All You Need to Know About Hip Pain

Our hip joint is a marvel of flexibility – they confer power when we stride and also absorb the impact when we jump. However, it can also take a beating, causing pain in the hip when it happens.

Hip Anatomy

The hip joint is one of the largest and most durable ball-and-socket joints in the body. The head of the thighbone (“ball”) sits inside the acetabulum (a hollow “socket”) in the pelvis. This call-and-socket joint allows the legs to move back and forth and side-to-side, as well as rotate, pointing toes inward and outward.

Both the thighbone and the acetabulum are rimmed with articular cartilage (labrum). It is an extremely robust and thick rubbery material that acts as a “shock absorber” to buffer the friction between the bones. Along with cushioning your hip joint, the cartilage acts like a rubber seal to hold the thighbone securely within the acetabulum.

Muscles and tendons also play a pivotal role in hip anatomy. The hip muscles run from the lower spine and pelvis, join together, then attach by a tendon to the upper thigh. The iliopsoas muscle is a workaholic muscle – it continuously flexes your hip, rotates your thigh bone, and bends your trunk towards your thigh. The iliopsoas tendon runs over the edge of the pelvis – it helps you bend your leg up. The hip flexors are muscles that extend from the hips to the knees – they are responsible for the range of motion in the legs and hips. The gluteus medius muscle surrounds the hip from the buttocks to the bony point of the hip bone – it lifts your leg to the side.

Bursae are small fluid-filled sacs, which act as cushions to reduce friction between tissues such as bones, muscles, and tendons. Each hip was two major bursae – the greater trochanteric bursa (at the outer point of the hip) and the iliopsoas bursa (on the inner aspect of the hip).

With age and overuse, any of these hip structures can wear down or be susceptible to injury, resulting in hip pain.

Causes

Hip pain can occur for a myriad of reasons. The precise location of your hip pain, along with other symptoms, can confer valuable clues about the underlying cause.

Issues with the hip joint itself usually trigger pain on the inner side of the hip or the groin. Injury of the soft tissues surrounding the hip joint tends to trigger pain on the outer side of the hip, outer buttock, or upper thigh. Hip pain may also be caused by pain that radiates from other parts of the body, such as your lower back – this is called referred pain.

Hip osteoarthritis

Hip osteoarthritis is a common cause of hip pain in older adults. It occurs when inflammation and injury to the hip joint cause a breaking down of cartilage tissue, resulting in pain and swelling around the hip.

Symptoms of hip osteoarthritis include:

  • Stiffness in the hip joints as you get out of bed or after you sit for a long time
  • Pain, tenderness, and swelling in the hip joint
  • Inability to move the hip to put on your shoes or socks
  • A crunching when the bone rubs against adjacent bone

In extreme cases, the leg can become shorter, and the hip can become fixed in a bent position. Also, hip osteoarthritis can change its biomechanics, causing ligaments, tendons, and bursa to undergo friction and tear. Furthermore, bone spurs (osteophytes) may also form on the hip bones, causing friction.

Rheumatoid arthritis

Although rheumatoid arthritis (RA) is most commonly associated with smaller joints of the hands and wrists, it can also affect larger joints, such as the hips.

Symptoms of hip RA include severe pain, swelling, and stiffness. You may also experience referred pain in the thigh and groin. Other symptoms of RA include fatigue and loss of appetite.

Psoriatic arthritis

Psoriatic arthritis usually begins in the small joints several years following the onset of psoriasis (1). It may also affect larger joints, including the hip.

Symptoms of psoriatic arthritis include pain and swelling of joints, tenderness where muscles or ligaments attach to the bones, and inflammation of the spinal column (spondylitis).

Ankylosing spondylitis

Ankylosing spondylitis is a type of arthritis that mainly affects the spine. The pain may radiate to the hip area.

Symptoms include:

  • Appetite loss
  • Low-grade fever
  • Malaise (a general feeling of discomfort)

Paget’s disease of bone

Paget’s disease of the bone occurs when the bone remodels abnormally, causing it to weaken. It usually affects the hips, pelvis, lower back, and arms. There is also a higher risk of bone fractures.

Common symptoms include:

  • Hip pain
  • Bowed legs (the knees are wider apart than usual)
  • Tingling and numbness down the legs
  • Hearing loss
  • Headaches

Hip fracture

A hip fracture is a severe injury, such as during a fall or when a strong force hits you. It tends to occur at the thighbone (top part of the femur) near the hip joint, with potentially life-threatening complications.

Symptoms of a hip fracture include:

  • Severe pain in your hip or groin
  • Inability to move upon impact
  • Inability to put weight on the side of your injured hip
  • Shorter leg on the injured hip side
  • Stiffness, swelling and bruising in and around your hip area

Hip fracture risk increases with age, as the bone becomes brittle and weak due to osteoporosis.

Strain or sprain

Repeated activities can strain or sprain the muscles, ligaments, and tendons that support the hips. Common causes include:

  • A fall or trauma
  • Sports injuries
  • Lifting something heavy
  • Twisting the hip in an awkward way

Symptoms include:

  • Muscle pain or weakness
  • Tenderness
  • Reduced range of motion

When they become inflamed, you can feel pain in the hip. The discomfort worsens with activity and gets better with rest.

Hip bursitis

Hip bursitis is the inflammation of the hip bursae. It is usually due to repetitive activities that irritate or overwork the hip joint.

Trochanteric bursitis

Trochanteric bursitis occurs when the bursa covering the greater trochanter (the bony lateral point of the hip) becomes inflamed. You may feel pain at the outside of the hip, which may also reach the outer thigh. Initially, the pain may be sharp, before fading into a dull ache. The pain will worsen with activities such as walking or climbing pain.

Iliopsoas bursitis

A less commonly affected bursa is the iliopsoas bursa, which is located on the inside (groin side) of the hip. Iliopsoas bursitis can trigger pain that starts around the front of your hips, which may also radiate to the thighs and buttocks, making it difficult to move. You may experience stiffness and tightness in the mornings. The discomfort may initially be mild, before intensifying over time.

Hip tendonitis

Hip tendonitis is a degenerative injury that causes the hip tendon fibers to disorientate. It occurs when the hip tendon is under extreme strain from activity that you are not used to doing. Other causes of hip tendonitis include repetitive stress from overuse or sudden progression of exercise without adequate training. Due to the restrictive blood supply in the tendons, they are slow to heal.

Symptoms of hip tendonitis include:

  • Pain that develops gradually over time
  • Pain that lessens after a warm-up but intensifies later in the day
  • Hip stiffness in the morning or after prolonged rest
  • Tenderness on the hip where the tendon starts
  • Discomfort when contracting the muscles of the hip

Hip labral tear

Hip labral tear refers to a rip in the ring of labrum cartilage that lines the outer rim of the socket of your hip joint.

Repetitive twisting movements may increase the risk of developing hip labral tears. It is especially common in athletes who participate in sports such as ice hockey, soccer, golf, and ballet. Structural abnormalities of the hip can also cause a hip labral tear.

Many hip labral tears have no symptoms. However, you may occasionally experience:

  • Pain in your hip or groin
  • A clicking, locking or catching sensation in your hip joint
  • Stiffness or limited range of motion in hip joint

Hip dysplasia

Hip dysplasia occurs when the hip socket doesn’t fully cover the ball portion of the upper thighbone, causing the hip joint to become partially or completely dislocated. Hip dysplasia can damage the cartilage lining the hip joint, potentially resulting in a hip labral tear.

Most people with hip dysplasia are born with the condition. Mild cases of hip dysplasia might be asymptomatic until you enter your teenage years or young adulthood.

Pinched nerve

A pinched nerve occurs when too much pressure is exerted on a nerve by adjacent tissues, bones, or muscles. The pressure interrupts proper nerve function, causing shotting pain, tingling, numbness, and weakness.

Pain from this condition usually persists for a short period and often results in no permanent damage if treated. However, if there’s persistent pressure on a nerve, you may experience chronic pain and may be at an increased risk of permanent nerve damage.

Avascular necrosis (osteonecrosis)

Avascular necrosis (osteonecrosis) occurs when the top of the femur lack adequate blood supply, so the bone tissues die (2). Dead bone breaks easily and eventually collapse. Although it can affect other bones, avascular necrosis most often affects the hip.

You may not experience any symptoms in the early stages of avascular necrosis. As the condition progresses, the hip joint might hurt when you put weight on it. It causes a throbbing ache in your hip and groin. The pain is severe and constant, but it gets worse with standing or movement. 

Legg-Calve Perthes disease (in children)

Legg-calve Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the thighbone (the rounded head of the femur) is temporarily disrupted. Without an adequate blood supply, the bone cells die via avascular necrosis.

One of the earliest signs of Legg-Calve Perthes disease is the way your child walks and runs, such as during sports activities. Your child may have limited motion, limp, or develop a peculiar running style due to irritability within the hip joint.

Femoroacetabular impingement (FAI)

Femoroacetabular impingement (FAI) occurs when the ball and socket don’t move freely through their normal range of motion. This may happen when the top of the ball isn’t completely round or because the socket is too deep.

Cancers

Although it’s rare, hip pain can be an indication of tumors that derive from the bone or that spread to the bone. Some types of cancer can cause hip pain, including:

  • Primary bone cancer
  • Metastatic bone cancer
  • Leukemia

Diagnosis

See your doctor if your hip pain doesn’t improve after two weeks or if the pain is severe. You may be referred to an orthopedic surgeon or a sports medicine specialist if required.

Medical history

A doctor will begin the diagnosis by first reviewing your medical history and symptoms. Your doctor will ask about your pain and what movement make it feel worse. They’ll ask how your symptoms started, how they affect your daily activities, and whether you’re in pain at night.

Physical examination

During a physical exam, your doctor will check for tenderness around your hip. Your doctor might also move your leg around to see if your range of motion has been restricted. They’ll examine your hip to determine its flexibility, and this will usually give them adequate information to plan your treatment regime.

Imaging tests

You may also need a scan to help pinpoint the source of hip pain.

X-rays

X-rays are often the best diagnostic test because they show any fractures or damage to the bones. However, they’re not useful for looking at the soft tissues around the joint.

CT scans

CT scans combine a series of X-ray images to show sections of the hip, which a computer then compiles to form a 3D image. It can help to diagnose any anatomical abnormalities around the hip region.

MRI scans

MRI scans use radio waves to build an image of the soft tissues, such as the muscles, ligaments, and tendons. They’re particularly helpful for diagnosing avascular necrosis.

Ultrasound scan

An ultrasound scan can help check your joints and tendons for any potential damage.

Blood tests

If your doctor thinks an infection or rheumatoid arthritis causes your hip pain, a blood test might be needed to confirm.

Treatment

Treatment options will depend on the severity and cause of your hip pain. Some people will recover with conservative treatments, while others may require surgery.

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen (Motrin IB, Advil) and naproxen sodium (Aleve), can relieve pain and inflammation. You can either obtain NSAIDs over-the-counter or with a prescription. Use NSAIDs cautiously and for limited periods to avoid adverse side effects.

Topical anti-inflammatory medications

You can massage anti-inflammatory creams or gels onto the hip. However, some hip problems are so deep within the hip joint that this may not help.

Electrical stimulation

Electrical stimulation of muscle tissue around the hip may help to strengthen the muscles that support the joint. It may also increase blood flow to the tissues around the hip joint to relieve pain and promote healing.

Physical therapy

A physical therapist can teach you gentle hip exercises to maximize hip strength and stability, prevent stiffness, and increase the range of hip joint movement. They also show you how to minimize movements that put stress on your hip joint. Furthermore, they may perform manual manipulation or massage of the soft tissues and joints.

Occupational therapy

An occupational therapist can help you regain independence in the workplace by showing you how to change your movements to minimize pain. They can also advise you on the adaptations that could reduce the strain on your hip at home, work, or while you’re driving.

Steroid injections

Steroid injections may help if your pain is triggered by inflammation or bursitis in or around your hip. If pain and inflammation recur, another injection or two, given a few months apart, may be needed. It is essential to limit the number of doses, as prolonged corticosteroid injections may damage the surrounding tissues.

Surgery

If conservative treatments don’t relieve symptoms, your doctor may recommend surgery. Hip replacement surgery is generally safe, but you may require rehabilitation afterward.

Lifestyle modifications

When the pain in your hip is mild to moderate, it can usually be treated at home.

Ice or heat

Hold ice wrap or cold compress on your hip for about 15 minutes in a 4-hour interval. The cold numbs the area, which can reduce pain and may cut down on swelling and inflammation.

Conversely, you can use a warm compress or heating pad may help prepare your muscles for stretching exercises that can lessen pain.

Rest

Try to rest the affected joint as much as possible to give it time to heal; however, you should avoid prolonged sitting to prevent hip stiffness. Avoid repeated bending at the hip and direct pressure on the hip.

Exercises

After a few days of rest, as soon as the pain begins to ease, start some gentle exercise to keep your muscles working, and stop your hip from getting stiff. Start by exercising gently and build up the intensity gradually.

As well as specific hip exercises, it’s a good idea to improve your general fitness. Low-impact activities such as a brisk walk or swimming will ease the strain off your hip by strengthening other muscles in the body. Even if you’re feeling better, you should keep exercising regularly to prevent the pain from recurring.

Improve posture and ergonomics

Lessen the strain on your hip by incorporating an ergonomic workstation. Find proper footrest, lumbar support, or other ergonomic equipment. Use a walking stick or cane if it helps reduce your hip pain when walking. Stand on a rubber anti-fatigue mat if you need to stand up to do work.

Avoid sitting in low chairs as it bends the hip more and might exacerbate your pain. Avoid sitting on a hard surface, such as a wooden bench or chair. Also, avoid sitting on something soft like a bed or sofa. A firm surface that allows you to sink into it slightly will support the hips better.

The Bottom Line

Hip pain is usually not severe and can be managed. However, some conditions require long-term care and need to be evaluated by a doctor.

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