Hip Pain Overview
Hip pain is a common complaint that can be caused by a wide variety of problems. The precise location of your hip pain can provide valuable clues about the underlying cause.
Problems within the hip joint itself tend to result in pain on the inside of your hip or your groin. Hip pain on the outside of your hip, upper thigh or outer buttock is usually caused by problems with muscles, ligaments, tendons and other soft tissues that surround your hip joint.
Hip pain can sometimes be caused by diseases and conditions in other areas of your body, such as your lower back or your knees. This type of pain is called referred pain. Most hip pain can be controlled with self-care at home.
Symptoms of Hip Pain
Depending on the condition that’s causing your hip pain, you might feel the discomfort in your:
- Inside of the hip joint
- Outside of the hip joint
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.
Causes of Traumatic Hip Pain
Falls are the most common reason that elderly people break a hip. The fracture is due to a combination of two effects of aging, osteoporosis (thinning of bones) and a loss of balance. These two risk factors are the potential cause of many falls. Occasionally, the bone may spontaneously break due to osteoporosis and become the cause of the fall.
Bones may also weaken because of other diseases that have affected the hip bones. A pathologic hip fracture describes this situation, and osteoporosis is but one cause. Other potential causes of bone weakening are cancer within the bones, benign tumors and cysts, Paget’s disease, and inherited diseases of bone.
When health-care professionals talk about a hip fracture, they really mean a fracture of the proximal or upper part of the femur. Fractures of the acetabulum are less common and usually are due to major trauma like a motor-vehicle collision or a fall down a flight of stairs.
The precise location of the fracture is important, because it guides the decision of the orthopedic surgeon as to which type of operation is needed to repair the injury.
Aside from a fall, any trauma can potentially cause a hip fracture. Depending upon the mechanism of injury, the femur may not break; rather, a portion of the pelvis (often the pubic ramus) may be fractured. The initial pain may be in the hip area, but examination and X-rays may reveal a source different than the hip joint as a cause of hip pain. Trauma can also cause a hip dislocation in which the femoral head loses its relationship with the acetabulum. This is almost always associated with an acetabular (pelvic bone) fracture; however, in patients with hip replacements, the artificial hip may dislocate spontaneously.
Contusions (bruises), sprains, and strains may occur as a result of trauma, and even though there is no broken bone, these injuries can still be very painful. Sprains are due to ligament injuries, while strains occur because of damage and inflammation to muscles and tendons (tendinitis: tendon + itis=inflammation). Because of the amount of force required to walk or jump, the hip joint is required to support many times the weight of the body. The muscles, bursas, and ligaments are designed to shield the joint from these forces. When these structures are inflamed, the hip cannot function and pain will occur.
Hip pain may also arise from overuse injuries in which muscles, tendons, and ligaments can become inflamed. These injuries may be due to routine daily activities that may cause undue stress on the hip joint or because of one specific strenuous event. Overuse may also cause gradual wearing away of the cartilage in the hip joint, causing arthritis (arth=joint + itis=inflammation).
Other structures should be mentioned as a cause of hip pain because they become inflamed. The iliotibial band stretches from the crest of the pelvis down the outside part of the thigh to the knee. This band of tissue may become inflamed and cause hip pain, knee pain, or both. This is a type of overuse injury that has a gradual onset associated with tightness of the muscle groups that surround the knee and hip. Piriformis syndrome, in which the piriformis muscle irritates the sciatic nerve in the buttock, can also cause significant posterior hip pain.
Bursa inflammation (hip bursitis)
The trochanteric bursa is a sac on the outside part of the hip that serves to protect muscles and tendons as they cross the greater trochanter (a bony prominence on the femur). Trochanteric bursitis describes the inflammation of this bursa. The bursa may become inflamed for a variety of reasons, often due to minor trauma or overuse.
Causes of Nontraumatic Hip Pain
Hip pain may be caused by a variety of illnesses. Anything that causes systemic inflammation in the body may also affect the hip joint. The synovium is a lining tissue that covers those parts of the hip joint not covered by cartilage. Synovitis (syno=synovium + itis=inflammation), or inflammation of this lining tissue, causes fluid to leak into the joint, resulting in swelling and pain.
- Osteoarthritis is the most common cause of hip pain in those over the age of 50; however, other types of arthritis can be present. These may include
- rheumatoid arthritis,
- ankylosing spondylitis,
- arthritis associated with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
- Some systemic diseases are associated with hip pain, including sickle cell disease, in which a joint may swell during a sickle crisis either with or without an underlying infection. The hip joint is not the only joint that may be involved.
- Viral or bacterial infections may cause hip inflammation. Examples include Lyme disease, Reiter’s syndrome, and infections caused by food poisoning.
- Avascular necrosis of the femoral head may occur in people who have taken corticosteroid medications like prednisone for a prolonged period of time. In this condition, the femoral head loses its blood supply, becomes weakened, and causes hip pain.
- Legg-Calvé-Perthes disease (or just Perthes disease) describes avascular necrosis of the femoral head in children and is idiopathic, meaning the cause is unknown. It usually affects males between the ages of 4 and 8.
- Fibromyalgia is a systemic pain syndrome associated with pain and stiffness that can cause significant discomfort throughout the body and may manifest as hip pain. There may be associated sleep disorders, muscle cramps and spasms, tenderness of a variety of muscle groups in the whole body, and fatigue.
Referred hip pain
Hip pain may not originate in the hip itself but may be felt there due to issues in adjacent structures.
- A hernia or defect of the abdominal wall may cause pain in the front part of the hip. A hernia occurs when there is a weakness or tear in an area where muscles of the abdominal wall come together. They are named according to their location; inguinal (groin) hernias are most common. Femoral hernias are another type of hernia that might also cause hip pain.
- Peripheral nerves can become inflamed, causing hip pain. Meralgia paresthetica occurs when the lateral femoral cutaneous nerve of the thigh becomes irritated. This condition is seen most commonly in pregnancy, in people wearing tight clothes, or in people with diabetes.
- Sciatica, or inflammation of nerve roots from the spinal cord, may also present with hip pain. There are a variety of reasons for the sciatic nerve to become inflamed, including spinal stenosis due to osteoarthritis of the lumbar spine, ruptured or bulging disks in the vertebral column of the back, and spasms of the muscles that support the low back. Piriformis syndrome describes sciatic nerve inflammation that causes buttock and posterior hip pain due to sciatic nerve irritation as it travels through the buttock muscles.
How is Hip Pain Treated?
The treatment of hip pain depends on what is causing it. For exercise-related pain, rest is usually enough to allow the hip to heal. This type of pain is typically gone within a few days.
For pain that could be related to a condition such as arthritis, your doctor will ask you a range of questions: Is the pain worse at a particular time of day? Does it affect your ability to walk? When did your symptoms first present? You may be required to walk around to let your doctor observe the joint in motion.
To diagnose arthritis, your doctor will perform a number of fluid and imaging tests. Fluid tests involve taking samples of blood, urine, and/or joint fluid for testing in a laboratory. Imaging tests may include X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), and ultrasounds. Imaging tests will provide your doctor with detailed views of your bones, cartilage, and other pertinent tissues.
If arthritis is diagnosed, you will be prescribed medications to relieve pain and stiffness. You may also be referred to a specialist who can offer further advice, and a physiotherapist for exercises to help keep the joint mobile.
For injuries, treatment typically involves bed rest and medications, such as naproxen, to relieve swelling and pain.
Hip fractures, malformation of the hip, and some injuries may require surgical intervention to repair or replace the hip. In hip replacement surgery, the damaged hip joint is replaced with an artificial one. Although hip replacement surgery will take some physical therapy to get used to the new joint, according to the experts at the Mayo Clinic, it is successful greater than 90 percent of the time (Mayo).
Some holistic therapies can provide relief from hip pain. Make sure you discuss treatment options with your doctor before undergoing any alternative treatment.
Possible holistic therapies include seeing a chiropractor for an adjustment, or having acupuncture, which involves the placement of very small needles into key body areas to promote healing.