Everything you need to know about hip pain
Hip pain is a common symptom that can be described as aching, sharp, or burning and can range in intensity from mild to severe. There are many possible causes of hip pain, including serious ones, like a fracture or joint infection, and ones that are less so (though still potentially debilitating), like arthritis or bursitis.In order to get to the bottom of your pain, your doctor will perform a thorough medical history, physical examination, and possibly, order imaging tests. Once diagnosed, you and your doctor can work together to formulate a treatment plan—one that may entail surgery, but more commonly includes self-care strategies, like rest and ice, pain control with medication, and physical therapy.Note: Hip pain in children is assessed differently than in adults; this article focuses on the latter.
The hip is a large “ball-and-socket” joint—the “socket” being a pelvic bone called the acetabulum and the “ball” being the femoral head, which is the upper part of the thighbone. Covering this ball and socket joint is cartilage—a smooth, white tissue that cushions the bones and allows the hip to move easily.Problems within the hip joint itself tend to result in pain on the inside of the hip (anterior hip pain). On the other hand, pain on the side of the hip (lateral hip pain) or pain on the outside of the hip, near the buttock region (posterior hip pain) is usually caused by problems with muscles, ligaments, tendons, and/or nerves that surround the hip joint.Differentiating the various causes of hip pain by location—anterior, lateral, or posterior—is perhaps the best way to understand this somewhat complex symptom.
Anterior Hip Pain
Problems within the hip joint, such as inflammation, infection, or a bone fracture, may result in anterior hip pain—pain felt on the inside of your hip and/or within your groin area.
Osteoarthritis of the hipoccurs when the cartilage in the hip joint gradually wears away over time. As the cartilage frays and degenerates over time—often with increasing age or as a result of a prior hip injury—the joint space between the bones of the hip joint narrows, so bone may eventually rub on bone.Depending on the degree of osteoarthritis, pain may be dull, aching, or sharp; although, in nearly all cases, the pain and stiffness of hip osteoarthritis worsen with activity and improve with rest.Understanding Hip Osteoarthritis
Various types of inflammatory arthritis may affect the hip, resulting in dull, aching pain, such as rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus. Unlike the pain of osteoarthritis, which is worsened with activity, hip pain from inflammatory arthritis is often eased with activity.
Hip Flexor Strain
Osteonecrosis of the Hip
Hip Labrum Tear
Femoroacetabular Impingement (FAI)
Infected Hip Joint
Rarely, bone cancer (either primary or metastatic) may cause hip pain. Usually, the pain starts off being worse at night, but as the bone tumor progresses, the pain often becomes constant. Swelling around the hip area may also occur along with weight loss and unusual fatigue. Due to bone weakening from the cancer, a hip fracture may occur.
Lateral Hip Pain
Lateral hip pain refers to pain on the side of the hip, as opposed to the front or back of the hip.
Snapping Hip Syndrome
Posterior Hip Pain
Hamstring Muscle Strain
Sacroiliac Joint Problem
When to See a Doctor
It’s important to seek immediate medical attention if your hip pain is sudden, severe, getting worse, or if you have fallen or experienced another form of trauma to your hip.While not an exhaustive list, other symptoms that warrant immediate medical attention include hip pain associated with:
- An inability to bear weight or walk
- Leg or foot weakness
- Bruising or bleeding
- Warmth over the hip
A medical history and thorough physical exam by a primary care physician, sports medicine doctor, or orthopedic surgeon are essential to properly diagnosing the source of your hip pain.Depending on your doctor’s underlying suspicion, imaging tests, like an X-ray or magnetic resonance imaging (MRI), may be ordered. Less commonly, blood tests are utilized in the diagnosis of hip pain.
- Is your hip pain better with rest or exercise?
- Do you have any additional symptoms (e.g., fever, swelling, other joint pain, etc.)?
- Do you or any family members have arthritis or a history of joint problems?
- Have you experienced any recent trauma to your hip?
During your physical exam, your doctor will inspect and press on various landmarks within your hip, leg, lower back, and abdomen. He may also perform a neurological exam to assess muscle weakness and reflexes.In addition, he will maneuver your hip to evaluate its range of motion, examine your gait (how you walk), posture, and ability to bear weight. Lastly, based on your doctor’s underlying suspicion for one or more hip pain diagnoses, he will perform certain “special hip” tests:One classic test commonly used to evaluate hip pain is the FABER test.
- Straight leg test
- Trendelenburg test
- Leg roll test
Certain imaging tests may be needed to confirm or support a diagnosis for your hip pain. For example, an X-ray is the standard test in diagnosing a hip fracture. An X-ray may also reveal changes associated with hip osteoarthritis (e.g., joint-space narrowing and bony growths, called osteophytes).An MRI may also be used to evaluate for a hip fracture, in addition to other conditions like hip osteonecrosis or an infected hip joint. A magnetic resonance arthrography is the test of choice for diagnosing a hip labral tear. Finally, an ultrasound may be used to confirm a diagnosis of bursitis.
Blood or Other Tests
While it is logical to think that hip pain is related to a problem within the actual hip joint, or the muscles or other soft tissues surrounding the joint, this is not always the case.Here are some conditions that refer pain to the hip, meaning they do not originate within the hip joint or within structures that closely surround the hip:
Some lower abdominal processes may cause pain that feels like it is coming from the hip. For example, a kidney stone can cause severe pain in the flank area (between the top of your hip and the bottom of your ribcage in your back). The pain may radiate toward your groin or inner thigh.
Aortoiliac Occlusive Disease
While the treatment of your hip pain depends on the diagnosis made by your healthcare professional, it’s common for a patient’s therapy plan to involve a combination of self-care, medication, physical therapy, and less commonly, surgery.
Your doctor may recommend a number of self-care strategies—a way for you to take an active stance in managing your hip pain.
- Limiting or avoiding activities that aggravate your hip pain, like climbing stairs
- Using a walking assistive aid like a cane or walker to improve independence and mobility
- The R.I.C.E. protocol: If you experience hip pain while performing a sport or other activity, follow this progression of rest, ice, compression, and elevation until you can get into see your doctor.
Various oral medications, such as Tylenol (acetaminophen) or an over-the-counter nonsteroidal anti-inflammatory (NSAID), are used to ease hip pain related to a number of conditions, including osteoarthritis, labrum tear, bursitis, or femoroacetabular impingement. Opioids, which are stronger pain medications, may be prescribed to treat severe pain from a hip fracture or an infected hip joint.Depending on your diagnosis, other medications, like a disease-modifying anti-rheumatic drug (DMARD) to treat rheumatoid arthritis or intravenous (through the vein) antibiotics to treat an infected joint may be used.
Physical therapy is an essential component to easing the pain of and treating most causes of hip pain. In addition to exercises to improve the strength, flexibility, and mobility of your hip, your physical therapist may use massage, ultrasound, heat, and ice to soothe inflammation within the hip. He may also offer guidance on when it is safe to return to sports or other activities (depending on your underlying diagnosis).5 Exercises to Keep Your Hips Strong and Mobile
Surgery may be required for certain hip pain diagnoses. For example, surgery is often used to repair a hip fracture. Likewise, for hip osteoarthritis that worsens despite conservative measures, a surgeon may perform a total hip replacement. Finally, a procedure called a hip arthroscopy may be used to correct a torn hip labrum.An Overview of Total Hip Replacement
While you may not be able to prevent all causes of hip pain, there are several things you can do to be proactive in this regard:
- Lose weight if you are overweight or obese
- Eat a balanced, nutritious diet that contains sufficient vitamin D and calcium to maintain bone health
- Opt for low-impact activities like swimming or biking
- Stretch before and cool down after exercising
- Obtain a special shoe insert if you have leg-length inequality
- Wear properly cushioned, fitted shoes and avoid or limit running on hard surfaces like asphalt
- Discuss a daily exercise routine for maintaining muscle and bone strength with your doctor
- Considering yoga or tai chi to help prevent falls, one of the most common causes of hip fractures3 Exercises to Prevent Falls