Hip Hypermobility: Definition, Causes, Symptoms, and Management

What is Hip Hypermobility?

Hip hypermobility refers to an excessive range of motion in the hip joint, extending beyond what is typically considered normal. While often asymptomatic, it can predispose individuals to instability, pain, and injury.

Defining Hip Hypermobility

Hypermobility, often colloquially known as being "double-jointed," describes joints that can move beyond their typical anatomical limits. When this occurs specifically in the hip, it is termed hip hypermobility. It's crucial to distinguish between joint laxity (the amount of passive joint movement beyond the physiological range) and hypermobility (clinical signs and symptoms arising from that laxity). While some degree of generalized joint hypermobility (GJH) is common, localized hip hypermobility can occur independently or as part of a broader hypermobility syndrome.

Anatomy of the Hip Joint

To understand hip hypermobility, a brief review of hip anatomy is essential. The hip is a highly stable ball-and-socket joint, formed by the head of the femur (thigh bone) articulating with the acetabulum (a socket in the pelvis). Its inherent stability is provided by:

• Bony Congruence: The deep fit of the femoral head into the acetabulum.
• Strong Joint Capsule: A fibrous capsule enclosing the joint.
• Robust Ligaments: Three primary ligaments – the iliofemoral, pubofemoral, and ischiofemoral ligaments – which reinforce the capsule and prevent excessive motion.
• Acetabular Labrum: A ring of fibrocartilage that deepens the socket and enhances suction, further stabilizing the joint.
• Surrounding Musculature: A complex network of muscles (gluteals, hip flexors, adductors, deep rotators) that provide dynamic stability and control movement.

In hypermobility, one or more of these stabilizing structures may be less restrictive than typical, allowing for greater range of motion.

Causes of Hip Hypermobility

Hip hypermobility can stem from a variety of factors, often a combination:

• Genetic Predisposition: This is a significant factor, often involving inherited variations in collagen, the primary protein in connective tissues like ligaments and joint capsules. Conditions such as Ehlers-Danlos Syndrome (EDS), Marfan Syndrome, and Benign Joint Hypermobility Syndrome (BJHS) are characterized by generalized joint laxity.
• Anatomical Variations:
  • Shallow Acetabulum: A less deep hip socket provides less bony constraint.
  • Femoral Anteversion/Retroversion: Variations in the angle of the femoral neck can alter joint mechanics and range of motion.
• Ligamentous Laxity: The ligaments surrounding the hip may be inherently more elastic or stretched due to repetitive end-range movements (e.g., in dancers, gymnasts).
• Muscle Imbalances or Weakness: Inadequate strength or poor activation of the muscles surrounding the hip can lead to a reliance on passive structures (ligaments, capsule) for stability, potentially stretching them over time.
• Hormonal Influences: Hormones like relaxin, particularly elevated during pregnancy, can increase ligamentous laxity.

Signs and Symptoms

While some individuals with hip hypermobility may be asymptomatic, others experience a range of issues:

• Pain: Often localized to the groin, buttock, or lateral hip, particularly during or after activities that involve end-range motion or prolonged weight-bearing. This pain can be due to increased stress on the joint capsule, labrum, or surrounding muscles trying to compensate for instability.
• Clicking, Popping, or Clunking: Sensations within the joint, sometimes audible, due to the femoral head moving excessively within the socket or catching on the labrum.
• Feeling of Instability or "Giving Way": A subjective sensation that the hip might dislocate or buckle, especially during certain movements.
• Recurrent Subluxations or Dislocations: Though less common in the hip than in other joints (like the shoulder), partial or complete dislocations can occur in severe cases.
• Excessive Flexibility: The ability to easily achieve extreme ranges of motion in the hip without much effort or prior training (e.g., full splits, deep squats).
• Fatigue: Increased muscular effort required to stabilize the joint can lead to muscle fatigue and soreness.

Diagnosis and Assessment

Diagnosing hip hypermobility typically involves a comprehensive approach:

• Clinical Examination: A physical therapist or physician will assess the hip's active and passive range of motion, looking for excessive movement. They may also perform specific tests to evaluate hip stability and identify potential associated issues like labral tears.
• Beighton Score: This standardized 9-point scale is commonly used to assess generalized joint hypermobility, though it doesn't specifically target the hip.
• Patient History: Detailed information about symptoms, previous injuries, family history of hypermobility, and activity levels is crucial.
• Imaging Studies:
  • X-rays: To assess bony anatomy, identify structural variations (e.g., acetabular depth, femoral neck angles), and rule out other causes of pain.
  • MRI (Magnetic Resonance Imaging): To visualize soft tissues like the labrum, joint capsule, and ligaments, identifying tears or degeneration.
  • MRA (MR Arthrography): An MRI with contrast dye injected into the joint, which can provide clearer images of the labrum and cartilage.

Implications and Risks

Unmanaged hip hypermobility can lead to several long-term implications and increased risks:

• Increased Risk of Injury: The laxity can predispose individuals to labral tears, capsular sprains, hamstring strains, groin strains, and other soft tissue injuries due to repetitive microtrauma or acute overstretching.
• Osteoarthritis: Chronic instability and altered joint mechanics can lead to accelerated wear and tear on the articular cartilage, increasing the risk of early-onset hip osteoarthritis.
• Chronic Pain Syndromes: Persistent pain can develop due to compensatory muscle activity, inflammation, or impingement of soft tissues.
• Pelvic and Lumbar Spine Issues: Altered hip mechanics can impact the kinetic chain, leading to instability or pain in the pelvis or lower back.
• Challenges in Exercise and Sport: While flexibility can be an asset, hypermobile individuals must be cautious about overstretching and focus on stability and controlled movements to prevent injury.

Management and Strategies

The primary goal of managing hip hypermobility is to enhance dynamic stability and reduce symptoms, rather than trying to restrict the range of motion.

• Strengthening: Focus on strengthening the muscles that dynamically stabilize the hip joint, including:
  • Gluteal Muscles: Gluteus maximus, medius, and minimus are crucial for hip extension, abduction, and external rotation, providing powerful stability.
  • Core Musculature: A strong core is fundamental for pelvic stability, which directly impacts hip function.
  • Hip Adductors and Flexors: Strengthening these muscles helps control hip movement in all planes.
  • Deep Hip External Rotators: These small muscles contribute significantly to joint centration.
  • Emphasis should be on controlled, moderate ranges of motion, avoiding end-range stretching under load.
• Proprioception and Neuromuscular Control: Exercises that challenge balance and coordination help the body better sense joint position and activate stabilizing muscles reflexively. Examples include single-leg stance, balance boards, and unstable surface training.
• Activity Modification: Identifying and modifying activities that exacerbate symptoms is key. This may involve adjusting techniques in sports, yoga, or dance to avoid extreme ranges of motion or excessive stretching.
• Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) may be used for acute pain. Physical therapy modalities like ice or heat can also provide relief.
• Patient Education: Understanding the condition, recognizing triggers, and adhering to a tailored exercise program are vital for long-term management.
• In rare and severe cases: Surgical intervention, such as hip arthroscopy to repair labral tears or address severe instability, may be considered.

When to Seek Professional Guidance

If you suspect you have hip hypermobility or are experiencing persistent hip pain, instability, or difficulty with daily activities, it is highly advisable to consult a healthcare professional. A physician, physical therapist, or sports medicine specialist can provide an accurate diagnosis, rule out other conditions, and develop a personalized management plan tailored to your specific needs and goals. Early intervention can help prevent further injury and improve long-term joint health.