The hip is a ball and socket joint that attaches the leg to the torso of the body. Pain in the hip is often the result of a problem in the joint itself, but numerous structures around the hip are sometimes also the source of a painful hip. Trauma, inflammation or another condition is often the cause of hip pain. Sometimes the source of the pain is also in another part of the body and the pain radiates to the hip. Various self-care measures can be used to relieve hip pain, such as taking painkillers and relative rest. Medical treatments and surgery are also options to treat the painful hip or hips. It is possible to reduce the risk of hip pain through some simple measures, although preventing hip pain is not always possible.
- Causes of hip pain
- Avascular necrosis (osteonecrosis)
- Hip fracture (broken hip)
- Labral tear
- Systemic diseases
- Legg-CalvÃ©-Perthes disease
- Other causes of a painful hip
- Pain complaints
- Radiating pain
- Alarm symptoms
- Diagnosis and examinations
- Treatment of hip pain
- Prevention of painful hips
Causes of hip pain
Hip pain is the result of bone or cartilage problems in the hip.
Hip pain is often the result of:
- arthritis (joint inflammation) associated with inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
- osteoarthritis (rheumatic disease of the articular cartilage)
- juvenile idiopathic arthritis (condition with joint pain)
- psoriatic arthritis (disorder with symptoms affecting the skin and joints)
- rheumatoid arthritis (inflammation of joints and organs)
- ankylosing spondylitis (ankylosing spondylitis: persistent joint inflammation)
Arthritis (joint inflammation) leads to inflammation of the hip joint and the breakdown of the cartilage that covers the hip bones. The pain gradually worsens. Patients with arthritis also suffer from joint stiffness and reduced range of motion in the hip. The hip pain is often felt in the front of the thigh or groin.
Avascular necrosis (osteonecrosis)
In patients with osteonecrosis, the blood supply to the hip bone is inhibited and the bone tissue dies. Avascular necrosis may affect other bones, but the hip is most commonly affected. A hip fracture or dislocation, or long-term use of high-dose corticosteroids (powerful anti-inflammatory drugs that suppress the immune system, such as prednisone) are often the cause of osteonecrosis, although other causes are also known.
Bursae are sacs of fluid that are located between tissues such as bones, muscles and tendons. The bursae ensure that there is less friction from tissues rubbing against each other. When the bursae become inflamed (bursitis), they cause pain, especially when a patient gets up from a chair, walks, climbs stairs, or drives a car. The inflammation of bursae is usually due to repetitive activities that overload or irritate the hip joint.
Hip fracture (broken hip)
A broken hip (hip fracture) is more common in the elderly because they fall more often and the bones weaken and become more brittle with age due to osteoporosis. Hip fractures cause sudden and acute hip pain. These injuries are potentially serious and can lead to major problems.
Viral or bacterial infections can cause hip inflammation. This happens, for example, with:
- Lyme disease (bacterial infection caused by a tick bite)
- shingles (infection with a rash and facial symptoms)
- Reiter’s syndrome (disease with symptoms of the skin, stomach, intestines and eyes)
- osteomyelitis (bone infection)
- septic arthritis (inflammation of a joint due to an infection)
- food poisoning
Tumors that start in the bone (bone cancer) or extend to the bone (bone metastases) cause pain in the hips, as well as bone pain in other bones of the body. Leukemia is also known to cause hip pain.
A labral tear causes a tear in the labrum, the meniscus-like structure in the hip. Athletes and people who perform repetitive twisting movements are at greater risk of developing this problem.
Repetitive activities overload the muscles, tendons and ligaments that support the hips. When they become inflamed from overuse, they cause pain and prevent the hip from functioning properly.
Some systemic diseases are associated with hip pain, including sickle cell anemia (red blood cell disease), in which a joint swells during a sickle crisis, with or without an underlying infection. Often other joints are also affected. A painful hip also occurs with fibromyalgia. This pain syndrome is associated with pain and stiffness that causes significant discomfort throughout the body (body pain). Sleep disorders, muscle cramps, muscle pain in various muscle groups and fatigue also occur with this condition.
Tendons are the thick bands of tissue that attach bones to muscles. Tendonitis causes inflammation or irritation of the tendons. Tendonitis is usually the result of repetitive strain due to overuse.
Bruises (bruises), an inguinal hernia (bulge or swelling in the groin or scrotum), dislocations, sprains and strains occur due to trauma. These injuries can be very painful.
Legg-CalvÃ©-Perthes disease (or just Perthes disease) is a condition in which avascular necrosis of the femoral head occurs in children. The cause of this is not known (October 2020), but boys between the ages of four and eight years old are usually affected.
Other causes of a painful hip
Other causes are also known for hip pain, such as:
- hip impingement syndrome
- Iliotibial band syndrome: The iliotibial band extends from the top of the pelvis along the outer part of the thigh to the knee. This tissue band may become inflamed and lead to knee pain and/or hip pain.
- Piriformis Syndrome: In piriformis syndrome, the piriformis muscle irritates the sciatic nerve in the buttock, which also causes significant hip pain and buttock pain.
- the snapping hip syndrome
- tension on the hip flexor muscle
- tension on the hamstring
- synovitis (inflammation of the lining of the joints)
- Still’s disease (disease with fever and symptoms of the joints and skin)
Depending on the cause of the painful hip, the pain can be felt in the inside of the hip joint, the thigh, the groin, the area outside the hip joint and/or the buttocks. The pain usually worsens with physical activity, especially when arthritis is the cause of the hip pain. Hip pain is also often accompanied by a reduced range of motion. Some patients develop weakness due to persistent hip pain. The hip pain is intermittent (intermittent) or constant. Furthermore, the pain occurs gradually or suddenly and is mild to very intense.
Sometimes pain from other parts of the body causes radiating pain in the hip.Endometriosis Endometriosis, a condition in which the uterine lining grows elsewhere, causes pelvic pain, which some women describe as hip pain. Menstrual cramps are also manifested here.Hernia A hernia or a defect in the abdominal wall results in pain in the front part of the hip. An inguinal hernia is the most common.Sciatica Sciatica is an inflammation of the nerve roots of the spinal cord. Hip pain and pain that runs down the leg (leg pain) are characteristic of this. Spinal stenosis (narrowing of the vertebral column causing back pain and weakness) due to osteoarthritis of the lumbar spine, ruptured or bulging discs in the spine of the back and spasms of the muscles that support the low back cause this inflammation.Meralgia paraesthetica also affects pregnant women / Source: PublicDomainPictures, PixabayMeralgia paraesthetica Sometimes inflammation occurs in the peripheral nerves, causing hip pain, numbness and pain in the thigh. Meralgia paraesthetica appears when the lateral femoral cutaneous nerve of the thigh becomes irritated. Pregnant women, people who wear tight clothes or patients with diabetes mellitus are most often affected by this disease.
If one or more of the following signs appear, it is wise to consult the doctor:
- persistent pain
- movement problems in the leg or hip
- a bleeding hip joint
- a deformed hip joint
- a popping sound in the joint (joint noises) during the occurrence of an injury
- a fall or other injury
- unable to put weight on the hip
- hip pain at rest
- hip pain during the night
- intense pain
- fever and chills
- sudden onset of hip pain
- swelling, redness, or warmth around the joint
Diagnosis and examinations
Interview To determine the cause of hip pain, a good interview is necessary. The doctor talks to the patient, his family or caregivers and maps out the location, duration, severity and frequency of the pain, as well as which factors worsen or improve the pain and what influence the pain has on daily life. The doctor also notes other underlying complaints and medical conditions.Physical examination A physical examination is important. The doctor checks the hip, leg and back, but he also looks for signs in other parts of the body to understand the cause of the complaints. An observation of the hip at rest and while standing or walking, palpation of the hip and surrounding structures, testing for range of motion and strength, and a test for sensation and pulsations are all useful tests.Diagnostic examination X-ray, CT scan or MRI scan The doctor often orders an X-ray of the hip and pelvic area to inspect the bones and joint spaces. An acute broken hip is usually (but not always) noticeable via an X-ray. If the doctor is almost certain that the patient is suffering from a hip fracture, a CT scan or MRI scan is useful to confirm the fracture. Narrowed joint spaces and arthritis are also visible on plain X-rays and help confirm the diagnosis of osteoarthritis and degenerative joint diseases.Arthrography Cartilage or labral tears in the hip can be detected with arthrography. This imaging test shows the joints. The radiologist injects contrast fluid into the hip joint using a long thin needle. Typically, the doctor takes MRI images to study in detail the joint surfaces that are highlighted by the dye. The doctor first injects a local anesthetic (numbing medicine) prior to the dye. If the pain disappears due to the anesthetic, this confirms that the pain comes from the joint itself.Bone scan A bone scan is another test that can be used to reveal inflammation. The doctor first injects a radioactive dye into a vein (intravenously) and then scans the entire body. The radiologist looks for abnormal accumulations of the dye, which is useful in establishing a diagnosis. This allows the doctor to determine whether only the hip joint is affected or whether several body parts are inflamed.A blood test is sometimes useful / Source: Frolicsomepl, PixabayBlood tests Sometimes the doctor suspects on the basis of the clinical picture that the patient is suffering from a systemic disease. In that case, he orders a blood test to detect inflammatory markers. He also looks at the number of white blood cells in the blood , because this may be increased during an infection.
Treatment of hip pain
The treatment for hip pain depends on the diagnosis.Suitable equipment It is especially important for athletes to wear suitable clothing. For example, good shoes are definitely required for running .Joint replacement When osteoarthritis is very serious, the pain is very intense or a deformed hip joint develops, a total hip replacement (arthroplasty) is an option. A hip fracture sometimes requires surgery to repair the fracture or replace the hip.Aids Crutches, a walking stick or a rollator are useful in the short term, although specific training is often required to use the aids correctly. Other specific arthritis aids are also available.Apply ice and heat It is also possible to cool the painful hip area with ice for about fifteen minutes every day. Warming the area is also helpful for some patients. This is possible by taking a warm bath or shower. This makes it possible to prepare the muscles for stretching exercises that reduce pain.Medications relieve hip pain / Source: Stevepb, PixabayMedication Over-the-counter painkillers (such as paracetamol) or NSAIDs = non-steroidal anti-inflammatory drugs (such as ibuprofen or naproxen) treat overuse injuries, osteoarthritis or tendonitis. Treatment for rheumatoid arthritis consists of prescription corticosteroids (powerful anti-inflammatories that suppress the immune system), disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate and sulfasalazine, and biologics that target the immune system.Exercises Patients with arthritis of the hip joint benefit from low-impact exercises, stretching exercises and resistance training. This reduces pain and improves joint mobility. For example, swimming is a good non-impact exercise for arthritis. Physical therapy also increases range of motion.Rest Hip pain caused by overuse, but without specific injury, is easily treated at home with rest and a gradual return to full activity. While rest is important, it is also essential to maintain range of motion, which means the patient must make efforts to extend the leg, hip, and back and keep the entire body moving.Avoiding excess weight reduces the risk of a painful hip / Source: Tobyotter, Flickr (CC BY-2.0)
Prevention of painful hips
The most common causes of hip pain are due to the aging process of the joint. They gradually lose calcium in the bone and are therefore more susceptible to fractures. A balanced and healthy diet and appropriate exercise keep the body, including the bones and joints, as healthy as possible. It is also important to avoid excess weight to put as little pressure on the hip as possible. Medications that prevent osteoporosis (calcium, vitamin D and bisphosphonates) reduce the risk of hip and back fractures. Wearing well-fitting shoes with a good tread, using a walking stick for stability if necessary and ensuring there are free walking areas in the house are other useful advice. Finally, it is necessary to maintain strength and flexibility (sufficient exercise) and to ensure good posture.
- Legg-CalvÃ©-Perthes disease: Hip disorder in children
- Hip fracture (broken hip): Causes and treatment
- Hip effusion (fluid in hip): Pain and stiffness of hip joint
- Piriformis syndrome: Pain in the buttock due to pressure on the sciatic nerve
- Sciatica: Condition with pain and weakness in the leg and back