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Hip Pain:

Hip pain is the experience of pain in the muscles or joints in the hip or pelvic region. Sometimes it is closely associated with lower back pain.

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Pain in the hip is very common. Hip pain affects children and adults and can have a variety of different causes.

hip pain

Chronic hip pain can change the life by limiting your ability to walk, sit comfortably or perform normal daily activities. When hip pain interferes with the ability to do the things patient need to do each day, it’s time to seek medical advice.

If you develop hip pain that persists, possibly with swelling or tenderness, a doctor can help you sort out the possible causes. The physician will thoroughly examine patient, take down the health history, and order hip X-rays or other imaging to view the joint.

Hip Pain Symptoms:

Pain at the hip joint is the single most symptom for hip pain. Some of the most common symptoms for hip arthritis (pain) include:

  • Joint stiffness which occurs oftenly while getting out of bed
  • Joint stiffness which sitting for a long period of time
  • Hip joint pain
  • Hip joint swelling
  • Tenderness in the hip joint
  • Buttocks pain
  • Groin pain
  • A sound or feeling (“crunching”) of bone rubbing against bone
  • Inability to move the hip to perform routine activities such as putting on the socks etc.

Hip Pain Causes:

Pain may arise from structures that are within the hip joint or from structures surrounding the hip.

Hip pain may be caused by a variety of illnesses. Anything that causes systemic inflammation in the body may also affect the hip joint.

Here are some of the key causes of hip pain:

Osteoarthritis:

Osteoarthritis is a wearing down of the cartilage which actually allows the bones to glide smoothly over one another in joints such as the hip. It is one of the most common causes of hip pain in people over age group of 65 years, usually triggering pain in the front of the thigh or the groin. As the cartilage wears away, the head of the thigh bone rubs directly against the inner hip socket. Splinters of bone and cartilage can interfere with normal hip movement.

Pain in the groin and front of the thigh is the most common symptom of hip arthritis, especially when walking or during activities that require twisting, like putting on socks or getting out of a car. The pain is caused by the hip bones rubbing against each other. The hip joint also may become swollen and stiff.

Hip Fractures:

Older individuals are susceptible to breaking a hip during normal everyday activities if their bones are weak due to osteoporosis. Although osteoporosis chiefly affects women, men over 65 are also at risk. Hip fractures are medical emergencies and require immediate surgery.

In addition, younger active individuals can develop stress fractures of the hip. When muscles become fatigued, they fail to absorb the shock of impact from jumping and other activities, and forces are transferred to the bone itself, causing tiny cracks. Stress fractures in the hip joint can cause severe hip pain.

Bursitis:

Bursitis is inflammation of any of the fluid-filled sacs protecting the body’s joints after an injury. Trochanteric bursitis affects the outer surface of the hip joint, producing pain while standing up, walking, climbing steps or driving etc.

Osteonecrosis:

Insufficient blood flow to bone can destroy bone cells, a process called osteonecrosis (also avascular or aseptic necrosis). Years of corticosteroid use to suppress the immune system for different medical conditions can cause osteonecrosis. The hip is the most common site affected by osteonecrosis.

Tendonitis:

The tendons – rope-like connective tissues connecting muscles to bone at the hip and other joints – can become painfully inflamed by repetitive and strenuous movement. Tendonitis is a common sports injury, caused by overuse of the same parts of the body.

Strains:

Strains are small tears in the muscle from overuse/irritation. Lower back strains can be caused by twisting, quickly turning, and “pulling” the muscles that support the spinal column. The back and hip muscles often become strained because the abdominal muscles are too weak to lend support.

Herniated Discs:

Falls and heavy lifting can injure the discs, the “shock absorbers” in the spinal column. They separate and cushion the vertebrae, but as we age the discs become more brittle and can rupture, or herniate. Pain from a ruptured disc in the lower spine radiates down the nerve extending from the spinal cord to the leg (sciatica).

Septic Hip:

Septic arthritis can develop in the hip during infancy and throughout childhood. Young immune systems may not be mature enough to kill bacteria that enter the bloodstream and settle in the hip, resulting in pain and limping. Fever, and warmth and redness over the hip, point to possible infection.

There are other possible causes of hip pain, ensure to consult a doctor if you:

  • Cannot walk normally because of the pain
  • Cannot bend hip joint
  • Experience hip pain for many days
  • Notice any deformity or swelling in the hip or upper thigh
  • Experience hip pain during nights or while resting
  • Develop a fever, with redness and warmth over the hip joint

Hip Pain Diagnosis:

The doctor or physiotherapist can work out what is causing the pain in the hip joint. They might examine how you stand, how you walk and what movements cause the pain. They may suggest blood tests and X-rays of the hip joint to diagnose the hip pain.

Treatments for Hip Pain:

Conservative care | Surgical care

Conservative care:

Most types of hip pain can be resolved with conservative care such as:

Rest:

When the hip is inflamed, as in bursitis, tendonitis or arthritis, it’s important to rest the joint and avoid overusing it.

Ice and Heat:

Ice packs are often useful to relieve pain, reduce inflammation and reduce muscle spasms. When applying the ice ensure to use something like a wet flannel between the ice pack and the skin for protection. Ice should be applied for 20 to 30 minutes.
Heat causes blood vessels to dilate (expand) this brings more blood into the area to stimulate healing of damaged tissues. It also has a direct soothing effect and helps to relieve pain and spasm. It can also ease stiffness by making the tissues suppler, and is therefore useful to do before stretching.

Physiotherapy:

Once doctor diagnoses the cause of the hip pain, physiotherapists can show the stretches and exercises to increase the flexibility and strength in the hip.

For problems such as bursitis, they can use ultrasound and massage techniques.

Physiotherapists can also advise about helpful aerobic exercises, such as swimming, aqua therapy or cycling, that won’t aggravate hip pain as high-impact activities would. Patient may be advised to lose weight to relieve pressure on the joints. Finally, physiotherapists will show the proper ways to sit, stand, lift and sleep which will help to avoid aggravating hip pain.

Pain Relievers:

Anti-inflammatory medicines can be purchased over the counter to relieve hip pain if needed.

Injections:

Steroids may be injected for hip problems caused by inflammation which will help to settle the inflammation down. When swelling is severe, fluid may need to be drained from the hip.

Weight control:

Maintaining a healthy weight or losing weight in case of overweight is good for the joints. Excess weight stresses the weight-bearing joints, such as the hip joint which contributes to cartilage damage. In addition, fat cells are believed to produce inflammatory cytokines that contribute to arthritis.

Surgical Options:

Hip problems like osteoarthritis will tend to worsen with patient’s age, and eventually conservative measures may not be enough to control the pain. At that point, the doctor may recommend undergoing surgery to get relieved from pain.

Common surgical options include:

  • Hip Replacement Surgery
  • Hip Resurfacing Surgery

Frequently Asked Questions:

  1. What causes hip pain?
  2. What is hip impingement?
  3. What are the common activities or sports that can impact the hip joint?
  4. What are the nonsurgical treatments available to someone with hip pain?
  5. Is there a way to relieve the hip pain?

1. What causes hip pain?

Hip pain can be caused by a number of factors including wear and tear (repetitive activity), accidents and injuries, arthritis, and poor blood circulation.

2. What is hip impingement?

Femoro Acetabular Impingement (FAI) occurs when the hip ball (head of the femur) does not have its own full range of motion within the socket. This causes a decreased range of hip joint motion, in addition to the pain. Most commonly, FAI is a result of excess bone that has formed around the head of the femur bone, otherwise known as “cam”-type impingement. FAI also commonly occurs due to overgrowth of the acetabular (socket) rim, otherwise known as “pincer”-type impingement, when the socket is angled in such a way that abnormal impact occurs between the femur and the rim of the acetabulum.

When the extra bone on the femoral head hits the rim of the acetabulum, the cartilage and labrum that line the acetabulum can be damaged. The extra bone can appear on x-rays as a seemingly very small “bump.” However, when the bump repeatedly rubs against the cartilage and labrum (which serve to cushion the impact between the hip ball and the socket), the cartilage and labrum can fray or tear, resulting in severe hip pain. As more cartilage and labrum is lost, the bone of the femur will impact with the bone of the pelvis. This “bone on bone” motion is most commonly known as arthritis which results in severe hip pain.

3. What are the common activities or sports that can impact the hip joint?

Nowadays, more athletes are being diagnosed with labral tears or impingement of the hip. This is very common in athletes who perform repeated hip flexion such as runners, hockey players, soccer players, martial arts competitors, wrestlers, skiers and football players.

4. What are the nonsurgical treatments available to someone with hip pain?

Non-surgical treatment should always be considered first when treating hip pain. In the case of hip impingement, it is possible to resolve the pain with rest, by modifying one’s behavior, and with a physiotherapy course. Such conservative treatments have been successful in reducing the pain and swelling in the joint. Know the best possible conservative treatments for hip pain.

5. Is there a way to relieve the hip pain?

An ultrasound-guided cortisone injection made directly into the hip joint can provide relief from pain. Ultrasound-guided cortisone injections using dedicated high-resolution ultrasound equipment are very precise and allow the radiologist to target the injections directly into an area, maximizing therapeutic outcomes.

Following the injection, pain relief varies from patient to patient. Generally patients may feel relief from pain within two to five days. If a patient feels no relief within ten days following the injection, the patient is unlikely to gain any additional improvement and further diagnosis has to be done to identify the source of the patient’s pain.

Exercises to reduce hip pain:

  1. Standing Iliotibial Band Stretch
  2. Seated Rotation Stretch
  3. Knee to Chest
  4. Supine Hamstring Stretch
  5. Hip Abduction
  6. Hip Adduction
  7. Hip Extension (Prone)
  8. Internal Hip Rotation
  9. External Hip Rotation

Standing Iliotibial Band Stretch:

Main muscles worked: Tensor fascia. One should feel this stretch at the outside of the hip

Step-by-step directions:

  • Stand next to a wall for support
  • Cross the leg that is closest to the wall behind the other leg.
  • Lean the hip toward the wall until one feel a stretch at the outside of the hip. Hold the stretch for 30 seconds.
  • Repeat on the opposite side, then repeat the entire sequence 4 times.

Useful Tip: Do not lean forward or twist at the waist

Seated Rotation Stretch:

hip pain exercise iIliotibial band stretch

Main muscles worked: Piriformis. One should feel this stretch in the buttocks, as well as at the sides

Step-by-step directions:

  • Sit on the floor with both legs straight in front. Cross one leg over the other.
  • Slowly twist toward the bent leg, putting the hand behind for support.
  • Place the opposite arm on the bent thigh and use it to help you twist further.
  • Look over the shoulder and hold the stretch for 30 seconds. Slowly come back to center.
  • Reverse leg positions and repeat the stretch on the other side. Repeat the entire sequence 4 times.

Useful Tip: Keep your sit bones pressed into the floor throughout the stretch.

Knee to Chest:

knee to chest hip exercise

Main muscles worked: Gluteus maximus, gluteus medius. One should feel this stretch in the buttocks.

Step-by-step directions:

  • Lie on the back on the floor with the legs extended straight out.
  • Bend one knee and grasp the shinbone with the hands.
  • Gently pull the knee toward the chest as far as it will go.
  • Hold the stretch for 30 seconds and then relax for 30 seconds.
  • Repeat on the other side, then pull both legs in together. Repeat the entire sequence 4 times.

Useful Tips: Keep the lower back pressed into the floor.

Supine Hamstring Stretch:

supine hamstring stretch hip exercise

Main muscles worked: Hamstrings. One should feel this stretch at the back of the thigh and behind the knee.

Step-by-step directions:

  • Lie on the floor with both knees bent.
  • Lift one leg off of the floor and bring the knee toward your chest. Clasp your hands behind your thigh below your knee.
  • Straighten your leg and then pull it gently toward your head until you feel a stretch. (If you have difficulty clasping your hands behind your leg, loop a towel around your thigh. Grasp the ends of the towel and pull your leg toward you.)
  • Hold for 30 to 60 seconds and then relax for 30 seconds.
  • Repeat on the other side, then repeat the entire sequence 4 times.

Useful Tip: Do not pull at the knee joint.

Hip Abduction:

hip abduction exercise

Main muscles worked: Gluteus medius, abductors. One should feel this exercise at the outer thigh and buttocks.

Step-by-step directions:

  • Lie on the side with the injured leg on top and the bottom leg bent to provide support.
  • Straighten the top leg and slowly raise it to 45°. Keep the knee straight, but not locked.
  • Hold this position for 5 seconds.
  • Slowly lower the leg and relax it for 2 seconds.
  • Repeat, then complete exercise on the other side.

Useful Tip: Do not turn the leg in an effort to raise it higher. The outside of the thigh should be lifted toward the ceiling.

Hip Adduction:

hip adduction exercise

Main muscles worked: Adductors. One should feel this exercise at the inner thigh.

Step-by-step directions:

  • Lie on the side of the injured leg with both legs straight.
  • Bend the top leg and cross it over the injured leg.
  • Raise the injured leg 6″ to 8″ off of the floor.
  • Hold this position for 5 seconds.
  • Slowly lower the leg and rest for 2 seconds.
  • Repeat, then complete exercise on the other side.

Useful Tip: Place the hand on the floor in front of the abdomen to prevent from leaning backward.

Hip Extension (Prone):

hip extension exercise

Main muscles worked: Gluteus maximus. One should feel this exercise in the buttocks.

Step-by-step directions:

  • Lie on the stomach on a firm, flat surface with a pillow under the hips.
  • Bend one knee 90°.
  • Lift the leg straight up as shown.
  • Slowly lower the leg down to the floor, counting to 5.
  • Repeat, then complete exercise on the other side.

Useful Tip: Keep the head, neck, and upper body relaxed during this exercise.

Internal Hip Rotation:

internal hip rotation exercise

Main muscles worked: Medial hamstrings. One should feel this exercise at the back of the thigh.

Step-by-step directions:

  • Lie on the side on a table or physical therapy bench with a pillow between your thighs. Place the lower arm in front of the body and use a pillow under the head for comfort, if needed.
  • Bring the top leg forward and lower the foot so that it is below the tabletop, as shown in the “start” position. Bottom leg can be slightly bent for balance.
  • Rotate the hip and lift the foot as high as possible, as shown in the “finish” position.
  • Slowly lower the leg back to the “start” position, counting to 5.
  • Repeat, then complete exercise on the other side.

Useful Tip: Stay centered on the side and do not lean the body forward or backward.

External Hip Rotation:

external hip rotation exercise

Main muscles worked: Piriformis. One should feel this exercise in the buttocks

Step-by-step directions:

  • Lie on the side on a table or physical therapy bench. Place the lower arm in front of the body and use a pillow under the head for comfort, if needed.
  • Bring the bottom leg forward and lower the foot so that it is below the tabletop, as shown in the “start” position. Top leg is mostly straight to help in balancing.
  • Rotate the hip and lift the foot as high as possible, as shown in the “finish” position.
  • Slowly lower the leg back to the “start” position, counting to 5.
  • Repeat on the other side

Useful Tip: Stay centered on the side and do not lean the body forward or backward.

Citations:

  1. Hip Pain – Healthshare Information for Guided Patient Management
  2. Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings.
  3. Chronic pain following total hip arthroplasty: a nationwide questionnaire study
  4. Hip Conditioning Program