Hip Pain, What is it?
Hip pain can be a terrible thing to live with. The hip is the largest joint in the body. Its purpose is to be a shock-absorber as well as to withstand friction, tolerate heavy weight bearing, and perform repetitive movements. It also connects the legs to the torso.
The hip is complex in nature because it is structurally designed for multi-directional movements, yet at the same time, it is also designed to be a stable joint to withstand load bearing weight from the body and the activities we do every day.
The hip joint is a ball-and-socket joint. The thigh bone (called the femur) is rounded and fits neatly and tightly into a socket, a part of the pelvis, called the acetabulum.
Cartilage within the socket to helps cushion and protect the integrity of the joint. By design, the femur swivels within this space which allows movement of the legs. Muscles, tendons, and ligaments surrounding the hip contribute to movement while also stabilizing the joint and preventing the femur from dislocating or “popping out” of the socket.
Hip joints are powerful and can withstand a significant amount of wear and tear, yet despite this, hip pain is a common phenomenon. The location of hip pain can provide a clue as to the primary cause.
If pain is in the front groin area, then most likely the pain is coming directly from the hip joint itself. Arthritis or labral tears are common causes of anterior hip pain, but there are other factors that may cause hip pain in this area, too.
Hip pain in the outer part of the hip or buttock area is frequently related to soft tissue like muscles, tendons, or ligaments that surround the area. Overuse or muscle imbalances can play a key role in how the hip functions. It is a delicate balance where over- or under-performance of any particular soft tissue in the area may cause irritation or pain.
Hip pain may be also be “referred” which means the source of the pain is somewhere else within the body, with the lower back commonly being responsible.
What causes hip pain?
Trauma, or an injury to the area does occur, resulting in pain. There are of course other less obvious reasons of why one may develop hip pain.
- Arthritis– irritation and breakdown in the cartilage of the joint
- Bursitis-inflammation of a fluid-filled sac whose purpose is to allow the tissue within the joint to glide and move with stress
- Dislocation-the femur is partially or fully removed from the socket; this is a medical emergency
- Fracture-a cracking, splintering, or breaking of a bone; this is a medical emergency
- Labral Tear-the ring of cartilage surrounding the acetabulum is torn
- Muscle Imbalance-for various reasons, certain muscles may overwork while others underperform which can cause undue stress to the pelvis and hip joint
- Osteoporosis-bones are brittle and at high risk for fractures
- Pinched nerve (sciatica, sacroiliitis, etc.)-inflammation or irritation to a nerve passing through the hip and causing pain (link to sacroiliac joint dysfunction article)
- Pregnancy-as the fetus grows, hormones change and ligaments become lax which can cause unwanted movement or stress of the hips (link pre-and postnatal article)
- Strain or sprain of muscles, tendons, and ligaments-overuse or a traumatic event causing overextension, stretching, or even tearing of tissue
- Synovitis-the inflammation of the slippery fluid substance within the joint to allow for the femur to glide within the socket
- Tendinitis-the tendons within and around the hip are inflamed and irritated
Hip pain can be treated effectively with early intervention. Physical therapists are specifically trained in the musculoskeletal system and will perform a comprehensive evaluation and develop and individualized treatment plan and goals based on the results and findings of a thorough examination.
Symptoms of Hip Pain
Symptoms will vary depending on the cause of pain, and because the hip is three-dimensional, pain can occur in the front, on the side, or in the buttock area.
Non-traumatic hip pain is frequently a dull ache but may become severe for some. When trauma such as a strain, sprain, or contusion (bruising) occurs, it may be tender to touch in addition to sensation of pain.
Some symptoms require immediate medical attention:
- Extreme weakness and inability to move the leg under its own power
- Hearing “popping” noise accompanied by pain and/or trauma
- Intense, sharp pain
- Appearance of deformity at the hip
- Traumatic incidents such as a fall, car accident, or significant contact during sports
- Inability to tolerate weight bearing on leg(s)
How is hip pain diagnosed?
In most circumstances, hip pain can be diagnosed and conservatively treated.
As an expert in the musculoskeletal system, a PT will perform a thorough assessment of the hip, including a medical history and a clinical examination of the hip, the surrounding joints and tissues. Based on this information, a treatment plan is developed. If clinical findings indicate something medically significant has happened, an immediate referral to a physician is made.
Using imaging techniques can be appropriate to get an accurate assessment, especially if there has been trauma to the hip area. X-rays can identify fractures and MRI is sometimes used to evaluate for soft tissue injuries, but the physician will determine which, if any, imaging is required.
Treatment of Hip Pain
Early diagnosis and intervention is key to reduction and resolution of symptoms.
If hip pain is present and there has been no trauma to the area, using ice within the first 24-48 hours is recommended. Applying a cold pack for 15 mins several times per day for 2-3 days which will help reduce inflammation in the area. If the hip pain is severe, or a traumatic incident occurred, immediate medical care is needed.
When functional daily activities like walking, sleeping, working, and recreation have been affected, seeking care from a physical therapist is an excellent choice. The PT will customize a treatment plan based on the findings of a comprehensive evaluation, Together, the PT will work with the patient to set goals and determine the treatment strategies best suited to the needs of the individual patient.
A PT will include instruction and progression of specific exercises and stretches to help address the factors contributing to symptoms, with the goal of restoring function to the patient. Other interventions provided by the PT may be helpful and will be discussed and determined throughout the plan of care.
Occasionally, other strategies may be needed to resolve the patient’s hip issues. Injections are sometimes used to calm inflammation, and are planned to work in concert with an active physical therapy program. While an injection may provide short-term relief, it is not a long-term solution to resolving hip pain. While a patient may be experiencing relief from the injection, the skills of a PT-directed program continue to help improve the structural cause of symptoms. By continuing with PT post-injection, it is anticipated the patient will see improved long-term benefits.
In the rare event that hip surgery is needed, the type of surgery that may be required will depend on the surgeon’s assessment, clinical findings, and imaging.
Several surgery options may be considered, but the risks and benefits need to be weighed before deciding on surgery. Different surgeries are best for different types of conditions. Conservative treatment is always recommended before surgery, and the need and best approach for surgical care will be discussed with an orthopedic surgeon
Conservative treatment is the best approach whenever possible.
An appointment with a physical therapist is an excellent place to begin. In all states, patients can see a PT first, without a physician’s order, however, specific guidelines may apply. Information for the requirements for each state is located on the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
As a consumer of health care, a patient has a choice in finding the provider who has good outcomes and is a good match for the individual needs of the patient. Find A Clinic will help identify a PT that has excellent outcomes in treating hip pain.