Three kinds of hip pain
Hip pain can range from a mild annoyance to a constant ache to a severe discomfort that negatively impacts your quality of life.
Treatment for hip disorders can be as simple as rest and as complicated as hip replacement surgery, depending on the underlying cause of pain and severity of symptoms.
While there are many problems that may affect the hip joint, most hip pain is caused by one of three problems: arthritis, bursitis, or back issues.
Understanding the difference in the symptoms and getting the correct diagnosis can help point you towards the most effective treatments.
Hip pain is becoming more common as senior adults are staying active later in life. And they are also less likely to accept limitations on what they can do. —Dr. Benjamin Schwartz
1. Hip arthritis
The symptoms of arthritis usually begin in your 50s and 60s, although hip arthritis is becoming more common in younger people, too.
Managing hip arthritis has improved greatly over the past 30 years. It is no longer necessary to live with the pain or be limited in your quality of life and activities of daily living.
The most common form of arthritis is “wear-and-tear” of the hip joint. In this condition, the cartilage that covers the top part of the thigh bone and lines the hip socket wears away, and the bones get closer and closer together until they eventually touch. This is known as bone-on-bone arthritis.
Hip arthritis causes
We continue to learn more about the causes of hip arthritis. Research shows that some arthritis is inherited, while some arthritis is the result of “wear-and-tear.” Wear-and-tear is usually caused by having an active lifestyle with lifelong participation in sports or physical labor.
Some arthritis is caused by differences in anatomy, for example having more shallow hip sockets or the way your hips are aligned. And some arthritis happens for unknown reasons.
Hip arthritis symptoms
People with hip arthritis often describe a feeling similar to a pulled groin muscle that never gets better. While many people think of their hip as being toward the back or side of their body, most hip joint problems actually cause pain in the groin or front of the hip area.
Arthritic pain is usually dull and aching and worse with activity. It can be painful to turn over in bed at night. Getting up after sitting for a long period of time can make those first few steps painful.
Other common signs of hip arthritis include stiffness in the joint (loss of motion), difficulty lifting the leg to get in and out of a car, and difficulty bending down to put on shoes and socks.
Treatment for hip arthritis
Unfortunately, there is no known cure for arthritis. Once the cartilage is gone, there is no way to regrow new cartilage. But many patients are able to manage hip arthritis pain and stay active for years.
Treatment includes physical therapy, regular use of anti-inflammatory medications (NSAIDs like ibuprofen), cortisone injections, use of a cane, and ultimately hip replacement surgery.
The good news is that hip replacement is one of the most successful interventions in the history of medicine. It has been called the “Operation of the Century.”
The overwhelming majority of patients who have their hip replaced experience pain relief. Hip replacement surgery involves removing damaged cartilage and some bone from both the ball and socket parts of the joint. This is then replaced with metal, plastic, and (sometimes) ceramic parts.
Once this is done, you can never again get arthritis in the hip. Most people find recovery from hip replacement tolerable with gradual return to function in about 6 to 8 weeks. They are also able to go back to doing most activities—for daily living and leisure.
2. Hip bursitis
A bursa is a thin sac of fluid that lies between muscle and bone and helps muscle slide past bone with less friction. There are many bursae throughout the body including the shoulders, hips, elbows, knees, and ankles. While any of these bursae can become inflamed, the hip is the most common area affected.
Women are more likely to develop hip bursitis. Though men can get it too. —Dr. Schwartz
Hip bursitis causes
Hip bursitis is typically caused by tightness in a muscle called the iliotibial band, which runs from the pelvis, past the outside of the hip, all the way down the side of the leg, and just past the knee.
Because this muscle is so long and passes by both the hip and knee joints, it is prone to stiffness and tightness. When the iliotibial band gets tight, it can press the bursa up against the side of the hip bone causing inflammation and bursitis.
Activities that tend to irritate the bursa and cause the iliotibial band to rub the bone include sitting for long periods of time (especially in cars that are low to the ground or low chairs), repetitive kneeling, crouching, bending, walking hills, or going up and down stairs.
What does bursitis in the hip feel like?
Bursitis pain is typically achy. It is felt directly over the side of the hip. (Arthritis pain is in the groin.) Symptoms usually worsen and are more noticeable at night from lying on the painful hip.
How long does it take to heal hip bursitis?
Unlike arthritis, bursitis can eventually go away. The challenge of bursitis is that it tends to be stubborn, can take up to a year to get better, and tends to come back.
Typical treatments for bursitis include physical therapy (to stretch out the iliotibial band), regular use of NSAIDs, avoidance of activities that make the hip hurt, and cortisone injections.
Surgery for hip bursitis is rare. It’s mainly for cases that do not respond to a year of treatment. The procedure involves removing the bursa and relieving tension on the iliotibial band by making multiple small incisions in it.
Recovery can take 6 to 12 weeks depending on your level of comfort and mobility.
Unfortunately, the bursa can grow back. Success rates of this surgery are lower and less predictable than hip replacement surgery.
3. Referred hip pain
One of the most common causes of hip pain has nothing to do with the hip itself. Referred pain is when a problem in one area of the body causes pain in another area.
Referred hip pain causes
The most common cause of pain at the back of the hip is actually referred pain from the low back (also known as the lumbar spine). After the nerves from the lumbosacral area exit the spinal cord, they first run into the back of the hip. Then they travel all the way down the leg to the foot.
When those nerves are pinched, such as from degenerative disc disease, bulges in the discs, and even bone spurs, it can lead to pain anywhere along the hip and leg.
You may even have hip pain without any back pain. This can cause further confusion figuring out what is going on.
Referred hip pain symptoms
Referred pain from the spine is often burning in nature. The pain is usually worse when sitting and there can be cramping in the leg when walking distances.
People with referred pain may have symptoms such as groin or front of the hip pain or pain over the side of the hip. In some cases, the pain can radiate from the back of the hip and buttock area down the leg, past the knee, and as far as the foot. This is almost always caused by a pinched nerve in the back.
True hip joint problems rarely cause pain past the knee. Many patients with referred hip pain feel better when leaning over a shopping cart or taking short breaks to sit during a long walk.
Keep in mind that it is possible to have back and hip problems at the same time. Even in this situation, the symptoms and location of pain often help tease out where the pain is coming from.
Treatment for referred hip pain
Most cases of referred hip pain improve with non-surgical back treatments such as physical therapy, regular use of NSAIDs, and occasional back injections as necessary. X-rays and, in some cases, an MRI of the back can confirm the diagnosis and help guide treatment.
Only in rare situations is surgery on the back necessary. It is only recommended when other non-surgical methods do not work.
What are the first signs of hip problems?
Depending on the cause of your hip pain, the first signs of a hip problem can vary.
A common early complaint is feeling as though you have pulled a groin muscle. In fact, many patients mistake early hip arthritis pain for muscle pain.
While it can be difficult to distinguish a muscle pull from hip arthritis, muscle pain usually eases off after a few weeks while hip arthritis pain never fully resolves.
Another early sign of hip arthritis is stiffness. It may become difficult to put shoes and socks on or reach down to cut your toenails.
One of the earliest signs is pain when lying on the painful hip. This is most often felt at night. Pain may start right away or may come on gradually the longer you lay on the affected side.
Referred hip pain
This often starts with difficulty sitting for long periods of time, which can cause a burning sensation at the back of the hip or in the buttocks.
The location of the pain—for instance if it’s on the outside of the hip versus the inner groin area—is often an excellent clue to what is causing it. —Dr. Schwartz
What is the fastest way to relieve hip pain?
It’s important to avoid activities that aggravate the hip.
For arthritis, this includes avoiding high-impact activities such as running or jumping. For bursitis, avoid lying on the affected side or sitting for long periods of time.
If you are going to take a long ride in the car or sit at a desk for hours, it is a good idea to stop or get up and stretch every so often (at least once an hour).
For referred pain from the back, avoid repetitive bending motions and lifting heavy objects.
Taking NSAIDs can help with the pain. Stretching on a daily basis and doing some simple strengthening exercises is also recommended.
What helps hip pain when sleeping?
Sleeping with a pillow between your legs helps relieve pressure on the hips and may make it easier to sleep. Taking an NSAID with dinner can help make sure you have some pain reliever in your system by bedtime. Regular stretching exercises can keep the muscles around the hip from becoming too tight and may help minimize the symptoms you feel in bed.
When should I go to a doctor for hip pain?
The decision to go to a doctor depends on how bad the symptoms are and how long you’ve had them. If your pain does not respond to 3 to 6 weeks of self-care or if your symptoms are getting worse, see your doctor. See your primary care provider first, and if necessary, they will refer you to an orthopedic specialist depending on your diagnosis and symptoms.
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