like blood clots and fat embolisms due to bleeding and swelling. The top part of the femur that gets broken off will get cut off from circulation and will slowly start to die if the fracture isn’t fixed early enough. This is called avascular necrosis. On top of these serious medical complications, your general mobility and strength will decrease severely because if will be too painful for you to walk if you have a broken hip. Without the right treatment for your hip fracture, you will simply get weaker and this improves your chances of falling and breaking your hip again.

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It’s only a stress fracture

Let’s say your x-rays showed that it was only a stress fracture of your femur. This means that there is a crack in your femur, but not big enough to break the bone apart. Repeated impact running through the same part of the bone causes too much compression causing the bone to slowly crack. This fragile crack can then break easily. Just like glass, it doesn’t take much to completelty break the bone. A stress fracture might not be as serious and you probably won’t need surgery, but you will still need to rest. Repeated impact on a stress fracture can lead to a full-blown fracture.

What if it’s not a hip fracture?

After seeing your doctor and having x-rays taken, it shows no sign of a fracture. You’re were pretty sure you broke your hip, but maybe the impact of the fall just was not big enough to actually break your femur. However, you can still have severe pain even if it is just a soft tissue injury. The inflammation, swelling and bruising of the layers of soft tissue and muscles around your hip can cause you the same kind of pain that shoots through the roof when you try to walk or step on your injured leg.

It is of vital importance to get your hip checked out if you think you might have broken your hip. Get the right treatment from the start before it stops you in your tracks.

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Causes of hip fractures

  • Falling directly onto your side or your hip
  • Severe impact like a car crash
  • Jumping or falling from a height
  • High impact sports like getting a rugby tackle from the side
  • Falling from sport equipment like a balance beam
  • Repetitive hip movement and impact like long distance running

Risk factors:

There are several risk factors that could increase your chances of a broken hip. If the bone structure changes on a cellular level it will be weaker and more vulnerable to break. Here’s a few things that can change the underlying structural integrity of the bone.

  • Osteoporosis – Low density of your bones that lead to it breaking easier
  • Gender – Women, especially post-menopausal, are more likely to have a hip fracture
  • Medications – Some medications can cause a decrease in bone density like long-term use of cortisone
  • Nutrition – Calcium and vitamin D increase bone mass, so a lack of it can lead to fractures
  • Age – Persons with higher age has a bigger chance of falling due to general weakness and poor balance and poor bone density
  • Physical inactivity – Physical activity is very important to maintain muscle strength and good density of your bones
  • Parkinsons disease or neurological disorders like strokes – These conditions will lead to poor balance, coordination and strength, which makes it much easier for a person to fall
  • Poor cognitive function like dementia – This will lead to a decreased ability to plan movements or understand the risks of falling
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Symptoms of a hip fracture

Signs that you have a serious hip injury and must get medical attention as soon as possible to rule out a hip fracture.

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Test to see if you could have a hip fracture

  • Stand next to a chair so that you can hold onto it for balance
  • Slowly lift up one leg in front of you
  • Repeat this test with your other leg and compare what you felt
  • If you felt pain in your hip or groin or if your leg felt very weak doing this action, it could be a sign that you have a broken hip
  • Getting the right treatment for a hip fracture is important, so rather seek help
  • Stand next to a chair so that you can hold onto it for balance
  • Now, stand on one leg
  • Repeat this test with your other leg and compare what you felt
  • If you felt pain in your hip or groin or if your leg felt very unstable doing this, it could be a sign that you have a broken hip
  • Getting the right treatment for a hip fracture is important, so rather seek help
  • Stand in front of a step, holding on to a railing for balance if necessary
  • Climb up the step with one leg
  • Repeat this test with your other leg and compare what you felt
  • If you felt pain in your hip or groin or if your leg felt very weak and unstable doing this action, it could be a sign that you have a broken hip
  • Getting the right treatment for a hip fracture is important, so rather seek help
  • You can do this test standing up or lying down on a bed
  • If you stand, stand next to a chair so that you can hold onto it for balance
  • Turn your whole leg outwards so that your toes are pointing out
  • Then slowly turn your whole leg in so that your toes are pointing in
  • Repeat this test with your other leg and compare what you felt
  • If you felt pain in your hip or groin or if your leg felt very weak doing this action, it could be a sign that you have a broken hip
  • Getting the right treatment for a hip fracture is important, so rather seek help
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How bad is it?

Hip fractures are always a very serious type of injury and can result in life-threatening complications. You can look at the severity of a hip fracture from a medical or functional point of view. We as physiotherapists will look at your injury from a functional side. Let’s discuss these topics separately.

Medical severity

  • Non-displaced fracture: The bone has cracked but not separated
  • Minimally displaced: The two pieces of bone has shifted slightly away from each other
  • Displaced: This is the most severe type of fracture because the broken bone has become completely detached and that makes it a lot harder to fixate it back into position.

Hip fractures can also be classified according to where the fracture is located.

  • Intracapsular fractures (femoral neck fractures): This type of fracture is contained within the hip capsule itself like a fracture of the femur neck. In other words the round head of the femur breaks off. This can have serious effects on the hip joint, because this fracture takes place inside the capsule that surrounds the hip joint.
  • Extracapsular fractures (intertrochantericic and subtrochanteric fractures): This type of fracture takes place outside the hip joint, closer to the shaft of the femur.
  • If the acetabulum or pelvis (hip-bone) gets fractured that is called a pelvis fracture.

It could be a life-threatening injury

  • Bleeding and circulation problems can cause blood clots in your leg. If a blood clot moves to your heart, lungs or brain this can cause a heart attack, stroke or pulmonary embolism.
  • Lung infections (pneumonia) and bedsores can become a problem if someone is not moving enough after the surgery.
  • Fractures of the femoral head can cause an additional complication by injuring the blood vessels that supply blood to this area. This type of injury can impair healing and lead to death of the bone. This is called avascular necrosis. You will need a hip replacement to replace the dead bone if this happens.
  • Fractures can cause severe trauma to the surrounding tissue like tearing into muscle tissue and skin or cut through nerves that run alongside the bone.
  • There is a chance that you could get long-term damage to the hip joint surfaces, causing arthritis.

Functional disability

Disability can be described as a disadvantage or handicap that limits a person’s movements and actions. Hip fractures directly affect the movement of the hip joint and leg. So, now you can understand why it will be hard to stand up and walk when you’ve broken your hip. Even if you had this type of injury and surgery years ago, it could still have an effect on your life.

  • If your hip fracture surgery is successful, you will be able to walk and get back into your routine quite soon afterwards. However, if you don’t recover well, it could leave you weak and dependent on a crutch or a walking frame.
  • It is possible that your injured leg will be shorter than your other leg after an injury like this. If the fractured bone is damaged, you lose some of the bone tissue. A shorter leg will cause permanent difficulty when you walk, causing you to walk with a limp even years after you had surgery.
  • The muscles around your hip will weaken after an injury like this. Hip muscles, together with ligaments, keep your hip joint stable. Without stability, the pressure in your hip joint will increase each time you take a step. This in turn leads to increased compression, friction and pain in your hip joint.

Getting the right treatment after your hip fracture is extremely important, whether you look at it from a medical perspective or a functional perspective.

Diagnosis

Physiotherapy diagnosis

Our physiotherapists are experts in human anatomy and movement with the necessary experience to diagnose a serious hip injury. If your physiotherapist suspects that you have a hip fracture, you will need to be referred for x-rays and from there to an orthopaedic surgeon. Even if you had a broken hip in the past and you are still struggling with hip pain, we can accurately diagnose your problem. Doing a full clinical assessment and getting the necessary information about your pain is the starting point.

During your physiotherapy evaluation, we will stretch and stress your hip joint and the muscles surrounding your hip to determine which structure has been injured. We can accurately identify where your pain is coming from. Thorough evaluation makes our physiotherapists the best at diagnosing this type of problem.

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X-rays

X-rays will be an effective way to show the integrity and alignment of the bones in your hip joint. This will enable us to see if you have a broken hip.

Your physiotherapist will refer you to get x-rays taken if deemed necessary.

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Diagnostic Ultrasound

Diagnostic ultrasound will not be an effective tool to image a hip fracture. However, if your physiotherapist suspects that you have a soft tissue injury like a muscle tear, you will be referred to the right person.

MRI

An MRI will show all of the structures in and around your hip joint. This includes bones and soft tissue like muscles, ligaments and nerves. It will effectively show the your hip fracture and any accompanying soft tissue injuries, like bleeding, swelling or muscle tears. However, an MRI is an expensive test and you need to be referred by a specialist to get one.

If your physiotherapist suspects that you have a broken hip, you will be referred to the right specialist.

Why is my hip pain not going away after I had a hip fracture?

Initially, after you had a hip fracture, the pain that you feel in and around your hip will be normal. The pain will serve as a warning if you’re doing an activity that is too strenuous. It reminds you that your broken hip still needs to heal and thus you can see the pain as a protective mechanism. If everything goes well, your pain should decrease with time as you recover. However, if you neglect to work through your rehabilitation process and don’t get the right treatment from the start, you’ll continue to feel pain. With time, it will bother you more and more, it will prevent you from walking properly and your hip will get painful, weak and stiff. You become stuck in a cycle of pain, not knowing if it is better to move or not.

Make sure you are getting the right treatment for your hip fracture from the start

This includes getting the right medical treatment and working through a proper rehabilitation programme. The medical treatment will include surgery to fixate the broken bone and ensure good healing of the bone. If this goes well, then you know you have a strong hip and a strong foundation to start from.

After surgery you will need rehabilitation. This is the only way to ensure that you get back on your feet, so that you’re able to walk, climb stairs, drive a car or exercise again. Maybe you feel like you didn’t recover well from a broken hip that happened years ago, because you’re still walking with a painful limp. However, you don’t have to lose hope. You can still get the help you need. In this case, your fractured hip has already healed, but the pain that you are feeling is caused by other problems. Weakness of hip muscles, poor hip stability or even a difference in your leg length are some of the things that can cause your pain even years later.

Let us help you get the right treatment after you had a hip fracture, so that your hip pain won’t stop you in your tracks. 

What NOT to do

  • Continuous use of anti-inflammatory medications are not recommended, as they are thought to delay healing

  • Stretch your hip through the pain

  • Walk, run or exercise through the pain

  • Do not ignore hip pain that gets worse it could be an sign of a deeper problem

  • Leave it untreated, if you are uncertain of the diagnosis, rather call us and be safe

What you SHOULD do

  • Make an appointment to confirm the diagnosis and determine the severity of your problem.

  • Rest as needed

  • Use crutches when you walk to keep weight off of your injured hip joint

  • Follow through with your rehabilitation programme when recovering from a broken hip

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Making the hip pain WORSE

  • Walking

  • Standing or balancing on one leg

  • Climbing stairs

  • Turning on one leg

  • Getting in and out of a car

  • Sitting cross legged

  • Getting up from a chair

  • Driving

  • Running

  • Jumping

Problems we encounter when patients see us after they had a hip fracture

Waiting too long before getting proper treatment

A common problem we see is that patients wait too long before they start working through a proper rehabilitation programme. Often, patients feel they need to rest and recover for a few months or even years and only then feel the need to start with rehabilitation.  Now, you’ve gotten used to walking with a painful limp or walking with a crutch, and you never fully recovered. Now, the problem is a lot more advanced and it will take a lot longer to get better.

Trying out, but not completing different forms of treatment

Often, while recovering from a broken hip, patients try to get pain relief by taking medication or getting a voltaren and cortisone injection. However, these treatments will only give you temporary pain relief, because you are not addressing the root of the problem. The pain that you are feeling in your hip is due to poor hip stability, weak hip muscles and a poor walking pattern. The only way to address this is by working through all the steps of a rehabilitation programme to get your hip conditioned to handle more load. It takes time and effort, but it will be worth your while.

Resting too much or too little

Resting too much leaves you weaker than before. Moving too much causes extra pain and inflammation. Finding the balance between resting and doing safe movements is key!

Use of crutches

While recovering from a hip fracture, you will need to use a walking aid to give you some stability. Initially, you might need to use a walking frame and with time you should feel strong enough to use crutches. Eventually, you need to stop using crutches and walk without any help.

However, people tend to get very used to a crutch or a walking stick. You become dependent on the extra stability it gives you. In some cases it is a handy tool, especially if you know you are going to walk far or on uneven terrain. But, wouldn’t it be so much easier and so much more convenient if you can walk without it? You need to ask yourself the question: “Am I using my crutch because I really need it or am I using it simply because I am scared or too lazy to exercise to get my hip stronger?”.

Let us help you to address these problems so that you can fully recover after a broken hip. 

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Physiotherapy treatment

We are confident that we can provide the best possible treatment after you’ve had a hip fracture. Patients are often anxious to get back to their normal daily routine and that is why we are here to provide guidance and answers to ease your fear. We’ll implement a very effective and structured plan of action that treats all the aspects of the problem. This way your hip pain, instability and walking pattern will improve and you’ll be able to move and exercise with confidence again. However, it’s important that you commit to the treatment plan, as this improves your chances of successful long-term recovery.

The basic structure of our treatments:

  1. Determine what has been injured
  2. How bad is it injured?
  3. Protect it from further injury
  4. Give it time to heal
  5. Strengthen surrounding muscles
  6. Re-evaluate to monitor progress

We will address and improve the way you are using your hip and leg when you easy daily activities like standing up, walking or climbing stairs. And we will also address and improve your muscle strength, range of motion, flexibility and stability. Treatment techniques will include: soft tissue massage, joint mobilisations, dry needlingstrapping, laser therapy, nerve mobilisations and guiding you through a rehabilitation program of gradual strengthening, control and conditioning of the muscles around your hip.

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Phases of rehabilitation

1st Phase: Protection and initial healing

Protect

A broken hip will cause a lot of pain and it will feel impossible to simply take a step with your injured leg. The hip joint is compressed and stretched each time you try to walk and this is what gives you pain.  Rest and use crutches to keep the load off. The main concern is to prevent continuous inflammation and pain.

Medication

Avoid using anti-inflammatory medication continuously. If you have severe pain, try to rather use medication without an anti-inflammatory component. That way, your pain will be under control, you’ll be able to get enough sleep and you’ll be able to move. Once the pain is under control, you can decrease the use of your medication and eventually stop taking it completely.

Strapping

By using strapping or elastic bandage, inflammation and swelling can be relieved. It gives support, which also helps for your pain.

Information

Make sure that you get information from the person who is treating you. Its important to understand what you should and shouldn’t do. You can make better decisions if you are informed. Your body knows best, so avoid too many types of treatments at once.

Load

Let pain guide you to gradually return to your normal activities. Initially, it is tricky to know if it is better to rest or to move, but finding a balance between the two is the best you can do.

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2nd Phase: Establish pain free range of movement

During your examination, it will become clear what kind of movements you are able to do, and what you should avoid. When you lift your leg up to put on pants or lift your leg out sideways to climb out of your car, you will be able to move to a certain point, before your pain starts. This is your pain-free range of movement. You are safe to move within this range and initially our exercises will be targeted between these boundaries of your pain.

The aim is that, with time, your pain-free range of movement improves and painful movements become less intense.

3d Phase: Tissue healing

During this phase of treatment, we monitor the progress of healing and the formation of scar tissue. With or without surgery, there will be scar tissue that needs to heal well. If neglected, scar tissue can become thick and painful and can even restrict your movement.

On a cellular level we’re able to accelerate tissue healing using dry needlinglaser and ultrasound. As healing takes place, we want to see improvement of your pain, and improvement in your ability to move your hip muscles and use your leg.

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4th Phase: Soft tissue bone and joint stress

During this phase of hip fracture treatment we will evaluate to see if your femur, hip joint and hip muscles are able to handle tensile, elastic and compression forces. Your femur and hip joint should get used to the compression load when you walk. And your hip muscles should be able to contract harder to give your hip the necessary stability. We start with small steps and minimal weight bearing and gradually get you used to more. We will use isometric muscle contractions with your initial exercises.

During this phase of your treatment, you should be able to stand on both legs, stand on one leg and walk, even if you need help.

5th Phase: Full range of movement

To regain full range of motion of your hip, will be a very important component of hip fracture treatment. Your hip joint should be able to stretch to the end of its range in all directions. Scar tissue can cause restrictions and irritation to the surrounding soft tissue. So, it must be lengthened and orientated to allow a smooth hip joint movement and smooth contractions of the muscles around your hip. We will help you to stretch more, move deeper and work into your pain. For this we use massage, stretches and joint and neurodynamic mobilisations to achieve full range of movement.

Now, you should be able to lift up your leg to put on pants or lift your leg sideways to climb out of the car.

6th Phase: Muscle strength 

This phase of hip fracture treatment will focus on strengthening hip, back and leg muscles. Repeated contraction of muscles, improves their strength. Stronger muscles have the capacity to work harder and can help to carry the load while keeping your hip stable. Standing up, sitting down, walking and climbing stairs are some of the basic activities that you will want to get back to. To do these things with ease, you will need the necessary strength. We will progress your exercises by adding resistance, doing more repetitions and using functional movements, like climbing up a step, as part of your strengthening programme.

At the end of this phase you should be able to do a lunge, climb up a step, squat and get up from a crouched position.

7th Phase: Hip stability, balance and walking pattern 

It is one thing to feel your muscles get stronger, but another thing to feel like you have control when you move. This is an extremely important component of treatment after your hip fracture. To ensure that you don’t fall and hurt your hip again in the future, you need to have good balance and stability. Addressing and improving the way you walk is a good way to get you to walk with more confidence and strength.

With time you should be able to balance on one leg and react in time if you want to fall. You should also be able to walk uphill and downhill and climb several flights of stairs without one leg feeling weaker than the other.

8th Phase: Testing for return to activity

A big part of your recovery is to gradually return to your routine again. Now, we can determine if you are ready return to work or start exercising again. Your physiotherapist will guide you to re-engage in safe increments, and make adjustments where necessary.

9th Phase: Speed and power

Now that you’ve worked through the different phases of treatment after your hip fracture, we want to improve the power and speed of your movements. Certain activities like dancing, running or jumping will require precise balance, high power and speed. We need to ensure that your hip and leg muscles are able to keep up with the demands of your body.

Your physiotherapist will challenge you past your normal boundaries to determine how your body reacts to different forces. Ultimately you need to be able to jump down a step, jump on one leg, jump over a hurdle, run, or even sprint again. All of this needs to happen in preparation for your return to your sport.

10th Phase: Sport specific training

This is the final stage treatment in your recovery from a hip fracture. Depending on your sport, your physiotherapist will tailor specific exercises to further improve your strength, endurance and technique. A successful outcome is when you understand your condition, know how to prevent flare-ups and can participate at full power and speed, not to mention the benefits of minimizing your chance of future injury.

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How long will it take for me to recover?

Depending on the severity of your hip fracture and which other soft tissue structures got injured, it takes 8 to 12 weeks for the initial healing of your broken femur. A hip fracture is a very traumatic type of injury and it will affect the stability of your hip afterwards. Getting back to a fully functional level and actively exercising or participating in sport will take you 3 to 6 months.

You will definitely have a range of other soft tissue trauma as well and complications with that will increase your recovery time. At first our main concern is bone healing, but during the weeks and months it will take to recover, there will be other things that needs our attention as well. It is important to start with physiotherapy and rehabilitation as soon as possible. This way, you can prevent longstanding problems of compensation, muscle weakness and poor hip stability. Patience is key when you recover from a broken hip, because it will take time. Even if you decide to get treatment for the hip pain you are still feeling years after your hip fracture, it will be a step-by-step process of clearing up different problems.

Initially, you will need physiotherapy treatment twice a week for the first two weeks. After this, your treatment sessions can be spread out to once a week or once in two weeks. You only spend an hour at a time with your physiotherapist. How fast you recover will greatly be up to you. If you complete your physiotherapy treatment protocol, you should be able to recover completely and return to your sport.

Other forms of treatment

  • Medication: Initially, you will need medication to manage your pain, but it must be reduced incrementally to get a clearer picure of what’s happening with the tissue. Be careful to not use these medications for too long as they can delay healing or cause dependancy.
  • Cortisone injections: Your doctor might suggest that you get a cortisone injection if your pain persists. This could ease the discomfort and pain coming from inflammation in and around your hip joint. However, long-term use of cortisone is not good for the integrity of your joints and if the problem is of a biomechanical nature, it won’t be the solution to your problem.
  • Getting a manipulation done: Your hip might feel stiff after you had a hip fracture and it might feel like it needs to be ‘clicked’  back in. However, getting a manipulation or re-alignment done is not a good idea. It could cause a flare-up of inflammation and pain.
  • Seeing a biokineticist: When you have worked through your treatment plan with your physiotherapist and you need help with further rehab, a biokineticist will be valuable to help you get stronger.
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Surgery for a hip fracture

Treatment of your hip fracture will always involve surgery. Your femur is an immensely strong bone, and surgery is the only way to ensure that it will properly grow back together. An orthopaedic surgeon will use various devices such as nails, plates, screws and rods to stabilise and fixate your femur fracture. A hip replacement may be necessary if the head of the femur or the acetabulum have been severely damaged. The only time that surgery will not be an option is if it is too risky for the patient. Then, a treatment called ‘traction’ will be used to encourage the bone fragments to realign.

After surgery, rehabilitation is the only way to get you back on your feet. Initially, your surgeon might not permit certain movements and you might not be allowed to step on your operated leg. However, you can start with physiotherapy in the first few days after hip surgery. Even if you aren’t allowed to do much, your physiotherapist can help you by passively moving your hip and leg to prevent any joints from becoming stiff. This way, when your orthopaedic surgeon gives you the green light to to start moving, your physio is up to date and ready to progress your treatment.

We work with a network of expert hip orthopeadic surgeons that has proven their expertise. We can refer you to the best specialist that suits your problem.

If you are not happy with the physiotherapy you have received after your surgery, give us a call. We can also help you with post-operative rehabilitation.

What else could it be?

  • Hip joint pain or hip arthritis – Pain and stiffness in your hip that feels worse in cold weather, in the mornings or when you’ve walked too far.
  • Quadriceps muscle tearGroin muscle tearHamstring muscle tearGluteus Muscle Strain (Hip) – pain specifically caused by one of these muscles that gets injured to the point of tearing. It feels worse when you try to move or stretch and better when you rest.
  • Quadriceps tendinitis, gluteal tendinitis – pain in your hip, groin or buttock that feels worse after you’ve done exercise or even the next morning.
  • Hip bursitis – Pain over the side of your hip that feels especially worse when you lie on your affected side at night.
  • Iliotibial band syndrome – Pain at the side of your hip or even as low as your knee. Usually worse when you run.
  • Stress fracture of femur head – Pain in your hip especially when you walk, run or jump. Usually caused by overtraining and can cause a full-blown fracture.

Also known as:

  • Broken hip
  • Neck of femur fracture
  • Intertrochanteric fracture
  • Subtrochanteric fracture
  • Broken femur
  • Femur fracture
  • Hip stress fracture
  • Avulsion fracture
  • Cracked hip
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