Hip Pain

Written by Rebecca Parsons

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Hip Pain Conditions

The hip joint is a ball and socket joint formed from the femur (thigh bone) and the acetabulum of the pelvis (hip socket). The anatomy of the hip best allows weight-bearing and stability as opposed to large ranges of movement.
Below are several conditions that can cause hip pain:

Osteoarthritis. Hip osteoarthritis is one of the most common locations of osteoarthritis in the body. It is caused by the cartilage thinning resulting in the underlying bony surface to rub. This in turn causes inflammation of the tissues surrounding the joint, further cartilage damage and osteophytes (bony growths) to develop within the joint leading to the common symptoms of pain and stiffness. Osteoarthritis is a common degenerative joint disorder that can occur with advancing age. People are more prone to develop OA if they’ve had previous trauma to the hip or an abnormality in the structure of the hip (such as hip dysplasia).

Trochanteric Bursitis. This is the inflammation of a fluid filled sac (bursa) on the outside of the hip. This causes pain on the outside of the thigh that can be aggravated by lying on the affected side, walking up stairs and getting up from a low chair or car. The main goals with treating this condition are to reduce any pain and inflammation whilst preserving the joint mobility. In many cases the cause is unknown but is often due to injury, overuse or stress on the joint tissues due to arthritis or poor posture.

Femoroacetabular impingement (FAI). FAI is a condition caused by abnormal bone growth and can occur in any age. With this condition, many patients experience reduced movement and pain. There are 2 types of deformities: ‘cam’ and ‘pincer’. Both can present as a deep ache in the groin during or after repetitive hip flexion – meaning exacerbating activities include things such as climbing, running (particularly up hills) and prolonged sitting. Pincer deformities can also cause pain in the upper buttock area, aggravated by repetitive hip hyperextension such as downhill walking and speed walking.

Iliotibial band (ITB) syndrome. This condition refers to a specific strain of a ligament in the thigh, often caused by overload in running. This causes a sharp pain on the outside of the knee but occasionally towards the hip, people may also experience swelling and the area may be tender to touch. This pain will become aggravated by running downhill, or increase with activity , if the issue gets worse, it may start to affect you when you complete everyday activities such as walking up and down stairs and sitting with knees bent. Treatment for this is rest. However if it is a common occurrence then it’s best to get this investigated by an Osteopath or Physiotherapist to see if your biomechanics predispose you to getting this recurrently.

Labral Tear. Many labral tears have no symptoms however some people get stiffness and pain in the hip or groin aggravated by sitting, standing or walking for long periods of time and a locking/catching sensation in the joint. This injury normally occurs from trauma, people with structural abnormalities in the joint and in sports with repetitive twisting/pivoting such as golf, football or dancing.

Hip fracture. A break in the bone within the hip joint. This is most commonly seen in older people particularly those with osteoporosis after a fall. Hip fractures will cause sudden acute pain, swelling and an inability to weight bear through the affected leg.

Meralgia Paresthetica. This condition is due to the entrapment of a single nerve called the ‘lateral femoral cutaneous nerve’ which supplies sensation to the outside of the thigh. Symptoms mimic numerous other conditions so it often goes misdiagnosed. Symptoms include pain (stabbing, burning and aching) and numbness in the outside portion of the thigh. There are a number of causes of meralgia paresthetica such as being overweight, pregnancy, wearing tight clothing. It can also be as a result of some medical conditions including diabetes, hypothyroidism and alcoholism.

Septic arthritis/Osteomyelitis. Is an infection within the bones of the hip joint or within the joint. This causes sudden severe joint pain, usually accompanied by swelling, fever and a general feeling of being unwell. Symptoms tend to develop quickly and can progress over a few days. Septic arthritis/osteomyelitis occurs when bacteria gets into the joint, this is most likely after complicated joint surgery, injuries to a joint (including a bad skin injury) and if there is infection elsewhere in the body that can get into the joint via the bloodstream. It needs treating as soon as possible, usually by hospital care, otherwise complications can occur.

Muscle strains. Hip muscle strains are most commonly an acute injury when a muscle or tendon is stretched beyond its limit or torn. These can also happen over time from deterioration of these structures. Most strains resolve with at home treatment but some may require help from manual therapy or even surgery. These can cause pain and tenderness in the area and increased pain while using the injured muscle/tendon. Other symptoms can include swelling, reduced range of movement and weakness. You are at increased risk of a strain if you’ve had a prior injury in the same area, muscle tightness and neglecting to warm up properly prior to exercise.

Hip Dysplasia. Hip dysplasia is a condition in which the hip joint is in the wrong shape or the hip socket is not in the correct position to completely cover and support the top of the leg bone (hip dysplasia). This is often congenital (present at birth) and with an early diagnosis, children are able to walk properly with full movement, but, there are a few cases that go undiagnosed until later in life. This will present later in life with a limp and/or hip pain in the groin area or outside of the hip often with a catching/popping sensation that will tend to increase with activity and relieve with rest.

Hip Pain can also be referred from the lumbar spine (low back), kidneys, reproductive system and cardiovascular system so its important to seek attention from a trained professional if you’re unsure why an issue has occurred or its not resolving as expected. .

How is hip pain diagnosed?

In many cases of hip pain and injuries, people will seek the help of a doctor or manual therapist including a physiotherapist or osteopath. During a consultation they will take an in-depth case history followed by an assessment of the area, and surrounding joints and structures in order to diagnose your cause of hip pain and allow you to understand what is going on.
After the assessment and examination, it may be deemed that further testing may be necessary, these may include:

Blood tests – although not routinely used to diagnose hip pain, it may be requested to seek out any signs of autoimmune conditions, infections and inflammation that may be contributing to the pain.

X-ray imaging – ontop of being able to diagnose bone fractures, an x-ray will show how much space there is between the femur (thigh bone) and acetabulum (hip socket). No space or an abnormally small space indicates cartilage loss. Bone spurs may also be seen, these are seen in most x-rays of patients over 50, but we may see many more in those with osteoarthritis as the body tries to compensate for the cartilage loss. X-rays aren’t always needed to diagnose osteoarthritis as on many occasions the extent of degeneration doesn’t always correlate with the account of pain experienced.

Magnetic resonance imaging (MRI) – if any abnormalities aren’t present in an X-ray and symptoms persist an MRI may be requested. This shows up any issues within the soft tissues of the body and can be used to diagnose muscle abnormalities, labral tears and bursitis and will be requested if more worrisome symptoms suggest infection of the bone or bony tumours.

Bone density scan – (DEXA) – these scans are able to help diagnose osteoporosis. Osteoporosis is a condition in which bones are weaker than normal and much more susceptible to breaks. A DEXA scan will be requested if this is suspected.

What are the treatment options for Hip Pain?

Treatment for hip pain can vary depending on the condition and the activities that a person does.

Non-surgical options include:

P.R.I.C.E – In some instances, hip pain can be resolved using at-home treatment using the P.R.I.C.E method (Protection, Relative Rest, Ice, Compression and Elevation).

Physical Therapy – Physical therapists such as osteopaths or physiotherapists will use a variety of techniques to help decrease pain, increase range and quality of hip movements and advice on rehab exercises to help facilitate your recovery. Techniques used may include joint articulation, mobilization and soft tissues massage. Some therapists may also use taping, medical acupuncture and exercise rehabilitation.

Medication: If you decide to visit your GP/pharmacist for your hip pain you may be prescribed oral medication to help relieve your symptoms. Most commonly these will be painkillers such as paracetamol and cocodamol or anti-inflammatories such as ibuprofen and naproxen. Occasionally you may require muscle relaxants such as diazepam to control muscle spasms in order for you to be able to perform stretching exercises to aid your recovery. If the pain is severe and chronic, your GP can prescribe antidepressants as these can assist when the nerves are too sensitive.

Steroid Injection: If your pain has been caused by inflammation or bursitis, steroid injections may be suggested by your GP. This involves an injection, under local anesthesia, to reduce the inflammatory response in these tissues, giving you temporary relief from your hip pain.

Surgical Options:

Not everyone with hip pain will require surgery however most hip fractures need ‘fixation’ to stabilize the bone or a replacement of the ball of the hip.

Hip replacement: For those with worsening arthritis your GP may speak to you about a surgical referral. In this surgery the hip joint is replaced with a prosthetic implant to replicate a normal-moving hip joint. Many people only require hospital stays of a few days. Physiotherapy and occupational health is important following surgery to aid with adjusting and managing with the new prosthetic.

Revision surgery: In a few cases, previous replacement surgery can become loose, infected or fail for other reasons. It is possible to get this repaired with revision surgery. Stays in hospital will tend to be longer than the first replacement and the recovery is longer. As before, you’d need assistance with day-to-day activities following surgery and support from a recovery team such as occupational health and a physiotherapist.

Acetabular labrum surgery: In the case where a person has a labrum tear and movement is greatly limited, this can be repaired with reshaping of the labrum. This is usually done through key-hole surgery and requires only a short hospital stay. Exercises rehabilitation is key post surgery.

What are the best exercises for hip pain?

Hips, like all other joints in the body, need regular movement and stretching in order to maintain their optimal health, movement and function. Keeping them this way allows them to respond to challenges of daily activities and any stresses that they are subjected to. With all stretches and exercises keep in mind:

  • Exercises that are causing your pain to worsen or causing your injury to become progressively worse, should be reduced or stopped completely.
  • Exercise should have a positive impact on your condition if done correctly. If you don’t have good technique and are completing stretches incorrectly you can also cause or worsen hip pain or injury. If you need help or advice then don’t be afraid to speak to an expert such as a personal trainer or a physical therapist such as an osteopath or physiotherapist.

It is recommended to get the OK from your osteopath, physical therapist or GP before trying out any of these exercises.

Hip flexor stretch:

  • Kneel on one knee to create a 90° angle with the opposite hip.
  • Tilt your pelvis forward to flatten your low back.
  • Lunge forward to feel a stretch in the front of your hip of the backwards leg.
  • Ensure the upper part of your body is upright and your lower back is not arched.
  • To increase the stretch, make sure you have a surface nearby to stabilize on, and flex the lower part of your backward leg towards your hips.

Glutes/Piriformis Stretch:

  • Lie on your back and lift one knee to your chest.
  • With the opposite arm, pull your knee across your chest to the opposite shoulder until you feel a stretch deep in your glutes.
  • Hold for 30 seconds, relax and repeat 5-6 times.

Butterfly (inner thigh) stretch:

  • Sit on the floor and bring both heels together as close as possible to your body.
  • With your hands pull your forefoot towards your body until you feel a comfortable stretch in your groin/inner thigh area.
  • Hold for 30 seconds, relax and repeat 5-6 times.

Hamstring Stretch:

  • Place one foot forward, pressing your heel into the ground and bring your toes towards your shin.
  • Whilst keeping your back straight, hinge forwards from your hips and place your hands on your thigh above the knee for balance.
  • Lower the upper part of your body until there is a comfortable stretch at the back of the front leg.

Hip balancing:

  • Stand on one leg with your hips level.
  • With the free leg, reach forward as far as you can whilst slightly bending the supporting knee to balance.
  • Return to the centre without putting your foot on the floor.
  • Reach the free leg out to the side as far as you can and again return to the centre without putting your foot on the floor.
  • Reach across the other side as far as you can and then return to the centre.
  • Repeat the sequence as many times as you can whilst maintaining your balance and without touching the floor with the free leg.

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