The Hip is the Largest, Strongest Joint in the Human Body.

The muscles and ligaments that surround the joint are also some of the largest and strongest in the body. So why does the biggest, strongest joint in the body become a problem?

There are 3 main reasons for hip pain and they will be highlighted below.

1.     It gets used all the time

When a joint gets overused it starts to compensate by recruiting surrounding muscles, ligaments, and tendons. This works for a short time and you continue on with your normal activity until there is no room to compensate anymore. Over time pain will be more noticeable and more frequent. The first sign that the hip has been compromised is restricted mobility. When the hip cannot move the way it should it will begin to damage the surrounding soft-tissue, creating soft-tissue adhesion. Adhesion acts like glue, leads to hip pain, and will affect athletic performance. Dr. Nottoli and Dr. Schultz have specialized certification to find and fix adhesion in the soft-tissues surrounding the hip joint. Reducing adhesion will allow the hip to move pain-free!

2.     Degeneration/Osteoarthritis (OA)


Healthy hip cartilage should be strong and smooth, almost like 2 pieces of porcelain gliding across one another. There should be almost no friction. When the cartilage begins to degenerate it becomes thin and weak. This creates a sandpaper effect. Now that once healthy, smooth cartilage is scraping and grinding in the joint every time the hip moves. Over weeks to months to years, there will be more deterioration of the cartilage ultimately leading to Osteoarthritis (OA). Without an accurate diagnosis or poor management, this problem will only get worse. The doctors at Functional Spine and Sport have great success in treating and managing patients who have been diagnosed with OA.

3.     Femoroacetabular Impingement (FAI)

This is most common in youth athletes who specialize in a single sport and do so year round. During the skeletal maturing process the growth plates of the hip are wide open to allow the bones in the hip to develop properly. When a young athlete starts to focus on one sport the hip is exposed to the same, constant stress. During this phase of the life the joints of the body to much better when put under a variety of different stresses, not one stress all the time. So when a youth athlete begins to develop hip pain it is a really big deal!

hip joint 2.jpg

Femoroacetabular Impingement happens when there has been too much bone growth in the hip. What happens next is the ligaments and cartilage of the hip start to wear down and tear. This should not happen until you are in your 70s. The doctors at Functional Spine and Sport have seen countless athletes in their early to late teens with these types of injuries. Recent studies have shown that those athletes who specialize in a single sport are 2-8 times more likely to develop FAI than their peers who don’t specialize. This needs repeated; 2-8 times more likely! Fortunately, Dr. Nottoli and Dr. Schultz have specific testing procedures that determine if your youth athlete is at risk for this injury. The patients they see with this type of injury have great success with our doctor's treatment.

Again, the hip is a very large, strong joint and having the expertise to figure out why hip pain happens is critical. Our doctors dedicate themselves to finding the root cause of hip pain and tailoring a treatment to get your hip healthy. In the following articles, we will be addressing what you can do to keep your hip healthy and how our doctors help those of you who are suffering from hip pain.

Now that we know why hip pain happens it is important to know what changes you can make to keep your hip healthy.

When the hip starts to become a problem that is a big deal so the smart thing to do is be proactive, not reactive with your health. Below we are going to outline 3 steps you can follow to maintain your hip health.

DISCLAIMER: These steps are only to be followed for those of you who currently are experiencing no hip pain. If you have had or currently have hip pain rated >2/10, this information will not fix your problem.

●      No specializing in youth athletes

○      As you read in our first article on why hip pain occurs, youth athletes who specialize in a single sport are 2-8x more likely to develop hip malformation than their peers! So how can that be avoided? In short, don’t specialize. Let your kids be kids and enjoy their time away from athletics. Having them in a variety of athletics is the key to health as they are going through their developmental years. The physical benefits far outweigh the costs.

○      Participating in a variety of athletics will actually increase their athletic ability while putting different stresses through the hip. You will be surprised with how much more of a well-rounded athlete your child will be. When they specialize, the same stresses are put on the hip leading to hip pain and malformation at a very young age. This is bad for a joint that is still going through skeletal maturity and can cause lifelong hip problems. In the end, we all want what is best for your child and making this tweaks will help you reach that goal. Having the ability to prevent a lifetime of hip pain with simple changes in athletics is invaluable.

●      Variety

○      Just like youth athletes should participate in a variety of athletics, adults also need to utilize a variety of exercises. But, there is a difference between the two. Adults who constantly do the same exercise are more likely to develop cartilage or labrum damage, sometimes both! Those of you who only run 5-6x/week or Crossfit that same amount are at greater risk for these types of injuries.

○      Instead of only doing one type of workout, mix it up. You can still run or do Crossfit but decrease the frequency to 2-3x/week. For runners, use the other days to develop strength through weight lifting or bodyweight circuits. For those of you who do Crossfit, do bodyweight movements or go on a run/bike ride. You will be surprised with not only how well you recover but also how much better you perform.

●      Hip Hygiene

○      Keeping your hip healthy is absolutely critical. Some of the biggest, strongest muscles in the body surround and attach to the hip. Knowing how to keep these structures in a healthy environment will increase your athletic longevity. Going on a walk is a great way to keep your hip moving without putting massive amounts of stress through the joint. Walking not only helps with physical stress but also with mental stress. It allows you to think about the day you had and bring some clarity to your thoughts.

○      Yoga is another great activity that is extremely beneficial in maintaining hip-health. Finding a studio that aligns with your goals and you enjoy going to is a good first step. Yoga allows you to safely move your body through motions and poses you wouldn’t typically do during a workout. And again, the amount of stress on your hip is much lower than running or lifting weights.

We hope this information was beneficial for those of you looking to keep and maintain your hip health. If you are currently injured or have had hip pain following these steps will not fix your problem. With that said, our next article we will address how our doctors assess and treat hip pain. That will be much more beneficial for you!

There are numerous treatments that make the claim to fix hip pain. The vast majority of treatments chase a symptom instead of finding and fixing the true reason for hip pain.

There can be multiple pain generators and it is the duty of the doctor to find the culprit. Anything less is a disservice to the patient. Being told you have bursitis or tight hip flexors are fancy ways to describe your pain. They are not answers to why you have pain in the first place. Fortunately for our patients, the doctors at Functional Spine and Sport work relentlessly to give you the answers you deserve and tailor a specific treatment plan to get you better.

Dr. Nottoli and Dr. Schultz treatment procedures for hip pain primarily focus on reducing soft-tissue adhesion using Manual Adhesion Release (MAR). Their treatment procedures are on the cutting edge of musculoskeletal health care. This allows Dr. Nottoli and Dr. Schultz to be the 2 most experienced doctors in the entire state certified through Integrative Diagnosis (ID) to use MAR. This extensive post-doctorate certification ensures every patient in their office receives the highest quality care when it comes to muscle, joint, and nerve pain.


Specifically for the hip, adhesion that has built up around the joint, inner thigh, and hip flexors will wreak havoc on the joint. Adhesion makes the hip less flexible, weak, and causes pain. When adhesion isn’t expertly removed it will cause damage in the joint and surrounding tissue.

So the most important step in fixing hip pain is finding and fixing all adhesion that has developed in and around the hip. This will allow the hip to be in a safe environment and significantly decrease the stress on the cartilage and ligaments. This is a crucial step in fixing hip pain, any soft-tissue dysfunction must be fixed first. The doctors at Functional Spine and Sport are the only specialists in Lake County that have the training to reduce adhesion and restore normal hip function.

If you have found yourself struggling with hip pain and have tried other treatments with no lasting benefit. It is extremely likely you have developed adhesion in the muscles and ligaments of the hip. Dr. Nottoli and Dr. Schultz are the 2 most experienced doctors to find and fix muscle adhesion within 100 miles of Chicago. Fix your hip pain for good by scheduling a consultation with the specialists at Functional Spine and Sport.

Carl Nottoli