Hip Pain: Causes and Treatment
The hip joint is the largest joint of the body and allows for the movement of the leg. Even though it is an extremely strong joint covered in an extensive amount of connective tissue and muscle it can still cause pain. The hip joint bears the responsibility of supporting your entire upper body weight and this can cause hip related arthritis issues over time. Arthritis means joint inflammation.
The connective tissue of the joint can wear down or injury can occur. This, of course, can be more common and detrimental as we age. The hip joint is made of connective tissue, bone, and muscle, but also contain blood vessels and nerves. Many people mistake hip pain on the outside of their pelvis to be true hip joint pain, however, this is typically untrue. If it is the hip joint itself, many times, the pain will be felt in the groin portion of the thigh, where the leg meets the torso.
When experiencing hip pain, the most important information for the clinician is the history of the presentation and current status of the hip pain. Then the clinician will perform a physical examination of the hip in order to better narrow down the potential cause of your pain. Sometimes this requires imaging studies such as an x-ray or magnetic resonance imaging (MRI) tests.
Symptoms of Hip Pain
Depending on the condition that’s causing your hip pain, you might feel the discomfort in your:
- Thigh
- Inside of the hip joint
- Groin
- Outside of the hip joint
- Buttocks
Sometimes pain from other areas of the body, such as the back or groin (from a hernia), can radiate to the hip.
You might notice that your pain gets worse with activity, especially if it’s caused by arthritis. Along with the pain, you might have reduced range of motion. Some people develop a limp from persistent hip pain.
When evaluating the cause of the hip pain there are multiple tissue types to consider. Here are some common causes of hip pain:
- Osteoarthritis. Many times, referred to as the “wear and tear” form of arthritis. This occurs when connective tissue in the hip joint breaks down and your hip joint is no longer cushioned as well. This degradation of joint tissue leads to joint stiffness and pain with movement of the joint, typically made worse with weight bearing movements.
- Rheumatoid arthritis. This illness is an autoimmune disease where your own body signals for tissue around your joint to become inflamed. This is typically hereditary and seen more often in those of Scandinavian ancestry. Rheumatoid arthritis occurs most often in those over the age of 60 and occurs twice as often in women. This pain can result in morning stiffness which improves upon movement.
- Hip fractures. With advancing age, bone can become weak and fragile. This can result in fractures, sometimes with or without trauma, such as a fall. This makes weight bearing difficult and very painful. It may even result in the inability to move the hip. An x-ray is needed for the diagnosis, and it may require surgery.
- Tenonitis. Tendons are the thick bands of tissue that attach bones to muscles. Tendinitis is inflammation or irritation of the tendons. It’s usually caused by repetitive stress from overuse. Repeated activities can put strain on the muscles, tendons, and ligaments that support the hips. When they become inflamed due to overuse, they can cause pain and prevent the hip from working normally.
- Avascular Necrosis. This condition happens when blood flow to the hip bone slows, and the bone tissue dies. Although it can affect other bones, avascular necrosis most often happens in the hip. It can be caused by a hip fracture or dislocation, or from the long-term use of high-dose steroids (such as prednisone), among other causes. This is typically well visualized on a simple x-ray.
As stated earlier, each type of tissue may result in hip pain. Nerve impingement may result in sciatica or meralgia paresthetica. Avascular necrosis is a vascular disorder of the hip. Tears of the surrounding ligaments and tendons may occur. Even the lymph nodes located in the groin portion of the thigh may be inflamed secondary to an infectious or cancerous process. It is important to consider every layer and level of anatomy when assessing for any joint pain.
Hip Pain Treatment:
Most commonly joint pain treatment is initially rest, ice, elevation, and compression (RICE). For the hip joint, compression may not be feasible, but the rest is recommended. After 48 hours it is recommended to switch to heat over the area of pain. Rest is the most important because it takes time to heal issues of the bones and connective tissue. One of the primary reasons for this is there is a lack of cells and blood flow to these areas. With this lack of blood flow there is then a lack of healing nutrients and oxygen getting to the damaged tissue.
Initial medication therapy typically involves the non-steroidal anti-inflammatory drugs such as ibuprofen (Advil), naproxen (Aleve), or acetaminophen (Tylenol). Diseases such as rheumatoid arthritis may be initially well managed with medicine such as the NSAIDs but typically require medicines which lessens the immune response so less damage occurs to the joints involved.
Stretching after a week or so of resting is typically recommended and is the primary mode of prevention. Regular stretching results in the tendons and ligaments being more flexible and so is less susceptible to injury. Similarly, exercise, especially swimming, is particularly good at preventing future injuries. Swimming and recumbent bicycles are excellent ways to increase joint stability, reduce pain, all while being low impact on the joint. Physical therapy is a superb way to treat joint pain as well as help with prevention.
Unfortunately, severe cases such as those involving the bones breaking may require surgery. In these cases, imaging is required and physical therapy after the surgery is absolutely crucial for long term success.
Get medical help right away if:
- A fall or other injury triggered the hip pain.
- Your joint looks deformed or is bleeding.
- The pain is intense.
- You can’t put any weight on your hip.
- You can’t move your leg or hip.
It is best to see your healthcare provider sooner rather than later. For as they say, “an ounce of prevention is worth a pound of cure.”
