Hip Pain

Overview

Does your hip hurt? Hip pain is a chronic condition experienced by both men and women yet is more common amongst women. This condition is characterized by pain in or around the hip joint. In most cases, a patient may not feel pain from the hip directly over the hip area. They may feel pain in their knee, groin, or thigh. Women might complain about pain in the side of the upper thigh, upper buttock, or lower back pain. However, this is not actually hip pain. It is often felt in the groin or the outer part of the hip directly over the region where the hip joint (a ball-and-socket joint) is located.
As with other types of chronic pain, women tend to experience it more than men. But because hip pain can have many different causes, determining the correct one is the key to getting the best treatment.

Types of Hip Pain

• Hip Osteoarthritis - Hip Osteoarthritis is the most common cause of hip pain. Aging can deteriorate hip joints. The cartilage covering and protecting bones tend to wear with age resulting in friction, inflammation, and pain in the area. Patients can experience symptoms worsening in the morning or after/during an activity. Hip pain can also be experienced after sitting for an extended period of time.
• Hip Bursitis - Hip Bursitis is characterized by the inflammation of a bursa near the hip joint. Patients with a previous injury or having lower back issues affecting the biomechanics of the hips are more prone to hip bursitis. If left untreated, the condition may worsen and turn chronic.
• Labral Tear - As the name suggests, the hip labrum comprises robust and flexible cartilage (similar to the shape of a ring) bordering the outer edge of the hip socket. The cartilage tends to tear over time and becomes prone to injury.
• Hip Impingement - Hip impingement is characterized by the growth of bony structures on the hips ball and socket, resulting in an unusual contact between the bones. Hip impingement restricts the range of motion in the hip. This condition may also lead to other issues such as Osteoarthritis, labral tears, or even both.
• Ankylosing Spondylitis - Ankylosing Spondylitis is a type of systemic inflammatory arthritis that causes the immune system to attack other joints in the body. It affects the sacroiliac joint connecting the spinal base to the pelvis. This condition causes lower back or hip pain.
• Soft Tissue and Muscle Injuries - Hips are surrounded and interconnected by muscles, tendons, and ligaments. These may stretch out or get injured.
• Symptoms/ Pain Common Symptoms of Hip Pain include the following:
  • Tenderness of the hip
  • Limping
  • Swelling over the hip
  • Warmth
  • Loss of motion of the hip
  • Difficulty sleeping on the hip
  • Joint pain
  • Groin pain

Symptoms of hip pain may vary in intensity from mild to severe, depending on the cause. In some cases, hip pain may also lead to disability.

• Causes of Hip Pain A variety of problems may cause hip pain. Here are the major causes:
  • Arthritis
  • Psoriatic arthritis
  • Injuries
  • Hip labral tear
  • Juvenile idiopathic arthritis (juvenile rheumatoid arthritis)
  • Bursitis (joint inflammation)
  • Osteoarthritis (disease causing the breakdown of joints)
  • Rheumatoid arthritis (inflammatory joint disease)
  • Inguinal hernia
  • Meralgia paresthetica
  • Septic arthritis
  • Pinched nerves
  • Hip fracture
  • Synovitis
  • Cancer
  • Sprains
  • Leukemia
  • Tendinitis
  • Other problems
  • Sacroilitis
  • Avascular necrosis (osteonecrosis) (death of bone tissue due to limited blood flow)
  • Osteoporosis
  • Osteomyelitis (a bone infection)
  • Sciatica
  • Legg-Calve-Perthes disease (in children)
  • Advanced (metastatic) cancer that has spread to the bones
  • Bone cancer

Diagnosis

Symptoms of hip pain should be mentioned to your doctor as soon as possible. A health care professional will check your history and conduct a physical examination to diagnose the cause of the pain. Doctors use physical examination movements, including rotating hips internally and externally, to detect pain-aggravating positions. Inflamed regions are palpated to stimulate tenderness. Sciatica may be diagnosed by raising the leg straight.

Other standard diagnostic tools used for detecting hip pain include MRI scans, X-rays, and CT scans. Doctors sometimes suggest nuclear medicine bone scans to detect an inflamed or fractured bone.

Treatment

The treatment of hip pain depends on the cause. Pain resulting from exercise is usually relieved with rest. Resting allows the hip to heal. This kind of pain is generally healed completely within a span of a few days.

A doctor will prescribe medications to relieve pain and stiffness due to arthritis. In some cases, the doctor may refer patients to a specialist for further advice and a physical therapist to help restore joint mobility.
Here are the two main options for Hip Pain Treatment:

Surgical Options

Surgery is not the only treatment for hip pain. Typically only a small percentage of patients with hip pain will need surgery. However, a hip fracture is an exception. This condition will always need surgery, which will facilitate the stabilization of the bone and hold it in place. A hip fracture will also require the replacement of the ball (known as the femoral head).

 Older patients are more vulnerable to hip fractures. Complete recovery may take up to 12 weeks. Here are some of the common surgical options:

• Hip Replacement Surgery Hip pain resulting from arthritis that has not responded to other treatments may require hip replacement surgery. Around 90% of individuals experience a significant reduction in pain after hip replacement surgery. The modern artificial hip has a life of 15-20 years. After recovering from surgery, physical therapists will help the hip regain mobility with simple exercises.
  Doctors will assess general health prior to surgery.
• Revision Surgery Revision surgery is corrective surgery for a previous hip replacement that has become loose, infected or failed. Failed hip replacements can be efficiently dealt with by revision surgery. Patients may be required to stay in the hospital longer than the first hip replacement surgery. The recovery may also take longer.
• Acetabular Labrum Surgery Acetabular Labrum Surgery is a surgery to reshape the hip with an aim to restore joint mobility and reduce pain and stiffness. In some cases, surgeons will perform keyhole surgery.

Non-Surgical Options

Non-Surgical Options are usually the first step of treatment. Doctors will suggest these options before resorting to surgery:

• Drugs
  • Non-Steroidal Anti-inflammatory Drugs (NSAIDs) - The doctor may prescribe stronger NSAIDs (diclofenac, naproxen, or a higher dose of ibuprofen) to relieve pain. These drugs may have side effects. Doctors may suggest precautions to reduce these risks by prescribing milder yet effective doses.
  • Bisphosphonates - These are usually prescribed for the treatment of osteoporosis and Paget’s disease of the bone. Bisphosphonates slow down the loss of bone while reducing the risk of hip fractures.
• Physical Therapy - Meeting a physical therapist may help you regain hip mobility by suggesting a gentle range of movement-related exercises and activities to relieve your condition. These specialists will train you to improve the function of your hip by performing strengthening and stretching exercises. They will also perform special massages and other therapeutic techniques.
  A physical therapist will suggest the following for the treatment of hip pain:
  • Exercises to strengthen weakened muscles
  • Correct use of a walking stick or crutch.
  • Improve awareness of the position of your hips and back
  • Posture-improving exercises
  • Exercises to relieve or prevent stiffness
  • Massage and manipulation to treat soft tissues and joints
  • Exercises to improve range of motion joint movements
  • Ways to walk when the hip hurts
• Occupational Therapy - Sometimes work or specific activities may be the reason for hip pain. An occupational therapist will help you to reduce the pain. This specialist is trained to help patients regain independence by suggesting changes in how activities are performed. Patients will be prescribed special equipment to reduce strain on the hip.
• Steroid Injections - Steroid injections can treat hip pain caused by Bursitis or inflammation in or around the hip area. A local anesthetic will numb the affected area to minimize the pain of the injection. They can treat conditions affecting the trochanteric area located on the outside of the hip.
  Steroid injections are also helpful in treating Iliopsoas Tendonitis. A radiologist will perform an ultrasound to inject into the iliopsoas tendon.

Frequently Asked Questions