Hip Tip 6 – Try a cushion

Further, there are times where it is simply impractical not to sit. Driving requires an upright sitting position and even as a passenger in a car, plane or during longer distance bus or train travel, some period of upright sitting is usually required.  Also, especially at this time of year where social gatherings are more frequent, periods of sitting are typically involved. With returning to restaurants and pubs after our Covid-19 lock-downs, in Australia all diners/drinkers were required to sit, with no standing to mingle or to order permitted.  An inability to sit meant an inability to get out of the house to socialise in these venues.

Cushions that help reduce hip and pelvic pain in sitting:

1. Wedge cushion

Common conditions that are helped with a wedge cushion:

• Hip osteoarthritis (OA)
• Femoroacetabular impingement syndrome (hip impingement)
• Labral tears
• Hip pain associated with acetabular dysplasia
• Gluteal tendinopathy/Greater Trochanteric Pain Syndrome (GTPS)

Chondrolabral pathology that may progress to OA is most common in the anterior-superior aspect of the joint. Sustained deep flexion of 90degrees or more tends to be provocative, so the deeper the chair - the more irritation. For those with cam morphology or osteophytosis associated with hip OA, femoroacetabular contact relatively early in range may result in compression of the labrum and/or increased pressure on nociceptive subchondral bone. Differing degrees of flexion will be tolerated by different people depending on their presentation, but as a general rule, keeping the hips a little higher than the knees (hips more open than 90 degrees) can be helpful.

For those with acetabular dysplasia and reduced anterior acetabular coverage of the femoral head, higher loads are placed on the anterior rim structures, including the labrum. Sitting in posterior pelvic tilt is likely to increase this anterior rim loading. A wedge cushion +/- lumbar support as required, can assist in reducing the anterior loads and pain that some may experience with prolonged sitting or driving.

Using a wedge is also helpful for people with gluteal tendinopathy/GTPS. While sustained adduction is a potent aggravating factor for those with gluteal tendinopathy, hip flexion can add to compressive loads at the lateral hip due to fascial connections between the ITB, fascia lata, gluteal fascia and thoracodorsal fascia. Greater hip flexion increases the chances of higher compression, particularly when combined with hip adduction i.e. sitting in a low chair with the knees crossed.

A wedge cushion is great for reducing hip flexion in sitting and is often more successful than tilting the seat-base of the chair. It needs to be a high-quality, medium density foam though to have adequate effect. We have tried many over the years – this is the one we recommend to our patients with great feedback - click the button below to view.